FOLIO 04 · Why the rate is lower
The friction-removal hypothesis, validated
Patient-cited no-show drivers consistently include forgetting and miscommunication as the leading reasons, with transportation and competing work or family obligations close behind (Kaplan-Lewis and Percac-Lima 2013). Telehealth removes the transportation barrier outright and meaningfully reduces the competing-obligation barrier by collapsing the practical time commitment from a 2-hour round trip (drive, parking, waiting room, visit, drive back) to a 25-minute video call. It does not solve the forgetting problem, which still requires reminders.
A 2025 systematic review and meta-analysis (Greenup and Best, BMC Health Services Research) pooled studies of telehealth versus in-person care and found a moderate reduction in non-attendance for telehealth: pooled odds ratio about 0.61, roughly 39 percent lower odds of a no-show. The authors stress very high heterogeneity between studies (I-squared near 100 percent): the effect is largest in general primary care and most medical specialties, but a minority of studies, concentrated in rural and behavioral-health settings with limited digital access, found no benefit or higher telehealth no-show rates. Treat telehealth as a strong lever in most settings, not a guaranteed one.
The implication for practice operations: shifting a meaningful share of follow-up visits to telehealth lowers the aggregate practice no-show rate and lifts revenue without requiring new patient volume. A primary care practice running 19 percent in-person no-shows and 9 percent telehealth, that shifts from 0 percent telehealth to 30 percent of follow-ups via telehealth, sees the aggregate rate fall to about 16 percent. That 3-point drop is worth roughly $40,000 to $55,000 in additional captured revenue per provider per year.
FOLIO 05 · Audio vs video
Audio-only runs a few points lower than video
Within telehealth, audio-only visits (a phone call, no video) run about 2 to 3 percentage points lower no-show than video visits. The mechanism is technical friction. Video requires the patient to install or open an app, grant camera and microphone permission, find a private enough location, and have enough bandwidth. Audio-only requires picking up the phone. For older patients, patients in rural areas with limited broadband, and patients with limited digital literacy, audio-only is materially more reliable.
CMS extended audio-only telehealth billing flexibility through the end of 2026 under the Consolidated Appropriations Act, with payment parity for most E&M visit codes. After 2026 the rules tighten back to the pre-pandemic baseline unless Congress extends. Practices that have built a meaningful audio-only book should track the regulatory calendar and have a plan for what happens to that volume if the parity expires.
FOLIO 06 · Technical issue tax
The technical-issue tax: roughly 4 percent of attempts
Telehealth no-show statistics typically exclude attempts that started but failed for technical reasons (patient could not log in, video dropped, audio garbled). Across the major telehealth platforms (Doxy.me, Zoom for Healthcare, Amwell, Teladoc, MyChart Care Connect), roughly 4 to 6 percent of scheduled telehealth visits encounter technical issues severe enough to require rescheduling or downgrading to audio-only. About one third of those get rescued the same day, two thirds need rebooking.
The dollar impact is real but contained. For a 5-provider practice doing 30 percent telehealth (about 33 telehealth visits per day, 7,260 a year), 4 percent technical issues means 290 affected visits. Half rescue same-day, half rebook to a new date with some patient drop. Net loss is roughly 100 to 150 visits worth $15,000 to $25,000 a year, mostly recovered if the practice has a clean recovery script and a same-day audio-only fallback.
Operationally the fix is procedural rather than technical: require a 5-minute pre-call equipment check (a one-tap "test your camera and microphone" link sent 1 hour before the visit), give the patient a same-day audio-only fallback number, and have the medical assistant initiate a phone call within 90 seconds if the video does not connect at the scheduled start. Most practices that adopt this discipline get their technical-issue loss under 1.5 percent.
FOLIO 07 · Behavioral health shift
The biggest no-show lever is behavioral health telehealth
For behavioral health practices specifically, telehealth is the single highest-impact intervention on the no-show rate. In-person therapy and psychiatry no-show rates run 30 to 40 percent per Kruse et al 2018 and confirmatory analyses. Equivalent telehealth no-show rates run 12 to 18 percent, a 12 to 20 point reduction that translates to roughly 35 to 50 percent more revenue captured per session-hour booked.
The behavioral health shift to telehealth has been the most durable post-pandemic operational change in healthcare. Where most medical specialties have settled at 10 to 20 percent telehealth, behavioral health practices commonly run 60 to 80 percent telehealth. The no-show implications are material: a behavioral health practice with 100 percent in-person at 35 percent no-show and a $175 session rate loses roughly $61 per booked session-hour. The same practice at 75 percent telehealth at 15 percent telehealth no-show and 35 percent in-person no-show on the residual loses roughly $33 per booked session-hour, almost a half. See the mental health no-show folio for the full math.
FOLIO 08 · Related
Related folios
FOLIO 09 · Margin notes
Frequently asked questions
What is the average telehealth no-show rate?+
On average telehealth lowers no-show risk: a 2025 systematic review and meta-analysis (Greenup and Best, BMC Health Services Research) pooled studies and found odds of a no-show about 39 percent lower than in-person care (odds ratio 0.61). The mechanism is removed friction: no travel, no parking, no childcare scramble. The caveat is very high heterogeneity between studies, with some rural and behavioral-health settings showing telehealth no-show rates equal to or higher than in-person.
Why do telehealth visits have lower no-show rates than in-person?+
Three reasons. First, the practical barriers (transportation, time off work, childcare) that drive a meaningful share of in-person no-shows are removed. Second, patients can join from anywhere with a phone, which collapses the lead-up window. Third, the visit can begin even if the patient is a few minutes late because the queue does not displace other patients. The effect is largest in behavioral health where transportation-and-stigma barriers to in-person attendance are highest. Note that the benefit is not universal: some rural and behavioral-health studies find telehealth no-show rates equal to or higher than in-person, particularly where digital access is limited.
How does audio-only telehealth compare to video on no-shows?+
Audio-only telehealth runs about 2 to 3 percentage points lower no-show than video telehealth, primarily because the technical barrier (camera permission, app installation, broadband stability) does not gate the visit. Audio-only is also more accessible for older patients and patients with limited broadband. CMS extended the audio-only telehealth billing flexibility through 2026 under the Consolidated Appropriations Act, with parity for most evaluation and management codes.
Can a practice bill for a no-showed telehealth visit?+
Generally no. CMS does not pay for a telehealth visit that did not occur, regardless of patient cause. Practices may charge a private-pay no-show fee within the same state rules that apply to in-person no-show fees (see the no-show fee by state folio). Some commercial payers allow a partial visit fee for telehealth attempts where the provider waited and documented in the EHR, but the policy varies by payer and contract.