What to put in a dental no-show and cancellation policy

A dental cancellation policy is a short written rule. It tells patients how much notice to give, what happens if they miss a visit, and who explains the rule. This post covers what the American Dental Association (ADA) suggests, what to put in the document, and what to hand to an attorney. It is general education, not legal advice.

Why do dental offices need a cancellation policy?

A written policy gives the team one clear answer to give every patient. The ADA says that “most practices have a very specific cancellation policy, which is especially helpful for patients who are prone to cancelling appointments.” The ADA also notes that patients are more likely to keep appointments when they know the office expects them to be there.

A missed visit leaves an open chair. The no-show is the extreme case: the patient misses the visit without notice. A shared way to count these misses is the no-show rate, which is the share of booked appointments that patients miss without notice. Without a written rule, each team member makes up an answer at the front desk, and patients hear different things.

What should a cancellation policy include?

A cancellation policy should state the notice period, the consequence, and the way to reschedule. Keep each item short and plain. The table lists the parts most policies cover and the question each part answers.

The ADA offers sample cancellation and rescheduling policies and communication scripts on its cancellations page. Start there, then adapt the wording to your office and your state.

How should the office tell patients about the policy?

Tell patients early, in more than one place. The ADA suggests three steps:

1. Display the policy in a prominent place, with a sign that is “big, but not obtrusive.”
2. Include the policy in every new patient package.
3. Ask patients to sign to confirm they received it. Some practices also have a staff member sign as a witness.

Reminders still matter. A policy that patients read once, months ago, does little on the day of the visit. Many offices pair the written rule with a call or text before the appointment. Check that any reminder method follows the privacy and consent rules in your state. The HIPAA for dental offices post covers the privacy side.

Should a dental office charge a cancellation fee?

A fee is an option, not a requirement. The ADA says to “consider implementing a policy that charges patients a fee if they cancel their appointment with less than 24 or 48 hours’ notice,” and then adds: “Apply the penalty judiciously; charging a fee can strain the relationship.”

Three points help an owner think this through.

• Patient mix. The ADA says that a small percentage of patients are more prone to cancel. A fee may matter for them and feel unfair to a long-time patient who has a real emergency.
• Staff comfort. The ADA notes that some team members are uncomfortable telling a patient that they owe money for a missed visit. A script helps.
• Consistency. A fee applied to some patients and waived for others needs a clear, stated reason, such as the exceptions in the table above.

Fee rules can differ by state and by insurance contract. Some payer contracts limit what a network dentist may bill a patient. Ask your attorney how a cancellation fee fits with your contracts and your fee schedule. The ADA Code of Ethics also says that “the fee for a patient without dental benefits shall be considered a dentist’s full fee.” A cancellation charge should not be a back door around the way fees are reported to a carrier. Ask your attorney and your CPA how to record it.

What else can reduce missed visits?

The ADA page lists several steps besides fees:

• Assign one team member to speak with patients who habitually cancel, using a short, friendly script.
• Use practice management software to track patients who often cancel, then talk with them about keeping scheduled visits.
• Where circumstances call for it, reschedule a cancelled visit four to six weeks out instead of right away, which “imposes a natural consequence for cancelling without being heavy handed.”
• Consider adjusting appointment times based on each patient’s record. The ADA mentions double-booking patients who routinely fail to show, and notes that this needs the practice to adapt if the patient does arrive.

Test each step with the team before you roll it out. Double-booking, for example, changes the day for everyone in the schedule. The dental practice KPIs and benchmarks guide explains how to track a number like the no-show rate over time so you can tell whether a change helped.

What should an attorney review?

Ask an attorney to review the policy before you post it. Questions to bring:

• Does the wording follow state law and the dental practice act?
• Do any payer contracts limit what you may charge a covered patient?
• Is the signed acknowledgment stored in a way that you can find it later?
• How does the policy apply to minors, to emergencies and to patients who need accommodations?

The final wording is a business and legal choice. This post does not say what your policy must contain.

Next step

For the wider set of front-office systems around scheduling and patient communication, read the dental practice management guide. To discuss practice policies with Dr. Jon Copeland, DDS, a general dentist in Wildwood, Missouri, contact Dr. Copeland about consulting.