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A PIP payout log is by no means the end-all to be all to what the insurance company paid. In exhaustion of benefits cases, the best practice to truly verify of benefits are exhausted is to review explanations of review and copies of canceled checks PIP payout logs can be invaluable tools to determine whether benefits are exhausted or if an insurance company has paid medical providers the correct amount of interest and medical bills. Insurance companies are hard-pressed to produce PIP payout logs before litigation. This is because a not-so-thoughtful District Court of Appeals ruled that an insurance company is not required to produce a PIP payout log pre-suit on the grounds that it would cause increased litigation if PIP payout logs were produced pre-suit. Later, the Florida Legislature amended the PIP statute that required insurance companies to produce PIP payout logs within 3o days of receipt of a request, but this can only be done post-suit. The PIP law also requires an insurance company to inform a medical provider within 15 days of the date that an insurance company exhausts its PIP policy limits that its benefits are exhausted. But how can a medical provider verify if benefits are truly exhausted pre-suit? A medical provider is out of luck on this one because the only time an insurance company is required to give a medical provider a PIP payout log is after a lawsuit is filed. This means that the only way to truly verify if benefits are exhausted is to file a lawsuit. How the District Court of Appeals’ rationale that preventing a PIP payout log to be produced pre-suit will slow litigation is a complete mystery and is another example of how District Courts of Appeals can sometimes misunderstand PIP law. PIP payout logs are also notoriously incorrect. Let’s face it, anyone can create a PIP payout log and put anything on it. PIP payout logs are not statements under oath and can be inaccurate with no penalty to an insurance company. I have seen PIP payout logs that list medical providers that have never made a PIP claim, and show payment to those medical providers; PIP payout logs that list interest as a “medical bill”; PIP payout logs that have wrong dates of service and wrong amounts of medical bills. It is to the advantage of the insurance company to include as much as possible listed on a PIP payout log to reach its $10,000.00 policy limits to claim that benefits are exhausted as an excuse to deny medical bills. So, a medical provider must verify the accuracy of a PIP payout log as a PIP payout log is simply a guide to the amount of medical bills that have been paid. A PIP payout log is by no means the end-all to be all to what the insurance company paid. In exhaustion of benefits cases, the best practice to truly verify of benefits are exhausted is to review explanations of review and copies of canceled checks. George A. David, Esq.   500 South Dixie Hwy, Ste. 220 Coral Gables, FL. 33146 305-569-9980 gadeservice@gmail.com

While the primary focus of healthcare providers is patient care, the economic health of a medical practice is equally crucial, as it ensures the practice’s continuity and existence to keep providing quality healthcare to patients. One effective strategy to maintain a steady cash flow is to prioritize the timely management of medical receivables. Understanding the Servicing of Medical Receivables Medical receivables refer to the outstanding amounts owed to a healthcare provider for services rendered, typically by patients or insurance companies. These outstanding balances can accumulate for various reasons, including insurance claim denials, patient co-pays, or deductibles. As these receivables pile up, it can create significant financial strain for healthcare providers. Effective receivables management ensures that these outstanding bills are converted into cash promptly, thus improving the practice’s cash flow and financial stability. What is the Servicing of Medical Receivables? The process of Servicing medical receivables can be broken down into several key components: Billing and Coding Accuracy: Ensuring that all medical services are accurately billed and coded is the first step in managing receivables. Claim Submission and Follow-up: Timely submission of claims to insurance companies and consistent follow-up on unpaid claims are critical. Patient Billing and Collections: Efficient patient bill- ing systems and proactive follow-up on unpaid patient balances are essential to minimize aging receivables. Payment Posting and Reconciliation: Accurate posting of payments and reconciliation of accounts ensure that all received payments are correctly applied to the corresponding receivables. Monitoring and Reporting: Regular monitoring and reporting of receivables provides insights into the practice’s financial performance. Key Strategies for a Medical Practice’s Financial Health Here are key strategies healthcare providers can implement to enhance their practice’s finances. Optimize Revenue Cycle Management (RCM): Streamlining the billing process and reducing errors can significantly improve cash flow. Monitor Key Financial Metrics: Keeping days in A/R under 30 to 40 days is crucial for financial health. Implement Robust Financial Planning: It’s vital to have a financial plan that includes budgeting, cash flow management, and investment strategies. Leverage Technology: Utilize advanced software for billing, scheduling, and financial reporting to reduce administrative workload and improve accuracy. Benefits of Professional Receivables Servicing Engaging a professional receivables management provider can offer several advantages: REDUCED ADMINISTRATIVE BURDEN: By delegating the collections process to experts, healthcare providers can focus more on patient care and other core activities. REGULATORY COMPLIANCE: Collection experts are well-versed in healthcare finance regulations, ensur- ing compliance and reducing the risk of legal issues. EXPERT DEBT COLLECTION: Professional providers are experienced in recovering outstanding debts efficiently (even in the most challenging cases) and bring specialized expertise and advanced technology for tracking and managing accounts precisely. COST EFFICIENCY: Despite the fees involved, outsourcing your collections to experts can be more cost-effective than managing them in-house, considering the time, effort, and resources required for effective debt recovery. ENHANCED CASH FLOW: Practices can accelerate cash flow by converting aging receivables into capital quickly. ENHANCED FINANCIAL HEALTH: By keeping receivables current and minimizing aging accounts, practices can maintain a healthier financial position, reducing the risk of bad debts and financial instability. In summary, the servicing of medical receivables is a critical component of effective healthcare practice management. Effective management of receivables not only ensures compliance, improves cash flow, and reduces administrative burdens but also enhances the overall financial health of a medical practice. For healthcare providers, partnering with a professional receivables management service can be a strategic move to concentrate on delivering high-quality patient care, and ensure long-term financial stability and success. Theresa Giordano QUANTUM OUTSOURCING GROUP.   2963 Gulf to Bay Blvd Suite 120 Clearwater, FL 33759 (813) 725-2466 Ext. 225 (813) 725-2466 Ext. 225 www.quantumog.com

It seems that filing claims against Uber and Lyst vehicles is a current trend in the Personal Injury world. However, before you jump on the bandwagon, there are a few things you should know. Before ride sharing became as popular as it is today, the big two, Uber and Lyst, provided much more comprehensive coverage for both their drivers and the passengers that utilized their services. It wasn’t unheard of for there to be an Uber or Lyst policy that carried $250,000 in UM coverage and $1 Million in BI coverage. This literally made riding in an Uber or Lyst vehicle a better option, as far as cover- age was concerned, than riding in most individual’s personal vehicles in Florida. However, over the years, with all of the direct marketing to individuals injured in a car accident while riding in an Uber or Lyst, or struck by an Uber or Lyst driver, both companies have significantly reduced coverage limits available for the uninsured motorist cover- age provided to the state minimum limit of $10,000. Additionally, both these companies are currently using either Progressive or State Farm to insure their ride share drivers. So, this means that the when you have a client that’s been injured by an Uber or Lyst driver, it’s more important than ever to make sure that you stay aggressive with the claims adjusters. You should make sure that your client begins treatment as soon as possible aster the accident. However, not just any chiropractor or orthopedic doctor will do. It’s impor- tant that your client treats with medical providers who understand the recent change in the law. You should make sure your client treats with medical providers who will not only provide them with top notch treatment but also provide you, the attorney, with the medical records you need to be able to aggressively litigate the case. This also means, the medical providers should understand that accurate and reasonable billing is becoming even more important. Additionally, if your client has health insurance, finding providers that can bill your client’s health insurance, even if they get denied, is important in this post-Tort Reform environment. We don’t want the insurance company to be able to successfully argue that your client did not mitigate his/her medical expenses because they did not attempt to use their health insurance. One of the injuries that osten is overlooked is when the client suffers a traumatic brain injury (TBI). Making sure you familiarize yourself with the symptoms of TBI allows you to be able to ask your client pertinent questions and ascertain whether a TBI evaluation could be beneficial for their health. Additionally, you