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Benefits Of Dispensing Orthopedic Bracing In Your Practice

1. Improved Patient Care and Outcomes Orthopedic braces are designed to support and stabilize injured or weakened joints, ligaments, and muscles. By dispensing bracing products directly within your practice, you can ensure that patients receive immediate and appropriate care. Braces can prevent further injury, reduce pain, and speed up the recovery process. Custom-fitted braces also improve comfort and function, encouraging patients to adhere to prescribed treatments. By offering a wide range of orthopedic braces, such as knee, wrist, ankle, or back supports, you allow patients to receive personalized care tailored to their specific needs. This approach often results in better clinical outcomes, as patients are more likely to follow the doctor’s recommendations and wear the brace consistently 2. Convenience for Patients Having a wide selection of orthopedic braces available at the point of care offers unparalleled convenience for patients. Instead of requiring patients to visit a medical supply store or wait for a prescription to be filled, your practice can immediately provide the required brace. This eliminates delays in treatment and gives patients the confidence that their injury is being addressed promptly. Moreover, patients are more likely to comply with a recommended brace when they can receive it during their visit, as they can begin the healing process right away. The convenience factor also builds patient satisfaction, contributing to improved retention and referrals. 3. Increased Revenue and Practice Efficiency Dispensing orthopedic braces in your practice can also provide a revenue stream. Medical practices can purchase braces in bulk and sell them to patients, marking them up at a reasonable price to cover costs and generate a profit. With proper coding and insurance billing practices, bracing can be reimbursed by insurance providers, ensuring financial sustainability for the practice. Additionally, having braces available in-house streamlines operations. Practices can better manage inventory, ensuring they have the right products on hand without having to rely on external suppliers. This results in less waiting time for patients and reduces the need for additional administrative tasks related to outside orders and deliveries. 4. Enhancing the Doctor-Patient Relationship Dispensing orthopedic bracing in your practice fosters a deeper level of trust between you and your patients. By offering a solution that directly addresses their pain or injury, you are demonstrating a commitment to their well-being. Patients value personalized care and providing a custom-fit or carefully chosen brace strengthens your credibility as their healthcare provider. In addition, patients often have questions or concerns about the proper use of orthopedic braces. By providing them with the brace directly, you have the opportunity to educate them on how to wear, adjust, and maintain the brace. This added layer of care reinforces patient confidence in your expertise. 5. Better Control Over Treatment Plans When bracing is dispensed in-house, the healthcare provider has better control over the quality of the products used in patient care. This allows for more consistent outcomes and reduces the chances of patients receiving subpar products from third-party retailers. Additionally, the provider can monitor the progress of treatment closely and recommend adjustments or modifications to the brace as needed. This also opens opportunities for follow-up appointments, where patients can be re-evaluated and provided with new or adjusted braces if necessary. 6. Education and Patient Empowerment Dispensing orthopedic bracing provides an ideal opportunity for patient education. By offering the right products and guidance, you empower patients to take an active role in their recovery process. Understanding how a brace supports the healing process gives patients confidence in their treatment plan, promoting long-term health benefits. Matt Snyder PRESIDENT, JMS MED SUPPLY 823 N. Thornton Ave Orlando, FL 32803 1855-700-5960 www.jmsmedsupply.com

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Identity Management In Law Firms: Protecting Against Fraud With Advanced Data Technology

