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  • Writer's pictureJoel White

Clinical Research Focus: Overcounting

The #1 determinant of how quickly, efficiently, and accurately you bill clients is not based on what financial system you use, or how integrated it is with operational systems, or the size of your A/R team.


It's how much stuff you have to count to get the invoice out the door.


Let's say you are a CRO writing a contract for a new 3 year full service project. You typically have 3 options below for setting your billing structure. Think about each option and how much resource across your organization is required just to count what needs to be counted to get an invoice out the door:

  • Unit Based- 50-80 or more unit types, tracked every month and cumulatively for the next 3 years.

  • T&M Based- Timesheet hours entered and approved (hopefully) every week for 15-30 or more people for the next 3 years.

  • Milestone Based- 8-12 total project milestones, one or two of which may be fixed flat monthly payments over 3 years.

Now, even if you say ok we are going milestone based, there will be cases where you must or want to take a unit based approach. Or, you might hate milestones for other reasons and want to stay unit based every time. Even there, you have numerous options within your control to reduce how many different things you have to count, without negatively impacting cash flow.

  • Entire Sections- take an entire section, like Feasibility, and say the entire section is 50% upon project start, 25% for Month 2, and 25% for Month 3, even if the pricing grid has 10 lines of different unit types. There is no law against applying a payment schedule to a service area.

  • Months instead of Items- it's incredibly easier to count Months versus Items. Item types you should consider charging as Month instead of per-item: recurring meetings, data review, site management (and yes, even monitoring), site payments, TMF, medical coding, and numerous others.

  • One-Time instead of Items- it's also far easier to determine "yes/no" versus "# of". Look for units based on counts where the counts are trivial or largely within your control, and change both the pricing and billing basis for those units to One-Time (or Project, etc.) instead of per item.

  • One-Time instead of Months- any duration-driven unit that is short duration (< 3-6 months), set as a unit of Project and notate "invoiceable upon initiation".

  • Consolidate Units- review units that 1) are mutually inclusive and 2) have similar drivers and consolidate as many of these as possible, either in terms of merging the units together or at least having them counted the same way for invoicing.

  • Ongoing vs Closeout- where you have both types of units for the same service, fold Closeout into Ongoing/Maintenance.


What About T&Ms?


There are occasions when T&Ms still make sense. Know that there is no magic bullet to making this easier, especially for complex service organizations. Whatever your system is set up to do, some clients will want something different. The way you price will not always perfectly align to your timesheet categories. Even if you set up your timesheets in strict accordance with your pricing units- even your client units- there will be headaches on the back end. Most importantly, timesheet accuracy and compliance is historically terrible for service providers.


So how do you do less counting for T&Ms?

  • Contract fewer of them- move as many new contracts as possible towards milestone and unit billings.

  • Consolidate your task structure- if you're going to routinely sign hourly based contracts, reduce the number of tasks your team codes time to, to as few as possible.

  • Consolidate your role structure- the more roles you have, the more lines for you to track and client to pick apart.

  • Go hybrid- convert at least some of your most repeatable, controllable services into one-time or easily countable units.


Bottom Line


Stop overcounting! Use billing structures that require as little counting as possible. When you have to use a structure that requires more counting, get creative in reducing how many things need to be counted. Get your invoices out the door far more quickly with far less effort, and stop making your customers review so much damn detail! (even if they act like that's what they want)


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Contact me or book a meeting to discuss how these principles can be applied to improve the performance of your organization.


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