can get invaluable information from reviewing ER records, which are osten overlooked if the subsequent providers do not request them or are unaware that the client was seen at the ER. Finally, once your client has been evaluated and treated for all of their injuries, and have reached maxi- mum medical improvement, then it’s time to send the demand letter to the adjuster. Be sure to include all the medical bills and treatment records. Be sure to thor- oughly explain your theory of liability and explain how the injury has impacted your client’s life and include any future medical expenses or care that they will need. These companies and the insurance companies that insure them are adept at devaluing your client’s claim. Don’t allow that to happen, with the proper medical providers, medical records and you having a compre- hensive knowledge of client’s injuries, you can be sure to obtain the maximum amount of compensation for your client’s injuries. Michael Mills, Esq. I.A.N.INJURY ASSISTANCE NETWORK 823 N. Thornton Ave Orlando, FL 32803 (800) 988-2341 mmills@injuryassistancenetwork.com www.injuryassistancenetwork.com

This is the fourth article in a series that lights the way to success under Florida Tort Reform’s Section 768.0427. This article will explain how Subsection (2)(e) can be used to prevent the insurance defense industry from presenting the health insurance reimbursement rates discussed in Subsections (2)(b)(1), (2)(b)(2), and (2)(c)(1). Section 2 deals with evidence that may be offered to prove the amount of damages for medical services. Subsection (2)(b), more specifically, deals with evidence offered to prove the amount necessary to satisfy unpaid charges for past medical services. Subsection (2)(c) deals with evidence offered to prove the amount of future medical services. Within these subsections, the Statute further discusses three scenarios in which the defense is permitted to present  insurance  reimbursement  rates to the jury. 1 First, Subsection (2)(b)(1) tells us (as to past medical services) that if the patient has commercial health insurance and the provider submits the bill to that insurer, the jury may consider evidence of the amount the insurer is obligated to pay the provider.” Second, Subsection (2)(b)(2) tells us (as to past medical services) that if the patient has commercial or govern- mental health insurance, but does not submit charges to that insurer, the jury may consider evidence of the amount the insurer would pay the provider had the patient obtained medical services pursuant to the coverage. Finally, Subsection (2)(c)(1) tells us (as to future medical services), that if the claimant has or is eligible for commercial health insurance, the jury may consider evidence of the amount at which future charges could be satisfied if submitted to the insurer.  After the Statute provides these three scenarios in which the defense is permitted to present insurance reimbursement rates to the jury, the Statute then tells us in Subsection (2)(e) that contracts between providers and commercial insurers and HMOs are not discoverable. This is curious because the supposedly admissible reimbursement rates discussed in Subsections (2)(b)(1), (2)(b) (2), and (2)(c)(1) can all be found only in the fee sched- ules contained within the supposedly undiscoverable contracts. Something has to give between the admissibil- ity of reimbursement rates and the non-discoverability of the contracts that contain those reimbursement rates. There are several ways this can play out in the courts, but there is not enough space in this article to discuss all of them. The following appears to a likely scenario: * Each Subsection also allows the jury to consider the patient’s out-of-pocket “medical expenses under the insurance contract or regulation.” This, however, is not relevant to this article. When the defense seeks reimbursement rates under Subsections (2)(b)(1), (2)(b)(2), or (2)(c)(1), the provider should file a motion for protective order (MPO) under Subsection (2)(e). The defense will argue that granting the MPO would unconstitutionally delete Subsections (2)(b)(1), (2)(b)(2), and (2)(c)(1) from the Statute. But the provider should point out the error in this argument – under all those subsections, the defense can still present the reimbursement rates when a provider or health insurer volunteers them and when the defense has already obtained the reimbursement rates in another case. Note that the defense does not have a similar response to the provider’s claim that denying the MPO unconstitutionally deletes Subsection (2)(e) from the Statute. …contracts between providers and commercial insurers and HMOs are not discoverable Because the provider’s argument allows for a consistent reading of Subsections (2)(b)(1), (2)(b)(2), (2)(c)(1), and (2)(e), and the defense argument does not, the court should grant the MPO. If the provider prevails on the MPO, the defense will not discover reimbursement rates, and if the defense does not discover reimbursement rates, the defense has no way to admit them to the jury. Aaron Proulx, Esq. THE DOCTOR’S LAWYER, PLLC. (813)486-7321 aaron@doclawfirm.com www.doclawfirm.com

