The uncertainties of health care reform make at least one thing certain — hospitals and other medical providers must fully mine every potential revenue source today. The $10,000 Personal Injury Protection (PIP) benefit available under Florida’s No Fault Insurance is a predictable revenue source, yet many hospitals miss out on the full PIP reimbursements to which they are entitled.
A 5-year PIP audit can remedy the situation and auto insurers are required by law to pay reasonable attorney’s fees for hospitals and providers pursuing PIP claims. A PIP audit can also establish a process to insure proper payment on an ongoing basis.
Why are hospitals “leaving money on the table”? There can be several reasons:
• Hospitals may not know that some auto insurers have misinterpreted reimbursement schedules to their advantage with PIP
law changes that took effect in 2008. For example, payment for a 2008 claim covered under a policy issued in 2007 must be paid at the higher rate in effect on the policy issue date, not the date of the claim.
On a typical $2,000 charge, this can mean a difference of $400 in revenue to the hospital. A PIP audit will determine if an insurer utilized the correct payment schedule so the hospital can recoup those unpaid fees before the statute of limitations runs out.
• Providers may not give PIP claims high priority as they focus on Medicare, which represents a far larger share of revenue. PIP benefits add up, however. Unpaid or unlawfully denied PIP claims on an aggregate basis can easily be in the hundreds of thousands of dollars.
• Many hospitals do not have the revenue cycle systems in place to track PIP payments as accurately and timely as needed. On the surface, it may appear that a hospital is being appropriately paid. However, delving deeper often reveals that’s not the case. For example, a hospital that fails to quickly file its PIP claim runs the risk of not being reimbursed through PIP at all.
That’s because emergency care providers have first priority for PIP dollars only for 30 days. Then, all medical providers’ bills contend for benefits on a first-in basis. If claims are not filed timely, benefits may be exhausted.
Experienced PIP counsel can advise when and how to efficiently challenge claims and recoup fees to which you are entitled.
