The devil is in the detail

Medico-legal reports can be a valuable revenue stream if you manage the billing effectively. Simon Brignall discusses some of the problems you may face with this work, including the importance of ensuring you devise terms and conditions. 

The composition of revenue streams in a typical private practice can be varied and may change over time. 

When they start out in private practice, many consultants opt for a clinical-based practice treating predominantly self-pay and insured patients. 

The practice could also include embassy or NHS patients in a private hospital – often referred to as choose and book – depending on where it 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. 

This portfolio approach can be accomplished in many ways and often may be as simple as adding a new practice location with a different patient demographic. For example, adding a central London location will likely increase your exposure to international self-pay and embassy patients.  

Medico-legal work

One option consultants choose is medico-legal activity, but they can be put off because they often find the medical billing and credit control challenging. 

So I thought it would help to focus on this sector this month, explaining what you need to know from a billing perspective if you are thinking of expanding into this area.

The medico-legal sector is extremely fragmented with thousands of solicitors working in this field either independently or as part of a group alongside the work coming from the medico-legal agencies. 

This wide range of potential clients means you often need to manage a multitude of commercial relationships, so it is important to be able to standardise these where possible. 


Terms and conditions

The most effective way of doing this is to have detailed terms and conditions (Ts&Cs) in place before any work is carried out. Your Ts&Cs should include your fee structure and payment terms. 

Practices that do not have these in place can find the case they have been working on turns out to be on a ‘no win, no fee basis’, which can mean they end up waiting years for their money. 

Remember, problems around delayed/deferred payments will negatively impact the cash flow of the practice and will only become more of an issue if they are inadequately addressed.

It is important to note that when you raise an invoice, you create a tax liability, which means that until you collect the money 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 Majesty’s Revenue and Customs every quarter – which just exacerbates the problem.

Ensure you have clear terms and conditions that are agreed by your client when they engage you. These should cover the following specific areas. 


How much do you want to charge for your standard medico- legal report? This should be based upon the length of time taken to review medical records, include any interview or examination of the client, including any dictation and preparation of documents. 

You may prefer to quote an additional cost per hour to provide some flexibility for cases that take longer to review, particularly where there are a large amount of medical records or where the case is very 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 do 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 they are clear and transparent. Some legal practices have different time stipulations that may result in your fee being invoiced either in full or a percentage thereof, 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. They can 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

As in all aspects of medical billing, it is important to ensure you have a robust system to reconcile and chase outstanding invoices.

The most important step is to always make sure your fees and terms and conditions are accepted up front before taking on any case. 

Once you have raised the invoice and it has been sent to your counterparty, then it needs to be followed up with a phone call to ensure it has been accepted and has been put on the solicitors/agency system with the correct payment terms.

Your practice will need to ensure it has an effective system to routinely chase outstanding invoices to ensure payment is made 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. 

Reporting tools

You may ask them to settle any invoices in full before you take on any new business from them. 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.

As your reputation and workload increases, you may choose to consider how you prioritise your availability and whom you work with based on many factors which will often include how quickly they pay.  

Chasing outstanding money owed is time-consuming and is the hardest part of the administrative process. Many practices do not have adequate processes or infrastructure to do this effectively and can find the task intimidating. 

It is only through the routine application of a rigorous chase process that aged debt and bad debts are kept to a minimum and cash flow is optimised. Our tried and tested chase process ensures we have a bad debt rate of less than 0.5%.

Practices taking on medico-legal work often do not have time to effectively carry out this task or they find they lack the specific skill set. This is especially the case when medico-legal work is just one component of the many tasks managed by the practice team.

For most practices the best option is to use a professional billing company who have years of experience in this field. Ideally, this will be before you start doing medico-legal work. But if you have been in the sector for some time, have experienced some of the problems I have related here and feel you want to gain control over the situation, we would be happy to hear from you.

Simon Brignall (right) is director of business development at Civica Medical Billing and Collection