Combating Patient No-Shows at Your Medical Practice

Like many physicians, chiropractor Jeff Robichaud experiences as many as 12 no-show patients per week. But when new patients don't show up, that's 60 minutes and up to $200 down the drain.

That's why Robichaud, and the other providers at his integrative medicine practice, Concord Clinical Health Center in Concord, Mass., charge fees for those patients who miss - $50 for a new patient appointment and $20 for an existing patient appointment. The practice also has an established 24-hour cancellation policy.

"We have a waiting list of patients who are looking to come into the practice," says Robichaud, who has charged the missed appointment fee for 10 years. "No-shows are a big deal for us. We used to be gracious with patients we'd see for a long time, but found that repeat offenders would be the patients that we didn't charge. Generally what we find is that when they get the first bill, they're very embarrassed."

Charging for missed visits is just one of the tactics Robichaud and other physicians have used to reduce patient no-shows, which are more than just a mere nuisance.

Missed appointments cost your practice money and waste providers' time. They may also invoke legal issues if your practice doesn't have an appropriate strategy in place to address them.

The no-show effect

Patient no-shows plague every medical practice and may be increasing in some parts of the country as the cost of care rises, says Elizabeth Woodcock, an Atlanta-based healthcare consultant, trainer, and author of "Mastering Patient Flow to Improve Efficiency and Earnings."

While some practices experience a small number of patient no-shows, and others see higher rates, the average hovers somewhere between 5 percent to 10 percent, says Woodcock.

"They've certainly risen after the recession," she says. "It varies by specialties, and the bigger factor is payers. We see higher no-show rates if you have a larger self-pay or Medicaid population."

Certain specialists, such as reproductive endocrinologists, tend to have a higher rate of patient no-shows because they aren't patients' regular physicians or they aren't covered by insurance, says Woodcock.

"We've seen a lot more no-shows with the self-pay patients," says Woodcock. "Ten years ago, it was sort of like, 'Well, gosh, our self-pay patients didn't show. It's not that big of a deal.' But today practices really have to pursue payment from everyone."

As Robichaud's experience shows, new patients are some of the biggest offenders at non-primary-care practices (like Woodcock, he suggests that it is due to a lack of a pre-existing physician-patient relationship). Other common no-shows are patients who schedule appointments between routine visits and forget to cancel.

Regardless of why a patient doesn't show up, it always costs practices money - especially if the practice doesn't charge for the entire missed appointment, says Woodcock.

"Some specialists take credit card numbers over the phone because they charge so much and it's not covered by insurance," she adds.

However, such an approach may not be right for your practice, particularly if your patients can't afford it. There are also some payers (such as a state Medicaid plan) that don't allow providers to charge for missed appointments.

"We're well over 30 percent Medicaid [patients], so we can't charge them," says Leann DiDomenico McAllister, administrator for Plymouth, Mass.-based Performance Pediatrics. "We had [another patient], one woman of means, who really liked our practice, and just said, 'Can I just pay if I miss?' because she didn't want to leave the practice, and I couldn't do that. I couldn't have one set of rules for one person, and another set of rules for another."

tactics and technology

At McAllister's practice, the rate of patient no-shows for the last two years is just under 2 percent. But because the practice is small - with one physician and one nurse practitioner - the effects of just one missed appointment have a big impact.

"If they cancel [without adequate] notice, it's too late to fill them; that's revenue we never make back," says McAllister. "When you go for a well exam, it's 45 minutes for the doctor. He has set aside that 45 minutes for you. If you don't show for it, the chances of us filling it with an acute-need [patient] is not high. We work very hard to set aside acute time."

While the practice used to have a 48-hour cancellation policy in place, that wasn't a cure-all solution, as it would be difficult to fill an appointment for a Monday that was cancelled on a Saturday.

The practice, therefore, recently revised its scheduled appointment policy to better explain to patients that no-shows and cancellations with little notice are problematic. For a copy of this policy to customize for your own practice, go to http://bit.ly/ptnoshowpolicy.

"We send a copy of the policy with a letter to the family the first two times they violate the policy, letting them know it's a problem," says McAllister. "[With] the third violation, they get a letter putting them on probation, stating that one more violation will lead to dismissal from the practice. The fourth violation - the patient is dismissed by certified mail, with a copy by first-class mail in case they refuse the certified mail, and with a copy to the insurance provider if the patient is in managed care and needs to have the primary-care physician reassigned."

