Billing for No-Shows? Here are Some Best Practices to Get Deserved Pay

Patients missing appointments?  Implement a no-show policy to keep your income steady despite missed appointments!

Missed appointments have an impact on your physician’s schedule or his availability to other patients, and can also pose a health threat to the patient. Here are some no-show best practices to ensure your practice is maximizing your physician’s time, and getting the reimbursements it deserves.

Make sure you bill the patient and not the payer

The first thing that you need to evaluate is to whether to charge a fee to patients who do not show up for appointment is to check with your payers. Medicare allows charging for no-shows so long as it is the office policy and done universally to all patients.

• Verify with health plans
• Some states’ Medicaid programs do not allow the practice to charge a no-show fee as long as it’s charged to all patients

Your contract may give you scenarios of when you can, and cannot bill for a no-show. For instance, most payers will not allow you to charge a patient who cancelled an appointment more 24 hours prior to the scheduled appointment time.

Do check your state’s laws to see if there are any laws preventing you from billing for no-shows.
Note: Even if your contract allows you to bill for no-show visits, that does not mean you can bill the payer. Instead bill the patient for the missed appointment.

Identify whether no-shows are a problem

Deciding what to do about no show appointments depends on your providers, your practice and your location. In some instances, charging patients a fee when they miss a visit will help your practice make up for lost time and money.

Set your fee
Make sure your no-show policy spell out exactly what fee you will charge for a missed appointment. You should also not limit your policy to just in-office appointments. Because your physicians likely perform procedures or surgeries, you should consider charging no-show fees for those as well.
Depending on the type of practice, the no-show for procedures may be higher than for an office visit.

Keep Your Patients on the Same Page

Inform your patients about the policy and make them sign the policy with their annual financial documents. The intent of a no-show policy is to notify your patients of a likely financial penalty for failure to cancel a planned appointment.

Stop No-Shows Before it’s Too Late
Send reminder notices or make appointment reminder phone calls to avoid no-shows. See if your electronic record systems will generate automatic phone or secure message through your patient portal with a detailed reminder 48 hours before the appointment.

A good reminder such as the day/night before an appointment can help to make sure that patients come in at the right time.

Problem: However, in some cases, charging patients a no-show fee could negatively impact your patient relations and could result in negative public relations for your practice.

Be considerate: Every missed appointment is not the result of a poorly behaving patient. You need to be flexible as such as car accidents, do take place. For instance if a patient misses an appointment because she is in the emergency room with her kid, you should not charge her.


With increasing payer scrutiny, changing reimbursement rates, and trouble collecting from patients who are struggling with their own financial matters, every dollar matters. If patients are missing appointments, the cost of that lost time and revenue could impact your practice. That’s why your practice needs a comprehensive resource such as SuperCoder’s Specialty Coding Alerts to stay profitable. These newsletters are available in over 30 specialties and get you all the specialty-specific how-to advice you and your practice need to code correctly and ethically maximize revenue.