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Medical Billing Tips: Charging Patients No-Show Fees

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Video | Billing Patients No-Show Fees

Medical Billing Tips discusses charging patients for missed appointments. Check with Medicare, Medicaid, and insurance companies to see if billing a no-show fee is allowable.


Medical Billing Tips Video Transcripts

Hi, my name is Manny Oliverez, Director of Operations here at Capture Billing, and today we are going to talk about charging no-show fees. Here at Capture, we get a lot of questions asking, “Should we charge for no-shows when a patient doesn’t show up?” Well, the answer to that is a resounding “Yes!” Charge those patients.

Let’s say you have a patient come in – well, actually, he doesn’t come in – and he misses his appointment. What happens to this doctor? Well, he’s just left twiddling his thumbs, and there is a vacant slot that could have been used for someone who is actually sick.

So, what we want to do is we want to charge the patient for not showing up as a negative reinforcement to not do that. So what are practices charging for no show fees? I’ve seen them charge anywhere from $10.00 to $25.00 for a sick visit, $50.00 to maybe $75.00 for a well check or physical exam, and I’ve seen them as high as $125.00 if they miss a procedure. That’s quite a bit of money, but you’re training your patient not to miss that appointment.

Now, how do we inform the patient about the no-show fees? Well, the best thing to do is, when they become a new patient, they should be signing a financial agreement with your practice. In that agreement you’re going to spell out that a missed appointment is $25.00, or whatever you want to charge. It depends on your practice, your specialty, what part of the country you’re in – whatever seems to be fair.

Spell that out, and also spell out how much notice they have to give you – how much notice in order to cancel that appointment. Whether it is 48 hours, or 24 hours, or just that day, it’s totally up to you, but make sure that they sign that agreement. Because what’s going to happen is when you charge them and send them out that bill, they are going to end up calling you and saying, “Hey, what are you doing charging me for this?” You can always refer back to that agreement.

Also, I would suggest the first time they miss an appointment, use it as an educational talk. Inform them why it is important to keep or cancel their appointment, and possibly even waive that first fee. Note it in the account, so that if it happens again, you will charge them. That’s what practices are doing, and it is okay to charge a no show fee.

Always check with your local regulations, your state, and your insurance companies to see how this all works out with them. Remember, a medical practice is a business. Treating it any other way is just nuts.

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is a 20 year veteran of healthcare having managed medical practices. He advises medical practices, physicians and practice administrators on how to run their practice and manage their medical billing and revenue cycle management. Manny speaks, blogs and makes videos at, a blog that is tops in the medical billing and coding field. READ MORE

8 Responses to “Medical Billing Tips: Charging Patients No-Show Fees”

  1. Dawn Harris says:

    Can a doctor charge a no show fee when he is doing an outpatient procedure at a surgical center?

    • Manny Oliverez says:

      In my opinion I don’t see why not as long as the patient had signed a form agreeing to the fee ahead of time. If it is a Medicare or Medicaid patient then I would not charge the fee.

  2. Steve Martinez says:

    Does this apply to Medi-Medi and/or Medicaid only beneficiaries?

    • Steve you should have no problem billing no show fees to patients with commercial insurance. However Medicare and Medicaid have their own rules which usually means you can’t bill a patient for no show fees. We never bill but double check with your local carriers. If a patient consistently no shows you may be able to dismiss the patient. Just do it properly.

  3. Jim Nelson says:

    So as a patient, I have been charged twice for no shows. Each time I refused to pay plus I will NEVER return. I guess if you don’t want my business and you have too much already, go for it. But I will never return to your business and will not recommend seeing you again.

  4. Jeff Hoyt says:

    Seriously….. How many times has a doctor just “sat twiddling his thumbs?” Offices overly schedule “slots” with so many patients the patient is the one who sits waiting. Do you knock a $25 to $50 discount for the hour or so that a patient sits waiting in your office? I did not think so. These fees are absurd and another reason physicians and billers are looked at with disgust whining about money

  5. How do you charge a new patient that is a no-show? If you send them a bill, they won’t pay it and you will ensure that that patient never reschedules. Any suggestions? Or when you get the patient info do you also request that they keep a credit card on file?

    • Sharon it is very difficult to charge a new patient for a no-show. Our practices do one of two things:

      1. Don’t do anything but will not make another appointment if the patient calls back;
      2. Take a credit card but only for a higher priced procedure.

      As management you walk a fine line between alienating a new patient by asking for a credit card and running your business but you need to decide what’s best overall.

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The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly.

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