Sharing data has become easier, but securely sharing that data remains elusive for many providers and attorneys. Email is ubiquitous – everyone has it, and patients and clients want to use it. You may think that HIPAA says you cannot, but you can – if you secure it. The main goal here is to protect your client or patient data and send data securely. However you also want to protect your organization from other risks – phishing, business email compromise, reputation loss, and more.Here’s an easy 8-step guide on how to ensure you’re sharing your client’s data safely: 1. Use Email Encryption when sending email. Software vendors like Sophos allow you to send encrypted emails simply by adding “SECURE:” at the front of the subject line. This also protects against business email compromise (BEC) which is crucial for lawyers handling sensitive information. Sending encrypted emails is the only way to meet HIPAA for sending email – you can’t send data securely without it. 2. Use MFA for all of your email accounts. Google and Office365 have it. In fact, if you don’t have it, you may have voided your cyber liability policy by not enabling it for all users. Multifactor Authentication means that if someone gets your credentials they still need the code from your phone to log in. In fact, use MFA on all of your accounts, not just email. 3. Use a filtering service before your email hits your provider. This will stop junk, spam, and malware from reaching your mailbox. If its not in your inbox, you can’t be phished or scammed. 4. Enable “external sender” policies so you know when emails are coming from outside your domain. You will see a message cautioning the email was sent from outside your organization. 5. Enable VIP protection policies so that you know if someone is pretending to be a user from a different email address. 6. Verify if any “typo” domains exist, for example an “i” when capitalized will look like a lowercase L and can be used to target your clients and patients. Go buy those domains so no one else does and then uses them against you or your clients.Email is ubiquitous – everyone has it, and patients and clients want to use it. You may think that HIPAA says you cannot, but you can – if you secure it. 7. Audit your IT services. If you use internal staff or an outside company make sure that you audit the work. Any decent IT person should not be fearful of their work being wrong or improved by audits. 8. Do regular security and compliance training. This teaches your staff how to recognize scams, phishing attempts, and other threats. Training should include compliance requirements to ensure adherence to legal and regulatory requirements.  Andrew Renck is the owner of RootPoint, an IT services and Cybersecurity Provider located in Miami, FL. Andrew Renck is a 2003 graduate of the University of Miami with multiple degrees including Finance and Economics. While attending the University he created his computer consulting firm RootPoint. He has been providing secure systems integration long before “Cybersecurity” became a recognized term. Renck is an ethical hacker and has provided services for both offensive and defensive cybersecurity projects. Email is ubiquitous – everyone has it, and patients and clients want to use it. You may think that HIPAA says you cannot, but you can – if you secure it. Andrew Renck ROOT POINT (305) 726 9091 arenck@rootpoint.com www.RootPoint.com

In a recent decision, the Florida Supreme Court actually strengthened the billed amount statute of FS §627.736(5)(a)(5) which states: “An insurer may limit payment as authorized by this paragraph only if the insurance policy includes a notice at the time of issuance or renewal that the insurer may limit payment pursuant to the schedule of charges specified in this paragraph… If a provider submits a charge for an amount less than the amount allowed under subparagraph 1., the insurer may pay the amount of the charge submitted.” (Emphasis added) This Florida Supreme Court opinion makes the billed amount doctrine alive and well In simple terms, this statute means that if the medical provider submits a claim form billing an amount for a CPT code that is less than 80% of what the fee schedule would allow, then the insurance company is required to pay the full billed amount of the CPT code on a medical provider’s claim form without any reductions. In the recent Florida Supreme Court case, aster rendering services to the patient, the medical provider submitted a HCFA with a CPT code charging $100.00. The 80% of the fee schedule under FS §627.736(5)(a) (1) for the CPT code charged was $149.92. So, 80% of the maximum charge under the fee schedule was $119.94 which was higher than the submitted $100.00 charge. Because the charge of $100.00 was less than $119.94, FS §627.736(5)(a)(5) expressly allowed the 16 insurance company to pay the $100.00 amount billed. Instead of paying the $100.00 amount billed, the