Step 1: Decide If PI Lien Work Fits Your Practice
Before you order forms or call attorneys, run an honest fit check. PI lien work is profitable, but it's slow money — you're extending credit to a patient whose case may not settle for 8–18 months. You need other revenue covering payroll while those cases mature, and you need staff bandwidth to chase status updates without dropping the ball on insurance patients.
Good fit if...
- You treat acute soft-tissue or musculoskeletal injuries (chiro, ortho, PT, pain mgmt, neuro)
- You have 60+ days of operating expenses in reserve
- You can dedicate at least 5–10 hrs/week of admin time to lien tracking
- You're in a metro area with active PI firms
Wait if...
- You're cash-flow-tight and rely on weekly insurance deposits to make payroll
- Nobody on staff has bandwidth to own lien follow-up
- Your specialty rarely sees accident-related injuries
- You're in a small market with only 1–2 PI attorneys total
Rule of thumb: most active PI lien practices need roughly $15–30K in working capital per month of cases to comfortably wait out the settlement cycle.
Step 2: The 6 Forms You Need Before Day One
Don't reinvent any of these. Have a healthcare attorney in your state spend 2–3 hours customizing templates — total cost is usually $1,500–$3,000 — and you're done. These six documents protect your right to be paid, give you legal access to discuss the case with the attorney, and make it clear the patient is on the hook if the case doesn't settle.
1. Medical Lien & Assignment of Benefits
The core document. Establishes your legal right to be paid out of any settlement, judgment, or verdict. Patient signs; attorney countersigns acknowledgment. State-specific language matters — some states require recording the lien with the county.
2. Letter of Protection (LOP) Template
A separate written commitment from the PI attorney to pay your charges out of settlement proceeds. The lien protects you against the patient; the LOP protects you against the attorney's office. Always get both.
3. PI Patient Intake Form (Accident Details)
Captures date/location/type of accident, the at-fault party's insurance carrier and policy limits if known, the patient's UM/UIM coverage, prior accident history, and the attorney's name, firm, direct line, and email.
4. HIPAA Authorization
A standard HIPAA release that specifically names the patient's law firm and authorizes you to share records, bills, and case-related communications with their team. Without it, you legally can't talk to the attorney about the patient.
5. Authorization to Release Records to Attorney
A separate, narrower release the attorney's office can present when requesting your records, narrative reports, and bills. Streamlines records requests and keeps your front desk from re-validating consent on every call.
6. UCR Charge Sheet
Your full Usual, Customary, and Reasonable rate schedule for every CPT code you bill. PI lien charges are not insurance-discounted — you bill full UCR. You need a defensible, written rate sheet on file the day you see your first PI patient.
Step 3: Build Your Attorney Referral List (Even If You Start with Two)
PI patients come from PI attorneys — not from primary care, not from word-of-mouth, not from Google ads. You don't need 20 attorney relationships to start. You need 2 good ones. Two mid-size PI firms can keep a starter panel of 15–30 active cases full year-round.
First 5 things to do this month
- 1Pull 5–10 PI firms within 15 miles of your office. Email each one with a one-paragraph intro and offer a 15-minute facility tour.
- 2Ask your current patients (especially anyone with a prior accident) which attorney represented them — request a warm intro to that attorney.
- 3Attend the next local trial lawyers' association CLE or networking event. Most state TLAs hold these monthly and welcome doctors.
- 4Set a 24-hour response SLA: any attorney call, email, or records request gets a same-day reply. This single habit puts you in the top 10% of providers.
- 5Join Disbo's medical provider network to be discoverable to vetted PI law firms searching for treating physicians in your area.
Realistic expectation: your first PI patient typically walks in 4–6 weeks after the first round of attorney introductions.
Step 4: Train Your Front Desk on the PI Intake Script
PI intake is fundamentally different from insurance intake. Your front desk has to identify a PI call within 30 seconds, capture accident and attorney details accurately, and route the patient to the correct paperwork stack — without scaring them off. Write a one-page script and roleplay it twice with every front-desk staff member before going live.
The 8-question PI intake script
Step 5: Set Up Your Tracking System (Spreadsheet or Software)
Your EHR tracks clinical care; it does not track lien status. You need a separate tracking system from day one. A Google Sheet works fine for the first 25 active cases. Past 25, manual tracking starts costing you real money — typically one missed settlement notification = $3,000–$8,000 in unrecovered charges.
Minimum spreadsheet columns
- • Patient name & DOA (date of accident)
- • Attorney name, firm, direct contact
- • Treatment start/end dates & MMI status
- • Total billed charges (running)
- • Lien & LOP signed (Y/N + date)
- • Last attorney contact + next follow-up
- • Settlement status & expected amount
- • Disbursement received & reduction taken
When to graduate to software
- • You hit 25+ active PI cases
- • You're missing weekly follow-ups
- • You learn about settlements weeks late
- • Your aging report takes > 1 hour to build
- • You want real-time settlement notifications
- • You want electronic disbursements (not paper checks)
Step 6: Your First 30 Days: What "Normal" Looks Like
Set expectations early so you don't panic when the pipeline feels slow. Here's what a typical first 30 days looks like for a doctor opening up to PI lien work for the first time.
Forms finalized with healthcare attorney. Front desk trained on the intake script. Tracking spreadsheet built. First batch of 10 introduction emails sent to local PI firms.
Follow-up calls to non-responders. First 1–2 attorney calls or facility tours scheduled. Confirm malpractice carrier in writing.
First 1–2 attorneys visit. Expect questions about your specialty, your typical treatment plan, your billing rates, and how quickly you turn around narrative reports.
First PI patient referral typically lands. Run the full intake. Send a copy of the signed lien + LOP back to the attorney within 48 hours — that single habit cements the relationship.
Common Setup Mistakes to Skip
- Using a generic 'lien' template downloaded from the internet — state-specific language matters and a bad lien is unenforceable.
- Skipping the LOP because the patient already signed a lien. The lien binds the patient; the LOP binds the attorney. Get both.
- Discounting your charges to insurance rates because it 'feels fair.' PI lien charges are billed at full UCR. Discounting upfront just gives the defense room to push you lower at settlement.
- Saying yes to every attorney who walks in. Vet attorneys before you accept their patients — one bad firm can tie up six figures of your charges in cases that never settle.
- Letting the lien get signed at visit 2 or 3 instead of visit 1. If a patient leaves AMA before signing, you have no claim against the settlement.