After most patients see that first letter and appointment policy, the problem does not persist.

"For well more than half [of no-shows], they don't realize it's a problem" says McAllister. "Our patients for the most part appreciate us, and once they realize it's a problem they don't do it again. For another small grouping, there are true emergencies that come up. We've had patients who've gotten in car accidents or their house caught on fire. And we do make exceptions for that. And then there is that very small subset of patients that, for whatever reason, don't believe it's their responsibility to show up on time, to be here when they say they're going to be here."

While Robichaud's practice, which doesn't accept Medicaid, has recently started charging a portion of a visit cost to patients who miss visits, that's not the only tactic the practice uses to make sure patients step through its front door, he says.

Over the last year, Concord Clinical Health Center, in an effort to further decrease missed appointments, has been using eligibility- and benefit-verification software from its EHR and patient portal vendor, Emdeon, to collect copays, insurance information, and patient information in advance. Patients simply click a link on the practice's website that takes them to a questionnaire where they can fill out their demographic and insurance information.

This not only helps the practice figure out coverage and patient copays in advance, but because patients are spending time prior to the appointment filling out information (and subsequently receive both an e-mail appointment confirmation and a text-based reminder), they're more invested in the practice.

"Because the patient has seen we've made an investment in time in them, they see more professionalism and more value in what the practice is," says Robichaud. "So there's a certain level of respect that comes with going the extra mile with patients."

The text-based reminders, which are part of the Emdeon system, only require a patient to confirm "yes" or "no" to a scheduled appointment a few days in advance.

"We're seeing the trend of no-shows significantly reduced with text," he says.

For more on what Robichaud does, please see http://bit.ly/noshow_patientsto come.

Not following up: legal issues

No-show patients don't just have a financial effect on your practice. They can also present legal issues.

Julie Loomis, a registered nurse and attorney for Tennessee-based State Volunteer Mutual Insurance Company's risk-management department, says patients who miss appointments can create serious problems for practices that don't follow up.

"The most common allegations we see would be negligence, delay in diagnosis, or failure to diagnose," says Loomis.

This could put a practice at risk for negligence, for example, if a patient booked an appointment for examination of a skin lesion that turned out to be a melanoma. In such a case, if a practice didn't follow up with the patient who missed her appointment, the patient's health is at risk.

"The courts would look at, 'How much did you know about this patient?' [and] 'Was it a referral from another physician?' Those are all levels that could [be considered]," says Loomis.

Ericka L. Adler, a partner at the law firm Kamensky Rubinstein Hochman & Delott, LLP, and contributor to Practice Notes, Physicians Practice's blog, says a practice should always follow up with a patient who does not show, and document the reason - Are they sick? Was there a work issue? Does the patient not think a visit was needed? - and try to see the patient again, and document those efforts.

"Clearly where it is a true medical issue, if a patient does not get required care it can come back to hurt the physician," says Adler. "This is not entirely fair since the patient was the one that chose not to come to the appointment, but there are many reasons that a patient may miss a meeting, and it is best to follow up no matter the reason. How do we know if the patient is following the doctor's directions? Maybe they did not understand the importance of the follow-up visit? These types of issues … can create a liability for the doctor."

Adler recommends that practices institute pre-visit reminders and follow-up calls to patients.

"They do not need to chase the patient down unless it's a serious issue, just make a reasonable effort," she adds.

Improving patient relationships

Practices that have the best relationships with their patients tend to also be the ones that experience the fewest patient no-shows. But when you have hundreds or even thousands of patients to manage, how can your practice establish a better relationship with patients? Woodcock offers the following suggestions below (see http://bit.ly/late-patients for more tips on dealing with late patients).

1. Give plenty of reminders. Often times, patient appointments are scheduled weeks or months in advance, so patients are inclined to forget about them. Or, even if they're scheduled just days in advance, not every patient remembers to add an appointment to her calendar. To make sure patients show up, Woodcock is a fan of multiple reminders, such as automated phone calls, or personal confirmation calls 24 hours to 48 hours in advance. She also recommends practices use text-messaging reminders. "I generally recommend texting two hours before an appointment," says Woodcock. "It's not the only reminder that you should do but it's a great supplemental tool."

