What PIP Insurers Don’t Want You to Know: How to Maximize Your Bottom Line

Florida No-Fault Motor Vehicle Statute has survived despite ongoing discussions to implement an all-inclusive bodily injury law. Insurers are attempting to make providers’ lives as difficult as possible. PIP insurers are denying reimbursement to medical providers left and right. Manual therapy is considered massage therapy to Progressive. MPPR, NCCI, OPPS and similar acronyms are being included with the insurer’s denial letters to you, the medical professional. Fear not, we have a plan of action to ensure that you’re reimbursed.

Manual Therapy Denials and How we Get You Paid

Send your bills to the insurance company as you normally do. Include all relevant documentation including, but not limited to, your SOAP Notes and bills. Give our office a call if you receive what’s known as a 6B request for information. We have letters tailored towards responding to these requests. It is essential to comply with the 6B request for information prior to filing a PIP suit. Any suit filed prior to complying with a request is considered premature and will be dismissed.

Progressive and State Farm are currently denying CPT Code 97140. According to the AMA’s CPT codebook, CPT CODE 97140 states as follows:

“Manual therapy techniques (eg, mobilization/manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes.”

Progressive and State Farm are attempting to ferret out fraud in the world of PIP. These insurers are denying manual therapy alleging that the provider is truly providing massage therapy. As you may know, massage therapy is no longer reimbursable under the PIP statute. It is important to document all of your treatments. Make sure that you document the soft tissue and joint manipulation to ensure that the insurer properly reimburses you for manual therapy. Your bills will most likely be denied if you bill CPT Code 97140 and fail to attach SOAP Notes. If the insurer requests additional information, call us. Our firm specializes in PIP Litigation. Our goal is to ensure that you’re reimbursed timely and properly.

Medicare Coding

Many PIP insurance companies are utilizing Medicare Coding to deny or reduce bills. Acronyms such as MPPR, OPPS, and NCCI may appear on the explanations of benefits you receive in response to sending out your bills. Insurers believe that the new law allows them to apply any payment limitation so long as Medicare recognizes it. Our firm does not agree with the insurers’ rationale. The Legislature did not expressly list the Medicare methodologies that insurers may adopt and use in practice. There is absolutely no binding case law on this issue. Certainly, insurers cannot utilize coding or methodologies that restrict the number of services a provider can complete at a time. We are fighting for your reimbursement while attempting to set precedent. If you see any of these codes call us immediately to ensure that we properly respond to the PIP insurers.

Our law firm has a devoted PIP Team that focuses solely on every aspect of a PIP claim. The new PIP law has created problems for you, the medical provider. Our team has crafted arguments and strategies to deal with the nuances of the new statute. Do not trust the PIP insurer to properly reimburse you. We are happy to look over your bills and discuss the ramifications of each strategy going forward.

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