insurance company chose to pay 80% of the amount billed which was $80.00. The Florida Supreme Court allowed the insurance company to pay 80% of the $100.00 billed amount or $80.00 because the insurance company’s policy had specific language that allowed the insurance company to make that reduction. The Florida Supreme Court allowed insurance company to pay less than the billed amount if the insurance company’s policy specifically allowed it to: “pay 80% of a submitted charge if that charge is less than the amount reimbursable under the sched- ule or other statutory provisions, may the insurer pay 80% of the charge submitted by a medical provider.” The good news is that this also means if the insurance policy does not have this specific language in it, then they would have to pay the billed amount under FS §627.736(5)(a)(5). This case is positive for medical providers because trial courts have used cases from the District Courts of Appeal to claims that the billed amount doctrine was gone for good. This Florida Supreme Court opinion makes the billed amount doctrine alive and well. I have not seen many insurance company policies with this specific language mentioned in the Florida Supreme Court opinion. So, it is important to review the insurance policy before determining whether the insurance company erred in not paying the billed amount. George A. David, Esq. 500 South Dixie Hwy, Ste. 220 Coral Gables, FL. 33146 305-569-9980 gadeservice@gmail.com

While it doesn’t occur too often, it’s practically inevitable if you’re a Florida medical provider who treats patients for Personal Injury claims that you will eventually receive a request from a Personal Injury Protection (PIP) insurance carrier for a refund of a supposed overpayment. In the realm of PIP insurance, medical providers often find themselves grappling with refund requests from insurance companies. These requests can be daunting, prompting providers to question their legal standing and obligations. However, it’s crucial for Florida medical providers to understand their rights and defenses, particularly the concept of detrimental reliance. Detrimental reliance, also known as detrimental estoppel, is a legal principle that comes into play when one party reasonably relies on the actions or representations of another to their detriment. In the context of medical providers and PIP insurance companies, this principle holds significant weight. When a medical provider renders services to a patient covered by PIP insurance, they do so under the assumption that they will be compensated for their services in accordance with the terms of the insurance policy. This reliance on the insurance coverage is not only reasonable but also essential for the provider to continue offering care to injured individuals. However, complications arise when PIP insurance companies retroactively seek refunds for previously paid claims. In such cases, medical providers may invoke the defense of detrimental reliance to resist these refund requests. By demonstrating that they reasonably relied on the representations of the insurance company regarding coverage and payment, providers can assert their right to retain the compensation they received for services rendered. It’s important to note that detrimental reliance is not a blanket defense and must be supported by evidence. Medical providers should maintain thorough documentation of all communications with the insurance company, including claim submissions, payment receipts, and any correspondence regarding coverage or reimbursement policies. Additionally, medical providers should be prepared to demonstrate the detrimental consequences they would face if forced to refund payments already received. This may include financial losses, disruption of patient care, and/or damage to professional reputation. Complications arise when PIP insurance companies retroactively seek refunds for previously paid claims In navigating refund requests from Florida PIP insurance companies, medical providers should also be mindful of legal requirements and procedures. Consulting with experienced attorneys specializing in PIP Insurance claims can provide valuable guidance and representation throughout the process. Ultimately, the defense of detrimental reliance serves as a crucial safeguard for Florida medical providers facing refund requests from PIP insurance companies. By understanding and asserting this defense, providers can protect their rights, uphold their professional integrity, and continue to prioritize the care of their patients. In conclusion, while refund requests from Florida PIP insurance companies can be challenging, medical providers have legal recourse in the form of the defense of detrimental reliance. By leveraging this defense and seeking appropriate legal counsel, providers can navigate these requests with confidence and uphold their commitment to patient care. Christopher M. Tuccitto,Esq. FLORIDA ADVOCATES PA. Florida Advocates 45 East Sheridan Street Dania Beach, FL 33004 (754) 263-4252 chris@fladvocates.com https://www.fladvocates.com/

