Hi Laura. My question is this… We work Monday to Thursday. On Thursday we confirm patients for Monday, the system also sends a text the day before. Still we have a lot of cancellations and no shows on Mondays. What do you suggest?

ANSWER:  Thank you for the great question. Monday is a popular day for cancellations for sure, but it is not because of your confirmations – it is because the patient is not being held accountable. These patients would probably cancel even if you confirmed them on Friday.[mepr-show if=”loggedout”][/mepr-show] [mepr-active memberships=”629,630,37388,37393,37672,37676,37670,37668,37674,44674,232156″ ifallowed=”show” unauth=”message” unauth_message=”Answer hidden, please login or purchase a membership to view.”]

I would change your thought process to targeting the patients and why are they cancelling.

• Are they college kids that can’t get up early after a weekend of fun – well don’t give them another appointment on a Monday
• Are they a patient that has cancelled a lot in the past – why keep rescheduling them – make them call for same day appointments in future
• Are they a patient that is not really great with their schedule – remind them when confirming them that this appointment is on Monday – after two days off – and make them commit that they will be there.
• Are they a patient in the schedule for treatment, make them put down a deposit or prepay for the appointment so they have the motivation to show up.
• Are they a patient that needs a last minute reminder, call them Monday morning and remind them of their appointment.
• Are they a patient that has cancelled a lot in the past and you only left them a confirmation voicemail on Thursday – call them again back on Friday and make sure in your messages you tell them they need to call back to confirm they are coming.

There are many reasons why patients try to cancel – so make sure you are addressing the patient and getting them re-trained not to cancel in the future, versus focusing too much on when you make the confirmation calls. I hope that this helps.

I am going to list out a few things that come to mind that I think are important to help you achieve what you are looking for:

1. ) Have a financial agreement with the patient that spells out what you offer and how they intend to pay. Make sure it gets filled out by your team, the patient signs it and then have it scanned into their chart. Always make sure to name it the same thing so everyone on the team knows what to look for when they need it.
2. ) Make sure your team is putting in excellent notes… Notes are so vital to making sure everyone on the team knows what is going on with the patient. We have our treatment coordinators print out the schedule each day and circle the appointments that they handled the treatment plan presentation as the day goes on. Before they leave at night, they have to make sure they have put in their consultation notes, to include the financial agreement information for the patient and the schedules are then turned into our Junior office manager, who reviews them the next day to make sure the arrangements are okay and that there are no red flags that need to be handled.
3. ) We have our insurance notes and our treatment plan notes in different colors so that when you are scanning notes, they are easy to see.
4. ) We try to keep our adult family members separated into different accounts so it does not get too confusing. Many times the kid’s accounts are not hard to figure out but the adult ones are the accounts that are confusing. They get more work done at larger amounts of money and if they are both getting the treatment done at the same time, it becomes hard to figure out the balance when their payments and the insurance payments are all coming in at different times for different procedures. It makes it much easier to have them separate because at least you know that you are narrowing down the balance for one of them specifically and not both.
5. ) We recently started outsourcing out insurance part of the practice which has helped a ton. We work now with a company called eAssist and they handle all of the insurance from submitting the insurance claim, to making sure that we get paid correctly and in a timely manner all the way through to entering the insurance checks and balancing the account. I was getting so frustrated with this area of the practice and decided to out-source it to them because this is their core competency and it allowed my employees to spend more time in the office with the patients and off the phone with insurance companies. They enter all the checks and call on all of our open claims and then put in notes that are in the exact same order each time with all the information my team needs to accurately discuss the balance with the patients. We are thrilled that we moved to this – let me know if you want information about them.
6. ) We do what I call “next day reviewer” and I teach on Front Office Rocks. Part of the problem about figuring out the balance is that the team waits until the day the patient has an appointment or sometimes even as the patient is walking up at the end of their appointment. That makes it very stressful for the employee and many times they just take a guess at where the balance is coming from. The patient ends up usually not thrilled with the answer and then leaves many times without paying because they tell the employee to let them know when they figure it out and they will pay then. As you know, it is better to get the patient to pay while they are in the office, versus letting them leave because the chance of that patient paying the bill goes way down and then patients come in sometimes for multiple visits without paying, which is never good. I would prefer that the team review all of the accounts the day prior to them coming in for two reasons: a) it gives them time in a not stressful environment to review the account and figure out the balance and; b) it gives the employee time to call the insurance company if needed to find out status of an outstanding claim before the patient comes in. This allows the educated employee to be able to clearly talk with the patient about the balance which gives your office a much higher chance of collecting on that balance. Also, this employee that figures out the balance, needs to put in clear notes and the entire team needs to be trained at where those notes are so in case someone else checks the patient out, they can also inform the patient on what those notes say and collect.
7. ) The huddle is also huge in the process of getting your team on the same page. Every patient should be checked out by the front desk before they leave no matter what but there should be specific discussions with everyone on the team when a patient has a balance and that it is very important that the team brings them to the front desk so they have to collect on that balance.

I hope that this helped… If your office is anything like mine, there are different people in the accounts and so many moving parts, there definitely is not one right answer but with training and follow through to make sure the right systems are in place, this issue can definitely get under control.

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