Defining a Legal Nurse Consultant Fee Schedule
Fee schedules are a list of costs and services that legal nurse consultants provide to attorneys. They help legal nurse consultants determine the standard fee for a specific service or product and allow them to compare revenue and expenditure ratios. Attorneys often require a legal nurse consultant fee schedule when there are multiple services performed in a case or to set up a retainer, which is a pre-paid fee paid by the attorney at the beginning of a case.
A fee schedule can be a simple list in alphabetical order of services provided, or more comprehensive, complete with services descriptions, codes, sub-codes, per hour fees, and add-on services for billable items. It should also include an explanation of a retainer, a list of payment options, and a series of conditions under which the retainer would be used .
Common items included on fee schedules are a la carte service listings, hourly billing rates, overtime rates and additional service charges, as well as a breakdown of items needed to properly bill a service or product. Types of services and products listed on a fee schedule might include transcripts of depositions, copies of affidavits or other legal documents, copies of tests or reports, telephone charges, travel time, patient graphing and hospital registries, processing fees, and more. The schedule might also include time estimates per task to determine the due date for reports.
LNCs should be organized and detailed when creating their fee schedule, since a vague document will cause confusion and lead to misunderstandings.
Factors Affecting Legal Nurse Consultant Fees
Given the broad variation in the size, complexity and demands of tasks that a legal nurse consultant may face, it should not be surprising that fees also vary widely. Generally, there is no set fee schedule across legal nurse consulting nationwide and most legal nurse consultants establish their own rates. Hourly legal nurse consultant fees have been known to range from $50 per hour to $175 per hour. Thus, factors for reviewing and establishing fee schedules for legal nurse consultants include:
Experience Fees typically reflect the average going rate for the level of experience or expertise of the consultant. For example, legal nurse consulting services rendered by a registered nurse with five years experience as a registered nurse may be expected to be higher than that charged by a recent nursing school graduate. Similarly, if the nurse has spent five years working in the area of mental health and specializing in evaluating cases involving trauma, record review, or other aspects of the civil litigation process, the legal nurse consultant has a unique expertise to offer. Such knowledge is reflected in the fee schedule. However, this does not mean that inexperienced nurse consultants need to charge the least for their services. By exhibiting a solid work product and conscientiousness and professionalism, the inexperienced consultant may still be able to compete in the marketplace.
Complexity of Case While most legal nurse consultants are adept in several areas, some nurses may choose to specialize. For example, some may have experience working in the areas of cancer, while others may work with patients suffering from back injuries. Still others are skilled in reviewing medical records in such areas as emergency room care, cardiac, and obstetrics. The more skilled the legal nurse consultant is in evaluating specific case types, the more justified are the fee structures.
Geographic Location The geographic area or location of the legal nurse consultant may also play a role in fee structures. For example, since cost of living varies from city to city, services priced in a high cost of living area may be higher due to the increased overhead associated with providing the service in that area.
Common Legal Nurse Consultant Fee Structures
Just like with many other professional service providers, Legal Nurse Consultants may charge a variety of ways depending upon the case and client. These different methods for charging for time and expertise dovetail with what the firm may decide to pay the consultant on their end.
Hourly — The consultant has a set hourly fee (based on the areas of practice, level of experience, and perhaps other factors). The client is then charged this set rate for every hour or portion thereof that they work for the case in question. The fee is typically broken out on an invoice giving a precise breakdown of the consultant’s time and activities for the case. A hybrid of this sort of arrangement might be an hourly fee for medical-legal consulting and a flat rate for record review.
Retainer — A retainer is a total fee agreed upon up front, which is billed against as the work progresses. While your typical fee agreement might break down the retainer amount into so much per hour for so many hours, the bottom line is that the consultant will not do any work beyond that amount without first discussing extra fees with you.
Flat Fee — In this model, the consultant is paid a set fee for a specific task. For example, a 5-hour record review might be a flat rate of $500—you know right up front what you’re going to spend.