Slip and fall cases have long been the albatross of the personal injury industry. Now, with the implementation of the Florida Tort Reform Act 768.0427 it has become even more of a task to be able to successfully handle these types of cases. This starts with the victim following practical measures after a slip and fall incident occurs. First, when the incident occurs, as difficult as it may be, it is very important that the victim document the conditions that lead to the slip and fall occurring. That means if there is liquid on the floor, they want to take pictures of the liquid before the premises staff or manager cleans it up. If there are track marks or footprints through the liquid, be sure to capture those images. Additionally, make sure to alert the store or premises manager so that they can create an incident report. Request a copy of the incident report for your own records. Please note that some stores will provide them with a copy of the report while others may not, due to their work product privilege. This is one of the reasons it’s so important to have your own documentation. After completing the incident report, the victim should immediately get examined either at the emergency room or an urgent care facility. Be sure to recall to the medical provider every detail to paint a clear picture of exactly how the incident occurred and how it led to the injury. Proximity of the medical treatment to the injury is always something that the insurance adjuster will try to use to decrease the value of the case if it did not immediately occur. Now, based on the injury that the victim suffered in the slip and fall, their medical provider will come up with a treatment plan to help them to get better. The treatment plan will usually begin with conservative care, such as chiropractic care or physical therapy, depending on the injury, and then graduate to more invasive care if the victim’s injury is not responding to conservative care. The type of treatment prescribed will also depend, in large part, on the diagnostic imaging results once the victim is sent for an MRL The most important thing is that the victim must remain compliant with the doctor’s orders. Failure to do so makes the attorney’s job much more difficult to relate the injury and need for care to the injury suffered as a result of the accident. Proximity of the medical treatment to the injury is always something that the insurance adjuster will try to use to decrease the value of the case if it did not immediately occur. Remember, although slip and fall cases can be difficult, a slip and fall victim’s case is due the same amount of vigor and aggressiveness that a car accident victim receives. It’s important that you follow the above recommendations to give yourself the best chance of success. Michael Mills, Esq. I.A.N.INJURY ASSISTANCE NETWORK 823 N. Thornton Ave Orlando, FL 32803 (800) 988-2341 mmills@injuryassistancenetwork.com www.injuryassistancenetwork.com

Thankfully, the 2024 legislative session has ended without inflicting any cataclysmic changes on the Personal Injury industry. Although none of them passed, there were some bills introduced in this session that are worth our attention, because they may be resurrected in future sessions. Motor Vehicle Insurance HB 653 and the identical SB 464 is a perennial effort to do away with Personal Injury Protection (PIP) coverage under Florida’s No-Fault insurance law and replace it with bodily injury (BI) liability coverage. The primary difference between PIP and mandatory BI is that under PIP, someone injured in an auto accident seeks coverage first under their own PIP policy, whereas under mandatory BI, someone injured in an auto accident would seek recovery from a responsible third party’s (other driver’s) BI coverage. The bills are like the bill vetoed in 2022 by Governor DeSantis and filed again in 2023. Last spring’s bills were never heard by a committee and neither of these bills received a hearing this session. Insurance Claims HB 731 passed its first committee on February 6th, 2024 by a 15-1 vote in the House Insurance & Banking Subcommittee. It requires insurance companies to report to the Office of Insurance Regulation (OIR) the recovery of funds from automobile claim judgments, settlements, and attorney fees and costs, as well as repayment of claims paid from unlawful acts. OIR, in turn, would be required to consider recovery of those funds in reviewing companies’ rates. The bill also specifies that a policyholder’s payment of a deductible or copayment is not a condition of a carrier’s payment obligations. There is a similar bill in the Senate (SB 1024) that never received a hearing. Litigation Financing SB 1276 and HB 1179 are identical bills to regulate third-party financing of lawsuits against businesses. The bill requires a court’s consideration of potential conflicts of interest that may arise from the existence of a litigation financing agreement in specified circumstances; prohibits specified acts by litigation financiers; requires