Practice Management Alert

Check out these ideas for protecting your revenue from no-show patients

Sure there are valid reasons for missing a scheduled appointment, but there are steps you can take to keep no-show patients from ruining your well-planned schedule and costing your practice money to boot.

Problem: When a patient doesn't show up for a scheduled appointment, it means lost revenue for your practice. And with some patients, being a no-show is more of a habit than a rare occurrence.

Solution: You shouldn't have to tolerate the inconvenience and lost revenue from no-show patients. "Most of us have a two-strike rule," says Victoria Jackson, executive director and owner of OMNI Management Inc., California member of Medical Group Management Association, Primary Care Assembly, and administrator/CEO of Southern Orange County Pediatric Associates Inc. in Lake Forest, Calif. If patients do not show up for two scheduled visits, they are warned: Should they fail to keep a third scheduled visit, they will be charged for the appointment, she says. This threat usually does the trick.

Your input: What methods do you think are the most successful for preventing no-shows? After deciding on your answer, scroll down to see what our experts suggest.







If you don't want excessive no-shows in your practice, you're going to have to work for it. Here are three tried-and-true tactics for no-show prevention:

1. Provide Clear Appointment Reminders. Most people agree the best way to reduce missed appointments is a reminder call ahead of time. Because many offices are reluctant to charge for missed appointments to deter no-shows, they instead focus on boosting appointment attendance with phone calls or reminder letters.

"We do confirmation calls two days in advance," says Christine E., biller at Jordan Family Eyecare in Rochester, N.H. If you can't get in touch with the patient directly, leaving a message usually works well.

Effective approach: "When we don't call, the no-show rate increases," says Hannah G. O'Brien, administrator with Deborah J. Morris and Associates, MD, PA, in Owings Mills, Md. After reminding the patient of his appointment, O'Brien's office also tells the patient, "If we do not hear from you or see you at your appointment time, there will be a $35 missed-appointment fee added to your account." This statement helps to grab the patient's attention, she says.

2. Charge a No-Show Fee. If a patient doesn't show for his appointment, "we send out a letter for a no-show fee - a flat fee of $35," Christine E. says. Her office usually doesn't charge the fee to the patient's account unless he comes into the office for another visit. "Most of the time that discourages no-show patients from coming back," she says. And this tactic can help you prevent wasted time.

Good excuses allowed: If a patient does want to schedule another visit and he has a good reason for missing his last scheduled appointment, "we're pretty lenient about waiving the fee," Christine E. says. Dropping the fee is OK as long as the no-show was a one-time occurrence, she adds.

Important: If you decide to charge no-show fees, you must list the fees in your financial policy so patients are aware of the fee ahead of time.

3. Keep Track. Keeping track of no-shows is not just about tracking the patients down. Documenting no-shows will allow you to determine quickly whether a patient is a repeat offender. And from a management standpoint, no-show information can also provide valuable insight on how you might change your scheduling to avoid missed revenue due to no-shows.

Consider liability: "We discharge patients who have missed three appointments in the last six months," O'Brien says. Depending on the patient's diagnosis, missed appointments might mean the patient is not compliant with his plan of care, which could represent an increased risk for malpractice liability, she says.