2. Engage patients. "The way we emotionally engage the patient while they're here is important," says Woodcock. "Helping patients understand why they're coming back is very important for the emotional engagement." Woodcock suggests allowing patients to be part of the appointment-scheduling process. "If you call in for an appointment, you [usually] hear, 'You want Thursday at 9:30?'" says Woodcock. "But you really need to start off with, 'What time and date work best for you?' I see good practices and they are capturing the fact that, for example, a Tuesday morning works well for a particular patient, and [the scheduler] says 'I see Tuesdays work well for you.'"

3. Give fair warnings. "I am not a believer in charging [patients] the first time for a missed appointment," says Woodcock. "But I do think charging the second time [is fair]." After the first missed appointment, Woodcock recommends sending patients a warning letter. It should say something to the effect of, "You missed your appointment, and that's a problem, and we want you to know, if you do it again, it's going to be [a certain amount of] money," she says.

4. Dig deeper. Don't just call a patient when they miss an appointment to ask them when they want to reschedule. "Call the patient and say, 'Are you okay? Are you alright?'" says Woodcock. "What you're doing is you are saying, 'We missed you. We are so concerned about you that we're taking the time to call you and make sure you are alright.'"

Most importantly, let patients know that when they miss their visit, it is not just about keeping a one-time appointment, it's about a long-term relationship.

"In order to really take our no-shows up a level, I think we've got to make our patients realize this is a relationship between you and the physician," says Woodcock. "You are not showing up for the doctor and the doctor cares about you."

In Summary

Want to reduce patient no-shows at your medical practice? Consider the following solutions:

• Give plenty of reminders, from automated telephone calls to text-based messages.

• Consider sending patients a warning letter for missed visits; if they miss a third time you may need to dismiss them from your practice.

• Encourage patients to fill out demographic and insurance information in advance.

• Check all your payers' policies to make sure they allow you to charge for missed visits.

• If your patient misses an appointment, always follow up; find out why they missed the appointment.

Marisa Torrieri is an associate editor at Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

Medical Office Supplies

Medical and Rx Pads

 Billing and Collection Supplies


 

Business Cards and Stationary


 

Chart Labels

What patients think about direct primary care

A new Hint Health survey using the Person-Centered Primary Care Measure shows DPC patients report easy access, strong relationships and high willingness to recommend their physicians.


Hint Health’s new DPC Patient Experience Benchmark Report offers one of the clearest pictures yet of how patients experience direct primary care (DPC).

To build the benchmark, Hint and its client clinics used the Person-Centered Primary Care Measure (PCPCM) — a patient-reported instrument that assesses access, comprehensiveness, coordination and continuity.

The survey combined 11 PCPCM items, eight demographic questions and a Net Promoter Score (NPS) item into a 20-question questionnaire delivered electronically to patients over a 14-month period ending in August 2025.

1,632 people completed the survey, but after excluding responses that did not meet PCPCM validity standards, the final sample included 1,534 patients from 12 DPC clinics in eight states. The total PCPCM performance score across all items and patients was 89%, with domain scores of 97% for Contact/Access, 90% for Comprehensiveness, 88% for Coordination and 82% for Continuity.

The same survey produced an NPS of 85, which the report describes as world-class in any industry and unusually high for health care compared with typical NPS ranges of 38 to 58.

The report argues that DPC is outperforming the traditional system on both loyalty and overall clinical experience when both are measured with these tools.

Patients who have known their physician longer report higher scores, particularly on items tied to shared history and personal knowledge. Scores are also modestly higher in older and healthier patients, while remaining strong across groups.

Medical Office Supplies

Medical and Rx Pads

 Billing and Collection Supplies


 

Business Cards and Stationary


 

Chart Labels

Cardiovascular care is overdue for a preventive reset

Nearly 6.7 million U.S. adults live with heart failure, which accounts for nearly 15% of all deaths each year—and more than $60 billion in annual costs.

And then there’s the issue of capacity. The demand for cardiovascular care continues to outpace the available workforce, with a projected shortage of more than 8,600 cardiologists by 2037. For physicians on the front lines – particularly in primary care – this gap creates an impossible tension: more patients at risk, fewer specialists to refer to, and too little time (and tools) to intervene early.

Today, most cardiac care is still reactive, triggered by symptoms, acute events, or late-stage disease. But prevention requires something different: earlier visibility into cardiac risk, objective physiologic data, and tools that help physicians identify problems before they escalate into emergencies. Patients are already generating unprecedented amounts of health data through wearables and connected devices, yet much of this information fails to become clinically actionable inside the exam room.

