What are Billable Services and Expenses for an LNC

One of the questions legal nurse consultants frequently ask me is, “What can I charge for?” The answer depends on the type of work performed, the expectations established with the attorney, and the agreement signed at the start of the engagement.

Understanding what is billable—and what is not—helps avoid misunderstandings, supports professional relationships, and improves your profitability.

Recently, I saw an experienced LNC ask, “Wait! I can BILL for that?” (She was referring to reading her expert witness deposition transcript.) Whether you are a new legal nurse consultant or have years of experience, it is worthwhile to periodically review your billing practices.

Billable Services

Attorneys expect to pay for the professional time you spend working on a case. This includes activities that require your nursing knowledge, analytical abilities, and consulting expertise. Many consultants bill in increments such as one-quarter of an hour.

Medical Record Review

Reviewing medical records is one of the most common billable services. This includes:

• Reading and analyzing records
• Identifying missing records
• Looking for inconsistencies
• Evaluating compliance with standards of care
• Identifying causation issues
• Assessing damages and injuries

The time spent reviewing records is usually billed hourly.

Some LNCs have a flat fee for screening a case for merit. But often that can penalize the LNC if the case is large or complex, making the flat fee inadequate to cover the work on the file.

Chronologies and Medical Summaries

Creating timelines and summaries requires careful examination of records and organization of information into a useful format.

Billable tasks include:

• Organizing records by provider or event
• Developing chronologies
• Writing medical summaries
• Preparing issue-focused timelines
• Creating treatment summaries

These billable services often save attorneys many hours of work and provide substantial value.

An AI program may dramatically cut the hours needed to organize the medical records and provide them in a chronological fashion that makes it easy to see the flow of events. Some LNCs have moved to flat fees for this phase of casework and spend their time verifying information and checking the accuracy of the AI output before applying their analytical abilities to the records.

Case Screening

When an attorney wants to know whether a case has merit, the analysis performed by the legal nurse consultant is billable and superior to AI programs because of the clinical experience an LNC possesses.

Case screening may include:

• Identifying strengths and weaknesses
• Idnetifing missing records and events
• Determining whether standards of care appear to have been met
• Highlighting areas requiring expert review
• Preparing written opinions within the LNC’s scope of practice

Research

Research related to the case is billable.

Examples include:

• Verifying the citations to medical literature if provided by AI (Both ChatGPT and Perplexity.ai have given me credit for writing books that I had nothing to do with.)
• Reviewing medical literature
• Researching standards and guidelines
• Locating professional organizations’ position statements
• Finding information related to medications, procedures, or diagnoses

The key is that the research directly relates to the attorney’s case.

Written Reports

Preparing written work products is a billable service because it requires both analysis and communication skills.

Examples include:

• Screening reports
• Expert witness reports
• Affidavits of merit, including travel to a notary
• Reviewing your own expert witness deposition and filling out an errata sheet pointing out transcription errors
• Case evaluation reports
• Deposition preparation reports
• Damage summaries, FRE Rule 1006 reports
• Missing record reports

Travel Time

Many legal nurse consultants charge for travel time when it is required for case-related activities.

Approaches vary. Some consultants charge:

• Their full hourly rate
• A reduced hourly rate
• A flat travel fee

Traffic conditions and the time of the day can greatly influence travel time.

An attorney who deposed me used MapQuest to estimate my travel time and said he would pay only for that amount. However, he checked the route during noncommuting hours and did not account for rush-hour traffic when I actually traveled. My client covered the difference.

One of the partners of one of my clients objected to my travel fee for coming to his office (a distance of 1.75 hours), which was my full hourly rate. He stated he “did not pay people to come to work” for him. I told him I was not his employee and if I was not sitting in my car, I’d be working on another income-producing activity. He dropped his objection.

Your approach to charging for travel should be outlined in the fee agreement before work begins.

Attorney Conferences

Time spent speaking with attorneys about the case is billable. Zoom conferences are convenient for the attorney and LNC and may be the first choice.

