PURPOSE AND PROVISIONS
The purpose of this policy is to encourage patients to make the corresponding arrangements in order to fulfill their responsibility to keep their previously scheduled appointments and avoid No-Shows. Our priority is to continue offering high-quality services in a timely manner. In order to do this, Salus has developed a policy to apply a charge or fee for the following reasons:
- Changes or cancellations made less than 48 hours in advance of your appointment.
- Failing to keep your previously scheduled appointment (No-Show). Charges or fees will not be applied to patients/customers who change or cancel their appointments through the official channels described in this policy or more than 48 hrs prior to the appointment or who show up to their appointments.
This policy helps us make a better use of the available appointments for our patients in need of medical attention. Maximizing the health care provider’s time and resources will help us fulfill our mission to provide easily accessible, patient/customer-centered, comprehensive health care services.
No-Show: patient who sets aside a space to be seen by a provider, fails to show up at their appointment or shows up later than the scheduled time, and, for availability reasons, cannot be seen the same day. For the purpose of this definition, we also consider a No-Show to be a patient that does not give prior notice or notification at least 48 hours in advance.
Change or Cancellation: removing or rescheduling the coordinated space or appointment through the channels approved in this policy.
Charge or Fee: applicable private fee of $25.00 USD per appointment charged to patients/customers, based on the provisions in the No-Show Policy, who fail to keep their agreed appointments or do not cancel / reschedule their appointments at least 48 hours in advance.
SCOPE OR APPLICABILITY
This policy applies to all eligible patients / customers who schedule a service at any of our Salus Clinics in the island. Scheduling should be performed through our Contact Center or at the authorized service areas within our facilities. Furthermore, the policy will be applicable to all Salus clinical service areas requiring appointment scheduling, as well as the areas of radiology, dental services, general medicine, specialized medicine, and other health-related professional services. This policy shall not apply to the following special programs: Salus@Work, Executive Health Program (Wellness), Preventive Services, and Team Based Care.
- Any patient who fails to show up for their appointment will be charged a No-Show fee of $25.00 USD.
- The charge/fee must be paid at the next appointment with the provider; otherwise, the patient/customer will not be able to have their appointment with the provider; certain exceptions may apply. This policy shall not contravene, in any of its parts, the Patients’ Bill of Rights, Law No. 194 of 2000.
- The following scenarios, such as:
- Discussing altered, panic, or critical laboratory test results;
- Urgent results or discussion of treatments at our facilities, such as biopsies, dental urgent care, etc.;
- And urgent follow-up appointments or consultations requested by the provider based on clinical criteria, are excluded, and you should have your appointment with the provider. Nonetheless, the patient must be oriented on the importance of keeping their appointments and paying off their balance before the next appointment. Under the provisions of this policy, the clinical personnel may consult special cases with the Administrator, Manager, Medical Consultant, or Medical Director at any time.
- The following scenarios, such as:
- If the patient cannot keep their appointment or would like to reschedule or cancel, they must notify it at least 48 hours in advance in order to make the corresponding changes.
- Patients who cannot be confirmed but who do show up to the scheduled appointment will not be subject to the $25.00 USD fee.
- To notify cancellations or reschedule an appointment, the patient must call 787-789-1996 or send an email to firstname.lastname@example.org 48 hours in advance. If the patient sends an email, they should specify whether they need to cancel or reschedule and include their full name, phone numbers, service for which they had an appointment or service they wish to reschedule, and the Clinic’s name or municipality.
- TERMINATION OF DOCTOR-PATIENT RELATIONSHIP: if a patient misses more than 3 appointments, in breach of this No-Show Policy, within a period of 12 months (based on the calendar year), the doctor-patient relationship will be terminated. This shall be done in accordance with the policy on terminations of doctor-patient relationships. Such cases must be consulted with the Salus clinical and quality team.
- We acknowledge that exceptional situations may arise that could force a patient to miss their appointment after it has been confirmed. If such is the case, the patient must submit evidence to the check-in personnel, the contact center, or the clinic’s management, based on the particular scenario, to be reconsidered to have the fee waived. Exceptions, if any, must be documented and approved by the clinic’s management or the Billing and Collections Manager.
