How to handle Missed Appointments & Cancellations

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Unfortunately, no-shows and cancellations are part of the job. This is, in part, outside of anyone's control (school changes, work changes, etc.), but we still want to do everything we can to make these appointments happen.

Schedulers are doing this:

During the intake call, they explain the cancelation policy.
During the intake call, we urge the client to find the email invite to the Client Portal and fill out the documents.
During the intake call, they explain that we have multiple locations and what location the client should be attending.
During the intake call, they explain where to access your Telehealth session, aka the Client Portal.

Steps when a client is a no-show

A clinician will need to follow these steps when a scheduled appointment is a no-show:

Call/text the client no more than 5 minutes after the session is supposed to start and verify if the client is on their way. Use CTM's canned messages to send a text quickly. Learn more here: CTM.
Use TN Messaging to message the client a few minutes after the session starts and verify if the client is on their way or if they need to reschedule. Learn more: How to use TN Messaging.
1. If the appointment was scheduled for in-person, clinicians can switch their session to telehealth if needed. They must update the appointment location in the TN appointment window.
2. If necessary, clinicians can modify the service code of a shorter session (e.g., 90834, 90832) if the client is running late. Remember, 90791 only needs 16+ minutes face-to-face to bill for this service..
If the client misses the session, clinicians will need to write a missed appointment/canceled appointment note for that session stating they called and emailed, which serve as the first and second communication attempts. If a clinician has not heard back from the client within a few days, they should remove the client's future scheduled appointments from their calendar and request a new client for that time slot. Removing the recurring sessions from the clinician's calendar is especially important if the client no-shows or late-cancels the Intake. Clinicians should not continue to reserve a time slot for the client; instead, take on a new client. If the no-show client calls back, the clinician can add them to their calendar in a different cancellation slot. Clients can also reschedule themselves in the Client Portal.
Ideally, the clinician would contact the client one final time (email or phone call) to reengage them in treatment and state in that communication that they will be terminated if they do not hear back by a specific date.
1. Make a contact note, and then this is the 3rd communication attempt.
2. If the clinician does not hear back from them by that date, they will need to write a termination note for the client only the client has signed the Disclosure Statment, which makes them an official client.
You only have to write a termination note for clients who have signed the Disclosure Statement. If they do not, the clinician can email Jennifer Luttman to inform her that this client can be removed from their caseload.

Effectively managing your ‘reoccurring’ appts will determine a successful outcome!

Cancellation / No-show Policy - As found in the Disclosure Statement

Disclosure statement policy:

Scheduling and Cancellations. Appointments can be canceled/rescheduled as long as 24-hour notice is provided. If less than the required notice is given, the client agrees to pay a fee of $110 (insurance will not pay for missed appointments). Please note that we do enforce this policy.

If a client cancels within 24 hours, it is up to the clinician to determine whether or not a fee should be charged. The clinician may have built some rapport with the client already and can, therefore, allow for leniency in this matter so that the therapy process can not be hindered. Most clinicians may allow 1 "accidental" no-show or cancellation within 24 hours. However, you do not have to follow this guideline.

Missed appointments for VA (Veterans Affairs)

Clients using VA authorizations are exempt from a no-show fee.

Missed appointments for Medicaid clients

Medicaid has a policy that does not allow late cancellation fees. It’s best practice to cancel/delete the recurring sessions from a client that no-shows you, but remember they are still on your caseload. Put the ball back in their court to schedule another appointment (which may be at a different time slot) with you via the Client Portal (send a msg to them via TN Messaging). The client may or may not reschedule, so in the meantime, request a new client to fill that time slot.

Medicaid’s 3-Strike Policy

Medicaid's 3 Strike rule is a "protection" for the clinician to enforce (if they choose) that says IF a Medicaid client has no-showed you 3 times (throughout treatment), you can terminate them without repercussions. Then, the client has to wait 3 months before they can book another session. This policy doesn't say YOU have to ALLOW them to no-show you, it's just IF it happens, you can do this. They do not have to be three consecutive sessions of no-shows.

You do NOT have to "allow" any client to no-show you. You can remove them from your calendar and allow them to self-book in the Client Portal when convenient.