Billable services during attorney conferences may include:

• Participating in the initial strategy meetings
• Participating in case update calls
• Coordinating expert witnesses
• Discussing the case with experts
• Reviewing expert witness reports, both written for your client and for opposing counsel
• Refuting opposing counsel’s expert witness’ positions
• Planning demonstrative evidence and coordinating with medical illustrators and experts
• Preparing for depositions
• Revising case strategy based on deposition testimony
• Planning trial strategy

Depositions and Trial Attendance

If you are attending depositions, mediations, arbitrations, or trials related to the case, that time is billable.

Attorneys expect to pay for:

• Waiting time when your presence is required – including when someone forgot to notify the court reporter of the deposition and you sit for an hour waiting for the start (this happened to me twice) or the opposing counsel is caught up in traffic.
• Your time spent preparing for the deposition, including time spent with your client before the deposition, deposition time, mealtime and breaks, and time spent after the deposition with your client discussing what occurred.

Expert witnesses often charge separate rates for testimony, while other charge a uniform rate for all services they provide.

Billable Expenses

In addition to professional time, certain out-of-pocket expenses may be billed to the client.

Common examples include:

Mileage

When using your personal vehicle for case-related travel, mileage reimbursement is often charged at the current IRS rate.

Parking and Tolls

Parking fees, tolls, and similar transportation expenses are generally reimbursable.

Airfare and Lodging

If travel is required, attorneys usually reimburse reasonable expenses such as:

• Airline tickets
• Meals
• Hotel accommodations
• Ground transportation
• Airport parking

These expenses should be discussed and approved in advance whenever possible. And it is desirable to make the law firm responsible for paying for the airline tickets, rather than to seek reimbursement. Don’t assume that they will pay for first-class tickets, also.

Shipping and Courier Services

If documents, exhibits, or materials must be shipped, those costs are passed through to the client.

Record Acquisition Costs

Some consultants obtain records on behalf of attorneys. Fees charged by hospitals, physicians, or record retrieval services are reimbursable expenses.

In my experience, some providers attempt to charge more than is allowed. This is a specialized service, so be sure to do research on this service before offering to get involved in collecting records.

What Is Usually Not Billable?

Not every activity performed during the day should appear on an invoice.

General Marketing Activities

You cannot bill a client for time spent:

• Networking
• Attending marketing events
• Creating social media content
• Writing blogs
• Updating your website
• Developing business relationships

These are business development expenses.

Administrative Tasks

Routine office administration is considered part of running your business.

Examples include:

• Bookkeeping and invoicing
• Making collection calls
• Paying bills
• Filing records
• Organizing office supplies
• Maintaining software subscriptions

Attorneys do not expect to pay for these activities.

Training and Continuing Education

The cost of learning new skills belongs to your business, not to your client.

This includes:

• Conference attendance
• Educational programs
• Certification renewal
• Professional memberships

Even if the education benefits your work, you cannot charge it to a specific case.

Correcting Your Own Errors

If you make a mistake and must spend additional time fixing it, that time should not be billed.

For example:

• Rewriting a report due to your error
• Correcting inaccurate citations
• Repairing formatting mistakes
• Reworking a document because you overlooked information

Clients should not be charged for time spent correcting your errors.

Excessive Internal Discussions

If you have subcontractors or staff, extensive internal conversations that do not directly advance the client’s case are not appropriate to bill.

Establish Expectations Early

The best way to avoid billing disputes is to discuss fees before work begins. A written agreement should clearly define:

• Hourly rates or flat fees
• Retainer requirements
• Billing increments
• Reimbursable expenses
• Travel policies
• Payment terms

When attorneys understand what will appear on an invoice, they are far more likely to view your bills as fair and professional. And if you practice in an ethical manner, you will win over and retain clients.

Thoughtful billing practices demonstrate respect for your clients while allowing you to be compensated appropriately for the knowledge, analysis, and experience you bring to every case.

Get detailed, expert advice on how to manage billing and collections so that you can painlessly collect your cash and build solid client relationships. Order it now. 

Pat Iyer MSN RN LNCC is president of The Pat Iyer Group. She has almost forty years of experience developing resources to assist LNCs in obtaining more clients, making more money, and achieving their business goals and dreams.

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