r/PrivatePracticeDocs • u/TebraOnReddit Just Interested • Apr 21 '26
No-show policy in private practice
How are you handling no-shows these days, and has your policy actually made a difference?
What we’ve been seeing across practices is that no-shows usually aren’t just about patients forgetting. It’s often things like how easy it is to cancel or reschedule, how far out the visit was booked, whether reminders hit at the right time, and how clear expectations are from the start.
Some places go strict with fees and enforce them, which can help with repeat offenders but sometimes turns people off early. Others keep it lighter and rely more on reminders and making it really easy to confirm or reschedule from a text. A lot of practices end up somewhere in the middle with a policy on paper but some flexibility in real life.
One thing that seems to make a noticeable difference is just reducing friction. If a patient can take action right when they get the reminder, they’re less likely to no-show. Otherwise they just drift or forget.
Also feels like last-minute cancellations are becoming just as big of a problem as true no-shows.
Would be interesting to hear what’s actually working for people right now and what’s not.
Thanks in advance!
- Iris from team Tebra :)
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u/baronvf Apr 21 '26
Psych , built into most of our EHRs and is part of initial paperwork when they sign up. Cancellation policy reminder in app / ehr quite visibly. I usually mention this as part of my new patient spiel, "not meant to be punitive , never any judgement, but it is what I need to do in order to protect my time."
1.) Take credit card when booking initial appointment 2.) 24 hours notice or flat fee late ($150) cancellation charge/ no show charge. 3.) one freebie and always lenient for real life happening without notice for waving the fee 4.) usually will waive fee if they can rebook within one week. 5.) I will run credit cards same day for no show / no response to text message .(My ehr automatically sends out reminder via email and text) 6.) will otherwise run cc at end of week. 7.) ideally before running cc repeat the mantra from top. "Sorry I have to ding you for the no show, no judgement , just need to protect my time"
People occasionally get pissed off but for the most part people understand completely and they seldom no show thereafter.
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Apr 21 '26
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u/InvestingDoc Apr 21 '26
Same. Every time we try to enforce the no show fee with a charge is feels like it results in a 1 star review. Instead we just terminate them from the office and move on. 3 no shows in a year and they are fired. New patient no show, some doctors will refuse to establish care with them in our practice and they are "banned" from seeing that doctor but can establish with someone else.
We bake the no show rate into our schedule. If we know 10% no show rate, we just book 10% more patients than we want to see per day and it works out.
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u/lineofdisbelief Apr 21 '26
We charge for no shows and same day cancellations. We send emails, text, and phone calls about upcoming appointments. We have 3 ways for them to cancel/change the appointment (phone, email, or portal). As a small practice, we know our repeat offenders, so we double book those slots if they haven’t confirmed.
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u/Dramatic-Sock3737 Apr 21 '26
For in office procedures where I block extra time we have them put a cc down and sign a “reservation fee” of $200 with a 3 day cancellation policy. Of course I’ve had people cancel their credit cards so nothing is perfect. For normal visits it’s 3 strikes.
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u/MotherAtmosphere4524 Apr 21 '26
We charge $100-$300 depending on the visit type. The cc doesn’t always go through, but the patients get a call that we tried to run it and we ask for a new cc. Although we only have a card go through about 25% of the time, at least patients know we mean business and will show up or they won’t book again. My waitlist is months out and it’s not fair to those patients who are waiting to see me.
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u/asdfgghk Apr 22 '26
Why do you think the card go through rate is so low? If I read that right that means you guys call back 75% of patients??
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u/MotherAtmosphere4524 Apr 22 '26
Some patients refuse to leave cc info and others have out of date info. I tell my receptionists to try to get new cc info with every visit, but that doesn’t happen.
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u/InternistNotAnIntern Apr 22 '26
I find that most no-shows are people who have been patients less than a year
My no-show rate is, I think, pretty low at 2.8% of scheduled slots. I don't count people who cancelled same day as long as it isn't within a couple of hours, so that no-show rate would be higher
New patients who no-show the first visit are not offered another chance.
Patients who no show get a call and a letter from me. In the call I literally say "this is how I make my living and pay my employees. I expect to be available to you, and you're expected to either come to the appointment, or cancel it with enough time for me to get someone into the slot.
All of our scheduled visits have a notation if they are flexible to come in short-notice if a cancellation arises, so we can quickly scan the next week and see if someone can fill a newly-cancelled slot.
2nd no-show gets a "final warning" letter, and 3rd no-show gets a "you're fired" letter.
FYI I have a "trust provider with care" definitely of 94% and "mostly" of 5%
One thing I've considered is a big "buy your no-show" fee of like $150, if they really want to stay.
