Most clinics lose an average of 20% of their revenue due to missed appointments. Lost revenue may not be the largest problem clinics face due to no-shows. Other problems span health damage, patient liability risks, reduced accessibility, and impeded resident education. Rigorous no-show management methods utilizing powerful vericle-like technologies, which integrate scheduling and billing data, reduce no-show rates and improve associated revenues by more than 50%.
No-Show Frequency Distribution
No-show rates average at about 20%, where 10% clinics have less than 10% no-shows, 42% clinics - 10%-20%, 34% clinics - 20-30%, and 14% clinics - more than 30% no-shows. Further, the top ten clinics range 3%-9% for no-shows, while the bottom 10 clinics reach 33%-57%.
No-Show Impact to Clinic
A missed appointment poses five kinds of problems:
Health damage: Damage to patient’s health due to interrupted continuity of care or missed an opportunity to solve an acute health problem. The doctor also loses an opportunity for a timely review of patient health, treatment progress, etc.
Liability risk: A patient that missed an appointment and suffered an injury may have a viable cause for a lawsuit against the practice. To avoid such risk, the doctor must maintain evidence of giving clear directions and making reasonable efforts to ensure patient’s compliance with care program, including keeping follow-up appointments.
Reduced accessibility: Other patients were postponed and did not get access to care because of a no-show or cancelled appointment.
Impedance to resident education: Resident doctor missed an opportunity to hone care skills.
Loss of revenue: Clinic is unable to make up revenue due to missed appointments.
Three-Phase No-Show Management Strategy
An effective no-show management strategy is based on tracking, rescheduling, and follow up:
Record all no-shows and reconcile with billing on a daily basis
Record no-show reasons and followup notes in patient records
Review End-Of-Day report daily
Reschedule in real time
Allow patients request appointments online using Internet
Overbook, use waiting lists
Fill new openings with walk-ins or patients from waiting list
Activate a sequence of reminder calls/emails to all patients 10, 2, and 1 day prior to appointment.
Follow up call to find reasons for no-show and reschedule
Follow up with warning letters after one no-show
Dismiss from practice after three no-shows
Reminder calls or emails prior to appointment remains the most effective method to prevent missed appointments. Additionally, sending reminders via email and allowing patients confirm online turns an office reminder into patient’s action item, significantly outperforming the impact of a voice message or postcard.
Note that outsourcing reminder calls to calling services and using the Internet reduce the cost of reminders. Therefore reaching all patients prior to appointment makes good business sense.
Three technologies are especially useful in implementing the no-show management strategy outlined above:
End-Of-Day Report: End-Of-Day report displays New patients, Visits, Cash, Insurance, Free, Insurance (Billed, Collected), Cash Collected, Missed Appointments, Recalls, Patient Visit Average. End-Of-Day allows the manager to reconcile revenues with patient visits, eliminating no-charge visits and unbillable appointments.
Allow patient access to Internet-based appointment scheduler
Update available appointment list due to cancellations
Alert about new openings for patients on the waiting list
Alert about appointments with missing authorizations
Most schedulers allow monthly, weekly, and daily views. Today view should change color for no-show appointments, prompting the front-office person to follow up immediately or at the end of the day
Search: Search feature must allow finding all no-shows within specific time interval subject to specific patient name, attending physician, CPT and/or ICD-9 code combinations, or other demographic conditions. Upon finding specific appointment, drill down should be available for related appointment history or recurring appointment plan.
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