Write the best no-show policy for your practice (and patients)

Does your practice manager constantly deal with no-show appointments and late cancellations? Missed appointments create plenty of hassle for hardworking healthcare staff and can significantly impact the bottom line and compromise care quality — but a no-show policy can help. 

Every missed appointment interrupts care for the patient and revenue for the practice. A no-show also inconveniences and delays care for others. Missed appointments affect productivity and waste resources, increasing "soft costs." A 2023 Tebra survey reveals that no-shows and cancellations cost practices as much as $7,500 per month. 

Your practice needs a strong cancellation policy to reduce no-shows and support your team. But how you handle no-show appointments also impacts patient retention. The same Tebra survey found that 53% of patients would switch providers because of a no-show appointment policy. Therefore, an effective no-show policy must consider the needs of both practice and patients. 

Here are best practices for writing a no-show appointment policy that won't alienate your patient base. 

A policy that reads like a stern list of rules and punishments can sound condescending. It may also intimidate patients who are experiencing stress from school, jobs, or family while dealing with a health crisis. If your policy doesn't treat the patient as an individual with a life outside the clinic, why should the patient show consideration for the practice? 

Instead, consider your cancellation policy as an invitation for patients to participate in an efficient and fair system that benefits everyone involved. To design a no-show policy that prioritizes patient engagement, use empathy along with clear, respectful communication.

Empathy is vital for a no-show policy that doesn't scare patients away. Your policy should be compassionate for the struggles that force people to miss scheduled appointments. Your policy can also help patients understand how missed appointments affect the practice, if you wish. 

Missed appointments usually occur because of forgetfulness, work conflicts, illness, and transportation challenges. Often, these circumstances are beyond patients’ control. A policy that clarifies boundaries while offering some accommodation in such situations encourages patient trust in the practice and provider. Trust helps motivate patients to improve health behaviors, including appointment adherence, and can positively impact health outcomes.

Use straightforward but comprehensive language, and assume patients are intelligent, well-intentioned, and trustworthy. For example, to communicate why no-show appointments cause problems, include a few details about how a no-show makes extra work for the practice manager or increases wait times for other patients.

A no-show policy should clearly outline expectations for scheduled visits and explain how to cancel appointments. It typically includes information about:

Some no-show policies include information about unexpected schedule changes that occur on the practice side. This treats the patient equally, shows respect for their time, and empathizes with any issues caused if the practice cancels at the last minute.

HealthTexas Medical Group has a strong example of an empathetic policy written clearly and respectfully. It opens:

"We understand that situations arise in which you must cancel your appointment. It is therefore requested that if you must cancel your appointment you provide more than 24 hours notice."

Right away, the practice establishes empathy by using "we understand," and shows respect by using “requested.”

After outlining the details, the document wraps up with language that supports the clear communication necessary for patient trust:

"HealthTexas believes that a good physician/patient relationship is based upon understanding and good communication. Questions about cancellation and no-show fees should be directed to the clinic manager at [phone number]."

You can start with this basic no-show policy template and customize the language and formatting to fit your practice:

No-show/late cancellation policy

We understand that you may need to cancel an appointment occasionally. In such circumstances, please contact us no later than 24 hours before your scheduled appointment time. You may do so by calling [phone number], emailing [email address], or using the patient portal. 

If you do not show up for your appointment, or cancel or reschedule within 24 hours of your appointment time, we will consider that a no-show. No-show appointments may be subject to a $25 fee. No-show fees are the patient’s sole responsibility and must be paid in full before your next appointment. If the no-show fee might prevent you from receiving necessary care, please contact us. 

We know that unexpected situations sometimes arise. In the case of emergencies or extenuating circumstances, we may waive the no-show fee. Waivers are determined on a case-by-case basis at the practice management's sole discretion. 

If our office must cancel your appointment with less than 24 hours notice, you may choose to meet with a different provider (if available) on the same day, to reschedule, or to cancel. In these circumstances, we will not charge you a cancellation fee.

If you have questions about our cancellation policy, or you’re experiencing an emergency, please call [phone number] or email the practice manager at [email address].

Patient signature:

Date:

The American Medical Association (AMA) considers it ethical to charge a fee for appointments missed with less than 24 hours’ notice. You must apply the same fee policy to all patients, so review your payer contracts before implementing a late-cancellation charge. You should also ask patients to sign a copy of the fee policy — if you charge them a fee without notice, you could end up with legal trouble.

Deciding whether to charge a no-show fee depends on the individual practice. Consider the pros and cons regarding factors such as your patient population, practice size, no-show rates, and retention rates.

Pros of charging no-show fees:

Cons of no-show fees:

Some practices use the following alternatives to avoid the potential negatives of a straight fee: 

This model adds a small no-show fee to the patient's bill. The fee disappears if the appointment is rescheduled and the patient shows up on time.

This approach rewards patients who keep appointments and arrive on time. Many practices use “soft” benefits, such as extra scheduling flexibility or priority check-in, as rewards. Practices should check with their legal team before offering discounts, gift cards, and other economic benefits.

This system penalizes patients who have a certain number of no-show appointments. For example, the practice might lock patients out of the online booking system if they miss 3 appointments, forcing them to call the office to book. However, these policies may not disincentivize patients who habitually no-show. Practices with no-show limits should ensure the office staff understands the call in policies for new medications and refills. Patients may skip appointments without rescheduling if they’re still able to get their prescriptions filled.

A cancellation policy won't help your practice unless patients know about it. When it comes to sharing the policy, think big picture. The more you amplify the message, the better chance it has to encourage appointment attendance and discourage no-shows. Your practice probably already uses some of the best tools for spreading the word.

Whether patients complete initial paperwork online or in the office, ask them to sign a statement saying they've read and understand the cancellation policy. 

Your website provides a channel for current and potential patients to become familiar with the no-show policy. You could include the main points in an FAQ or upload the entire document to the site. 

Send a subtle message by displaying monthly or quarterly no-show totals around the office. This helps raise awareness and shows the practice takes missed appointments seriously. You can post the data at the check-in/check-out desk, waiting area, or exam rooms. 

Include the basics in the body of email reminders, or attach the entire policy if you wish. Text reminders can include something brief, like, "notify us at least 24 hours in advance to avoid a cancellation fee." Or, include a link to the policy document on the website.

Instruct office staff to remind patients about the no-show policy in all confirmation calls. Use a prewritten script so they can explain the policy politely and concisely.

A patient-friendly cancellation policy can effectively address no-shows and late cancellations. Automated scheduling tools also help prevent missed appointments. Preliminary research using a quality improvement initiative in a multi-specialty healthcare system suggests that a patient will show up for more appointments when they receive both phone calls and automated reminders. Automated platforms typically support customized messages that include the cancellation window and other details.

Digital scheduling solutions also let patients personalize their reminder preferences and manage their appointment times without calling the office. According to the recent Tebra survey, access to online rescheduling would help 75% of patients show up for more appointments.