How Late Is Too Late?

pedspnp · Jan 7, 2013

Our office policy is 15 minutes, then you need too reschedule. My stylist is not even that generous, 10 minutes late and she asks you to reschedule.

allnurses Guide · Jan 7, 2013

Our policy is 15 minutes. People still complain, even though they are told this up front. I have a question for you-do you charge patients for missed/no-show appointments? My office does not, as it's been found to be too difficult and expensive to chase these patients down. However, three no shows and they are discharged.

AngelfireRN, MSN, RN, APRN · Jan 8, 2013

Yes, we charge a no-show fee. We also charge a $10 fee for every time a patient calls to be reminded of their appt. This is because all patients are provided with an appointment card at their visit with the date and time of their next appt.

We also dismiss for repeated no shows or tardies...unless there are extenuating circumstances, of course.

We require that balances be paid in full before we call in scripts. As a pain management practice, this is usually seen to fairly quickly, since they want their meds.

We had one last week that was an hour late, still expected to be seen, and got positively irate when she was told to reschedule. She's not aware of it, but her next appt will be her last. I have a very low BS tolerance these days, and she just went above and beyond.

BlueDevil,DNP, DNP, RN · Jan 8, 2013

15 minutes, and I am firm about it. Frankly, I resent their being 15 minutes late as it totally screws my schedule. I stay on time for the most part, but someone's being 15 minutes late can ruin everything. I don't think I should see them at all if they are more than 5 minutes late, because technically they are supposed to be there 10 minutes before the appointment time anyway. However, clinic policy beyond my control says 15 minutes, so I see them so long as it is merely 15 minutes and not 16! However, if they are late they are told that I have moved on to the next patient and I have to try to work them back in between the other patient's that were on time. Other people obviously cannot be made to wait on account of Ms Tardy's irresponsibility, so s/he is likely going to wait a while. When I'm lucky, they don't like the sound of that and leave. When I'm unlucky, they stick around and I have to rush later to work them back in. When I'm very unluck they are nasty about having to wait an hour, as if it were my fault they couldn't arrive on time. IME, once you get a rep for being inflexible about it, you weed out the people with punctuality issues and the others know you mean business and get there on time most of the time, unless it really could not be helped.

I dismiss after the 3rd no-call no-show each and every time. We do not charge a no-show fee because it is too expensive to try to collect it and uneven collections can apparently be a medicare fraud issue. I am not allowed, per policy, to prescribe for people with an outstanding balance and failure to make arrangments and/or keep them current. I never know what the arrangments are (I know there is one patient who pays $1.50 a week on a bill that is still over $7,000. She has never missed a week in years. She has medicaid now and doesn't have new bills compounding, but still keeps paying toward an old bill that the clinic actually wrote off years ago. She doesn't have to, and the $1.50 just goes into the employee assistance fund, but it does a lot for her self esteem to know she is going to pay off that bill someday. It isn't my patient and I don't even know who it is. I just know we have one such patient), and I could not possibly care less. There is an alert in the medical record about them in case they should try to do an end run and call to request something after having fallen behind in a payment plan. I can't prescribe for them. If I did, I'd get fired.

AngelfireRN, MSN, RN, APRN · Jan 8, 2013

BlueDevil, that's a tough spot to be in. Here, since I'm responsible for the bulk of the patients, I write the contract. Basically, act right, get here on time, and pay your bills and everyone gets along just fine. The sad part...I have to have a FULL PAGE that spells out exactly what to do and not do because people can not figure it out on their own!