Home Forums Discussions General Discussion No Show Warnings

Hi everyone. Since we have been rather lax about this for way too long, I was hoping to get some advice. First off, we have 65% MaineCare, so I do not feel comfortable charging those who are self-pay or who have insurance any amount of money. Besides, it tends to be the patients with Medicaid who no-show. Just stating the statistics.

So, we are instituting a three-strike rule as most people do. Two warning letters, then dismissesd on the third no show. The problem is the same people who tend to no show, change cell phones, addresses, etc. So, what do you do with the patient who you have notified, but the letters are returned? And, do you assume that any letter which is not returned made it through and was read. We certainly can't do Certified Mail on these.

So, you send two no-show letters, which are returned. They no show again. Do you just send a dismissal letter? Then that is returned. Of course, after each no show where a letter doesn't make it, we would call them. But, what if they don't answer. I do realize that when they call for another appointment where they intend to no show, we can tell them at that point.

Sorry to make it so confusing. Basically it boils down to what do you do with someone who no shows three times, and you aren't successful with the notification and dismissal letters?

And, I should add (and this is my fault), but one of the great traits of my receptionist also works against me. She is just really, really good and nice on the phone. Best ever. But, she is also too soft on them. She isn't the kind of sort of mean gatekeeper who would feel comfortable telling someone they are being dismissed. And, even then, they need some type of notification so they can find another place to no show.

Some no show on the same day they made an acute appointment. Some make three well child visits and we lose three slots.

Bump. Can someone please help. Thanks.

Hi Bert,

I don't think anyone intends to ignore you, I just don't think anyone has a real good answer for this.

Each practice is going to be different. If you run on a tight schedule, and a no-show is wasted provider time, obviously this becomes a huge issue. I am a family physician, I'm usually overbooked and/or running behind, so a no-show is not as big a deal to me.

Most of the discharges from our practice involves controlled medications, which is a whole different story?

My understanding, and this is just the "wisdom of the ages" passed down, is that we are required to provide emergency care for 30 days after discharge/ termination. So if you have been unable to verify that a patient received your discharge letter, and they show up in your office with an emergency, you are legally obligated to see them. If they show up for routine visit, medication refill, or so forth, you can just give them a copy of the discharge letter at that point.

Hope this helps.

Gene

Bert: I have a similar policy about no show visits: a simple warning letter on the first, explaining the issue, an explanation + fee on the second, and discharge on the third. If letters are coming back, of course you try by phone. If phone out of service, you can send a certified letter to the effect of "cannot contact you by other means" it "appears you have withdrawn from the practice" you have 30 days for emergency care/ you have a no show fee, etc. People who are continually changing their phone numbers, emails, and addresses are probably running from creditors or someone else. Do you want to continue with them when they obviously do not want to continue a relationship with you? Tough situation, discharge legal procedures recommended.

I generally follow the three strikes rule as well. If for some reason the pt can't be notified of dismissal I put a flag on the chart "talk to doc before scheduling" and handle them on a case-by-case basis. I tend to give kids a lot more leeway than adults.

Having said that there may be specific rules within your state's Medicaid program that would take precedence.

I have read the above discussions and the florida medical association had at one time clarified that technically you can charge Medicare patients for no shows but Medicaid does NOT allow you to do so. Apparently it is in our hand book. The following link is to the article: http://www.flmedical.org/LRC_Charging_patients_for_missed_appointments.aspx


Raj

Thanks everyone. One thing I am learning from you is that everyone has a similar problem. It is definitely true that you can't charge Medicaid for ANYTHING. I always laugh when a hospital like Mass General asks for info on a prior authorization "so they don't bill the patient." The very fact that they require a PA so they can be seen out of Maine is because they have MaineCare. We always tell them we will try to give them the info so they can get the PA, but good luck charging the patient. You can't. You can't charge them for records either. I know practices charge $25.00 to $30.00 for no shows. We don't because I don't think it would be fair to those with private insurance to pay while those with Medicaid not to. Besides, I would think I would deal with a lot of angry patients (even though it was posted).

Thanks Gene. I know no one is avoiding me. It is just helpful to see what others do. It is so frustrating to look at a day with 25 scheduled and see five no shows. Or, three in one family. Especially ones that were confirmed the day before. WHICH MEANS THEY MUST HAVE A WORKING PHONE NUMBER. I know at least in Maine, you don't have to give 30 days. You just have to give enough time for them to find another physician based on their health. You can give 15 or 60. If you have a patient who is very sick or fragile, you must give them more than 30. I agree, though, I tend to give 30 days, because most patients think that is the rule.

I used to not care. When I was less busy, I would think who cares. How does it hurt me? But, then, I would see where someone no showed at 2:00 pm and, if I had that slow, I wouldn't have had to schedule the 5:30 pt, which would have been helpful for me and the patient.

Sometimes I feel I should give two strikes to someone who made an acute appointment on the same day. That is just the height of rudeness.

We have charged medicaid patients for 8 years .... Patients have complained to medicaid, but alas the medicaid reps don't really care. I guess they are too busy with other problems. I dismiss chronic no-shows; We are not overbooked everyday, so an empty slot affects our practice revenue.

Wow. I remember before I knew I could charge MaineCare patients for record transfers (most patients who have transferred in the past go nuts, because other doctors didn't charge them, and they think you can't), I charged MaineCare patients as well. I don't know how many we billed and either received payment, or they didn't get a COPY of their records.

But, one MaineCare patient complained to MaineCare, and oh my god! Whoever was in charge of not allowing MaineCare patients to have to pay anything, was on the phone with me the next day. She was very rude, and she made it very clear that if I tried to do it again, she would have someone come to the office and audit every single MaineCare visit. I gave the patient their records.

We typically do not charge patients if its a fax or updox direct transfer to another provider. If they ask for a paper copy in hand we do charge a copy fee.

LOL. For us it's just the opposite. Not to exaggerate, but if they are a patient of the practice, I would give them a copy a day for 10 days. But, if they transfer to another local practice without an obvious reason, and they have a one page record, we will charge them $5.00. If it's 100 pages, we will charge them $5.00 and 45 cents per page. The only caveat is the law states if it is electronic, you can only charge what seems appropriate (the amount is not set) for the time. Given I do all of those, my time is fairly valuable. Yes, I admit it is passive-aggressive. But, we do deserve to get paid for the time.