In today’s fast-paced, data-driven world, law firms face increasing risks associated with identity fraud. Handling vast amounts of sensitive client information, including protected health information (PHI), puts legal practices at the forefront of cybersecurity challenges. As healthcare data grows exponentially, accounting for approximately 30% of the world’s total data as of 2023, it is expected to grow at a compound annual growth rate of 36% by 2025, far surpassing sectors like manufacturing, financial services, and media. This rapid growth highlights the urgent need for law firms to implement robust identity protection measures to safeguard sensitive data and enhance operational efficiency. The Growing Threat of Fraud and Cyberattacks Data breaches and cyberattacks have become more sophisticated, targeting vulnerabilities in identity verification systems. According to a 2023 study by Cybersecurity Ventures, global fraud losses are projected to exceed $40 billion annually, emphasizing the importance of proactive security measures. Law firms, particularly those managing personal injury, malpractice, or other cases involving medical records, are prime targets for cybercriminals. A single breach can expose sensitive client data, leading to legal, ethical, and financial repercussions. The 2024 Change Healthcare ransomware attack is an example of this vulnerability. The attack compromised the PHI of 100 million individuals, making it the largest healthcare-related breach reported in the United States. This incident prompted heightened scrutiny from federal and state regulators, who have imposed stricter requirements on organizations handling sensitive data. Noncompliance with regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and the General Data Protection Regulation (GDPR) can result in significant penalties, extending beyond healthcare providers to include law firms. Legal professionals have already faced disciplinary action for lapses in identity verification. For example: 1. Robert Kaufman (New Jersey, 2006): In this case, the attorney failed to verify the legitimacy of client-provided documents, facilitating a real estate fraud scheme. The court ruled that Kaufman’s lack of diligence violated professional conduct rules, highlighting the importance of identity checks to prevent fraud. By Tiffanny J. Anghel, MHA 2. McQueen v. State of New York: A federal case where an attorney overlooked suspicious identifications provided by clients involved in a wire fraud scheme. Although McQueen was not criminally prosecuted for accepting fake IDs, his failure to adhere to due diligence practices subjected him to scrutiny (DOJ Case Report). 3. Robert Perez v. State of New York: This disciplinary case involved an attorney who failed to verify the identity of clients using fake IDs in real estate closings, which were part of a mortgage fraud scheme. Perez’s negligence in conducting due diligence led to identity theft and mortgage fraud, resulting in professional discipline. These cases illustrate the significant legal and ethical risks law firms face when they neglect identity management. Health Data and Its Importance in Future Growth Health data’s increasing volume and value make it a prime target for fraud. With the adoption of electronic health records (EHRs), telemedicine, and other digital health technologies, the need for robust identity verification systems has never been greater. For law firms handling medical cases, mishandling or failing to protect health data exposes them to heightened risks of fraud and regulatory violations. Identity verification is critical in ensuring that only authorized personnel can access sensitive health information. Without strong identity management protocols, law firms remain vulnerable to schemes exploiting gaps in their systems. Effective measures not only protect against breaches but also ensure compliance with evolving regulations, safeguarding client trust and firm reputation.  Tiffanny J. Anghel, MHA HEAD OF PARTNERSHIPS YOCIERGE & YC API. ta@ycapi.health 862-209-0195 yocierge.com cal.read.ai/tiffanny-a5xwi/

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Is Manual Muscle Testing Validly Unbundled And Not Compensable By Pip?

Both chiropractors and orthopedic surgeons alike will perform manual muscle testing billed under either CPT codes 95851 or 95832 along with a 99205, 99204 or 99203 office visits. Insurance companies regularly deny manual muscle testing CPT codes on the grounds that the manual muscle testing is bundled into office visits and therefore is not a separate billable medical service. For both CPT codes, there must be a separate manual muscle testing report that specifically sets forth the results of each manual muscle test, the need for the muscle test and the signature of the physician. There is an appellate opinion from the Fourth District Court of Appeal that interprets manual muscle testing billed under CPT code 95832 and the Court required a separate manual muscle test report consisting of specifying each measurement of the muscle testing, the need for a muscle testing and a signature of the physician. The District Court of Appeal frowned on an office visit report that specifically referred to manual muscle testing. The District Court of Appeal found that under those facts, the manual muscle testing was part of the initial office visit report and therefore could not be separately billed. For CPT code 99851, I have seen that some insurance companies claim that the Medicare guidelines requires a manual muscle testing to take place and to be billed on a separate day from office visits. I have read the Medicare guidelines and it is ambiguous as to whether the manual muscle testing is required to take place and to be billed on a separate day from office visits. Although the Fourth District Court of Appeal opinion involves CPT code 95832 instead of CPT code 95851, both codes are manual muscle testing and the Fourth District Court of Appeal opinion should apply to CPT code 95851 and CPT code 95832. As a belt and braces tactic to avoid denials of manual muscle testing on the grounds of improper bundling, a medical provider should perform and bill manual muscle testing on different dates that there is an office visit. However, it is not mandatory. The long and short of it is that if an insurance company declines paying manual muscle testing CPT codes for not being billed on the same day as an office visit, there is an opinion from the District Court of Appeal that does not make that requirement. As a PIP suit lawyer, I have run across this issue on various occasions and have been successful in getting medical providers paid for their services. George A. David, Esq. 500 South Dixie Hwy, Ste. 220 Coral Gables, FL. 33146 305-569-9980 gadeservice@gmail.com

