#19 – Handles No shows and cancellations


If you have a real problem with no shows and cancellations in your office, then the first thing to do is to re-evaluate your philosophy on how to handle these patients. If you work out of a sense of desperation, then you most likely immediately reschedule everyone that cancels. You may also follow a philosophy of never billing patients for missed appointments for fear of upsetting them. If this sounds familiar, then you may have trained your patients that there is no consequence to cancelling appointments with you – and so, they cancel and no show frequently!

Another way to handle no shows and cancels is to establish a philosophy that your time is valuable and that patients who disrespect their appointments must be retrained. You can determine the guidelines for your office to follow that are fair to the patients who show up on time for their scheduled appointments as well as appropriate for the patients who simply cannot make their appointment.

I recommend a philosophy that reflects:

  • No fee for first time offenders – we want to maintain a friendly relationship with our clients and feel that charging them for their first missed appointment would cause bad publicity
  • Consequences exist for missing an appointment –  This is as simple as not rescheduling patients at the time they cancel/no show.
  • Chronic offenders must be handled differently – For patients that repeatedly abuse our schedule, different rules must apply. We believe that if these patients leave the practice because they don’t like our rules, that is okay.
  • Excellent communication with patients that miss appointments so they know exactly what they need to do to schedule appointments with our office.


Should we charge for missed appointments?

No and yes.

No, do not charge for first time offenders or even for very infrequent offenders.

Yes, charge patients who are chronic offenders. However, only charge them after you have spoken with them and they understand.


How much?

In my experience, we charged $25/ 15 minutes of missed appointment time. So, for a one hour hygiene visit the charge was $100. Yes, this is a lot. It’s supposed to be. We want to establish the value of our time and discourage patients from short notice cancellations and no shows. Plus, we never surprise a patient with this bill, we always talk with them first.


To put this philosophy into practice – If a client cancels:
With more than 24 hrs. notice – reschedule their appt immediately, no problem
With less than 24 hrs. notice – use your best judgment to decide:
#1 – Is this a legitimate excuse?  Such as illness, funeral, car accident – if so, acknowledge and go ahead and reschedule the appointment.
#2 – Is this a poor excuse?  They have a cold, forgot, changed their schedule – if so, follow the Cancel/No Show reschedule system.


How to handle a client calling to cancel with a poor excuse
Receptionist:  “Oh Mr. ______. I’m sorry you won’t be able to make your appointment. I know Dr. Smith was concerned that we get that (crown filling, root canal, etc.) done before it gave you any more problems. Are you sure there’s no way you can be here?”

If “no”

Receptionist: “Ok, Mr. ____ All our available appointments are filled, I can place on our call list until something opens up, it will probably be 2-3 weeks. Will you be okay until we can arrange that appointment?”

This is done (even if we had another opening the next day) to help our clients understand how important it is for them to show up for our appointments.

If a client No Shows:
Look at your schedule to see if there are any other openings later in the day, if so call the patient to try to either get them in ASAP to do the best we can with their existing appointment time or possibly work them into the later opening – if we talk to them, options:

  • Keep all or part of the appt. – come now
  • Too late – ok to fill later that day only
  • They refuse to come in that day – give them the speech above (I’m sorry, all our available appointments are filled), then write up day box note, put 1 week out and follow the No Show/Cancel system
  • The first time a patient no shows, they get the chronic no show speech.


To log a no show or less than 24 hour cancel in Dentrix (do not do for a first visit)
1st… Record the event in the ledger

  • Double click on the column next to the cancel/no show appointment.
  • Type in the patients name (appointment screen will come up.)
  • In initial box select no show or cancelled appt (you may need to add these if they don’t come up)
  • On Appointment line, record how many units the patient was scheduled for and note reason for cancel.
  • Highlight “no show” or “cancel” and schedule for 2 units. Choose the appropriate dentist or hygienist whose time was failed and then put in your initials.
  • Click set complete
  • Click on the ledger to make sure you see that this was charged out


2nd . . . Break the appointment so it shows up on the broken appointment list
Go to the actual appointment
-left click to highlight them
-right click to bring up grey box.
– Make sure the correct provider is selected for the appointment.
-Choose break appointment icon and click. Do this step for each part of that appointment. Remember each patient may be scheduled in more than 1 column check other providers also (ex. Dr. and Hygiene).


To log a no show or less than 24 hour cancel in EagleSoft:

  1. In the schedule, right click on the appointment to bring up a small window
  2. Select Delete this Appointment – this brings up another window
  3. Choose to consider this appointment as: Failed  or Cancelled or Neither
  4. Choose to Create an account note
  5. Choose to Apply a cancellation fee
  6. Choose to Add to QuickFill list
  7. You can type a note in the box to include this note in the QuickFill list – and checkmark below to use this same note for the account note.

If you want to show the appointment that was there – you’ll create a block off to the side:

  1. Double click in the schedule – instead of the default Patient info, click the arrow and choose Block.
  2. Now enter the patient name & if they no showed or cancelled.

