Account Matters Blog:

Cancels/No Shows- To Charge or Not to Charge?

Posted by Diane McCutcheon on January 16, 2020
Diane McCutcheon

Right off the bat, I have to say this is a subject that I get very passionate about.  When I do assessments, I always address the cancellation/no show issue.   I tracked my last 50 client’s responses as to whether they charge for cancels and/or no shows and went from there.  Here is what I found:

Average cancellation rate: 19%

Average no show rate: 9%

Practices having a formal cancellation/no show policy that is supported by the entire staff: 19%

Practices diligent in adhering to their cancellation/no show policy: 13%

Practices that have a cancellation/no show statement included in the new patient info: 85%

Average charge for a cancellation/no show: 55%

Average percentage of fees billed and collected: 12%

Average of fees waived: 72% 

Top 3 reasons why owners do not have or enforce a cancellation/no show policy

  • Afraid to lose patients – fear they won’t come back
  • Therapist opts not to bill patient
  • Front desk does not “feel comfortable” asking for the fee at the next appointment


The cancellation/no show discussion is one that boils my blood.  My clients tell me all the time about how low reimbursement is killing them.  I try and look for ways to increase revenue and charging and collecting for cancel and no show appointments is one way to get more cash.
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If you are afraid to lose a patient because you charge them for cancelling or no showing for their visit, then I must question your confidence in your profession and providing exceptional patient care.  You went to school to become a therapist and your time is valuable – shouldn’t patients respect your time and profession? 

Do you think the patients who are offended that you charge for canceling or no showing will gladly pay for patient balances they owe for treatment?  Not likely.  I base that answer on the numerous patient A/R’s I have seen that include not only unpaid cancel/no show fees but unpaid deductibles, co-pays etc.  I even want you to charge your friends and relatives.  Why?  They are sometimes the worst offenders.

Too many practices do not demand that the administrative and professional staff get involved in communicating to the patients that their commitment to the plan of care program set up for them is critical to their meeting their goals.  It is also critical that your administrative staff explains the cancellation/no show policy to the patient before treatment begins.  Emphasizing the importance of the treatment plan and having the patient understand the cancellation/no show policy will decrease the likelihood of patients abusing your time because they will be aware of the consequences.

Now for the no shows – my feeling is this, unless the patient can prove that a mistake in the patient’s appointment day is the fault of the practice they should be charged for not showing up.  No excuses. 

I think that charging for no shows and cancellations shows support your profession and lets the patient know that you are a professional who cares about them and sets time aside for their appointment which is important to both of you.  I think you are as valuable as any other healthcare provider out there.   My doctor has no problem charging me if I cancel or no show and I still go to her, respect her and pay the fee.

Every time a patient cancels or no shows and you are not collecting something for the visit you are losing money.  The longer you let this happen the more you lose.  Dust off your original policy or create a new one but put one in place and hold your team accountable for implementing the new rules.  As your culture changes so will the bottom line.

If you need help in developing a policy and procedure for charging and collecting on cancellations and no shows give me a call.  I am sure I can help.  

TAKE MY REHAB THERAPY FRONT DESK TO THE NEXT LEVEL

Topics: Front Desk, Management

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