Documenting No-shows

Question: When patients miss appointments, what should a practice do to document it and communicate back to the patient?

Answer: No-shows can pose a significant liability risk. Patients who miss appointments and suffer injury as a result may have a viable lawsuit if they have evidence that their physician didn't give clear directions or make reasonable efforts to make sure the patient complied with the advice, including keeping follow-up appointments. You also lose the opportunity to do standard, timely reviews of medications, medical problems, disease progression, and so on.

To be safe, keep clear, consistent records of missed appointments, and follow up on no-shows. If a very ill patient misses an appointment, every effort should be made to determine the reason as soon as possible.

Note in the patient's chart how and when you followed up. While follow-up calls can be time-consuming, they can also be well worth it if they prevent problems. Find out during the call why the patient didn't come in, and note the reason. If patients can't get access to your office fast enough and go somewhere else, you know you need to improve your procedures.

For more standard no-shows -- and with patients who aren't particularly sick -- you can print routine follow-up letters from the physician expressing concern about the missed appointment and asking the patient to call in to reschedule. Keep a copy of the letter in the patient's record.