Billing Patients No Show Fees
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Video | Billing Patients No-Show Fees

Medical Billing Tips discusses charging patients for missed appointments. Check with Medicare, Medicaid, and insurance companies to see if billing a no-show fee is allowable.

Medical Billing Tips Video Transcripts

Hi, my name is Manny Oliverez, Director of Operations here at Capture Billing, and today we are going to talk about charging no-show fees. Here at Capture, we get a lot of questions asking, “Should we charge for no-shows when a patient doesn’t show up?” Well, the answer to that is a resounding “Yes!” Charge those patients.

Let’s say you have a patient come in – well, actually, he doesn’t come in – and he misses his appointment. What happens to this doctor? Well, he’s just left twiddling his thumbs, and there is a vacant slot that could have been used for someone who is actually sick.

So, what we want to do is we want to charge the patient for not showing up as a negative reinforcement to not do that. So what are practices charging for no show fees? I’ve seen them charge anywhere from $10.00 to $25.00 for a sick visit, $50.00 to maybe $75.00 for a well check or physical exam, and I’ve seen them as high as $125.00 if they miss a procedure. That’s quite a bit of money, but you’re training your patient not to miss that appointment.

Now, how do we inform the patient about the no-show fees? Well, the best thing to do is, when they become a new patient, they should be signing a financial agreement with your practice. In that agreement you’re going to spell out that a missed appointment is $25.00, or whatever you want to charge. It depends on your practice, your specialty, what part of the country you’re in – whatever seems to be fair.

Spell that out, and also spell out how much notice they have to give you – how much notice in order to cancel that appointment. Whether it is 48 hours, or 24 hours, or just that day, it’s totally up to you, but make sure that they sign that agreement. Because what’s going to happen is when you charge them and send them out that bill, they are going to end up calling you and saying, “Hey, what are you doing charging me for this?” You can always refer back to that agreement.

Also, I would suggest the first time they miss an appointment, use it as an educational talk. Inform them why it is important to keep or cancel their appointment, and possibly even waive that first fee. Note it in the account, so that if it happens again, you will charge them. That’s what practices are doing, and it is okay to charge a no show fee.

Always check with your local regulations, your state, and your insurance companies to see how this all works out with them. Remember, a medical practice is a business. Treating it any other way is just nuts.

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26 thoughts on “Medical Billing Tips: Charging Patients No-Show Fees”

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    I signed one of those contracts but yet today, I had a scheduled phone visit with the doctor at 10:00 a.m., 10:00 a.m. At past 10:15 a.m. I call the doctor’s office. The office said they cancel my appointment without giving me notice. I should be able to charge them $50 for the cancelation and without notice. If I promiser breaks the contract doesn’t he have to pay the promisee the $50. It’s a 2 way street not of one way.

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      David, unfortunately, it’s not a two ways street. It’s very frustrating I know. I have been canceled on too. It’s a big waste of time.

      If you take a real close look at what you signed I bet you will see that only the doctor can charge. Sorry.

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    To Isabel 1/2 of what you said is not true. I audit doctors, time, bills, etc. One they don’t do their own dictation, made in the 60s now someone does that for them Or they computer does it as they are speaking. I don’t know what doctor office you go to, but mine closes down at lunch and they go. All the ones I have audit close for lunch and they go eat, no seeing patients. So yes my time is just as valuable. I shouldn’t have to sit and wait 2 hours after scheduled to be seen. There is no excuse with technology, refill a prescription takes one click of a button and it off the pharmacy. Charging for no shows is BS. I don’t get to charge them when they don’t show up.