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5 Ways Your Front Desk Staff Can Help Improve Your Pip Collections In 2025

Recent changes in the PI industry have emphasized the importance of ensuring your billing practices are more efficient than ever. As the PIP suit attorneys still struggle to find the best way to continue helping medical providers collect balances owed on their behalf, making sure you bill PIP claims correctly from the start plays a key role in ensuring you maximize your PIP recovery on every PI patient. Here’s some of the best strategies that all medical practices should train their Front Desk and intake staff on to help increase PIP collections in 2025: 1. Collecting all accident information prior to the patient’s first visit This includes date of accident, whether the patient has received treatment by any other provider (including paramedics) within 14 days, and the correct PIP carrier and claim number that covers the patient. If you wait too long to get all these details, you might find yourself with hundreds if not thousands of dollars’ worth of treatment only to find out later that the patient has no insurance coverage to pay your bills. Try to discuss all these details during your first interaction with the patient while setting up the initial appointment to ensure that by the time they come to your office for the first visit, they have all the information needed and have already discussed with their attorney any questions they may have. 2. Track the status of required tasks for every new patient This is one of the toughest strategies for clinics to implement if they’re not used to it, but it is by far one of the most efficient if you want to increase your collections. Take advantage of tools such as spreadsheets or EMR software to keep track of missing information or processes that will impact your ability to get paid. As soon as a new patient starts treatment, make sure to add them to your list and keep track of items such as data entry, PIP coverage verification, BI limits, Notice of Initiation submission, 14-day treatment confirmation, EMC determination, and PIP suit status. You can customize it according to your office requirements 3. Ensure your patient signs all required paperwork It is crucial to get all required paperwork properly filled out before the patient leaves your office. Forms such as the Assignment of Benefits, Standard Disclosure & Acknowledgement and an Automobile Insurance Questionnaire are specially important for all your PIP files. Do a thorough review to confirm that every page was filled out properly and completely before scanning them into your EMR or putting them on the file. 4. Promptly enter all data into the EMR/billing system Part of your closing tasks before the end of each shift should include entering all data for every new patient file as much as possible. This will help all the other processes by the rest of the team to be completed smoothly and avoid mistakes. If your patient filled out their intake electronically, make sure to review all information entered is correct, particularly the data related to the accident and insurance information. 5. Schedule the patient in advance to comply with their treatment plan Having all the prior steps done properly can only go so far in helping increase PIP collections. Once the file has been properly processed and the insurance coverage confirmed, all your Front Desk staff has to do is make sure your patient is scheduled according to the doctor’s prescription. Do not allow anyone to deviate from the prescribed treatment plan without scheduling the patient for a re-eval or consult with the doctor. Use your scheduling system to set up appointments for 2-4 weeks at a time and you’ll see your patient compliance and collections significantly improve! Don’t miss our article in the next magazine issue where we’ll discuss the top ways in which your billing staff can help improve PIP collections for your medical practice. Angely C. Maria Senior Biller & Consultant, AMB Group amaria@ambgroupcorp.com (786) 881-9311 www.AmbGroupCorp.com