If we want to meaningfully reduce cardiovascular disease, control costs, and give physicians back time, we must rethink how early screening, prevention, and diagnostic support fit into everyday care. The future of preventive cardiology will not be built on a single function or siloed technology, but on integrated, end-to-end systems that help clinicians see risk sooner, act with confidence, and intervene before a patient ends up in the emergency room with heart failure.

RPM laid a solid foundation for next gen preventive tools

Remote monitoring made its first big splash more than six decades ago, when Alan Shepard took an EKG, thermometer, and a respirator sensor into space. That original use case and the ones that followed were all designed for a single purpose: to sound the alarm in the event of an emergency. Modern consumer tech is built with the same goal in mind. Watches tell individuals when their heart rate is too high, or when they start to show signs of illness. It is all reactionary data.

As a result, most RPM programs start after a diagnosis, hospitalization, or decompensation. They help reduce readmissions, but the data come too late to truly change outcomes. Clinicians are reacting to alerts, when their expertise might be better used in identifying and understanding patterns to help prevent catastrophic events in the first place.

Despite the drama of a heart attack, cardiovascular disease does not happen suddenly. What if we took this into account and instead of monitoring a patient after an acute incident, we harnessed the incredible tools and technological advances available today to identify risk and patterns long before a serious adverse event?

Data before the visit

If prevention is the goal, what if physicians could have the data before a visit begins?

Imagine the typical annual exam, but as the patient enters the waiting room, they receive an easy-to-use wearable device. As they fill out paperwork, the device collects cardiac function data that is automatically uploaded to their records. In the exam room, the physician begins the appointment by explaining to the patient what the data shows, and asking questions about lifestyle to put the data in context and identify whether further testing or treatment are needed.

In this scenario, the appointment is grounded in clear, accurate data. Instead of asking questions and relying on the patient’s memory or reading from months or years before, we get an instant snapshot that allows clinicians to walk into appointments informed – and armed with actionable insights. The visit is now about explanation and decision making, instead of digging for information that may or may not be reliable.

Where needed, the data can become even broader. A patient could receive and begin wearing the device days or weeks ahead of time and provide information on real-life factors, like sleep, stress, movement and recovery. All of this data gathering, when paired with software that can effectively analyze context (versus just patterns) instead of flooding the provider with too much information, leverages preventive monitoring for prevention rather than a trigger for late-stage response.

Where we go from here

I can almost hear the collective sigh of overworked physicians wondering how they are supposed to integrate one more thing into an appointment. But in this new model, work – especially administrative – is reduced. Automated collection and pattern-based analysis means fewer false alarms, fewer rushed visits, and fewer late-stage crises.

One of the biggest health risks facing patients in the U.S. is not unfixable. In fact, it’s quite the opposite. The demand (and patient appetite) is there. The need to provide more support to cardiologists and physicians is there. And, the technology and innovation are there. What we do need is a mindset shift and a willingness to reject the status quo. If we can overcome those challenges, there are a lot of lives (and money) we can save.

Medical Office Supplies

Medical and Rx Pads

 Billing and Collection Supplies


 

Business Cards and Stationary


 

Chart Labels

How to counter medical misinformation and support engaged patients

In 2021, the American Health Information Management Association Foundation surveyed 1,059 U.S. residents age 18 or older in a nationally representative sample. The survey found that Americans typically seek out health information by contacting their doctor and the internet equally. Of those who secure health information from the internet, 86 percent are confident the information is credible.

This can sometimes be a challenge for healthcare practitioners, because health misinformation—information that is false, inaccurate, or misleading according to the best available evidence at the time—is abundant on the internet. Health misinformation is a significant obstacle in healthcare, as it can lead to misunderstandings, poor health decisions, and adverse outcomes for patients. In a recent survey of physicians by The Doctors Company, 64 percent of physicians named misinformation on social media one of the most challenging aspects of practicing medicine.

Calling Dr. Google

Patients’ engagement in their personal health can be an advantage, with the proper guidance and support from practitioners. However, when patients consult “Dr. Google,” some websites may provide inaccurate or misleading content.

This issue of accurate versus inaccurate online medical information was highlighted during the COVID-19 pandemic. In 2021, the U.S. Surgeon General’s advisory Confronting Health Misinformation focused on this serious threat to public health and called on all of us to limit the spread.

