Don’t Fall For A PIP Insurer’s Tricks! Why It’s Important To Continue Billing!

June 8, 2016 in

Florida PIP Statute Requires:

  1. All Medical Providers (With the exception of hospitals and emergency service providers) to submit their bills within 35 days of date of service.
  2. Can submit up to 75 days of the date of service if:
    • You send a simple letter to the PIP insurer indicating you initiated treatment within 21 days of the initial visit with the patient (there is a form);
    • No specific form required. Simply indicate treatment was initiated within 21 days from the initial visit!

PIP Insurer Defenses And Tricks

The PIP insurer may choose to cut off future benefits utilizing an Independent Medical Examiner (“IME”) or a Peer Review.

What Is An IME?

An IME is simply an independent doctor who sees your patient once and decides whether a certain treatment is reasonable, related and medically necessary in light of the injuries sustained.

What Is A Peer Review?

Simply a mechanism for looking over medical records and deciding whether a certain treatment is reasonable, related, and medically necessary in light of the injuries sustained.

This may be done by one doctor or a group of doctors. In most cases, these evaluating doctors do not see your patient.

Certain treatment is reasonable, related,  and medically necessary in light of the injuries sustained.

What You Should Do

Continue billing. An insurer’s use of the above defenses does absolutely nothing to your normal billing time frames.  Unfortunately, despite the insurer’s refusal to reimburse your office, you must continue to comply with the PIP statute. Your office still remains obligated to bill with the 35 day period or the 21/75 day period.

DO NOT fall into their trap. If an insurer indicates all benefits are cut off after a certain date, you must continue to bill the PIP insurer, despite your knowledge of the denial. The statute remains the same; bill within the statutory time frames, the insurer will make a decision to pay or deny, and we will demand then if warranted file a PIP suit on your behalf.

What Happens If Your Refuse To Bill Because You Know The PIP Insurer Won’t Pay You 

YOU WILL NOT BE PAID.  As unfair as no reimbursement sounds, the Florida PIP statute requires your office to continue billing within the above statutory time frames. This rule is set in stone. Failure to timely bill leads to billing defense in addition to the IME and Peer review defense. Bill timely, and we will get you everything your office is owed.

What Happens If I Don’t Know Which Is The Correct Insurer?

Rely on the information you have. Bill the company your patient believes to be the proper PIP insurer. It all comes back to the GOLDEN RULE: bill timely.  Do not worry about having all the correct information at the initial billing point in time.

You can always retrieve the correct information from the patient/patient’s attorney. As soon as you have the correct information at your disposal, simply attach the timely billing and a statement indicating you relied on bad information.  We have forms and can help you complete a simple letter indicating the same.  This “exception” to the timely billing rule is actually contained in the Florida PIP law and gives you the opportunity to amend billing down the road.  Again, ERR on the side of BILLING.

Keep All Health Insurance Claims Forms/UB’s And Mail Receipts/Envelopes

It is important to keep all HICFAS/Bills and envelopes or mail receipts. If the PIP insurer claims they did not receive bills from your office for a particular claim, you will be able to prove they were in fact generated and mailed timely. The envelope or mail receipt will prove timely mailing. The bill will prove that one was generated with the proper services were rendered to the patient.

It is enough to keep a copy of the bill, and photocopy of the mail receipt or envelope electronically. Simply keep this stored on your desktop/computer network. We can certainly upload this information when we audit your files. Capturing this information creates a system of checks and balances. The PIP insurer may allege they did not receive your bills. They may also allege the first submission of your bills was at the demand stage. Make sure to keep a copy of all relevant documents to ensure reimbursement in a timely manner.

I cannot tell you how many claims I have litigated due to the insurers’ contention that they did not receive the bills. The majority of the time the PIP insurer is wrong. Moreover, it’s equally as important to continue billing regardless of what the PIP Insurer does. IMEs, Peer Reviews, allegations of untimely billing, should not cease your billing operations. Bill, re-bill and bill some more. We can help you with any billing issues such as sending information to the correct insurer on a re-bill, defeating the PIP insurer’s defenses to ensure reimbursement, etc. The LaBovick PIP team is highly trained in all PIP litigation and has experienced defeating insurers on these billing issues. Give us a call today!