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The Pros And Cons Of Participating In Class Actions For Florida Pip Claims

As a Florida medical provider, the work often involves treating patients injured in car accidents and submitting bills to Personal Injury Protection (PIP) insurers. When insurers fail to pay claims in full or act unfairly, providers might find themselves drawn into class action lawsuits. These lawsuits aim to address widespread insurer misconduct, but they aren’t always the best path for every provider. Let’s examine the pros and cons of participating in and opting out of class actions involving PIP claims.  The Pros of Participating in PIP Class Actions Strength in Numbers A key advantage of a class action is the collective power it provides. When numerous medical providers join forces, the sheer volume of claims strengthens the case against the insurer. This collective pressure often leads to settlements that may not be achievable through individual lawsuits. Minimal Time Investment By joining a class action, you delegate much of the legal work to the class attorneys. You won’t need to appear in court or handle extensive documentation. This is particularly appealing for busy providers who lack the resources to manage a prolonged legal battle. Access to Experienced Counsel PIP Class actions are handled by attorneys with significant experience in PIP litigation and insurance law. This ensures the case is in capable hands, increasing the likelihood of a favorable outcome. The Cons of Participating in PIP Class Actions Limited Control As a class member, you have little say in how the case is managed. Decisions about settlements, legal strategy, and court filings are made by the lead plaintiffs and their attorneys. If the provider is dissatisfied with these decisions, there is limited recourse. Potentially Lower Recovery Class actions aim to distribute settlements equitably among all members, which can result in lower payouts compared to pursuing an individual lawsuit. For providers with substantial claims, this might be a significant disadvantage. Lengthy Process Class actions often take years to resolve. If a provider is seeking a quick resolution to their PIP disputes, this route may test their patience. Release of Claims Settling a class action typically requires the provider to release the insurer from liability for all related claims, even those not fully compensated by the settlement. This may bar the provider from seeking additional remedies in the future. The Pros of Opting Out of PIP Class Actions Greater Control By opting out, the provider retains complete control over the case. The provider and their attorney can decide on legal strategies, whether to settle or litigate, and what recovery amount is acceptable. Potential for Higher Recovery Individual lawsuits often yield higher payouts, especially for providers with substantial claims. The case won’t be diluted by the need to share a settlement with numerous other providers. Tailored Representation Opting out allows the provider to hire an attorney who’s fully focused on the case and specific concerns. This personalized approach often leads to better outcomes. The Cons of Opting Out of PIP Class Actions Time-Consuming Unlike class actions, individual lawsuits require active involvement. The provider may need to provide extensive documentation, attend court hearings, and spend significant time on your case. Weaker Bargaining Position Standing alone, the provider lacks the collective weight of a class. Insurers may be less inclined to settle or offer favorable terms when negotiating with individual providers. Final Thoughts Whether to participate in or opt out of a PIP class action depends on the provider’s specific circumstances. If the provider’s PIP claims are relatively small and they are looking for a low-risk, low-effort resolution, joining a class action might be the best option. On the other hand, if the claims are substantial and the provider is willing to invest time and resources, opting out and pursuing an individual case may yield a better outcome. 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/