Challenges for Practitioners

Correcting misinformation requires time and effort: Practitioners are encountering longer visit times when there is a need to discuss internet-collected health information with patients. Patients can sometimes have a strong belief in and be adamant about the assembled misinformation, which can result in increased patient anxiety.

Practitioners who dismiss or criticize the online search efforts of patients may negatively impact practitioner-patient trust. It can also be a challenge to change patient perspectives when misinformation is deeply believed, even when the practitioner is providing information from a trusted source.

Addressing health misinformation with patients

Former American Medical Association (AMA) president Gerald E. Harmon, MD, noted in a 2022 press release regarding a new AMA policy addressing public health disinformation that “physicians have an ethical and professional responsibility to share truthful information, correct misleading and inaccurate information, and direct people to reliable sources of health information.”

It’s often said that trust is the medical currency of healthcare, and in partnering with patients to help them understand medicine, practitioners are making deposits. Ruth Carrico, PhD, DNP, APRN, explained to the American Association of Nurse Practitioners (AANP) her view that overcoming medical misinformation is a journey on which to partner with the patient, first understanding why patients turn to the sources they do for medical guidance.The AANP offers an infographic tool, A Clinician’s Guide to Medical Misinformation: Communication Is Key, to support clinicians in combating medical misinformation.

Patient Safety Strategies

Engaging with patients who are relying on health misinformation requires a thoughtful approach to ensure patient safety, retain trust, and promote health literacy. Here are some strategies practitioners can use:

• Listen to patients' concerns and beliefs without judgment. This fosters open communication and shows that you respect their perspective. By actively listening to concerns and providing clear, evidence-based information, practitioners can build trust and encourage patients to participate in their healthcare journey.
• Show empathy and understanding toward patients' fears and misconceptions. Acknowledge their feelings and provide reassurance.
• Use plain language to explain complex medical terms in simpler language. Avoid medical jargon and ensure that patients fully understand the information being provided. To support this, apply universal health literacy precautions—an approach that assumes all patients may have difficulty understanding health information and therefore emphasizes clear, accessible communication for everyone. Clear communication helps prevent misunderstandings and misinformation.
• Share reliable, evidence-based sources of information. Use reputable websites, peer-reviewed articles, and official health guidelines. (See the resources listed below.)
• Using the Teach-Back Method, ask patients to repeat the information in their own words to ensure they have understood correctly. This helps identify any misunderstandings.
• Use visual aids such as diagrams, charts, and videos to explain complex medical concepts. Visuals can make information more accessible and easier to understand.
• Gently correct misinformation by providing accurate information and explaining why the misinformation is incorrect. Use facts and evidence to support your explanations.
• Help patients develop critical thinking skills by teaching them how to evaluate the credibility of sources and recognize biased information. Critical thinking skills are essential in identifying and rejecting misinformation.
• Maintain a trustworthy and transparent relationship with patients. Be honest about what is known and what is still uncertain in the medical field. When patients are well-informed, they can actively participate in discussions about their care, leading to decisions that are aligned with their values and preferences.
• Schedule follow-up appointments to address any ongoing concerns and reinforce accurate information. Continuous follow-up and support maintain positive patient engagement.

Through these strategies, practitioners can effectively combat health misinformation and empower patients to make informed health decisions.

Reputable resources

These are reputable websites, known for their accuracy, credibility, and comprehensive coverage of health topics, where patients can find reliable health information:

• American Cancer Society (ACS): The ACS offers detailed information on cancer prevention, treatment, and research at https://www.cancer.org.
• American Heart Association (AHA): The AHA provides information on heart health, including prevention, treatment, and research on cardiovascular diseases at https://www.heart.org.
• Mayo Clinic: The Mayo Clinic offers expert advice on a wide range of health topics, including symptoms, treatments, and preventive care at https://www.mayoclinic.org.
• MedlinePlus: MedlinePlus, a service of the National Library of Medicine, offers reliable health information, including articles, videos, and links to other trusted sources at https://medlineplus.gov.
• National Institutes of Health (NIH): The NIH provides detailed information on medical research, clinical trials, and health conditions at https://www.nih.gov.
• WebMD: WebMD provides comprehensive health information, including symptom checkers, drug information, and articles on various health conditions at https://www.webmd.com.
• World Health Organization (WHO): The WHO offers global health information, including disease outbreaks, health statistics, and international health guidelines at https://www.who.int.

