A doctor's office should offer the patient a new time at once, release the slot to a waitlist, and apply a fee only under a written policy that follows the payer rules. In GoHighLevel the Appointment Status trigger starts that workflow when a booking is cancelled. The bottom line: a same day cancellation is partly a scheduling problem and partly a policy problem, and the workflow handles the first while the office decides the second.
The scale of the problem
A peer reviewed study of ten clinics found a mean missed appointment rate of 18.8 percent and an average cost of $196 per missed visit, in 2008 dollars. The Medical Group Management Association figure cited by a health care law firm is lower, a 5 to 8 percent average no show rate for physician offices, and higher with more new patients. A vendor estimate puts the national cost at about $150 billion a year, which we could not trace to a primary source. Whatever the exact rate, each missed slot is hard to recover unless the office can fill it, which is what the waitlist does.
Reminders that help
A randomized trial description on ClinicalTrials.gov tested text reminders with date, time, and location sent 7, 3, and 1 day before outpatient appointments, among patients who missed 30 percent of scheduled visits. The same schedule appears in the court reminder studies we covered for law firms. Use it as a starting point and measure your own no show rate.
Fees: what the rules say
CMS's Medicare Claims Processing Manual, chapter 1, section 30.3.13, as described by McBrayer and NoShowLine, lets a practice bill a Medicare Part B patient directly for a missed appointment only if the same fee and policy apply to non Medicare patients, the charge is never submitted to Medicare, and the policy is written. Medicaid providers generally may not bill recipients for missed appointments. State law may add limits. Get the policy in writing and have counsel review it before any fee is charged.
| Step | Action |
|---|---|
| Patient cancels by text, call, or link | Status changes to Cancelled |
| Immediately | Text a reschedule link, with no health details |
| Within minutes | Notify patients on the waitlist about the open slot |
| If the slot is not filled | Task for the front desk to review the list |
| If the policy applies | Staff decide on any fee, per the written policy |
Build it in GoHighLevel
HighLevel help center pages describe the Appointment Status trigger as firing when an appointment is created or its status changes, with statuses New, Confirmed, Cancelled, Showed Up, No Show, and Invalid, and with filters for calendar, calendar group, tag, user, and who made the change (customer, user, or API). The Update Appointment Status action can set the same statuses from inside a workflow. A third party agency guide adds that Appointment Status is now the main appointment trigger and the older Customer Booked Appointment trigger is being phased out, so use Appointment Status for new builds.
- Build a workflow with the Appointment Status trigger set to Cancelled for the practice calendars.
- Add an If/Else on the time of cancellation, for example less than 24 hours before the visit.
- Send the patient a generic text with a reschedule link.
- Tag the contact Cancelled same day, and notify the waitlist with a Smart List of patients who asked for earlier times.
- Add a task for the front desk to fill the slot if no one takes it within an hour.
- Do not charge fees automatically. Create a task for a staff member to apply the written policy.
Worked example
For example, if a practice has 40 same day cancellations a month and fills half from the waitlist, it recovers 20 visits (40 times 0.5). At an illustrative $196 each, that is $3,920 a month (20 times 196), a number to replace with the practice's own visit value.
Mistakes to avoid
- Charging Medicare patients differently. The policy must apply to everyone.
- Billing Medicaid patients. Generally not allowed.
- Automatic fees. A person should apply the policy.
- A waitlist with no consent. Patients must opt in to text offers.
How this was handled before
A cancellation call went to the front desk, which tried to fill the slot from memory or a paper list. Reminder calls and later texts reduced the problem, and CMS clarified in its manual how missed appointment charges may be handled.
What to measure after launch
Track same day cancellations, slots refilled, no show rate, and fees applied under the policy. Compare the no show rate before and after the workflow.
Check before you switch it on
US text messages sent from a standard 10 digit number need A2P 10DLC registration. The HighLevel support portal says registration is required for texts to US recipients from 10 digit long code numbers and that toll free numbers do not require it. HighLevel's opt in guidelines also say a person cannot be forced to agree to text messages in order to submit a form, so keep the consent box optional. One compliance guide separates informational texts, which need documented consent, from marketing texts, which need prior express written consent. Ask your attorney which category your reminders fall into. Keep cancellation texts generic, and have counsel and your billing lead approve any fee policy. This is general information, not legal advice.
Questions people ask
Can a practice charge Medicare patients for no shows?
CMS's manual section 30.3.13 allows it only if the same fee applies to non Medicare patients, it is billed to the patient, and it is not submitted to Medicare.
Can Medicaid patients be charged?
Medicaid providers generally may not bill recipients for missed appointments, according to a health care law firm.
What reminder schedule has trial support?
A trial registered on ClinicalTrials.gov sent reminders 7, 3, and 1 day before appointments.
Ready to try it yourself? Start a GoHighLevel account here.
You can also see this in action in our GoHighLevel capabilities demo.