A consultant share computed on billed value transfers the payer’s deduction risk onto the doctor without saying so. A share computed on collected value states it openly and reconciles.
The four models, and where each one breaks
Every consultant arrangement in an Indian hospital is a variant of four structures. They differ less in generosity than in who absorbs the gap between what was billed and what arrived.
| Model | Computed on | Who absorbs a deduction | What it needs to compute |
|---|---|---|---|
| Fixed retainer | Nothing variable | The hospital, entirely | A calendar |
| Per-case fee | Cases performed | The hospital, entirely | A verified case list |
| Percentage of billing | Gross billed value | The doctor, silently | The bill only |
| Percentage of collection | Value actually received | Shared, and stated | Bill, receipt and settlement advice |
The third row is the one that causes disputes, because nothing in the arrangement announces it. A consultant on twenty per cent of billing whose claims are cut ten per cent is, in effect, on eighteen per cent — and finds out at the end of a quarter rather than at the point of agreement.
What a collection-linked payout has to show
Moving to collection-linked payment is only fair if the doctor can see the collection. Otherwise it is the same risk transfer with better vocabulary. A defensible payout line carries four things.
| Field | Why it is on the line |
|---|---|
| The case reference | Ties the payout to a specific admission or encounter |
| Billed value | What the hospital claimed |
| Collected value | What actually arrived, and on what date |
| Variance reason | If the two differ, the clause or the shortfall that explains it |
Where a claim is unsettled, the honest treatment is to hold the line rather than drop it: pending is not the same as denied, and a payout that quietly omits pending cases reads as a reduction.
The conversation this is actually for
Most consultant disputes are not about the percentage. They are about a number arriving with no way to check it. A payout that shows its own arithmetic ends the argument before it starts, and that is worth more than a point of margin either way.
Questions we get asked
Should a consultant be paid on billed or collected value?
Either can be fair, but only one is transparent. A share of billed value silently transfers deduction risk to the consultant, because the hospital pays out on money it may not receive and adjusts later. A share of collected value states the risk openly, and requires the hospital to show the collection behind each line.
What should a consultant ask to see on a payout statement?
The case reference, the billed value, the collected value with its date, and a reason wherever the two differ. Pending collections should appear as held rather than omitted, because a line that silently disappears is indistinguishable from a reduction.
On the figures in this piece. Every rupee amount above is arithmetic on the assumptions stated beside it, not a market statistic. Where you need published Indian claim data with its source named, that sits on claim data. We publish no figure we cannot show the working for.