For guidance and assistance in addressing any patient safety or risk management concerns, contact Patient Safety and Risk Management at (800) 421-2368 or by email.


The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Medical Office Supplies

Medical and Rx Pads

 Billing and Collection Supplies


 

Business Cards and Stationary


 

Chart Labels

2026: The year for sunsetting old guard revenue cycle metrics

For decades, healthcare financial leaders have leaned on the same tired revenue cycle metrics: days in A/R, net collection rate, clean claim pass rate. While these metrics can provide a surface-level view of financial health, the big question is: what have they done for your operational margin lately?

Scaling operations is imperative for providers within the current economic climate, but when it comes to moving the needle on margin, many financial leaders are finding that traditional workflows and benchmarking are not rising to the challenge. The reason? Healthcare organizations still rely on labor heavy processes and metrics that are lagging indicators. The model is broken. We can’t keep throwing people at problems and hoping margin magically improves.

Macro-economic pressures are only intensifying as reimbursements continue to shrink, operational costs keep rising, and staffing shortages aren’t going away. Meanwhile the industry is bracing for the dual shock of Medicaid cuts and higher ACA premiums. Rural health is in especially dire shape with over 30% of rural hospitals now at risk of closure.

So, if we think that legacy revenue cycle metrics are going to carry us through 2026, we’re fooling ourselves. New challenges require new operating models. Below are four tactics financial leaders must embrace to build a sustainable, margin-positive future.

1. Embrace new benchmarking models focused on labor effectiveness

There’s a massive margin opportunity hiding in plain sight: administrative waste, which represents nearly a third of all healthcare waste.

Yet most organizations have zero visibility into how effectively staff are converting work effort into actual dollars. Until financial leaders can quantify the number of human touches required to collect a dollar, they can't measure the true cost, or opportunity, inside their revenue cycle.

A recent analysis of millions of human touches within MedEvolve’s database related to insurance claim collections found that 62% of revenue cycle touches are wasted, and 40% of denials result from pre-registration breakdowns. That’s not a workforce problem; it’s a process problem. And process problems can be fixed.

Benchmarking must evolve to focus on labor effectiveness to speed reimbursement and financial health. Some key targets include:

• >85% Zero Touch Rate—payments that received no human intervention
• <15% Avoidable Touches—actions that did not produce a financial outcome
• <10% of Touches for Denials—efforts to overturn a denial and get payment, including claims issues like pre-authorization, benefits and eligibility and coding
• >90% First Touch Payment Rate— when staff must intervene, payment is received after the first touch

These leading indicators help leaders identify where breakdowns are occurring by identifying root causes of revenue cycle hangups before the financial impact.

2. Use AI and automation where they actually drive ROI

Of all the administrative areas in healthcare where AI and automation are expected to have an impact, revenue cycle ranks high. The key is identifying and deploying solutions that will deliver the greatest ROI.

The reality is that the market is flooded with shiny new tools to improve financial performance. However, moving towards a benchmarking model built on labor effectiveness requires automation that tracks every “human touch” behind a claim and drills down into that data to uncover performance improvement opportunities. EHRs and practice management systems alone are not built for this.

Workforce automation and AI can not only deliver this kind of labor intelligence, but the right solution can also guide staff to daily activity that will speed revenue cycle and produce the greatest ROI.

3. Prioritize upstream fixes; especially in pre-registration

With 40% of denials originating before the patient even walks into the clinic or hospital, pre-registration is the single biggest choke point in revenue cycle performance.

Pre-registration accuracy has become even more critical as payers increasingly deploy bots to deny claims at scale. They simply look for errors such as eligibility gaps, missing authorizations, inaccurate demographics and deny claims instantly.

In effect, providers are competing against automated denial engines with manual processes. It’s a losing battle. If providers don’t automate financial clearance upstream, they are guaranteeing downstream denials, rework, and wasted labor.

Automation and AI that validate eligibility, benefits, authorization, and accuracy before the visit reduce downstream chaos, speed reimbursement, and massively improve zero-touch rates while allowing staff to focus on more complicated revenue cycle issues. Every dollar saved from preventing a denial is worth exponentially more than the cost of overturning one.

