Problem Solving Common Patient Issues

Throughout the course of the day, practices tend to encounter repeated issues with their patients, such as arriving late or without a referral. While the front office staff is generally tasked with handling these situations, they are often handled inconsistently and resolutions are communicated poorly. Ongoing issues at the desk can cause patient flow problems, financial issues and patient satisfaction concerns. Discussing with your front desk staff some of the issues they commonly tackle is the first step in changing the process from reactive to proactive.

Once the issues have been identified, take note on how the problem affects your practice. For example, patients who don’t pay their co-payment at the visit need to be billed. While one or two patients may not be noticed, what if 40 percent of your patients didn’t make this payment? Would it affect your cashflow at the end of the month? Perhaps there are patients who don’t show up for their appointment. Every appointment slot in your schedule should be viewed as potential revenue. Last minute cancellations and no-shows leave voids in the schedule with no opportunity to fill them and equate to lost revenue.

Deciding beforehand how you want to address these situations and communicating the agreed upon process, alleviates the pressure on your staff and defines the expectations for your patients. When creating the protocols on how to handle situations in the office, it is essential to train your staff on positive communication. Teach them the best way to communicate with patients while enforcing policies. Assuring the staff understands the rationale for the policy and the spirit in which it is written is the key to maintaining good relationships with your patients. In addition, give parameters to your staff, such as overiding a “late patient policy” during times of poor weather conditions. While it is important to keep things under control, it is just as important to be flexible when it makes sense to do so.

Once your staff has been trained and understands how to enforce the policies, it’s time to communicate your new standards to your patients. Often, creating a Patient Policy Page as part of the Registration Packet is the easiest method to provide information to your new patients. Handing out copies of the policy page to the return patients at their next visit is very effective, as well. All policies should have a signature line. Patients don’t need to agree to the policies, but signing confirms they have received the information.

Some of the common areas that you may want to consider:


Most patients know a copayment is expected at the time of service. However, there are always times when the patient does not have a method of payment in person and requests to be billed. Assuming you are still willing to see the patient in these cases, creating a statement and mailing it to the patient is an expense to your practice. Considering most patients will pay their balances after two or more billing cycles, the cost of sending the statement has now doubled. Collecting co-payments at the desk provides cash flow to the practice. Delaying the co-payments for 60 days could have a significant impact on your cash flow. Notifying patients of an “Administrative Fee” for any co-payments not made at the time of service, provides a deterrent for future visits.

Tip: The front desk can be more helpful when enforcing the policy if you allow them to extend the payment opportunity until the end of the business day. This allows the patient to call the office with a credit card later that day, thus avoiding the fee and keeping your cashflow intact.

Cancellation Policy

By implementing a cancellation policy, it sets a courtesy expectation if an appointment cannot be kept. Requesting notice of 24 business hours alleviates the late Friday afternoon cancellation for the Monday morning appointment, thus allowing for opportunity to schedule another patient in the cancelled slot. Attaching a fee for improper cancellation provides a deterrent as well as a precedence for repeat offenders.

Tips: While it may seem obvious, it is important for your staff to apply courtesy and common sense to all of the policies. A patient cancelling inside of the 24-hour requirement due to an illness or another reasonable excuse should be handled without referencing the cancellation policy. For those without an emergency, it can be helpful for the front office to politely advise a patient that he/she is technically cancelling within the 24 business hours, yet the staff member has arranged for the fee to be waived at this time. This both re-enforces the policy and casts a positive light on the receptionist for waiving the fee. For no-show patients, it is important to get them back on the schedule without penalty. There are times patients feel the office is upset with them and will not reschedule an appointment if they have not shown for a visit. Reaching out to them re-opens communication and keeps your staff in a positive position with your patients, especially if they open with, “We understand things happen from time to time. Can we reschedule your appointment?” Then, close with a gentle reminder, “I was able to waive the no-show fee for you last time, but I may not be able to do that again for you, so please do your best to keep this appointment. Thank you.”

Account Balances

While patients are made aware of balances through their monthly statements, a policy notification regarding consequences can encourage timely payments. Indication of payment methods or payment plans along with a 90-day head’s up prior to involving a collection agency gives patients an idea of available options and consequences if balances are not paid.

Payment Plans

With high deductibles and co-insurances, many patients find themselves with a balance after their appointment. The payment plan policy may not be something you wish to include in the Registration Packet, but having a plan for how to handle patients who are having difficulty paying their balances will allow for quick and automatic action without working through each patient’s particular situation.

Offering a payment plan is helpful to your patients, but can be time consuming to administrate. Late payments are problematic for cash flow. Requiring all payment plans to be done with a credit card on file, pre-determines the payment dates and amounts. It also ensures that the patient has signed off on them. This gives the office the control over the payments and guarantees they will be executed on time each month. Credit card on file is becoming more commonplace in practices. Some are handled quite rudimentary with a form containing all of the information and signed by the cardholder, locked in a file and accessible only by one individual for processing. More advanced options are now available from a variety of merchants that allow for the card to be entered but only for the last 4 digits to be visible for protection. With the account set up, future charges can be virtually run without the card present.

Each practice has its own unique needs when it comes to alleviating recurring patient issues. Determine what those issues are ahead of time and find solutions that can consistently be applied. It will alleviate wasting precious time during the busy day and set up a positive relationship with your patients and staff for years to come.


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