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The 2025 New ICD-10 Codes

QUESTION: Dr Kolar, “I have heard there are new diagnosis codes for 2025. Do any of them relate to personal injury?” ANSWER: Yes, there are many ICD-10 code updates that physical therapists, chiropractors, medical doctors and other healthcare providers that treat personal injury patients should be aware of because they relate to back pain and spinal disc pathology. The official ICD-10 code guidelines for 2025 take effect on October 1, 2024, and remain in effect until September 30, 2025. The updates include 252 new codes, 36 deleted codes, and 13 codes were revised. There are 8 new ICD-10 codes that relate to low back pain, lower extremity pain and disc degeneration: M51.360: Other intervertebral disc degeneration, lumbar region with discogenic back pain only MSL361 Other intervertebral disc degeneration, lumbar region with lower extremity pain only M51.362: Other intervertebral disc degeneration, lumbar region with discogenic back pain and lower extremity pain MS1.369: Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain M51.370: Other intervertebral disc degeneration, lumbosacral region with discogenic back pain only M51-371: Other intervertebral disc degeneration, lumbosacral region with lower extremity pain only M51372: Other intervertebral disc degeneration, lumbosacral region with discogenic back pain and lower extremity pain M51.379: Other intervertebral disc degeneration, lumbosacral region without mention of lumbar hack pain or lower extremity pain There is 1 new ICD-10 code that relates to low back muscle dysfunction: M62.85: Dysfunction of the multifidus muscles, lumbar region There are 5 new shoulder ICD-10 codes: M65.90: Unspecified synovitis and tenosynovitis, unspecified site M65.91: Unspecified synovitis and tenosynovitis, shoulder M65.911. Unspecified synovitis and tenosynovitis, right shoulder M65.912: Unspecified synovitis and tenosynovitis, left shoulder M65.919. Unspecified synovitis and tenosynovitis, unspecified shoulder There are a new upper arm ICD-10 codes: M65.92: Unspecified synovitis and tenosynovitis, upper arm M65.9211 Unspecified synovitis and tenosynovitis, tight upper arm M65.azz: Unspecified synovitis and tenosynovitis, left upper arm M65.929: Unspecified synovitis and tenosynovitis, unspecified upper arm There are a new thigh ICD-10 codes: M65-95: Unspecified synovitis and tenosynovi tis, thigh M65.951: Unspecified synovitis and tenosynovitis, right thigh M65.952: Unspecified synovitis and tenosynovitis, left thigh M65.959: Unspecified synovitis and tenosynovitis, unspecified thigh There are 4 new ankle and foot ICD-10 codes: M65.97: Unspecified synovitis and tenosynovitis, ankle and foot M65/971: Unspecified synovitis and tenosynovitis, right ankle and foot M65.972: Unspecified synovitis and tenosynovitis, left ankle and foot M65.979: Unspecified synovitis and tenosynovitis, unspecified ankle and foot The official ICD-10 code guidelines for 2025 take effect on October 1, 2024, and remain in effect until September 30, 2025. Additional Comments Acute traumatic versus chronic or recurrent musculoskeletal conditions. Many musculoskeletal conditions are a result of previous injury or trauma to a site or are recurrent conditions. Bone, joint or muscle conditions that are the result of a healed injury are usually found in chapter 13 of the Tabular List. Email info@target- coding.com for a copy of the Tabular List. In ICD-10, the trauma episodes of care are designated by 3 types of encounters. Initial encounter, subsequent encounter and sequelae. Use the letter A for initial encounter. This occurs when the patient is receiving active treatment for the condition, and you are the first provider the patient visits for the present condition. Use the letter D for subsequent encounters. This is for follow up visits after the patient has seen another provider. Use the letter S for sequela. Sequela is a late effect problem as a result of the original problem. This is used for complications or conditions that arise as a direct result of a condition. If you’d like to know the ICD-10 codes that pay for the most treatment, email info@targetcoding.com to receive a FREE ICD-10 code cheat sheet. Marty Kotlar, DC, CPCO, CBCS, COF TARGET CODING 1-800-270-7044 info@targetcoding.com www.targetcoding.com

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Is A Material Misrepresentation Defense The Death Of A Claim?