Other billing models include fee sharing (the consultant gets 10% of any settlement or other fee awarded to the client), a contingency fee (in which the client agrees that they don’t have to pay unless the case is won), and a no-win, no-fee arrangement (the fact that the matter is lost does not cost the client a penny). These sorts of arrangements are most common for personal injury cases, where the potential award can be substantial and the consultant’s fees are a small fraction of the total.
How to Develop a Fee Schedule
In order to determine a fee schedule, research your market. How do other expert witnesses in your field charge for their expertise? If you don’t know where to look, start by searching the American Association of Legal Nurse Consultants (AALNC) member directory. The directory is a members only benefit, but if you contact headquarters, they may be able to provide the information. A quick Google search can also get you information on what other experts in your field are charging.
Once you are aware of what other experts are charging, you need to understand your target market. In the past, there was a more traditional method of hiring experts, once you figure out how your prospects want to hire you, you have to tweak the fee schedule to meet their needs. The more forward thinking attorneys, like those in the medical malpractice field, are hiring their experts through online services like Experts Online.
You will also have to decide whether you want to offer different packages for your services . For example, if your research shows that other experts are offering $500 and $150/hour options, which package makes sense for your business? While your price set initially puts you in competition with the other experts and your fees should all fall within a range that the market will bear, it’s better to be the same amount than to be both less expensive and more expensive. Knowing the "going rate" for your services can help you position yourself.
Here is a sample Fee Schedule for my business: Davidson and Associates Nurse Consulting provides nurse expert witness services in the areas of OB/GYN and Urology. We are willing to testify as either the expert or consulting expert, and we offer support services for additional fees, such as reviewing records, researching issues, providing chart reviews and doing witness preparations.
The time required for reports and depositions is always included in our hourly rates.
Moreover, Physician and Legal Charges are not included in our fees.
Determining Fees – Negotiating
When you first meet with a new client, we suggest that you discuss your fees clearly and professionally. This means that you should have a documented fee schedule handy to show them and to leave them with. You also want to maintain your integrity so don’t negotiate away from your written schedule model to accommodate a client. Instead, suggest that they can pay by charge card. You should never discount your rates.
Legal Considerations In Fee Schedules
Legal Nurse Consultant Fee Schedules may also be governed by contractual provisions, laws and regulations that the medical malpractice plaintiff can rely upon to establish the validity of the fee. It is important that the Legal Nurse be versed in federal and state consumer protection and contractual law. Under those statutes, the language of the contract will govern unless legislation renders the statutory language in the contract unenforceable.
As stated by one court:
Contract law governs the performance of all contracts, including a contract for medical services. Russell v. Knicky, 616 N.E.2d 1, 12 (Ind. Ct. App.), trans. denied, 622 N.E.2d 921 (Ind. 1993). "Our goal is to ascertain and give effect to the parties’ intent as expressed in their agreement." Id. Whether the contract is ambiguous is a question of law for the court to determine. Id. A contract is unambiguous when reasonable persons could not disagree as to the meaning of the contract’s terms. Id.; Mitchell v. Schilsky, 593 N.E.2d 1247, 1250 (Ind. Ct. App. 1992) , trans. denied, 605 N.E.2d 738 (Ind. 1992).
Each party has a duty to exercise good faith and fair dealing in the performance of the contract. Mitchell, 593 N.E.2d at 1250. However, this duty does not expand the terms of the contract or create a new contract between the parties. Id. "The duty to engage in good faith and fair dealing in a contract arises because every contract carries with it an implied covenant that a party will not do anything which will have the effect of destroying or injuring the right of another party to receive the fruits of the contract." Russell, 616 N.E.2d at 12.
The duty to engage in good faith and fair dealing means that the parties must deal fairly with each other, not that they must agree to every term offered by the other. Mitchell, 593 N.E.2d at 1250; see also Russell, 616 N.E.2d at 12. In other words, the duty of good faith and fair dealing does not require one party to render a performance that is in fact contrary to its financial interests. Mitchell, 593 N.E.2d at 1250.