We can imagine how frustrating it must be for you to sit waiting for patients who do not show up. It is disrespectful and costs you.

It may be appropriate to forward these patients to collections, depending on the circumstances. Here are some things to consider:

• Did you communicate your policy regarding missed appointments to your patients? A well crafted office policy that reminds patients that you will bill them for missed appointments is a must. It should part of a larger patient financial agreement and should be signed by the patient. Simply posting it in your office is not enough.
• Did you receive any notice from the patient as to why they did not show up for the appointment? Emergencies happen, and it is probably not a good idea to penalize someone for an emergency situation.
• Is your missed appointment charge reasonable? It should reflect any out of pocket costs (eg, you had a specialist come in to do a test, etc.) and the length of time you set aside for the visit).
• Is the length of time required for cancellation reasonable? Asking for a week’s notice may be a bit extreme. Only you can determine what kind of notice you require. Usually, 24-48 hours is appropriate.
• Do you have a good service to record phone call cancellations? Our debt collectors tell us that most people say that they canceled the appointment. Do you have a way to prove that they did not cancel in time?
• Is the patient a repeat offender? Many practices opt to forgive one missed appointment but will charge for any subsequent appointments missed. Your written agreement should clearly outline how it works. 
• Is it worth your time and effort?

If you believe you can document and support a missed appointment charge, and you know that patients are aware of and have agreed to your policy, then it can be entirely appropriate to treat those files as collection files. We recommend you try to collect the balances on your own before sending them to a collection agency, and if you receive a dispute from the patient, make sure the collection agency knows that going in.

Yours truly,