Most insurance companies do not understand what triggers an insured’s appearance to an examination under oath or giving a statement. One of an insurance company’s favorite methods of wiggling out of coverage is a material misrepresenta- tion defense. A material misrepresentation occurs when an insured misrepresents material facts that prejudices an insurance company. Material misrepresentations are in 2 categories: 1) a material misrepresentation made before claim arises and 2) material misrepresentations made after the claim arises. The second category is more difficult for an insurance company to prove than the first category. Many times lawyers and medical providers are afraid of material misrepresentation claims and will abandon a PIP claim or a personal injury claim once an insurance company raises a material misrepresentation defense to cover age. A knowledgeable attorney well-versed in coverage can definitely defeat an insurance company’s material misrepresentation defense in both categories. One of the keys to defeating a material misrepresentation claim is proper preparation of an insured giving statements and examinations under oath. No statements and/or examinations under oath should be provided until the insurance company follows the strict letter of the law in requiring attendance to a statement or an examination under oath. Most insur- ance companies do not understand what triggers an insured’s appearance to an examination under oath or giving a statement. This provides an avenue for an experienced attorney to protect an insured from giving a statement and/or an examination under oath. Many attorneys practicing personal injury are great attorneys but unfortunately are not well-versed in coverage cases. Insurance companies love to use policy provisions against an insured to try to prove a material misrepresentation. But why not use those same policy provisions against an insurance company to defeat a material misrepresentation claim. This is what an experienced attorney well-versed in coverage cases does. Smart medical providers will make sure that they use experienced attorneys in coverage cases to stand in and represent the insured in cases where insurance companies ask an insured to appear to a statement or an examination under oath or in cases where an insurance company claims that the insured committed a material misrepresentation. So the next time a lawyer or a medical provider sees a material misrepresentation defense, do not be afraid just get someone well-versed in coverage to handle the claim. George A. David, Esq. 500 South Dixie Hwy, Ste. 220 Coral Gables, FL. 33146 305-569-9980 gadeservice@gmail.com

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Succeeding Under Tort Reform Part 5-reasons Why Tort Reform Is Not A General Cap On Damages

This is the fifth article in a series that lights the way to success under Florida Tort Reform’s Section 768.0427. This article is a slight break in the flow of the series to Issue what appears to be a necessary broad reminder to all personal injury attorneys in Florida: Tort Reform is NOT a general cap on damages. While Subsection (2)(a) limits the amount the jury can award to the amount that was already at the time of trial paid to the provider to satisfy the bill, that subsection will seldom come into play because, by definition, that subsection applies only when the provider’s bills have already been paid. The heart of the statute is Subsection (2)(b), which applies to past medical bills that have not yet been satisfied. That subsection deals with evidence offered to prove the amount necessary to satisfy such bills. Please see Article #3 for detailed statutory analysis. Here are two examples in the month of September alone wherein a personal injury attorney settled or was about to settle a case at a figure far below value because the attorney did not understand the distinction between Subsections (2)(a) and (2)(b). In all three of these cases, I learned of the mistake when my medical provider client called me to help avoid an interpleader between my client and the attorney First, an attorney settled a case based on Medicare rates even though the providers had opted out of Medicare. The fact of the opt out meant that the providers did not, and were not required to, submit the bills to Medicare. Because the providers did not submit the bills, Medicare did not pay. Because Medicare did not pay, Subsection (z)(b) – not Subsection (2)(a)-applied. By the plain language of the statute, this meant that the jury could award any amount above Medicare that it found reasonable. The attorney had no reason to accept the claim representative’s offer to settle at the Medicare rate. Second, an attorney settled a case based on an “approximation” of the health carrier’s reimbursement rate where the provider did have a contract with the carrier and did submit the bill to health insurance. The health carrier, however, denied the claim. The fact of the denial meant that the carrier did not pay. Because the carrier did not pay, Subsection (2)(b)-not Subsection (2)(a) applied. By the plain language of the statute, this meant that the jury could award any amount above the “approximation” of the carrier’s reimbursement rate that it found reasonable. The attorney had no reason to accept the claim representative’s offer to settle based on the approximation. Third, a provider performed a procedure that is not covered by Medicare. The attorney settled the case based on the Medicare rate of a “similar procedure” to the one performed. But the fact that the actual procedure was not covered meant that the provider did not, and was not required to, submit the bill to Medicare. Because the provider did not submit the bill, Medicare did not pay. Because Medicare did not pay, Subsection (2)(b) not Subsection (2)(a) – applied. By the plain language of the statute, this meant that the jury could award any amount above Medicare that it found reasonable. The attorney had no reason to accept the claim representatives offer to settle based at the Medicare rate. It is critical that the personal injury attorneys and medical providers get on the same page. If an attorney settles a case at an amount based upon a non-applicable portion of the statute and the medical provider is aware of that mistake, the medical provider is not going to accept the attorney’s resulting request for an extreme reduction on the bill. The attorney will then have a difficult decision to make based upon his or her ethical obligations to the client/patient, which include the responsibility to protect the client from liens. Aaron Proulx, Esq. THE DOCTOR’S LAWYER, PLLC. (813)486-7321 aaron@doclawfirm.com www.doclawfirm.com