Termination Procedure for Medicaid clients with 3 no-shows

If they have met the three or exceeded the 3, then you can communicate with them that, due to Medicaid's policy, you can no longer continue providing them services for three months.
You would want to give them three recommendations for other therapists to meet their clinical needs (not someone at Overcomers).
You can do this via a phone call, but the preferred method would be to TN Messaging. You can then export the conversation into their chart in TN that you communicated the termination with them and provided them three referral sources.

You can use a sample letter if you like, and it can be found by going to the Template Gallery in Google Docs. Learn how to here: How to create letters from the Template Gallery.mp4

How to add a missed appointment note

How to cancel and reinstate an appointment.mp4

A Missed Appointment Note allows you to record information about the appointment and the reason it was missed or canceled. If you collect missed appointment fees, a Missed Appointment Note also creates a billing line item.

Click Scheduling > Click the appointment

Click the Cancel Appt or Appt Missed button
Once you mark the appointment as canceled or missed, a yellow bar appears at the top of the Appointment dialog. Click Create Note.

Note Header

The note header automatically fills in information for the clinician, client, and appointment in addition to which staff member created the note. To edit information in the note header such as the Note Title or Service Code or to add information such as add-on codes, click anywhere on the note header or click Edit in the upper right corner.

Missed Appointment Information

Select the reason the appointment was missed from the dropdown. If you collect missed appointment fees, select the A cancellation fee will be charged for this appointment checkbox to create a billing line item for the appointment.

Comments

Enter any comments related to the circumstances of the missed appointment. Did the client provide a reason for missing the appointment? If the clinician was the reason for the missed appointment, what were the circumstance which forced the clinician to cancel or miss the appointment? Has the appointment been rescheduled?
Example:

Your appointment is now marked as a missed appointment. I attempted to call you, left you a voicemail, and an email to remind you to log in. Per Overcomer's no-show policies, you will be billed $110 for the missed appointment. As of now, the appointment scheduled for 00/00/0000 will be canceled until I hear back from you and can confirm the next appointment. This is also to prevent another missed appointment from happening. Please get back to me as soon as you can. Thank you.

Sign and Save

Note: In order to save a Missed Appointment Note, you must select an option from the Why was this appointment missed? dropdown. All other fields are optional.

Once you have completed your Missed Appointment Note, select the Sign this Form checkbox to sign the note and save.

When to write a missed/cancelation note

When should you write a missed/canceled appointment note, or when should you just delete the session from your TN calendar?

Since most of us book our clients for recurring sessions, we are seeing a lot of missed/canceled appointments that are not "really" missed appointments. A missed/canceled appointment is when a client either calls/emails to cancel a session that they INTEND to be present for and the client has confirmed their attendance. If a client lets you know a week in advance that they are going to be unable to attend the session for whatever reason, you can just delete this session from your calendar and not write a missed/canceled session, as this session was never going to be attended.

If you, the clinician, will be on vacation or taking the day off, which is PREPLANNED, you can delete the session from your calendar. There is no need to write a missed/canceled appointment note as the session was not missed/canceled, it was never going to take place.

Canned messages for a missed appointment

Here are a few TN Messaging canned messages that a clinician can use to send their client when they late cancel/no-show a session:

Medicaid Clients

Hello!
It looks like you missed your appointment today! I hope that everything is okay. I’ve attempted to call you, but there was no answer. You still have future appointments scheduled, but please let me know if we need to cancel/reschedule these appointments as well. You can manage all your appointments by clicking on the Appointments tab here in the Client Portal.

Please keep in mind Medicaid’s policy: if a member has 3 no-shows or late cancellations, they are ineligible to book appointments with the clinician for 3 months. This rule is designed for cases where cancellations are necessary and unforeseeable.

Non-Medicaid clients

Hello!
It looks like you missed your appointment today! I hope that everything is okay. I’ve attempted to call you, but there was no answer. You still have future appointments scheduled, but please let me know if we need to cancel/reschedule these appointments as well. You can manage all your appointments by clicking on the Appointments tab here in the Client Portal.

A late-cancel/no-show fee ($110) has been applied for today’s session that was missed. We’ll attempt to run your card on file to pay this balance, but if we don’t have a card on file, please pay your outstanding balance by clicking on the Billing tab here in the Client Portal.