I. Managerial Personnel:
The Contact Center Manager, the Billing and Collections Manager, the Clinic Managers, and the service staff Supervisor will be primarily responsible for reviewing and ensuring compliance with this policy. Both the Contact Center Manager and the Billing Manager will be the leading reviewers of the exceptions performed every month. The Billing and Collections Manager will be responsible for preparing and providing guidance on the policy for the management, exceptions, auditing, and recovery of this billing line.
II. Salus Personnel:
- All personnel scheduling appointments must ensure the following:
The person scheduling the appointment is responsible for notifying the patient or authorized representative of the date and time of the appointment. They will also need to advise the patient or representative to arrive at least 15 minutes prior to the scheduled time to complete the check-in process. They must also inform them of any preparations or protocols to follow prior to the appointment (if any). Lastly, the patient must be advised of the No-Show Policy, the process to reschedule or cancel appointments, and the fees to be charged in case of a missed appointment. All guidance provided must be documented in the appointment record system (TRA) as evidence that the patient was advised.
- All personnel confirming appointments must ensure the following:
- During the process of initial appointment setup or confirmation, the representative shall confirm the appointment date and time with the patient or the patient’s representative. They will also need to advise the patient or representative to arrive at least 15 minutes prior to the scheduled time to complete the check-in process. They must also inform them of any preparations or protocols to follow prior to the appointment (if any). If the patient requests to have the appointment cancelled or rescheduled at this time, the representative must proceed as requested and coordinate the appointment according to the availability in the appointment system. If the patient confirms it, they should be advised again of the No-Show Policy, the process to reschedule or cancel appointments, and the applicable charges for a no-show. All guidance provided must be documented in the appointment record system (TRA) as evidence that the patient was advised.
- All personnel in charge of rescheduling no-show patients
The Contact Center’s personnel will be tasked with calling patients who failed to show up for their appointments (no-show) in order to reschedule. The patient will be reminded of the importance of complying with the No-Show Policy and keeping their medical appointments to ensure they’re receiving effective care for their health conditions.
- Revenue Cycle Personnel (upon patient check-in)
- When checking in patients, this personnel must confirm that the patient has no pending balances due. If there is a balance due, it must be collected before the patient is seen by the provider.
- They will be required to sign the Commitment to Punctuality and Compliance, along with the No-Show Policy (responsible for scheduling appointments and the check-in and check-out processes). This document must be completed as required by the process for Commitment to Punctuality.
1. Late arrivals to previously scheduled appointments
If the patient arrives at the clinic after their appointment time, the check-in personnel will follow the steps below:
- Make sure the late arrival was not caused due to delays in the clinic’s processes (for example, if the patient has been waiting 30 minutes to be checked in).
- Inform the patient that they are late for their appointment.
- Let the patient know they are checking to see where their appointment can be fit in, and then make the necessary arrangements with the supervisor’s intervention.
- The provider will be notified that one of their patients is late. If the patient cannot be seen due to special circumstances, the check-in personnel will reschedule their appointment for the earliest date available in the doctor’s calendar.
- Revenue Cycle Personnel (end of shift) Validate the appointment records.Ensure that all the patients that were seen by the provider have a registered status. Generate the billing line in the patient’s file with the code GACPA / MOD26, which entails a $25.00 USD private fee charged to the patient. When checking in patients, this personnel must confirm that the patient has no pending balances due. If there is a balance due, it must be collected before the patient is seen by the provider.
III. Related Patient Rights and Responsibilities:
- The patient will be entitled to receive all appropriate and sufficient information regarding the cost recovery and dispute resolution mechanisms and procedures, as well as the mechanisms and procedures for quality control and satisfaction guarantees for patients, users, or service consumers.
- Patients and their family members are responsible for making reasonable arrangements in order to avoid affecting the needs of the clinic, of other patients, and of the medical faculty and staff through their particular actions.
- Patients are responsible for following the administrative and operational procedures of their health care provider, Salus.
- The patient is responsible for scheduling their appointments for a date and time that is not inconvenient for them.
- The patient is responsible for contacting us 48 hours prior to their appointment to have it rescheduled or notify its cancellation.
- The patient or authorized family member is responsible for requesting and notifying rescheduled or cancelled appointments, as provided in this policy.
- The patient is responsible for paying any No-Show fees incurred, as well as any other charges provided in this policy, during their next appointment with the provider.
Salus reserves the right to revise this policy at any time. Employees will be promptly notified of any revisions through our portal and at documented team meetings.