4. Re-evaluate outsourced vendors with real performance data

Outsourcing has long been framed as a cost-saving strategy. But lower hourly rates don’t mean lower total cost. Not when the quality of work is inconsistent, inefficient, or flat-out ineffective.Once you benchmark against metrics like zero-touch and first-touch payment rates, you might find that while you’re paying $10 per hour for offshore staff versus $20 for onshore, the difference in quality and effectiveness of work effort tells a different tale. Unfortunately, most leaders lack transparency into the actual work that’s being done by outsourced partners.

Consider what it would mean for the average provider organization to increase its labor capacity by 60% or more internally and eliminate those offshore contracts. Or, by increasing capacity for existing resources, consider how a rural health organization struggling to stay afloat could materially improve operational margin.

2026: The year for rewriting financial health

Every headline right now is about crisis: closures, cuts, staffing shortages, declining reimbursement. Communities depend on financially stable healthcare organizations and patients depend on accessible care, but healthcare organizations are only as healthy as their bottom line.

It’s easy to stay anchored to what’s “always worked” in revenue cycle. However, the industry’s economic reality demands stronger, forward-thinking leadership, and financial leaders are the ones who can reverse the trend by adopting benchmarking and technology that directly improve operational margin.

2026 isn’t the year to just survive. It’s the year to sunset the old revenue cycle metrics and focus on what truly matters: measurable, predictable, margin-positive performance.

Medical Office Supplies

Medical and Rx Pads

 Billing and Collection Supplies


 

Business Cards and Stationary


 

Chart Labels

Navigating the complexities of staffing in modern medical practices

In today’s fast-evolving health care landscape, medical practices face a myriad of challenges, with staffing emerging as one of the most significant hurdles. As the second biggest problem confronting clinics today, effective staffing is crucial to maintaining the quality of care and ensuring operational sustainability. In this article, I delve into the multifaceted issues surrounding staffing in medical practices and share insights from my own journey to illustrate how innovative approaches can lead to meaningful solutions.

The staffing conundrum: A dual perspective

From the clinic’s viewpoint, the staffing dilemma is a complex puzzle. The current health care ecosystem is witnessing a decline in the number of individuals pursuing careers as medical assistants and licensed practical nurses. This trend, coupled with high attrition rates, leaves clinics scrambling to cover essential roles. In stark contrast to my experience in 2018, where we maintained a balanced ratio of medical assistants to clinicians, by 2022, the burden had shifted dramatically. Often, a single medical assistant was tasked with supporting three physicians, a situation that inevitably led to burnout and accelerated staff turnover.

On the other hand, the staff face a slew of external pressures that exacerbate their professional challenges. The soaring inflation rate has made everyday living increasingly difficult, and the rising costs of childcare strain family resources further. Additionally, the consolidation of medical practices under larger health systems has resulted in reduced workplace flexibility and inflated costs of health insurance, factors that heavily influence job decisions.

Innovative solutions for recruitment and retention

In response to these challenges, my transition to a direct primary care model in 2022 has been both a revelation and a relief. Our approach centers on creating a work environment that is both nurturing and sustainable, prioritizing the well-being of our staff as much as that of our patients.

1. Managing patient load: By consciously keeping patient numbers low, we mitigate the risk of burnout among our medical assistants. This strategy allows us to allocate sufficient time for each patient interaction, enabling physicians to manage their own orders directly and efficiently.

2. Valuing our team: Competitive salaries are just the starting point. We conduct regular performance reviews to ensure our staff feel recognized and compensated fairly. Bonuses are awarded to those who exceed expectations, fostering a culture of excellence and motivation.

3. Flexibility and work-life balance: Understanding the importance of time off, we offer additional holidays, such as the Friday after Thanksgiving and both Christmas Eve and Christmas Day. These gestures not only boost morale but also demonstrate our commitment to our team’s personal lives.

As well as the support staff, we also need to consider the stresses placed on clinical staff, including physicians, physician assistants and nurse practitioners. Over the past few years, the demands placed on these professionals have escalated dramatically. The relentless increase in patient numbers necessitates a considerable amount of time and energy from health care providers. Simultaneously, the administrative burden has surged, with documentation requirements expanding and bureaucratic involvement intensifying. These layers of complexity not only detract from the time clinicians can dedicate to patient care but also contribute to professional burnout, a growing epidemic within the medical community.

