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Medico-legal reports can be a valuable revenue stream to private practice if you manage the billing effectively. Simon Brignall, from Civica Medical Billing and Collection, discusses some of the problems you may face in this area including the importance of terms and conditions.
The composition of independent healthcare revenue streams can be varied and may change over time. Typically, consultants opt for clinical based activity treating a mixture of self-pay and insured patients alongside embassy funded or NHS patients depending on where the practice is located. Diversification of revenue is beneficial to any business as it helps mitigate any fluctuation in demand from one source just as a mixed portfolio of investments can help manage risk.
Medico-legal work
One such option is Medico-legal activity, but consultants are often dissuaded as they find the medical billing and credit control challenging.
The medico-legal sector is extremely fragmented with 1000’s of solicitor’s working in this field either independently or as part of a group, and there is also the work that is available from the medico-legal agencies. Such a wide range of potential clients means that you often need to manage a multitude of commercial relationships. At Civica Medical Billing and Collection, we partner with a wide range of practices ranging from those who carry out a few reports a year to those generating multi-million-pound revenues.
The Importance of terms & conditions
The most effective way of conducting this activity is to have detailed terms & conditions (T&Cs) in place before any work is carried out. Your T&Cs should include your fee structure and payment terms. Practices that do not have these in place can find that disputes around payments arise. The case they have been working could be on a ‘no win no fee’ basis which can mean that they end up waiting years for their money.
Problems around delayed payments will negatively impact the cash flow of the practice and will only become more of an issue if they are not addressed correctly. It is important to note that when you raise an invoice, you create a tax liability, which means that until you collect the monies owed, you are effectively paying to carry out this activity.
For larger medico-legal practices, which are required to charge VAT, the situation is even worse, as you would have had to pay the VAT to His Majesties Revenue & Customs (HMRC) every quarter only exasperating the problem.
Best practice is to ensure that you have clear T&Cs that are agreed by your client when they engage you covering the following specific areas. At Civica Medical Billing and Collection, we routinely review clients T&Cs as part of the onboarding process.
Fees
One of the major benefits of medico-legal activity is that your fee structure can reflect both the demand for your services and your experience. It is important to consider the length of time taken to review medical records, include any interview or examination of the client, dictation and preparation of documents. You may prefer to quote using an hourly rate to provide some flexibility for cases that take longer to review, particularly where there is many medical records or where the case is complex.
For court cases where you are required to attend, you should have a fee schedule per day. Please note that your fee should be for a minimum charge and not related to the amount of time you have to appear. This is due to the impact on your schedule and your availability to undertake other work. You should also outline your fees for travelling expenses as well as any other costs you may incur.
Supplementary work should also be quoted using an hourly rate – this is to cover any further reviews and additional work relating to the case. This work can then be invoiced using your hourly rate and typically can be broken down into 15-minute increments.
You need to outline your ‘did not attend’ (DNA) rules. These cover cases where the patient does not attend without prior cancellation within a set time frame or where your court appearance is cancelled within a given notice period. Decide what your charges will be in these instances and make sure that they are clear and transparent. Some legal practices have different time stipulations that may result in your fee being invoiced either in full or as a percentage there of depending on what notice was provided.
Payments rules
You will need to decide what your standard payment terms are going to be for your medico-legal reports. These will need to be tailored to the sector that you are operating in and reflect what you are prepared to enforce which may include penalty clauses for late payment.
You should have different payment terms for any court appearance, and these should also be applicable to any charges you enforce under your DNA policy.
Credit control
One of the major challenges of medico legal activity is cashflow. It is not uncommon for many of the medico legal practices we partner with to have considerable aged debt. At Civica Medical Billing and Collection, our UK-based dedicated account managers employ a robust system to reconcile and chase outstanding invoices in a timely manner
Access to up-to-date and accurate information about your aged debt is key as this will allow you to police your problem payers. Where there are issues with collecting payment from a particular solicitor/agency, then you can decide whether to take on other cases from the same company or you could end up making the problem worse. At Civica Medical Billing and Collection, our comprehensive reporting dashboard provides you with access to an array of reporting tools to analyse your data and tailor your approach accordingly.
Chasing outstanding monies owed is time consuming and many practices do not have adequate processes or infrastructure to do this effectively especially when this activity is combined with a clinical practice. At Civica Medical Billing and Collection, our tried-and-tested processes deliver a bad debt rate of less than 0.5% which is a 90% improvement on most private practices.
Often the best option is to partner with professional billing company who have years of experience in this field. At Civica Medical Billing and Collection, we have over 35+ years’ experience of partnering with consultants in this field so we can both optimise your revenue and cashflow as well as provide valuable advice and guidance.
Simon Brignall is Director of Business Development at Civica Medical Billing and Collection.