The Cancel/No Show reschedule system

  1. For cancellations – Receptionist: “Oh Mr. ______. I’m sorry you won’t be able to make your appointment. I know Dr. Smith was concerned that we get that (crown filling, root canal, etc.) done before it gave you any more problems. Are you sure there’s no way you can be here?” If “no”- “Ok Mr. ____ All our available appointments are filled, I can place on our call list until something opens up, it will probably be 2-3 weeks. Will you be okay until we can arrange that appointment?”
  2. For no shows – The clinical staff should let the front desk team know so they can call. Clinical staff should look through the patient’s history to see if they are a chronic no show/cancel and let the front desk team know.
  3. Follow the steps in Dentrix or EagleSoft to document a no show or cancellation
  4. Add the patient name to the broken appointment list – see below for these instructions
  5. Now, work the broken appointment list to have these patients “heal” your schedule:
  6. 1st call – Offer open time the next day only – They will either schedule or Refuse. If they refuse the appointment time we offer, then say we’re full and we will call again. Update the list and record your conversation or message in clinical notes.
  7. 2nd call – Offer open time the next day only – They will either schedule or Refuse. If they refuse, then say we’re full and we will call again. Update the list and record your conversation or message in clinical notes.
  8. 3rd call – Offer open time the next day – This time, if they Refuse it is okay to schedule out.
  9. After 3 calls, if you cannot get in touch with them to schedule, just delete them from the list.
  10. Create alerts for the accounts of people who need to receive the no show/cancel speech to reschedule.
  11. Once the speech is given, document in their ledger/account this occurred. Create a no fee code (Perhaps use D9923 and change the description to Discussed Missed Appointments Personally” – then charge this into their ledger/ account.


The Broken Appointment List

This is a list of patients who either no showed or cancelled appointments. The front desk team uses this list to fill holes in the schedule. You can keep this list in the computer or you can just keep a handwritten version at the front desk.

Here is a template you can use: Broken Appointments List


To determine if the patient is a Chronic No Show/ Cancel: 
Not a chronic problem is they miss less than one appointment in the past 12 months.

They are a chronic problem if:
They no show/cancel 2 appointments in the last 12 months or
They no show/cancel 3 appointments in the last 5 years

If this person has a chronic problem, then:

We will put them on a broken appt call list and try to work them into our schedule on short notice 3 times. If after 3 times, this still hasn’t worked out, then we can reschedule them into the future – letting them know that they must keep this appointment.

Place an alert in Dentrix or EagleSoft – “No show” or “Cancel” – Then in note, write “Must get speech to reschedule.” Include in the note below this entry the date of previous missed appointments, along with the treatment, provider and number of units missed. Once the speech has been given, the upper-level secretary will change the wording of the note to say “Gave no show/cancel speech. Date / Initials”

The Chronic Cancel/No Show System:

  1. Determine that this person is a chronic problem
    2. Front desk staff person calls and either talks with the person or leaves a message
    3. Mail the quick letter “Missed Appt” – edit this letter to include the date, procedure and amount of time missed for all appointments.
    4. If the person misses after receiving the speech/letter, then mail the quick letter “Missed Appt Charge” along with a billing statement.

Missed Appointment Letters you can use

Send this missed appointment letter to every patient that no shows or cancels an appointment – including first timers: Missed Appt Letter

Send this missed appointment charge letter to every patient who has missed a second visit and you will charge them. Send a statement along with this letter to the patient.  Missed Appt Charge Letter

Options for a patient that is a chronic no show / cancel person:
Permanent day of only – The patient can call us in the morning to find out if we have any openings for the type of treatment they want. They can call us every morning if need be. They will not be scheduled in advance.
Pay to play – Schedule as normal and pay $25 for every 15 minutes you canceled/no showed for the most recent missed appointment. If they pay this amount, then they can be rescheduled in advance.


Voicemail message for chronic no shows – Call these folks one week after they miss:

“Hi, this is Niccole with Dr. Smith’s office calling to schedule your appt for (procedure). Please call me at 667-1234 so we can get this scheduled for you.”
1. When you leave this message, make a G note or clinical note of the date, “Left message to review future scheduling guidelines due to chronic no show” and your initials.
2. In Dentrix, enter a Guarantor note with the same info. In EagleSoft, enter a Patient note.
3. Make sure the chronic no show alert is set up so when this person calls in, they will talk with an upper level front desk team member to get the chronic no show speech.
4. Then, file the chart.

The Missed Appointment Speech

When the chronic no show patient calls back:
Thanks for calling me back, it looks like you need to get scheduled for (procedure), right? I see you missed your last appointment (or 2 or 3!) with us.
(Pause here & let the person speak – they might give you an excuse, or apologize, just let them speak.)
I understand that things come up & schedules change. The tough part is that we wasted that time that we could have given to another patient for their treatment. So, you have a couple of options to get your appt scheduled – the first is to call us on the morning when you know you have time and see if we have an opening or you are welcome to pre-book like you have always done – however, if you miss this appointment you will be charged $25 for each 15 minutes. Which works better for you?
(Let the patient speak.)

