Practitioner pointer: How to handle late and missed appointments

Be sure you have written policies in place to address the situation.

You are looking forward to a busy week, having scheduled every available slot on your calendar. By Wednesday, you have had three cancellations and your morning appointment was 20 minutes late. You have lost income, lost new patients and are about to lose your cool.

What can you do?

Can you bill the patient for the full session? Can you bill the insurance company? Can you charge a late fee? Are you stuck with a lost hour? How do you address the matter with your patient?

Have it in writing

You know you will need to deal with these situations from time to time, so have a good written policy in place beforehand to govern how you handle them. Not only is it good business; it is good risk management. When you can rely upon a written document that the patient has signed, that individual is less likely to file a complaint, let alone prevail. 

The initial visit is the time to review  with the patient your policies and the informed consent. Your informed consent ideally details how you deal with insurance, reminds patients of their financial responsibility for the services you provide, and lays out your billing procedures. It should also clearly state your policy when patients cancel appointments, arrive late or don’t bother showing up at all. 

Here are some key related points you may want to consider for the informed consent document:

  1. Set the tone by emphasizing the importance of respecting each other’s time. Let patients know that their tardiness or absence hurts other patients whom you could have seen during that time. 
  2. Specify the time frame required for notice of a late or missed appointment. It is typical to expect a 24-hour notice. 
  3. Tell the patient that you will charge him or her for a missed appointment when proper notice was not provided, and state the amount you will charge. If you take Medicare, make sure that you charge the same amount for Medicare and non-Medicare patients.
  4. Let the patient know your policy for late arrivals. If your insurance contract allows you to bill the patient for missed time, let them know what they can expect to pay. For example, a patient is scheduled for a 45-minute appointment and arrives 15 minutes late. You will bill insurance for 30 minutes and expect the patient to pay for 15. (Again, verify that your contract allows you to do this.) 

Items 2 and 3 are already covered if you used for your informed consent the Psychotherapist — Patient Agreement provided in the HIPAA for Psychologists Privacy Rule compliance product from the APA Practice Organization and the Trust (also available for download from the Trust’s website). You should remember, however, to also discuss these issues with your patient.

Item 4 is not covered by those documents, but you can include language like the following in your informed consent:

Once we have scheduled an appointment, please arrive on time. If you are late for a scheduled appointment without proper notice and that delay requires me to bill your insurance for a shorter session than we had scheduled, you may be billed for the difference.

This insert would fit logically after any discussion of missed appointments. (In the HIPAA for Psychologists or Trust’s Psychotherapist — Patient Agreement, late appointments are covered under the “Meetings” heading.)

More on Medicare 

Centers for Medicare and Medicaid Services (CMS) policy (PDF, 74KB) allows providers to charge Medicare beneficiaries for missed appointments as long as they also charge non-Medicare patients. The amount charged must be the same. If you do bill for missed time, bill the patient and not Medicare. Medicare will not pay and will deny the claim, since Medicare (like commercial insurance) only reimburses for services actually provided. 

Note that Medicare has no provision allowing you to charge the patient for being late. 

Enforcing your policy

It is important to enforce the policy you have put into place to protect yourself from being accused of discrimination or bias. If you are prone to making exceptions in certain cases, you may want to specify those circumstances in policy.

Please note: Legal issues are complex and highly fact specific and require legal expertise that cannot be provided by any single article. In addition, laws change over time and vary by jurisdiction. The information in this article does not constitute legal advice and should not be used as a substitute for obtaining personal legal advice and consultation prior to making decisions regarding individual circumstances.