No Show Policy

I. Purpose:

The purpose of this policy is to encourage patients to attend their scheduled appointments and therefore avoid incurring in “No Show”. This policy allows maximizing the available appointment for patients who need medical attention, as well as the time and resources of the health service provider. This will help us fulfill our mission of providing integrated, easily accessible, comprehensive patient/customer-centered health care services.

II. Scope:

This policy applies to all eligible patients / customers who schedule a service at any of our Salus Clinics and doesn’t comply with the following:

1. Changes or cancellations made less than 48 hours before scheduledappointment.
2. Failing to keep their previously scheduled appointment (No-Show). 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 does not apply to the following:Salus@Work, Executive Health Program (Wellness), Initial Preventive Services visit, and Chronic Care Conditions. This polic does not  apply to Vital Health Plan patients.

III. Policy:

1. Any patient who fails to show up to their scheduled appointment will be charged a No-Show fee of $25.00 USD.
2. This fee must be paid in full for before the patient’s next appointment: The patient will not be able to be seen by any provider, or get any diagnostic imaging study, until the No-Show fee balance is paid.
3. Certain exceptions may apply: This policy shall not breach the Patients’ Bill of Rights, Law No. 194 of 2000.
   1. The following scenarios are exceptions to the policy and, therefore, patient must be seen by the provider:
      1. Discussing altered or critical/panic laboratory test results or emergent radiology results.
      2. Urgent results or discussion of treatments at our facilities, such as biopsies, dental urgent care, among others.
      3. And urgent follow-up appointments or consultations requested by the provider based on clinical criteria. Nonetheless, the patient must be oriented and educated 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 clinic Administrator/Supervisor. If the administrator or supervisor is not available at the time, the clinic personnel must consult with the a member of the managerial staff.
   2. If the patient needs to reschedule or cancel a scheduled appointment, they must notify with at least 48 hours in advanced to make the corresponding changes. Otherwise, the No-Show fee will be applied.
   3. To notify cancellations or reschedule an appointment, the patient must call 787- 789-1996 or send an email to cancelacioncita@saluspr.com with at least 48 hours anticipation. If the patient sends an email, they should specify whether they need to cancel or reschedule and include the following information: full name, phone numbers where they can be reached, service(s) the wish to cancel or reschedule, and the Clinic’s name or municipality.
   4. Termination of doctor-patient relationship applies: if a patient misses more than three (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. These cases must be evaluated with the Salus clinical and quality department before putting into effect said termination.
   5. In the event of an extraordinary circumstance, where the patient has an emergency or an emergent situation that impedes appointment assistance: , he/she must submit evidence to the billing department and/or clinic patient service clerks,based on the particular scenario, for the fee waive to be reconsidered. Exceptions, if any, must be documented and approved by the clinic’sAdministrator/Supervisors or the Billing and Collections Department Manager.

IV. Definitions:

1. No-Show: any patient who does not show up to their scheduled appointment, or shows up late to their scheduled appointment and, for any reason, cannot be seen that 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 of cancellation or rescheduling with at least 48 hours in advance.
2. Change or Cancellation: removing or rescheduling the coordinated appointment through the appropriate channels, as described in this policy.
3. Charge: applicable private fee of $25.00 USD per appointment that is charged to patients/customers, based on the provisions mentioned in the No-Show Policy.
4. Fee: Any balance for the concept of ”No Show” must be collected before being evaluated by a provider in any of the clinics or undergoing any diagnostic imaging study.The following are examples:
   1. Patient has two appointments with two different providers on the same day and misses both or is late and cannot be evaluated. In this case, $25 fee is charged for each of the appointments, for a total of $50.
   2. Patient has two appointments scheduled in different days: one of the appointments is with a primary care physician and the other appointment day is with a specialist. Patient does not attend scheduled appointment with the primary care physician, but does shows up tothe appointment scheduled with the specialist. In this case, the ”No Show” fee of $25 will be applied since patient did not attend appointment with the primary care physician. . Said feehas to be paid in full before patient can be evaluated by the specialist.
   3. Patient has a coordinated appointment in the Hato Rey clinic and, in the same week, has another appointment in the Guaynabo clinic. Patient misses the appointment in Hato Rey clinic but shows up to the appointment in Guaynabo. In this case, the ”No Show” fee of $25 will be applied due to the No-Show incurrence in the Hato Rey clinic. This fee has to be paid in full before the patient is evaluated in the Guaynabo clinic.
   4. Patient schedules an appointment for two radiology studies. The patient does not show up to the clinic. In this case, a $25 will be charged for each of the scheduled services, for a total of $50 Said fee must be paid in full before patient receives any service at any of the clinics.
   5. The physician or provider cannot determine whether the ”No Show” fee is charged or not. This determination is only made by the Clinic Administrator, the Billing and Collection Department Manager or by a member of the Management Team.

V. Responsibilities:

1. Managerial Personnel: The Contact Center Manager, the Billing and Collections Manager, the Clinic Office Managers or Operations Supervisor , and the Patient Service Clerks Supervisor will be primarily responsible for reviewing and ensuring compliance with this policy.
2. All Salus personnel that coordinates or confirms appointments for patients, either through the Contact Center or directly at the Clinics, must ensure that patients are advised on the “No Show” policy.
3. Revenue Cycle Personnel and Special Program Services Officers: must confirm that the patient has no pending balances due during the during the process of registry. If there is a balance due, it must be collected before the patient is seen by the provider. Also, they are responsible for adjudicating the charges for ”No Show”.

