Charging a missed-appointment fee, or waiving it
How a practice invoices a missed-appointment fee, and how to waive it cleanly after the invoice is issued: a void if unpaid, a credit note if paid.
By Achekam · · 5 min read · For Healthcare businesses in South Africa, Nigeria, Kenya
A patient booked an hour-long appointment, the practitioner kept the slot free, and the patient did not arrive or phone. The practice's policy says a missed-appointment fee applies. Reception is uncomfortable sending it, the practitioner is annoyed, and the patient, when they eventually call, has a good reason: a sick child, a flat tyre, a family emergency.
A missed-appointment fee only works if it is handled consistently: charged when the policy says so, waived when the practice decides it should be, and recorded properly either way. This article covers both halves, from the policy to the invoice and, when needed, the clean way to take it back.
Put the fee in the practice's terms first
A fee nobody was told about is hard to defend and harder to collect. Before you charge anyone, make sure the policy is written down and the patient has seen it:
- How much notice a patient must give to cancel without a fee.
- The fee, or how it is worked out (for example by appointment length).
- Exceptions the practice will consider, such as emergencies.
- How it is billed: to the patient or account holder, payable directly, not through a claim to their scheme.
Put it in the practice terms patients agree to when they register, on the booking confirmation, and on the website. In South Africa, the Consumer Protection Act's section 17 sets out when a supplier may take a reasonable deposit for a booking and what cancellation charge it may keep if the customer cancels, so read your policy against it.
Issue the invoice and e-mail it
When the fee applies, raise it as its own invoice, separate from any consultation.
Create a draft, which can still be changed or deleted, with one clear line: "Missed appointment" with the date and time of the booking. Issuing it takes the next number in your sequence and posts it to the ledger as debtors, sales and output VAT. Default terms are 30 days.
Set the VAT on the line in line with your accountant's advice. A South African business sets each line to 15% or 0%. A Nigerian or Kenyan business picks a tax code on each line (standard, zero-rated, exempt, out of scope or reverse charge), and only standard lines carry VAT.
Then download the PDF on your letterhead or e-mail it from the invoice, with or without a pay link. If the e-mail fails, the invoice says it was not sent. A short, neutral covering note works best: the booking that was missed, the policy, and how to pay. If the patient has a reason, they will tell you, and the decision below is easier when the invoice has gone out on time.
Waiving it: void or credit note
Once a fee is invoiced, there are two correct ways to take it back. Which one depends on whether anything has been paid.
Nothing paid yet: void
An administrator can void an issued invoice that has no payments or credits, and voiding reverses its journal. For a missed-appointment fee waived before the patient pays, that is the cleanest option: the sale and the amount owed are both reversed in the books by the same action.
Already paid, in full or in part: credit note
Once a payment has been recorded, the invoice can no longer be voided. Instead, issue a credit note from the invoice it corrects, in full or for chosen lines. The credit note is posted to the ledger and can be downloaded as a PDF or e-mailed to the patient. If the patient had already paid, the leftover credit is held for them, so it can go against their next visit or be refunded.
There is no credit note without an invoice. Every waiver therefore points back to the fee it cancels, which is what you want when someone later asks why the account looks the way it does.
A worked example in words: a patient misses an appointment and is invoiced the fee. Two days later she phones to explain that her child was admitted to hospital. The practice manager agrees to waive it. Because nothing has been paid, an administrator voids the invoice that afternoon. Had the patient already paid through the pay link, the practice would have issued a credit note instead and held the credit for her next consultation.
Keeping waived fees out of reminders and statements
Credit control is on for new workspaces. Once a day it e-mails overdue reminders, by default at 7, 14 and 30 days overdue with the invoice attached, and once a month a statement to every patient with a balance. It never charges anyone and records whether each e-mail went out.
That is exactly why a waiver must be recorded, not just agreed on the phone. A fee the practice has forgiven but left open will keep generating reminders and will appear on the next statement, and the patient who was told "don't worry about it" receives a reminder a week later. Void or credit the invoice as soon as the decision is made. Afterwards, a statement of account, produced as a PDF and e-mailed from the same screen, shows the patient the account as it now stands.
Who decides on waivers
Leave waivers to one or two named people, not whoever answers the phone.
- Reception explains the policy and passes on the patient's reason.
- The practice manager or a partner decides whether to waive, using the exceptions in the policy.
- An administrator voids an unpaid invoice; voiding is an administrator's action in Achekam.
- Someone keeps a simple log of waived fees and reasons, reviewed now and then, so the policy is applied evenly.
For the wider routine of following up patient balances, see statements and reminders for patient accounts. If the patient prefers to settle a fee at the desk, giving patients a proper receipt at reception covers the receipt they leave with.
A missed-appointment fee protects the practitioner's time only if patients trust it is applied fairly. Write the policy down, invoice promptly, and record every waiver as a void or a credit note on the day it is decided.
General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.