certain disclosures related to litigation financing agreements and the involvement of foreign persons, foreign principals, or sovereign wealth funds; and requires the indemnification of specified fees, costs, and sanctions by a litigation financier in specified circumstances, among other provisions. Despite the Senate bill making it through all committees and the House bill getting through its initial committee, neither reached a floor vote. Attorney’s Fees SB 1782 and HB 1651 both seek to reestablish the right to attorney’s fees for the prevailing Plaintiff in a PIP lawsuit. As I’m sure you recall, the the passing of HB 837 last year removed this right, which was previously in existence since 1896. Unfortunately, despite their noble efforts, neither of these bills have received much traction within the legislature, with neither of them advancing beyond the initial committees that reviewed them in early January. Worker’s Compensation SB 362 and HB 161 are related bills that seek to increase a health care provider’s witness fee for a deposition and the reimbursement amounts under Worker’s Compensation for physicians and surgical procedures. Both the Senate and House bill would increase the medical provider’s witness fee to $300.00 per hour. The Senate bill increases the maximum reimbursement for a physician licensed under chapter 458 or chapter 459 and for surgical procedures to 200% of the Medicare allowable amount. The House bill would raise Worker’s Compensation reimbursement amounts to 150% of Medicare. While both bills were advancing through committees in January and February 2024, both the Senate and the House have decided to postpone consideration of these bills, at least temporarily. Due to this postponement so late within the session, neither version had a chance of passing this year. Based on the above, 2024 was a relatively uneventful year for our industry when it comes to legislative changes. Lately, it seems that no change is good for us, although it would’ve been nice to have attorney’s fees reinstated in PIP lawsuits. Maybe this bill will gain greater traction in future sessions if it is reintroduced. We shall see. Stay tuned. Christopher M. Tuccitto,Esq. FLORIDA ADVOCATES PA. Florida Advocates 45 East Sheridan Street Dania Beach, FL 33004 (754) 263-4252 chris@fladvocates.com https://www.fladvocates.com/

One of the most common questions our company gets regarding the billing and coding of orthopedic bracing is what type of brace to prescribe and dispense? When it comes to bracing, the two main classifications are off-the-shelf and custom prefabricated. Knowing the difference can be very important in order to remain compliant.  The first type of orthopedic bracing is custom prefabricated. Examples of these codes for lumbar braces are Lo627, Lo631 and Lo637. These braces are required to be trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. You may ask, who is considered a person with expertise? This becomes a bit complicated based on the insurance you are billing. According to Medicare, a person with expertise is an Orthotist/ Prosthetist, MD, DO, APRN or PA. What is required to custom fit a brace? Many of the bracing manufacturers provide documentation worksheets showing the steps needed to customize a specific brace whether it be lumbar, knee or wrist. This includes steps on how the patient was measured, how the product was trimmed, and/or how it was molded to specifically fit the patient. This document needs to be filled out in detail to remain compliant when dispensing these custom prefabricated braces. The second type of orthopedic bracing is the off-theshelf or OTS. OTS braces are the most common braces being dispensed by providers. According to CGS Medicare, these braces require minimal self-adjustment for fitting at the time of delivery. Fitting these OTS braces does not require fitting by a person with expertise. Essentially, these braces should be able to be taken out of the package and adjusted to fit the patient by simply reading the instructions. The reimbursement between the custom prefabricated and the off-the-shelf does differ. Since there is more of a fitting required, the custom prefabricated braces reimburse higher. Many of the brace manufacturers have had their products dual-coded. This Way, physicians can choose how they would like to fit the patient. Many patients need more of a custom fit, and others just need a standard fit. One code will be the custom prefabricated code and one will be the OTS code. When dispensing orthopedic bracing it is very important to know the difference between the different classifications. At JMS Med Supply, we can provide physicians and billing personnel with the necessary documents in order to bill both classifications of orthopedic bracing. When it comes to bracing, the two main classifications are off-the-shelf and custom prefabricated. Knowing the difference can be very important in order to remain compliant. Matt Snyder PRESIDENT, JMS MED SUPPLY 855-700-5960 matt@jmsmedsupply.com https://www.jmsmedsupply.com