South Florida Hospital News
Tuesday July 7, 2020
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January 2020 - Volume 16 - Issue 7
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Ged Lawyers: Helping Providers Recover Millions of Dollars in PIP Benefits

In Florida, the No-Fault Insurance Law requires that all motor vehicle owners purchase Personal Injury Protection (PIP) insurance. PIP coverage pays up to $10,000 of the medical expenses of a patient when he or she suffers any injuries in a car accident—no matter who is at fault. PIP may also provide coverage of lost wages in certain circumstances. The intent of this law, passed in 2012, was to reduce auto accident fraud, lower the cost of auto insurance premiums, and reduce litigation costs.

What PIP Covers
The No-Fault Law in Florida provides coverage for patients if he or she:
• Owns a vehicle
• Is a passenger in a vehicle
• Resides with a resident relative who owns a vehicle
• Is a pedestrian
 
If a medical provider deems that PIP coverage should apply to medical services provided to the injured patient, the provider has to notify the insurance carrier. Under the No-Fault Law, they have 30 days to pay the provider. However, Glen Ged, founding partner of Boca Raton, FL-based Ged Lawyers, LLP, which specializes in handling PIP claims, notes that these claims often represent the worst-performing revenue stream for hospitals.
 
Collecting PIP Benefits for Providers
The law firm can help providers become more proactive in collecting PIP benefits in several ways, first by educating and training the provider’s admissions staff. They will review the intake forms to ensure the provider is capturing all necessary information.
 
“Hospitals are missing a significant stream of revenue under the No-Fault Law because they are not asking the right questions on the intake forms,” says Ged. “This is a simple fix.”
 
Some providers only ask if the injured patient owns a vehicle. If the patient answers no, they could still be covered under the No-Fault Law if they were a passenger in the vehicle, live with a relative who owns a vehicle in Florida, or was a pedestrian. But some intake forms do not ask these other questions meaning that the provider can lose out on $10,000.
 
“If you have 100 patients come through, that’s one million dollars of lost revenue,” adds Ged. “We offer a free evaluation of their intake forms to make sure they capture the necessary information.”
 
Next, they will assist the provider by seamlessly gathering all the necessary records, including:
• Assignment of Benefits (AOB)
• Explanation of Benefits (EOB) and Billing Ledger
• Auto Insurance Information
 
Sometimes the carrier will deny claims based on the following:
• Reduced according to an alleged usual and customary charge or based upon geographic region
• Denied based upon an IME cut–off
• Denied for failure to appear at a EUO
• Denied based upon an alleged material misrepresentation
• Paid at 200% of Federal Medicare Fee Schedule or Florida Workers Compensation Fee Schedule
 
If they do not pay within 30 days, Ged Lawyers will send a Statutory Demand letter on behalf of the providers giving the carriers another 30 days to pay. As a result, Ged says about 80 percent of the time; the bill gets paid.
 
“Providers lose revenue as well because they were not sending a Statutory Demand letter when the bill was unpaid,” says Ged. “This hurts cash flow and exposes the provider to exhausting the medical benefits that are available.”
 
Conducting Retrospective Audits of Unpaid PIP Claims
In addition to recovering this lost revenue for current claims, Ged says they can also help with the recovery of forgotten PIP receivable accounts through a retrospective audit.
 
“Under the Florida statute, we can go back five years and audit these unpaid bills because the claim is based on a breach of contract,” says Ged. “Sometimes, we can go in and find hundreds of millions of dollars for clients.”
 
This retrospective audit is relatively simple. The healthcare provider authorizes access to the Ged Lawyers’ audit team for their PIP billing cases. If the records have not been electronically provided, then the audit team will have the files delivered to the law firm’s 85,000 sq. ft. offsite facility and deploy mobile scanner vehicles to scan the files. The audit process begins by indexing each case and applying its internal algorithm. Through this process, they can identify overdue benefits under the No-Fault Law. At this point in the process, the Statutory Demand letter is sent to the insurance carrier. If necessary, Ged says they will file a lawsuit to collect overdue benefits and litigate through final judgment.
 
For one hospital system in Florida, Ged and his team were able to collect over $2.8 million. They deployed mobile scanner vehicles and an audit team to scan over 10,000 boxes of medical and billing records. They also helped an imaging center in Florida collect over $3.7 million using the same method.
 
What distinguishes the law firm from others in regards to recovering PIP claims is that they have a dedicated team solely focused on PIP.
 
“Many people try to do this type of work for providers, but they don’t have specialists as we do,” says Ged. “Our staff of lawyers who handles these claims used to work for insurance companies. We make the process seamless and take the burden off hospital employees who can focus on other things.”

For more information, visit www.gedlawyers.com.

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