Turning patient no-shows into billable time

8 practical strategies to help your practice convert no-shows and cancellations into valuable time

Patient no-shows are more than just a scheduling inconvenience – they're a costly disruption to your day. Missed appointments and no-shows can cost single physicians up to $150K per year¹, according to MGMA research. No-shows can lead to lost revenue, reduced clinical efficiency, and an opportunity for quality care that goes unrealized. But with some planning and strategic thought, those unexpected gaps in a clinician’s day can be turned into productive, billable time.

Try these 8 tips for physician-owners and practice managers to help use no-show windows to generate value.

First, a helpful tip to prevent future patient no-shows

Reminding patients to confirm an appointment via email, text, or through the patient portal can be a helpful way to proactively prevent no shows and keep upcoming care top of mind. Additionally, setting up a no-show campaign, in which your practice reaches out to patients after an appointment is missed, can have real, tangible financial benefits across practice size.

According to recent athenahealth research, customers who have an active no-show campaign see an average of 1 more patient per provider per day.² Added up over a week or a month, those additional patients seen by providers can greatly impact a practice’s patient volume and financial performance. As the data shows, communicating with patients in a timely manner after a missed appointment is a proven way to help reduce the likelihood of future no shows while also protecting revenue.  

1. Offer to convert last-minute cancellations into telehealth visits

When a patient cancels within 24 hours, or tries to cancel through the patient portal, practices can offer a convenient alternative: a same-day virtual visit.

This quick pivot preserves continuity of care and helps avoid losing the entire appointment slot. It also allows patients to stay on track with their treatment plan while potentially avoiding no-show fees or charges. Additionally, for practices that charge no-show fees or co-pays for missed appointments, this can enable patients to still get the benefit of care and avoid the fee.

Many types of patient visits work well in a telehealth format, including:

• Medication checks and prescription renewals
• Chronic disease management
• Routine follow-ups

These visits are typically reimbursable under standard CPT codes, making them a convenient and revenue-saving solution for all involved.

2. Use no-shows or 24hr cancellations to see a patient on the wait list

Wait lists can be powerful tools if used effectively and proactively by a practice.

If a patient doesn’t show up for their scheduled appointment, consider repurposing that time for a virtual visit with a patient waiting to be seen by the same provider. Front office staff can also reach out to schedule a same-day appointment with a patient who’s next in line on the list.

Having a system to identify and contact waitlisted patients in real time is key to making this strategy viable and billable. But with the right tools and strategies in place, these quick swaps can allow practices to maintain productivity and deliver care to patients who need it.

3. Complete chronic care management or RPM documentation

Medicare reimburses non-face-to-face care coordination under chronic care management (CCM) and Remote Patient Monitoring (RPM) under the Medicare Physician Fee Schedule.

According to the Centers for Medicare and Medicaid Services, physicians can typically provide chronic care management services outside of in-person patient visits. CCM services may include:

• Continuous patient relationship with a chosen care team member
• Supporting the patient with a chronic disease in achieving health goals
• 24/7 patient access to care and health information
• Patients receiving preventive care
• Patient and caregiver engagement
• Prompt sharing of patient health information

These services require detailed time tracking and robust documentation. A no-show can therefore provide an opportunity to spend that time documenting clinical review, phone calls, or care planning — activities that are billable under CPT codes.

4. Tackle inbox messages that qualify as e-visits

Not all patient portal messages are quick responses—and some may be reimbursable. Under certain CPT codes, cumulative patient communication over a 7-day period (totaling five or more minutes) may be billed as an e-visit.³

During a no-show window, clinicians can review and respond to portal messages, track time spent on each interaction, and document appropriately for billing. Practice managers can help train clinicians to recognize and document when portal communication rises to a billable level.

According to athenahealth research, customers who have an active no-show campaign tend to see 1 more patient per provider per day.

5. Pre-chart and code for upcoming visits

While not directly billable, time spent pre-charting can indirectly increase revenue through better, more accurate medical coding and reduced under-documentation.

Reviewing charts, confirming HCC codes, and preparing clinical decision-making elements before a patient arrives for their appointment can lead to higher-complexity coding supported by documentation.

Doing this pre-visit coding work also helps improve the efficiency of a patient visit as well as the quality of care.

6. Update quality metrics and close care gaps

Value-based contracts and incentive programs often depend on accurate documentation of quality measures.

A no-show period can be used to review eligible patients for care gaps or incomplete MIPS data. Take the open no-show time to address these gaps by reviewing charts, generating outreach lists, or placing needed orders to help drive bonus revenue and reduce risk.

7. Reach out to high-risk patients

No-shows can give clinicians a rare opportunity to connect with high-risk patients who may benefit from brief, regular check-ins to help maintain progress with their personalized wellness plans.

If permitted by payer rules, these calls may be billable as part of a care management program or as a brief telehealth visit. Even when not directly reimbursed, these interactions can help reduce downstream costs and reinforce adherence to care plans, which are both valuable in risk-bearing value-based care contracts.

8. Invest in reimbursed Continuing Medical Education (CME) or administrative time

For certain clinicians, some practices and healthcare organizations will reimburse time spent on CME or quality improvement tasks.

The time that could have been wasted with a no-show may actually be the perfect opportunity for watching a learning module, completing coursework, reviewing updated guidelines, or participating in a short internal training session to earn CME credit hours.

While not billed to insurers, this time is often compensated and contributes to higher quality of care and better practice performance.

Empowering clinicians to optimize their time

Patient no-shows are inevitable—but lost time and revenue doesn’t have to be the outcome.

With the right systems, training, and tools, clinicians can convert those empty slots into moments of clinical value, revenue recovery, and improved care delivery.

Whether it’s a billable e-visit, a waitlist fill-in, or an administrative task with long-term impact, use these strategies to not only recapture lost income, but improve care delivery, coding accuracy, adherence to wellness plans, and patient engagement.

Want more research-backed best practices to help your organization drive revenue? Read our article on how updating fee schedules can lead to a 9.5% increase in collections per visit.