VI. Procedure:

1. Managerial Personnel:
   1. The Contact Center Manager, the Billing and Collections Deparment Manager, the Clinic Office Manager or Operations Supervisor, and the Patient Access Supervisor will be primarily responsible for reviewing and ensuring policy compliance within their teams. Both the Contact Center Manager and the Billing and Collections Department Manager will be the main reviewers of the exceptions performed every month.
2. Salus Personnel:
   1. All personnel scheduling appointments must ensure the following:
      1. 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 authorized representative, to arrive at least 30 minutes prior to the scheduled time in order to complete the registration documents and process. They must also orient patient on any preparations or protocols to follow prior to the scheduled appointment (if any). And lastly, patient must be advised on 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 to the patient, or authorized representative, must be documented in the scheduler system as evidence that the patient was duly advised.
      2. It is the responsibility of the person coordinating an appointment to advise the patient about pending balances and that the amount must be liquidated before their next appointment or on the day of their next appointment. Additionally, you must advise the patient that they can make payment by phone call and, if the patient accepts, you must transfer the call to the Billing and Collection Department using thefollowing extensions: 8331039, 8330148, 8330149, 8331035, 8331130 or 8331163.
   2. All personnel confirming appointments must ensure the following:
      1. When scheduling an appointment or confirming an already scheduled appointment, the contact center representative shall emphasize appointment date and time with the patient, or authorized representative.They will also need to advise the patient (or representative) to arrive at least 30 minutes prior to the scheduled time, in order to complete the check-in/ registrationprocess, as well as inform 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 scheduler system. If the patient confirms appointment, he/she must be advised again of the No-Show Policy, the process to reschedule or cancel appointments, and the applicable charges incurred if patient does not show up to the scheduled appointment. All guidance provided must be documented in the appointment scheduling system as evidence that the patient was duly advised.
   3. All personnel in charge of rescheduling no-show patients:
      1. The Contact Center’s personnel shall call patients who failed to show up to their scheduled appointments (no-show) and reschedule. The patient will be reminded of the importance of attending scheduled appointments to ensure they’re receiving effective care for their health conditions, as well as remind them of our No-Show Policy.
   4. Revenue Cycle Personnel and Special Program Services Officers (upon patient check-in)
      1. When commencing patient registration process/check-in, patient service clerks must verify system and make sure that the patient has no pending balances. If there is a balance due, it must be collected before the patient is seen by the provider or receives any service at any of our clinics. Patients who do not pay due balance will not be seen, except for the exclusions mentioned in this policy. (See Policy section, item B)
      2. Patients will be required to sign the Commitment to Punctuality and Compliance and No-Show Policy (responsible for scheduling appointments and the check-in and check-out processes) documents. These documents must be completed as required by the Commitment to Punctuality policy.
         1. If the patient arrives at the clinic after their scheduled appointment time, the patient service clerk will follow the steps below:
            1. Make sure the late arrival was not caused by delays in the clinic’s processes (for example, if the patient has been waiting 30 minutes to be checked -in/ registered).
            2. Inform the patient that they are late for their scheduled appointment.
            3. Let the patient know they are verifying scheduler to see where their appointment can be fit in, and then make the necessary arrangements with the supervisor’s intervention/approval.
            4. The provider will be notified that one of their patients is late. If the patient cannot be seen that day, the patient service clerk will reschedule their appointment to the earliest available date. In case of a diagnostic imaging study, patient service clerk must consult with Supervisor if the scheduler is completely full, to see if there is any way they can accommodate patient that same day.
            5. Must notify the patient that he/she will have a pending balance reflected in the system, and that said balance must be paid in full before he/she can receive any service at any of our clinics.
   5. Revenue Cycle Personnel and Special Program Services Officers (end of shift)
      1. Validate the appointment scheduler system.
      2. 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, these 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.
3. Billing Personnel
   1. Receive transferred calls from the Contact Center for the collection of pending balances.
   2. The letter will be saved as evidence in TRA in the SCAN section , under the folder: Carta de Cobro-Facturación
4. Revenue Cycle Specialist Personnel
   1. They are responsible for sending collection letters to patients.
5. Manager of the Billing and Collections Department
   1. At least once a month, must issue a report to audit and monitor the collection of No-Show charges. Said report must be sent to the Senior Operations Manager and/or the President of Salus.
6. Related Patient Rights and Responsibilities:
   1. The patient has the right to receive all adequate and sufficient information regarding the collections process, dispute resolution mechanisms and procedures, as well as the mechanisms and procedures for quality control and patients, users, or service consumers satisfaction guarantees.
   2. Patients are responsible for following the administrative and operational procedures of their health care provider, SALUS.
   3. The patient is responsible for contacting us at least 48 hours prior to their scheduled appointment if they wish to cancel or reschedule.
   4. The patient, or authorized representative, is responsible for requesting and notifying rescheduled or cancelled appointments, under the provisions in this policy.
   5. The patient is responsible for paying any No-Show fees incurred, as well as any other charges provided in this policy, during their visit at any of out clinics. Said fee must be pair in full before patient receives any service at any of our Clinics.