Home Forums Discussions General Discussion NO SHOWS

This has probably been discussed before, but what are other practices doing about FTKA's?? I know it's summer, but it seems we are getting 1-2 per day (even with reminder calls), and with a one provider practice at this point, it hurts. I realize we can't bill insurance, but do you bill the patient if they don't cancel within 24 hrs? We send cards out, but that seems kind of lame. If pt is habitual, we have a 3 strike policy. Do you post a FTKA charge notice, or tell pts when scheduling? Thanks for the imput!

OK, so I will go ahead an show my ignorance <G> What is an FTKA?

FTKA = Failed to Keep Appointments

The issue becomes is it worth it to charge a fee (will they pay or will you have to go after them). In our case, per contract, we cannot charge a no show fee to patients with Medicaid or Managed Care (which is essentially DSHS).

What we are doing is giving people warnings and then discharging them. I know one practice which puts them on a same-day-appointment-only. If they fail to show that...she discharged them.

Last week, I had one mother schedule all four of her children for well child exams and had them call and cancel that morning. She is no longer allowed to schedule them all together. Sigh...she does not understand what the big deal is.

Barbara

I do charge a "No-Show" fee and post this in the waiting room and on my statements. I would say I collect 80% of these. All patients are called 1-2 days before their appointments to confirm. If they are confirmed and do not show and do not call and apologize or have a really good excuse I charge them $30. Patients that can not be reached to confirm are later contacted to reschedule. Any patient who No-Shows 2 times is warned they will be dismissed if they FTKA again. After the 3rd No-Show, they are dismissed. As a solo office I cannot afford to have patients stand me up, especially when there are other patients having to wait to get in.
In a similar vein, I also am very quick to let patients know the various reasons I may be running late any given day. I will say something such as, "Mrs. Angryface I am so sorry I am running so late today. My first appointment of the day, which was a complete physical, was 30 minutes late getting here and it has thrown my whole schedule off." Or, "Mr. Madashell, please forgive me for making you wait so long today but, the patient scheduled before you made an appointment for a simple cold but then had numerous other serious questions and problems I felt I needed to address. I am sure you would want to have the same attention if needed." Or, "Mr. and Mrs. Twoforone, I really am sorry but since you made an appointment today for only one of you, I will not be able to address the other's problems today or all those people sitting in the waiting room right now will gang up on me and run me out of town for being so late. We will address the most urgent problem today and then I will ask you to reschedule your appointments to allow enough time to address your other concerns."

Leslie

Leslie,
That's amazing. It looks like some of your patients (Mr. and Mrs. Twoforone, Mr. Madashell, and Mrs. Angryface) are also obtaining care from me!!!

Roy

Speaking of FTKA, we lovingly refer to our no-shows as Dinkas (the DNKA in AC) in noun form, or, that we have been Dinka-ed, the active verb. We are a new practice and have just recently come up with our policy wherein the patient gets one freebie with a warning, verbal, noted in their charts or written and mailed to them if we are unable to make contact by phone, that the next missed appointment they will be required to pay for out of pocket if they wish to be scheduled for subsequent appointments. Of course we do extend grace for extreme circumstances, accidents, hospitalizations and the like... but this is working out fairly well so far. While we are on the subject, has anyone been able to successfully use the DNKA feature, we have tried but cannot seem to get them to show up on the Summary Sheet under the Stats section, what are we doing wrong? We use the red x DNKA button and the Doc saves it to their chart but its a no show of its own in the Summary Sheet where it shows as a note.
Also, how are you guys handling phone calls for the Doc in regards to charging for them? Beginning to see the need to do that here - we are a child/adolescent/adult psych office.

AC user since March 2007,

Joan

This is how we document FTKA/DNKA's:
We added "FTKA" to our appt type so we can edit that in when pt doesn't show up. This way, the appt shows up on the schedule, and in the appt history (binoculars).
We then send a msg to provider that pt FTKA'd, and put "FTKA" in comment section so it shows up in "past encounter" area.
We also put FTKA date(s) in yellow sticky note section so the receptionist will see it when scheduling that pt (and warn them about keeping appt).
I realize this is all a PITA (pain the the [censored]), but it's the only way we can make sure it gets to all the necessary sections.
What's everyone else doing?

