IT'S ALL FREE! Charging by the Inch

As a new legal nurse consultant, it can be difficult to estimate the time needed to review medical records. That's why some LNCs opt for an easier way to charge for medical record review. Instead of charging an hourly fee, they charge for each inch of records. For example, if their per-inch fee is $100, they charge $300 to review 3 inches of records. This fee schedule simplifies their lives, but is it a good idea? 

There are several problems with this type of fee schedule. For example, typed records (dictated or entered electronically) are much easier to read than handwritten ones. Thus, dictated records will take less time to review and analyze. Some electronic medical records, although easy to read, can be repetitive and therefore take more time to decipher.

On the other hand, handwritten notes can vary widely in legibility. Records with bad handwriting can take a very long time to decipher. If you think the time needed to review handwritten and typewritten medical records will balance each other out, think again. One inch of handwritten records may take as long to review as three or four inches of typewritten records.

In addition, some records are more important to the case than others. You may need to spend extra time on certain records to determine the nuances of the case. If that happens, your fees may be unrealistic leaving you with two undesirable choices: be profitable by glossing over the other records in the case or be thorough but unprofitable.

And finally, what if the number of inches wasn't accurately quoted? For example, what if you negotiated to review six inches of records but you were sent eight inches? Again, you have two undesirable choices: review all the records, resulting in less (or no) profitability, or renegotiate your fee with your client which could jeopardize your relationship with the client.

What's the alternative to charging by the inch? Set up a realistic fee schedule that's based on actual time for your services. Get a retainer. Explain upfront that additional fees may apply depending on length of time needed to review the records.

...Katy Jones