Want to Boost Revenues by $150,000 a Year? Reduce Patient No Shows

Patient no shows

The High Cost of Patient No-Shows 

Patient appointment cancellations cost US physician practices billions of dollars in revenue losses. According to a 2017 MGMA survey on patient no-shows, a typical medical practice has a patient-no-show rate of 5%, with specialties such as neurology and general surgery reporting median no-show rates of 8%. These percentages in some healthcare specialties are reported to be significantly higher:

  • Cardiology –18%
  • Endocrinology – 14%
  • Gastroenterology – 25%
  • OB/GYN – 18%
  • Ophthalmology – 22%
  • Orthopedics – 11.5%
  • Pediatrics – 30%

If two patients cancel appointments at a medical practice daily, that could imply more than $150,000 a year of lost revenue. Apart from this loss in revenue, there is a hidden cost to patient no-shows that goes unnoticed. Athenahealth surveyed 3.5 million visits by 1.2 million patients at 1,626 primary care practices. The research on patient no-shows revealed that a no-show patient has a 70% higher risk of not returning to the practice compared to a patient that does not have a no-show. Therefore, with a patient no-show, you are losing transactional revenue and risk losing the client to a competing practice.

Tips to Reduce Patient No-Show

While there are many reasons for a patient to miss their appointment, here are a few things you can do to reduce the risk of a patient not turning up:

Use automated reminders via email or text notifications to remind patients of their upcoming appointments.

  • If patients feel you don’t value their time, they are not likely to value yours. Reduce the patient wait time in your office. One way to achieve this for new patients is digital patient registrations through your website or patient portal. 
  • Schedule new patients and urgent need cases as soon as possible.
  • Offer telemedicine appointments or in-office appointments over weekends.
  • Allow online self-scheduling so patients can choose a timeslot that suits them.
  • Implement a patient no-show fee.
  • Make it a point to thank patients who show up at your office on time.
  • Offer an incentive to patients who opt for pre-paid appointments.

Guidelines for Implementing No-Show Fee 

Although there is no CPT code for missed appointments, most payers don’t prohibit medical practices from charging a no-show fee. Any payer-specific guidelines on no-show fees will be in their contract. Most commercial payers mimic Medicare guidelines. Therefore, complying with the Medicare no-show guidelines is an excellent place to start when drafting the patient no-show fee policy for your medical practice. 

Medicare does not have guidelines on the no-show fee to be charged but requires that the fee amount be the same for Medicare and other payer patients. Penalizing all patients with the same no-show fee can also help avoid possible claims of discrimination.

Your practice and patients are unique, so how much you charge is up to you. The no-show fee should discourage patients from canceling but should also not be so high that it becomes a financial burden on some patients. The two most popular options for levying a no-show fee are as follows:

  • Create a staggered no-show fee structure. So, you levy a minimal no-show fee for the first appointment missed and a higher fee for subsequent missed appointments.
  • Set a parameter for the number of free cancellations, after which you levy a flat no-show fee.

It would be best if you offered some flexibility, such as waiving the fee for a client with a one-off issue. 

The no-fee can be collected through the credit card on file information captured at the time of patient registration or appointment booking. 

The no-show fee must be mentioned on the documents signed by the patient at the time of registration – this will help avoid surprise billing cases. The no-show policy of your medical practice must also be displayed in the waiting area and shared on the practice website. You must immediately notify patients (through automated alerts/phone calls) of the no-show policy from the first missed appointment.

 Minimizing patient no shows is one way to improve your practice revenues. Subscribe to our blog to continue to receive tips on revenue cycle management. You can also contact us for a free consultation.


Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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