Moreover, the financial landscape for health care professionals is fraught with challenges. The escalating costs of medical education and training have created significant financial burdens, compelling many physicians to gravitate toward higher-paying specialties. This financial imperative often leaves primary care — a cornerstone of effective health care delivery — understaffed and overburdened. The shortage of primary care specialists is exacerbated as seasoned professionals retire, leaving a chasm that must be filled by the next generation of clinicians.

However, the future of health care remains uncertain as these younger physicians are increasingly drawn to nonclinical roles, driven by the allure of better work-life balance and fewer bureaucratic hurdles. This trend threatens to perpetuate the cycle of shortage, further straining the system and potentially compromising patient care.

The path to resolving staffing issues in medical practices is neither simple nor straightforward. However, by embracing innovative models and prioritizing the needs of health care professionals, we can begin to reverse the trends of attrition and burnout. It is imperative that we continue to explore adaptive strategies that not only attract top talent but also create an environment where they can thrive. In doing so, we ensure that our clinics are not only operationally sound but also places of healing and hope for both staff and patients alike.

The journey of transforming staffing challenges into opportunities for growth is ongoing. By sharing our experiences and insights, we can inspire others in the field to rethink traditional paradigms, ultimately paving the way for a more resilient and responsive health care system.

Medical Office Supplies

Medical and Rx Pads

 Billing and Collection Supplies


 

Business Cards and Stationary


 

Chart Labels

MGMA poll: Denials are biggest revenue-cycle “leak” for medical practices

Denials and appeals are the leading source of revenue “leakage” for medical practices, according to a new Medical Group Management Association (MGMA) Stat poll that also points to persistent breakdowns at the front desk, in coding and documentation, and in patient collections.

In the Jan. 6 poll, 48% of respondents said denials and appeals were the biggest leak in their revenue cycle, MGMA reported in a post published Jan. 7. Another 23% cited front-end issues such as eligibility and benefits verification, followed by billing and collections (14%), coding (13%) and charge posting (2%). MGMA said the poll drew 288 applicable responses.

MGMA’s takeaway: Many organizations don’t have one failure point, they have a chain reaction. An eligibility miss at scheduling or check-in can turn into a denial, a delayed bill and an aging account, the association said.

Denials: Payer rules, prior authorization and medical necessity disputes

Respondents described denials as “overwhelmingly payer-driven and preventable,” MGMA said, citing common themes such as medical necessity determinations, noncovered services, bundling and global package edits, utilization-management friction tied to prior authorization and post-service records requests, eligibility and coordination-of-benefits problems, timely filing, and credentialing- or CLIA-related denials.

The survey findings arrive as practices continue to report heavy administrative burden tied to prior authorization. The American Medical Association has reported that prior authorization consumes staff time and contributes to physician burnout. Federal watchdogs have also flagged concerns in Medicare Advantage, with the HHS Office of Inspector General reporting that some denied prior authorization requests met Medicare coverage rules.

A fix that starts before the claim: Front-end discipline

Physicians Practice coverage has long argued that denial prevention is often an upstream problem, not a back-end heroics problem: verify eligibility, confirm deductibles, and check prior authorizations before the visit when possible.

One practical starting point is measurement. A Physicians Practice article on revenue KPIs recommends verifying eligibility for every single patient for every appointment, confirming how much deductible has been met, and tracking denial percentage, bill lag and days in accounts receivable to identify process drift.

Patient-pay pressure shows up in collections

Billing and collections ranked third in MGMA’s poll, with respondents pointing to higher patient responsibility and inconsistent point-of-service collection.

On the practice side, Physicians Practice has urged leaders to set expectations early and make it easier to pay. Recent guidance includes collecting balances at check-in with clear signage and staff scripting, plus tracking point-of-service collections for consistency.

Coding: Undercoding and documentation gaps can quietly drain revenue

Coding was identified as the biggest leak by 13% of MGMA poll respondents, with MGMA pointing to undercoding — particularly for evaluation and management services — missed codes, modifier issues and documentation gaps that fail to support medical necessity.

Physicians Practice recently published a 2026-focused coding guide that argues “simple, repeatable coding habits” can cut denials, support compliance and protect margins — the kind of operational consistency MGMA says practices need across the revenue cycle.
Where tech fits: don’t skip the fundamentals

MGMA noted that many organizations are exploring AI and automation, including documentation tools, to reduce errors and improve the completeness of clinical notes.

Medical Office Supplies

 Medical and Rx Pads

 Billing and Collection Supplies


 

Business Cards and Stationary


 

Chart Labels