Recently, I have had the misfortune of requiring the services of some of my more esteemed members of the legal profession. My faithful readers will be happy to know that it has nothing to do with malpractice, but it does have to do with this blog. Rest assured I will be more forthcoming in future weeks about the situation, but for now, especially after learning when not to blog about legal proceedings thanks to the misfortune of fellow-blogger, Flea, I will table any discussion regarding my circumstances.
But that does not mean I can’t speak about what I have learned from my lawyers, especially about how their billing practices differ from doctors’ billing practices. To say I am envious how they conduct business is an understatement. For when it comes to accounts receivable, lawyers rock. (I can’t believe I’m saying this, but it’s true).
So here are the differences I have realized so far:
- Lawyers work in their offices, then travel to court rooms, billing for their travel expenses there. Doctors work in their offices and travel to hospitals. They drive their own car to the hospital and pay for gas that is not reimbursed.
- Courtrooms do not bill patients or lawyers. Hospitals always bill patients.
- Lawyers bill by the hour. Doctors bill by the procedure.
- Anyone can see a lawyer, but they'll have to pay for it. Anyone can see a doctor at anytime (can you say ER?) without concern of having to pay for it.
- Senior law partners make $595 per hour and junior law partners make $395 per hour. This pays for their expertise, office expenses, including personnel, etc. Doctors are paid irrespective to experience and are paid much less than lawyers, but few really know what their hourly wage is because it differs from patient to patient and procedure to procedure, based on the patient’s insurance plan.
- Lawyers do not accept partial payment from their clients. With the exception of most plastic surgeons and some dermatologists who are cash-only, most doctors must accept partial payment from their patients based on pre-negotiated agreements with insurers as payment in full.
- Lawyers divide their hour in 0.1 increments (6 minutes) and bill for work accordingly (the smallest time I was billed for was 0.2 hr – 12 minutes). We must work for over 20 minutes to move to a level “2” evaluation from a simpler, level “1” evaluation.
- Lawyers bill for conversations, research, phone calls, meetings at the same rate as they do for being in court. Doctors’ do not bill for time spent discussing cases, research, phone calls, or meetings – their income comes from “bundling” of a single Medicare payment from their time before and during surgery.
- Lawyers continue to bill for additional services rendered after being in court. Doctors cannot bill for any evaluation of a patient after surgery for 90 days, lest they be prosecuted by Medicare for “double-dipping.”
- Lawyers describe the service rendered and bill for it based solely on the time required to complete the task. Doctors can describe and describe their service until their blue in the face, but unless they add a family history, 12 elements of a review of systems, do 15 back flips and thirty push-ups, they cannot bill a level “5” consult.
- If lawyers do not get paid, they sue you directly. (God help you.) If a doctor does not get paid, doctors either write off the loss or pay for a collection service to hound you or sue you and, if lucky, receive 60% of the amount due.
In summary, lawyers set their own value, guard it carefully, and increase their hourly wage based on reputation, supply, and demand. Doctors, on the other hand, have succumbed to socialist pressures that have prevented a more realistic, capitalist approach to their economics. As such, they have allowed their value to be set for them by others and have watched their market value (and any ability to negotiate their value going forward) to dwindle, irrespective of specialty.
No wonder there’s a doctor shortage looming.