Fam Pract Manag. 2008 Mar;15(3):42.

Encourage patient payments at time of visit

Train your staff to tell patients the total of your charges upon checkout and specify the amount due (for example, “Your amount due today is $80”). This approach can improve your accounts receivable because it requires the patient to refuse to pay at the time of service instead of making it easy for him or her to pay later. If he or she does ask to be billed for the amount owed, supply a printed envelope and encourage the patient to mail the payment.

Source: Fleischman M. Improving efficiencies in a small family medicine practice. Talk presented at: AAFP Scientific Assembly; Oct. 3, 2007; Chicago.


Use online tools to identify drug seekers

Because of past problems with drug-seeking patients, each time our practice sees a new patient who complains of chronic pain, we consult an online database that lists all prescriptions for controlled substances filled by pharmacies in our state (see We search the database using the patient's name, date of birth and zip code. The results list the prescribing physician and the pharmacy that filled the patient's prescription.

Currently, 25 states have a database similar to ours, and at least nine more will be operational in 18 months or less. To find out if your state offers a database like ours, visit the Web site for your state's department of health or board of pharmacy.

Simplify refill requests

To streamline the prescription refill process, I designed a simple form that facilitates communication. When a patient calls the office to request a refill, a staff member completes the patient information portion and lists the drug name, dose and pharmacy. The form is then attached to the patient's chart for my review. I check one of the following three boxes and add detail as needed: “Refill ___ number of times,” “Refill once and schedule an office visit,” or “No refill until the patient is seen.” I then initial the form and give the chart to a staff member, who calls in the refill.

Charging Medicare for a missed appointment


Can I charge Medicare if a patient misses his or her scheduled appointment?


No, but the Centers for Medicare & Medicaid Services' current policy (available online at does allow you to charge Medicare patients directly for missed appointments as long as you do the same to non-Medicare patients who miss appointments.

Editor's note: Click below to download a copy of Dr. Sagall's form.


Practice Pearls presents the best advice on effective, efficient practice operations and patient care drawn from the medical and business literature, along with tips developed from your experience. Send us your best pearl (250 words or less), and if we publish it, you'll earn $25. We also welcome questions for our Q&A section. Send your pearls and your questions to us at



Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to, or add your comments below.


Copyright © 2008 by the American Academy of Family Physicians.
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