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    For those of you that have commented that they have to wait so long in the lobby for the doctor I ask them to be honest with themselves about how many times they have taken up more than their assigned time with the doctor. Most Internist and Family Practice offices schedule appointments every 15-20 min. The patient will spend more time in the office because there is paperwork to fill out with each visit, the nurse or Medical Assistant will then “work the patient up” by getting their vitals, reviewing their medication sheet and asking for the chief complaint. The chief complaint, here in lies the problem, patients schedule the appointment to review their lab results or another test or because they have a new complaint, its never that simple. The doctor goes over the patient’s lab and then the patient says they didn’t take their medication last week and now they can’t poop and their hemorrhoids hurt really bad when they strain and what should they do? The doctor spends another 10 minutes with them and then they say oh and by the way I forgot to tell the nurse I need a refill on my blood pressure medication and can I have a muscle relaxant because I hurt my back getting out of the car and on and on and the nurse finally has to knock on the door to rescue the doctor after 45 minutes. And that one patient has thrown the whole morning schedule off but it doesn’t stop there because he/she is not the only patient that thinks the doctor works for them. So the doctor see patients through the 2 hour lunch break and is luck to go to the bathroom before he starts back seeing patients at 2pm. But it doesnt stop there for the doctor because after he sees the last patient of the day, who leaves the office at 6:30pm with all his questions answered, the doctor is stuck with hours of dictation and charting to do before he can go home to eat a cold dinner. So to all those patients that say the doctor keeps them waiting I say stick to the topic when you go to the doctor and respect his time. And to all of those patients that dont have the courtesy to call to cancel their appointment shame on you your mother raised you better than that!

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    What about being charged a $25 no show fee when the Doctors Office is always “busy assisting other callers” when you try to call them, and too busy to return your voicemails to cancel and reschedule the appointment? I had a Doctors Office charge me $25 for a no show fee when I tried cancelling the appointment 5 times. Each time I called it was during normal business hours and I waited 10 minutes in queue before being redirected to their voicemail, gave all my information and nobody ever returned my call. The only call I received from them was a robocall reminding me of the appointment 2 days before, not a live person. This call alerted me that they never got my voicemails to cancel and reschedule. So this robocall was at 7pm at night. So I call the office right away and I get redirected to their after hours line and I actually get to speak to a live person! Except this person does not take messages for the office or have access to their appointment schedule and cannot cancel your appointment or reschedule it. For that you have to call during normal business hours where you will be told that they are too busy assisting other callers and leave a voicemail that goes unanswered. So they make you sign an agreement as a new patient that informs you that you will be billed $25 for a no show fee if you miss an appointment. All the while the office staff is so busy, so overwhelmed with patients and patient phone calls, that they can’t answer the phones or check their voicemails and respond to them. Yet, they have plenty of time to bill you. This fee sounds like a scam to me and I will not pay it.

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    Is there a website that specifically states Meducare Dr. Policies in state of Mo. On no show fees? I was charged $50 as a new patient seeing a psychiatrist for PTSD ANXIETY. Missed aot. Because was burglarized that day. Has to pay $50. Then two weeks later had to go back in via recommendariin of A RAPE KIT nurse at local hospital. Attacked and raped by tennent iņ same building Extreme anxiety. Dr. Only took 2 minutes with me as usual. He never listens to me if meds work or not. It was tume for med refill apt. He said mske another apt for that. Well Im sorry. I missed it to. My phone broken. But wull take responsibility and PAY. Just seems like a run around. Enough emotional trauma. Rape,by another tennent, who is still allowed to reside here.every time I leave myÀpt Someone robs me.So I have great anxiety about even leaving.The management didnt take me seriously, then I get raped. He knows this but acts like he could care less. I feel like its patient profiling. I fully understand yiur point of view. If a patient is too kazy, but what do you do when the Dr or staff refuse to take into account there are circumstances beyond yiur control? Thank you

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    Hi! What about opposite? If you showed up for the appointment but the doctor or nurse failed to check in advance if they have necessary medication to do the simple procedure. You end up going home. That happen to me today. I wasted three hours because had to wake up earlier to be on time, driving to doctor’s office, back to home, looking for parking.