Patient response: “I think your policy is awful.”

Our response: I’m sorry you feel that way. However, these are the only alternatives I have available. (Silence – the client must speak next.)

Patient response: “I’ll just go somewhere else.”

Our response: Well, Mr./Mrs. _________ that is certainly your choice. I know Dr. ______ is concerned that your treatment not be delayed. He will be sorry to hear that you’ve chosen to leave us. Dr. ______ will review your chart and forward a copy to your new dentist. Is there anything else I can do for you?

You can also use these chronic no show folks to fill schedules the night before when you have openings.

By talking with the patients who miss appointments, you are helping them to realize that this missed appointment caused a problem for another patient. Most patients will be apologetic and understand this is a problem – and they will agree with you that they don’t want this to happen again. Some patients will be angry or feel like they have the right to miss appointments because their schedule is more important than other people’s schedules. Your job is to simply let the person know that there is NO FEE, but in the future, there may be a fee – we are helping them to avoid any fees in the future.

Since this can be a difficult conversation to have with patients, be sure that the person you select to talk with patients about these missed appointments is well trained and can handle these type of discussions. These calls are very similar to calling patients who have a past due balance.

Admin Team Responsibilities with the Broken Appointment System

  • When patient calls to cancel an appointment – follow the script & policy
  • Update the broken appointment list – if multiple phone numbers missing, get them
  • Log the cancellation/no show appointment in Dentrix & make sure it’s on the broken appt list
  • As part of the ideal day, compare the broken appointment list with the Dentrix schedules – look at each provider’s page & make sure every patient is on the list. If not, talk to that provider about making sure those patients get onto the list. If a provider routinely doesn’t add patients to the list, then work with team leader to fix.
  • Follow the alerts regarding broken appointments – if a patient calls to schedule & they need the chronic no show speech, then have a higher level secretary talk to them (or call them back) but do not schedule this appointment. If a patient misses an appointment after receiving the speech (you know if they’ve had the speech b/c the alert will say so), then give a note to the higher level front desk staff person to charge their account for this missed appointment.
  • Add patients needing exam/prophies or CMS/Comp exams with e-mail or text opted in through DemandForce to the hotlist and delete from the hotlist as patients schedule or are removed from the broken list


To Schedule a Broken Appointment in Dentrix:
1. Click on time.
2. In family file, select the client’s name.
3. When the notice pops up, Click yes.
4. Click on unscheduled in View Appointment.
5. Insert dateline, type rescheduled from broken.
6. Pinboard on the appointment information box.
7. Go to the new day and time.
8. Drag the broken appointment on Pinboard to its rescheduled time.


The QuickFill List in EagleSoft

To use this list to fill schedules:

In the schedule, choose the QuickFill list icon (red Q) to bring up the list
Click the dropdown menu in the Search Criteria to search for a specific type of appointment that will fill the schedule. You can search by Classification (Quickfill, Sooner if possible, Failed, Cancelled or neither) and/or you can search by Appointment Type. Then click apply.
Once you have your list of patients, click on a patient name – then you can see the number of times that person failed, cancelled or neither. The initials SIP in the type column stand for Sooner if Possible. Here’s where you can call each patient to try to fill the schedule – and add a note if you left a message or talked with a patient and they didn’t come in.


To add a patient to the Quickfill list:

Double click in the schedule, enter the patient name
Go above the patient name and select from the dropdown menu Schedule Entry – choose Quickfill appt.
This opens a new window – enter the provider, appointment type & duration and any notes.
To add a patient to the Sooner if Possible list – Double click on an existing appointment & checkmark the Sooner if possible button (right under the appointment date).


Clinical Responsibilities with the Broken Appointment System

  • Check the health history in the chart and update the family file with phone numbers & email addresses.
  • Do not put emergency patients on the broken appointment list
  • Put new patients on the list.
  • If a new patient misses 2 appointments, then they go on the chronic no show list.
  • Write the appointment missed into the clinical notes – note the date, the appointment type that was missed, the number of units missed and the provider and your initials.
  • If a client did not receive a confirmation call, then they do not have to be placed on the list & can be rescheduled immediately.
  • If a client called us to cancel days in advance of their appointment and no one took it out of the schedule, then they do not have to be placed on the list and can be rescheduled immediately.
  • For no shows and chronic no shows, put the patient chart in front desk team members bin the same day.
  • If a client misses an appointment and has a flag that shows they have had the chronic speech, then give the chart to the front desk team to charge the patient for missing this appointment.


Person Responsible for Managing No Show & Cancel list

  • Calls all no show and chronic cancel folks to give them the speech.
  • If you leave a message, then note in the chart and set flag in the computer “Do not schedule – Needs Chronic no show speech.”
  • Once the patient has received the speech, then the flag changes to “Charge if misses – Has had the chronic no show speech”
  • Charge the clients who miss after the speech – $25/15 minutes.

_____________________________ has shown competence in the following:

__________ following “don’t break appointment” script
__________ following broken apt steps
__________ using and adding notes to the broken appointment list.

___________________      __________________
Team Leader                                   Date