I wouldn' worry about sensoring the word "[censored]" as it has definitely been used here before. <G>

I don't know why the DNKAs aren't showing up. They used to.

As far as charging for phone calls and emails, I would find it tough if they had insurance. Ironically, ALL the psychiatrists here accept only cash, so they could easily charge for calls. They have waiting lists a mile long.

At the current time, we have openings everyday so no one is left out in the cold if there is a no show. Financially, we are better off not getting rid of patients who no show, although trying to charge them may work.

No one has addressed this issue: But, in order not to be biased, I have never had a set policy on no shows, i.e. three strikes and you're out. I have too many patients that I love in my practice and would not be able to discharge if they no showed ten times. That's just I, though.

Dear "I",
Funny how quickly one gets attached to patients, our bark is much worse than our bite and we extend grace liberally to those no shows who we know are not intentionally blowing us off. I know firing patients can seem like cutting off your nose to spite your face but since both the Doc and I are push-overs we take turns using "the policy" as our shield and defender.
As a newbie to the medical profession dealing with insurance companies who seem to try every trick in the book to discourage you from even making a claim I can see why a physcian would opt for a cash only practice.....

Hi folks,

We charge for no-shows.. and we collect it or they don't get past the front desk for their next appointment. We collect their co-pays up front, too, as many patients make a bee line for the door once they have their question answered or their prescription in their hand. They want us to send them a bill, which they're never going to pay, rather than stiff us up front.

We had been charging $25 for no-shows. As of the first of last month this changed. It's now $25 for the first no-show, $50 for the second no-show, and dismissal for the third one.

We have a waiver as part of the new patient paperwork, where they initial each paragraph that they have read and understand our policy, and one of those paragraphs is our no-show policy.

That being said - if they call up to 24 hours AFTER the no-show, with a good reason, it's waived. We've had no-show people actually get indignant when they tell us "Well, I HAD to take the kids to Great Escape yesterday".. um, taking your kids to the amusement park is not an excuse.. suck it up and pay your $25 bucks, or go find another doctor.

Lately Dr. Vinny has become a hard a*s.

Keep fighting the good fight, people...

V.

After 20 years in practice, I believe I have found a happy medium between being a real hard-[censored] and a finacial survivor. I too have many, many patients I would hate to have to dismiss because of persistent "No Shows". On the other hand, I take it personally. If a patient thinks so little of me and my time then I really don't want them as a patient and I believe it is wrong to ask the rest of my patients who were not able to get an appointment that day to suffer because of an inconsiderate patient. I too leave several openings each day for the call-ins who have to be seen urgently. So, when someone "No Shows" (especially a 30 minute visit)it can really leave some ugly gaps in my schedule.
As far as billing for phone calls...good luck. I have never had any success at this. Rather, unless it is a very short question, my patients are asked to shedule an appointment to discuss what's on their minds. Almost invariably their visit will spark additonal problems that also need to be addressed. Also, I almost never call in antibiotics without seeing the patient. Why take the legal liability without having the opportunity to examine the patient and document your assessment and treatment?
I also collect all co-pays and co-insurance at check-in. And, if a patient does not present a new card reflecting a new co-pay amount and I must send them a bill for the balance or, if they do not pay their co-pay and must be billed, there is a $5 charge for that. This policy is also clearly posted in the waiting room. Consequently, I very rarely have to bill for co-pays.
My advice to all of you just starting out is to set firm (but reasonable) policies from the start. Your patients are much less apt to complain or b#*ch than if you change them mid-stream. Also, when there are extenuating circumstances and you waive a rule, be sure to let the patient know you are waiving the rule just for them. Guilt is a powerful motivator to keep them from making the same mistake twice. "Back in the day" we physicians had a lot more freedom to overlook a lot of things. Today, if you want to be able to pay yourself and your overhead, you will need to be ever vigilant.

Leslie