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    This is BS. I got charged a No show fee even though I showed up to my appointment but the doctor was 4 hours behind. I had to go back to work. The same thing is happening to my sister today. Save the “train your patients” rhetoric and call it what it is. A scam.

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    today i had an appointment with my eye dr, i been going to this dr. for the last 26 years and i have not miss any appt. when a arrive to the office the staff office gave me the policy of the no show appts. that this practice change in the last year. and he is charging $100 for no show appts. that is quite bit of money,and when i told him that i did agree with his policy he got very upset and started yelling at me. and said ” IF YOU DO NOT AGREE YOU CAN LEAVE MY OFFICE” he did not have a sent of loyalty or respect.
    Yes, i left and i will never come back to this doctor aging. and I’m writing a review

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    Francis E. Doudney

    If a patient misses an appointment well i’m sorry. How about about anyone can charge a fee just because the cable guy did not show up and i’m being charged for a day of program i didn’t use for example. Charging patient should not be legal. I guess i could charge the doctor for sitting in lobby an hour past my appointment. What doctors tend to forget is they work for me, employers have never waited on employees. This fee is a big scam in my opinion. Its the nature of any business. Get over it.

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    Kiyoshi Hannigan

    I understand that doctors can legally charge their patients a “no show” penalty fee. Many doctors do that and many don’t. But whether or not they engage in such a practice, aren’t doctors required by law to first inform their patients, either verbally or in writing, about their “No Show” fee policy?

    I was recently referred to see an eye specialist for a sty in my left eye by my regular doctor who gave me the phone number to the specialist’s office for me to call and schedule an appointment, which I did. During the time I spent on the phone making my appointment, I was never informed of the doctor’s “no show” fee policy. Of course, because the appointment was made over the phone, and because I had never been to the doctor’s office yet, nothing was provided to me in writing, either, about the doctor’s “No Show” policy.

    My appointment to see the eye doctor was scheduled about a month and one week from the time that I called the office to make the appointment, which was the earliest date available, according to the doctor’s office. About two weeks before my scheduled appointment, the company through which I received my government-sponsored free cell phone dropped out of the program, so I lost use of my cell phone and could not call the specialist’s office to cancel my appointment ~ my sty by then had been healed by using home-remedy cures.

    Today, I just received a “no show” bill in the amount of $45 from the eye doctor’s office!

    Had I been informed of the doctor’s “No Show” fee policy when I initially called to make the appointment, I would have driven the 5 miles to the doctor’s office to cancel the appointment, but since I was given no notice I didn’t think it was necessary.

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      Hello Kioshi —

      You will need to talk to a lawyer in your state to see if doctors are required to inform their patients either verbally or in writing about their “No Show” fee policy.

      Now that said, let me tell you what doctors should do and what I would do.

      When you start seeing a new doctor there is new patient paperwork that the office has you fill out. Included somewhere in that paperwork should be their No Show Policy stating the fees and when you would be charged. The practice usually has you sign the paperwork to acknowledging that you agree with the policy. Of course if you do not agree with the no show policy or any other policy the practice has you don’t have to sign but you will have to find another doctor as they will probably not see you since you are not an established patient yet.

      Now I too have a problem with being charged when I was not told or signed a document agreeing to a fee when I am a new patient and have not been to the office. I don’t believe it’s the right thing to do.

      I have come across medical offices that ask for a credit card on file for new patients prior to making an appointment. If you don’t show up they then would charge you their no show fee. I personally do not like that practice and move on and find another doctor.

      However, I have the responsibility to cancel the appointment thus freeing up the appointment slot given to me so that another person in need of medical attention could use it and not have to wait 5 weeks for an appointment as you did. I would pay the $45.

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        How about the customer/client whose waiting for an hours at the doctors office if the doctor/professional didnt show up??? all they could say was “Oh,sorry I was late or the doctor counldnt make it” this happened to me several time, waste of time and gas, doctors are sometimes unprofessional, customer/client should reimbursed for inconvenient too, not only doctors or professional who didnt showed up right? so biased practices….

