Risk Reduction Resources

Appointment Management

Missed and canceled appointments, referrals not completed

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Managing patient appointments is an important function of any office practice. A poorly managed appointment process poses not only a risk to patient safety and continuity of care but also a risk to the practice’s finances.

Policy: Practices should determine their appointment management process. Once the process has been defined, a policy should be written, and all staff members should receive training on the steps and their importance to ensure patient safety and financial stability. The policy should be reviewed regularly, and staff roles should be clearly defined. The following actions should be included in the process:

Appointment Reminders: Appointment reminders are an important aspect of the appointment management process. Patients should consent in writing to receive reminders, and by what means. Reminders should not contain protected health information. Phone calls, automated messages, text messages, or the patient portal can be used to send appointment reminders. Reminders should be scheduled several days in advance of an appointment. Appointment reminders help ensure patients will keep their appointments and provide the opportunity to cancel or reschedule, thus opening up appointments for other patients.

Patient Follow-up: An important aspect of the appointment management process is ensuring that patients schedule their follow-up appointments. Whenever possible, patients should schedule follow-up visits before leaving the practice. If the patient is unable to schedule their follow-up appointment at check-out, there should be a process in place to continue contact with the patient until the appointment is scheduled.

No-Shows: When a patient misses an appointment and fails to notify the practice, this could mean the patient simply forgot the appointment or has decided not to keep it. Inform new patients of the practice’s policy for no-show appointments and consider posting policy details in a conspicuous location in the practice. Some questions to consider are: should the practice require a 24-hour notice for cancellations? Will there be a charge for no-show appointments? How late can a patient be before their appointment is canceled? Be sure that patients are aware of your policies. When a patient does not keep their appointment, the following steps should be taken:

• Notify the provider of patients who missed or canceled appointments. This allows the provider to direct additional follow-up activity.
• Follow up with the patient as directed by the provider. Make at least three attempts to contact. Include the following steps in the process:
  • The initial attempt is a courtesy contact by phone call.
  • The second attempt may also be a phone call or a letter sent by first-class US mail.
  • Because receipt of voicemail messages by the patient cannot be verified, proceed to send a written notice if the second phone call does not result in direct contact.
  • Document all attempts in the patient’s medical record.
• For missed or canceled appointments where serious consequences could arise, because of a lack of follow-up, the letter sent in the third attempt should outline the possible risks of not returning for treatment. This should be sent certified, return receipt requested mail.
• If the patient refuses a certified letter:
  • Note the refusal in the patient’s medical record.
  • Place the unaccepted letter in the envelope in the medical record, or scan a copy of the unaccepted letter and place it in the patient’s electronic health record.
  • Make a copy of the letter.
  • Send the copy back to the patient in a plain envelope with no office practice identifiers.

Cancellations without Rescheduling an Appointment: When a patient cancels an appointment without rescheduling, the provider should be notified. Follow the steps outlined above for no-show patients to ensure that patients receive appropriate continued care.

Referred Patients Who Fail to Schedule or Miss Initial Appointment: Specialty practices should have a process in place to track referrals to ensure continuity of care. If a referred patient fails to schedule an appointment or misses their initial consultative appointment, the specialist should notify the referring provider that the patient did not present for their appointment.

Patients with Repeated No-Shows or Cancellations: While missed appointments can be frustrating for providers and office staff, they may indicate issues with patient adherence to treatment plans. When a patient cancels or misses an appointment, it may be a sign of barriers to care, such as a lack of understanding of their treatment plan, difficulty affording their medication, or difficulty losing weight, quitting smoking, or exercising. Could they be concerned about the provider’s reaction to their lack of progress on treatment goals? Providers can use missed appointments as an opportunity to address concerns that may be causing the patient to miss their appointments, utilizing resources such as care coordinators or social workers when available. If, despite the provider’s best efforts, the patient continues to miss appointments, it may be necessary to consider terminating the patient from the practice. See our practice tip: Termination of Physician-Patient Relationship.

Patient Portal and Appointment Management: A patient portal may offer options designed to facilitate appointment management. When using a patient portal:

• Verify that the patient’s appointment view is enabled so they may view all their appointments on the portal.
• Verify that the patient’s referral appointments are listed in the patient’s appointment view.
• Enable a standard patient response to their attempts to schedule, reschedule, or cancel an appointment via the patient portal. Require a care team member to review all patient attempts to schedule or modify an appointment and require an email confirmation of the patient’s request. See our practice tip: Using Patient Portals to Promote Patient Communication.

Resources

Littrell, A. (2025, August 21). 8 patient scheduling strategies every practice needs. Physicians Practice.

Marbouh, D., Khaleel, I., Al Shanqiti, K., Al Tamimi, M., Simsekler, M. C. E., Ellahham, S., & Alibazoglu, D. (2020). Evaluating the impact of patient no-shows on service quality. Risk Management and Healthcare Policy, 13, 509–517. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280239/

American Society for Health Care Risk Management. (2016). Physician office risk management playbook. American Hospital Association.

Updated on: 2/2026