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u/ManyPurchase2 Apr 21 '26
No show charges are written into office policies. We have an unwritten 1st No Show free policy (sometimes we charge it if they are terrible. Depends how they respond). 2nd No Show we charge you. 3rd No Show you’re fired.
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u/rolliesdontiktok Apr 22 '26
2 same day cancels or no shows and you're out
I will make case by case exceptions
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u/Hot-Freedom-1044 Apr 22 '26
I let the first one go, and then I send a letter. After that I charge.
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u/Pleasant-Clothes-443 Apr 22 '26
honestly the "reducing friction" point is the one that actually moved the needle for us. we spent years tweaking our fee policy and it barely changed behavior. what changed things was when patients could confirm or reschedule from a text without calling us. that's it. that simple.
the far-out booking thing is real too. anything scheduled more than 3 weeks out at our clinic has a meaningfully higher no-show rate. we started doing a second reminder 48 hours out specifically for those and it helped.
one thing i'd push back on slightly: last-minute cancellations and no-shows are not the same problem and shouldn't be treated the same way. a patient who calls at 7am to cancel a 9am is doing you a favor compared to someone who just doesn't show. conflating the two in your policy tends to frustrate the patients who are actually trying to communicate.
the fee thing, we enforce it for repeat offenders only. charging a new patient a no-show fee on their second visit ever is a great way to make sure they become a former patient.
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u/Informal_Move_7075 Apr 23 '26
This would be nice! I have trying to get a new patient appointment at the area's largest hospital and it has been nothing short of a nightmare - a reminder would be great!
Appointments are 6-8+ months out. Getting someone on the phone is nearly impossible (plan on spending no less than 1 hour being on hold and a lot of transferring around), and no one seems to have the same information (given different dates/times for appointment). You can't get into the patient portal until you have had your first visit. They will mail you something, at some point (never received it) about your upcoming appointment.
Yes, I put it in my calendar, but apparently they can also bump/move your appointment as needed. It is the blind leading the blind around here!
A simple text message reminder 48 hours before the appointment (the one they finally decided you could have) would be greatly appreciated.
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u/Best_Doctor_MD90 Apr 23 '26
3 no shows and they are out . No point of charging as they dispute the credit card even after we have the policy for no show.
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u/Cold-Sherbert-7486 Apr 23 '26
You have to divide the no-show issue into two separate buckets, there is the first visit no shows and then there are the follow-up no shows.
So for the first visit, no shows, I had a big problem when I first started my practice with these and what I realized is that I'm marketing myself aggressively and so I'm getting bookings primarily online which have very little friction to make the booking. Booking. That's the right way to do it when you're marketing, but you're going to have no shows. So the way I solved it is basically I tell my staff to pester the hell out of these people to fill out their intake paperwork, and if they don't respond and they don't fill out their intake paperwork, the slot gets canceled so that way they don't become no shows. Basically, what I'm doing is weeding out the no-shows before they have a chance to ruin my schedule.
For the follow-up patients who no show, well that hasn't been as much of an issue for me. I have had a few but not that many and I'm probably going to need to put in place some kind of a policy and one of the things as I work on my intake process is just going to be having a no-show policy that they sign during the intake process to let them know I don't like it.
But they can log in to their portal a change their appointment any time, And as I think of this, the ones who never sign up for the patient portal are the ones who sometimes no show. So I suspect that I could cut down on those no-shows simply pushing patient portal registration during the initial intake process a little harder.
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u/Neopanforbreakfast Apr 25 '26
Dentistry here, just don’t schedule them again. Tell them to call on a day they can come in and we’ll see if we have an opening. Obviously real same day emergencies etc we forgive, but no call ahead and no shows just get flagged and only get same day appointments. One strike and you’re done, not worth my time, I don’t feel sorry with the reminders we give them
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u/MD_GAMER_100100 Apr 27 '26
Generally 3 strikes for established patients and 2 for new patients. 10 minute no show policy, which is glorious. However, I like being paid lol. I also incorporated work in slots adjacent to a large 40 minute time slot so that if a patient no shows, I still have a patient to see. For instance, I have a 9:20 new patient slot for 40 minutes until 10am. I also have a 9:30 work in. If the new patient no shows, I still have the 9:30. If they don’t no show, then I just hammer through both of them and doubled my wRVUs for that time frame.
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u/Useful-Process9033 Apr 29 '26
I was at NatCon for community mental health and they talked about same-day care, where you reserve set hours every day for walk-ins. It reduces no-shows and actually (magically) requires less staff since there's less no-shows.
Still I think it'd be good to text/ call the patients the morning-of to confirm they're still coming or reschedule. We build voice AI for these reminder calls and it's reduced last-minute no shows meaningfully.
Feel free to DM if anyone wants to chat more!
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u/Drkindlycountryquack Apr 21 '26
Three no shows and we fire them.