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          It’s great that we have access to doctors and it’s great that there is no timer that goes off where the doctor says I’m sorry your times up. So, as long as my doctor continues to take his time and doesn’t rush thru my visit and miss something then I will gladly wait an extra hour. I also know his policy is to waive the first no show fee. Our country has become complacent and want everything handed to them.

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    You are correct in telling the viewers to double check with an attorney, or other legal professional. The wording of these provisions is extremley important. I cannot tell you how many times I’ve received a last minute call that the Dr. had to cancel their appointment. Or, what ever happened to basic courtesy in an Office. When checking in, it really would be nice to still know how many mins., (ballpark estimate) it might be before I see my Dr? This was a common practice not so long ago.

    Now, in legal circles there is a common tenet, In order to impose such a fee or provision, the provider or office..MUST have “clean hands” in legal circles. In other words, if they are always running late, i.e. where the patient may sign in for a (2) 14:00 pm appt., but not ever see their Dr. until (2:30) 14:30 pm or later, this sort of penalty charge, the likelyhood this fee will not hold up in a small claims courtroom. Plus, Dr will come across in a very negative way. This is the feedback I hear all the time in offices.
    (What’s good for the goose is good for the gander is what I hear.) I actually know an attorney who became so fed up, he left the Dr’s office and sent them a bill for his time wasted sitting there after (60) sixty minutes. Which sometimes one wonders if the employees are properly trained in setting up appts. in the first place. Too many offices are scheduling too many patients since the fees reimbursed to the physicians have been reduced in many different practices. Some providers are attempting to make up in volume instead and are actually killing their practices. Personally, I always delete the wording in those agreements then sign my name. (It’s my legal right to refuse.) Some offices need to plan their pt appts better. Incidentally, Yes, I have run the front end of more than one practice, I am aware of the many interruptions, problems that arise in the daily operations of an office. (These offices had > (4) providers.)
    Interesting conversation otherwise.

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    You are crazy if you think a doctor is sitting there twiddling there thumbs. In my experience most patients wait on average 30 mins after their initial appointment time to see the doctor. I have been in the healthcare business for 20 plus years and the abuse that goes on is ridiculous. This so called no show fee should not apply to your regular patients. So to advocate draining people for more money is horrible. Sorry if they doctor cant have that extra cup of coffee at Starbucks, trust me they are not hurting.

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      In my opinion I don’t see why not as long as the patient had signed a form agreeing to the fee ahead of time. If it is a Medicare or Medicaid patient then I would not charge the fee.

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      Steve you should have no problem billing no show fees to patients with commercial insurance. However Medicare and Medicaid have their own rules which usually means you can’t bill a patient for no show fees. We never bill but double check with your local carriers. If a patient consistently no shows you may be able to dismiss the patient. Just do it properly.

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    So as a patient, I have been charged twice for no shows. Each time I refused to pay plus I will NEVER return. I guess if you don’t want my business and you have too much already, go for it. But I will never return to your business and will not recommend seeing you again.

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    Seriously….. How many times has a doctor just “sat twiddling his thumbs?” Offices overly schedule “slots” with so many patients the patient is the one who sits waiting. Do you knock a $25 to $50 discount for the hour or so that a patient sits waiting in your office? I did not think so. These fees are absurd and another reason physicians and billers are looked at with disgust whining about money

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    How do you charge a new patient that is a no-show? If you send them a bill, they won’t pay it and you will ensure that that patient never reschedules. Any suggestions? Or when you get the patient info do you also request that they keep a credit card on file?

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      Sharon it is very difficult to charge a new patient for a no-show. Our practices do one of two things:

      1. Don’t do anything but will not make another appointment if the patient calls back;
      2. Take a credit card but only for a higher priced procedure.

      As management you walk a fine line between alienating a new patient by asking for a credit card and running your business but you need to decide what’s best overall.

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