Running a mental health practice means that, at times, you must balance your role as a mental health expert and a business owner; certainly not an easy task. You of course want what’s in the best interest of your patients, but you also understand your time is valuable. Each time a patient no-shows or cancels on you last minute, you’re essentially loosing that time slot which is ultimately costing your business money.
How Do Other Therapists Deal with No-Shows?
The answer? Every practice handles no-shows and late cancellations differently. But with rising costs, economic instability, and the steep cancellation rate of telehealth services, many practices are led to wonder if it’s time for a policy change.
Simply put, no-shows mean less money coming in. With operation costs growing for everybody, you’re not alone in seeking a solution to this problem.
Current Policies & Restrictions Regarding No-Show Fees
Medicaid & Medicare Restrictions
Before digging into the nuances of this decision, it’s important to note that, in most states, Medicaid prohibits providers from billing members for no-shows. Be sure to confirm with your states DHS ahead of time to avoid any problems. Often times this will be explicitly written out in their provider manual. If not, you should request confirmation in email so you have something tangible to refer back to, if needed.
Medicare on the other hand does allow you to bill their members for late cancels and no-shows. Under Chapter 1, section 30.3.13 of the Medicare Claims Processing Manual, providers are permitted to bill Medicare beneficiaries for these incidents given they are not discriminating against them and are billing non-Medicare beneficiaries the same. The amount the provider charges Medicare beneficiaries for missed appointments must be equivalent to the amount that they charge non-Medicare patients.
Provide & Communicate a Written Policy
For applicable clients, a no-show or late fee charge will need to be documented in a written policy.
Billing Insurance for No-Show Appointments
Navigating no-shows with insurance companies must be handled with care. Billing a commercial, state or federal insurer for a session that did not occur is generally considered fraudulent, even in the case of no-shows. Review your plan contracts and provider manuals for specifics or contact your plans provider contract liaisons for any possible unpublished details.
Some EAP services MAY allow you to use an EAP session to cover a no-show, but ALWAYS confirm with them before submitting a bill for an appointment the client did not attend.
While a frankly awkward aspect of mental health care, it’s necessary to examine whether increasing or implementing no-show fees might benefit your practice. Before moving forward with this policy, here’s what you need to consider:
Pros of No-show Fees in Therapy
- The policy itself reduces no-show rates.
Many practices find that communicating the policy alone decreases no-show rates. When your patients know there’s a consequence for late cancellations, they know to try their best to show up or let you know of the cancellation in advance.
For this to work, you must be thorough and transparent with your policy. Continually inform patients of the policy in your appointment reminder and confirmation messages.
- Prevents significant loss of revenue.
Frequent no-shows cause a massive loss in revenue. Over time, these costs can certainly add up.
One statistic revealed that no-shows cost the healthcare industry as a whole over $150 billion annually. Most mental health professionals could be missing out on an additional $100-$200 for each missed appointment (depending on their rates with the plans). That appointment that was missed is an appointment that someone else could have scheduled and shown-up for.
Strategic cancellation fees and policies can compensate for the time, resources, and revenue lost from those missed appointments.
- Encourages a productive provider-client relationship.
Remember: Appointments aren’t just beneficial for practices — they’re essential for the patients. One recent study showed that missed appointments have a negative impact on a patient’s treatment and progress in their therapy sessions.
Consistent, reliable sessions create a trusting relationship and productive results for the patient’s goals. A no-show policy can indirectly help nurture and support this professional relationship and overall progress.
Cons of No-show Fees in Therapy
- It’s often difficult to collect no-show and late-cancellation payments.
Implementing these policies is one thing — collecting the payment is another.
It’s often difficult to collect payments for appointments patients didn’t attend. Having a card on file is best practice, this way you can more easily enforce your policy. If the client challenges your charge, you may be able to submit the financial policy they signed.
- Risk losing patients.
While it may save time/money for a provider to institute late cancel and no-show fees, it’s equally as vital for them to keep their patients. If a client didn’t understand the policy clearly and their card is charged, or at minimum are sent a bill for the no show, it can create a sense of distrust and even hostility for some patients.
- Could lead to negative online feedback.
Some patients may see these no-show charges as a dealbreaker and simply seek care elsewhere. And in the social media era we live in, they could be more likely to leave behind bad online reviews that damage your reputation
Over 9 in 10 consumers look at a company’s online reviews before making a purchase decision. This is especially relevant for mental health providers, as patients want to find a practice and professional, they can trust.
How to Decrease Missed Appointments in Behavioral Health Care
Perhaps this problem can be solved with a simple solution: increased patient communication.
With healthcare no-show rates between 12-80%, depending on the healthcare setting, it’s clear action is needed to benefit patients and providers alike. Here are a few simple yet powerful steps to promote a healthy appointment attendance rate:
Send out appointment reminders.
How tech-savvy is your clinic? Third-party software and partners can allow you to add or improve multiple forms of appointment reminders to help keep your patients accountable.
While pre-appointment phone calls may feel sufficient, combining call reminders with email and text messages can reach patients with different standards of communication and organization.
For both reliable patients and chronic no-shows, more direct messaging may improve your relationships and attendance rates.
Communicate the purpose of any no-show or late cancellation policies.
If you choose to implement a no-show policy, you must let your patients know. Help them understand that you want them to show up, not just for the operation of the clinic, but for their mental health.
Final Thoughts
For a smooth and risk-free relationship with insurance providers, team up with a third-party Revenue Cycle Management, like Sawgrass Behavioral.
If Revenue Cycle Management is already a stressor for your mental health clinic, working with a digital partner can make all the difference. Whether you’re a small, family-owned practice or a nationwide organization, Sawgrass Behavioral can properly verify benefits, manage claim filing, optimize follow-ups, and organize payer enrollments.
With Sawgrass Behavioral Resources, you’ll find more time and resources to effectively reach your goals, grow your practice, and, most importantly, serve your patients. Contact us today to get a quote!