no show

Should I begin charging patients who don't show up for appointments?

Risk Management

Should I Charge Patients Who Don't Show up?

Question: Lately, it seems like more of my patients have simply missed appointments without canceling in advance. In the past, I've considered this a cost of doing business. But it's really beginning to affect my bottom line. So, I'm wondering: Should I begin charging patients who don't show up for appointments?

Answer: This is a tricky question. The best policy, of course, is to prevent no-shows from occurring in the first place. Some doctors have had good results with practice communications that emphasize how missed appointments disrupt the practice, and an unfilled slot is a lost chance to help another patient. Other practices have set up telephone reminder systems to alert patients of an upcoming appointment, typically within the next 24 to 48 hours.

Even so, prevention can only go so far. Consequently, some practices have adopted the practice of charging a fee for missed appointments.

Like most aspects of practice management, there are pros and cons with this approach and some states may not allow it. As always, check with your legal counsel, managed care organizations and Medicaid/Medicare as appropriate before instituting this procedure in your practice.


  • In a busy practice, no-shows keep other patients from receiving timely chiropractic care.
  • Missed appointments deprive the no-show patient of needed care, as well as the continuity of care, and it exposes doctors to malpractice risk if an untreated condition worsens.
  • Unfilled appointments represent lost revenue that could have been avoided if the spot was filled by other patients. Some empty slots may be filled with walk-in and same-day appointments, but probably not all of them.
  • No-shows waste the time of staffers who prepare for appointments and spend time trying to determine why the appointment was missed.


  • Patients often resent what they perceive to be unfair fees. Not only may you lose some patients, your staff may balk at having to deal with the angry phone calls.
  • Patients have been known to file claims in response to billing disagreements, and it’s not unheard of for a patient to complain to the state licensing board soon after receiving a bill they feel is unwarranted.
  • Sending billing statements for missed appointments costs you money in supplies and stamps. It also can divert your staff from more important tasks. It’s possible to spend more money trying to collect no-show fees than you’ll get back.
  • Some third-party payers allow these charges for missed appointments, but others don’t. (Note: Medicare allows doctors to bill patients for missed appointments, as long as non-Medicare patients are also billed.)

Before you charge for missed appointments, consider whether the negatives outweigh the positives. Some practices have decided it is better to establish consistent policies rather than charging patients for missed appointments. For example, some doctors will terminate a patient who repeatedly fails to show up for appointments without canceling.

It’s also important to be aware of other reasons patients miss appointments. Some patients worry that the treatment will be uncomfortable. Or, they may mistakenly assume that their absence doesn’t hurt your practice – and may even give you a welcome breather on a busy day. Whatever your policy, make sure to apply it across the board. Any lack of consistency will send mixed messages and result in confusion.

The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.