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PIP Billing For Unlisted Services: A Guide For Medical Providers

As medical providers in Florida strive to comply with the complex landscape of billing Personal Injury Protection (PIP) insurance, the question of how much to bill for services lacking established reimburse- ment amounts under the Medicare Part or Workers’ Compensation fee schedules looms large. The intricacies of this issue are particularly relevant following a recent court decision that shed light on insurance company obligations to pay for unlisted services. PIP insurance is a crucial component of Florida’s no-fault insurance system, designed to cover medical expenses for individuals injured in automobile acci- dents, regardless of fault. According to Section 627.736. Florida Statutes, PIP insurers are expected to reim- burse medical providers for “all reasonable expenses” incurred during treatment. This broad mandate raises significant questions when the services rendered do not align with pre-established reimbursement schedules. Florida law stipulates that when available, reim- bursement amounts should adhere to existing fee schedules set forth by Medicare or Workers’ Compensation. However, the reality is that some medi- cal services-especially specialized treatments do not have corresponding amounts listed in these schedules. In August 2023, the Fourth District Court of Appeal Issued a pivotal ruling in the consolidated cases of Safeco Insurance Company of illinois v. MD Now Medical Centers, Inc., LM General Insurance Company. MD Now Medical Centers, Inc. a/a/o Lisa Lugo, and Liberty Mutual Insurance Company v. MD Now Medical Centers, Inc. These consolidated appeals raised important concerns. regarding the obligations of PIP insurers to reimburse medical services without established reimbursement amounts under Medicare or Workers’ Compensation. The Court reiterated that while PIP reimburse ment should reference these established fee schedules, when possible, it is not strictly bound to them. The ruling established that PIP insurers must have a methodology for determining reimbursement for an unscheduled service that is done by comparing the billed code(s) with clinically similar codes found in the Current Procedural Terminology (CPT) Manual or the Healthcare Common Procedure Coding System (HCPCS) Manual. This ruling is particularly significant because it clarifies that providers may seek reimbursement of their charges even if the charges do not have an established reimbursement amount. Given the court’s affirmation of reimbursement for unlisted services, medical providers must implement comprehensive strategies for billing PIP insurance when it comes to these unlisted services. The basis for this strategy should involve: Assessment of Market Rates: Providers should research and document the standard fees forsimi- lar services within their region. Using industry benchmarks will help establish a fair and justifi- able billing rate. Documentation of Medical Necessity: Each service should be accompanied by thorough documentation demonstrating its necessity, Clear medical records can substantiate charges and enhance the provider’s position during potential disputes with insurance companies. Billing Procedures: Adopt transparent billing practices by breaking down services into detailed line items. This approach not only helps justify the total charges but also provides clarity for both the insurer and the patient. Engagement with Insurers: Providers should be proactive in communicating with PIP insurers regarding their billing practices, especially when services do not fit neatly into existing reimbursement structures. Open dialogue can help prevent disputes and promote timely payment. As Florida’s medical providers face the challenges associated with PIP billing for services without predetermined reimbursement amounts, the recent 4th DCA ruling provides ammunition for medical providers who are seeking reimbursement for unlisted services. By emphasizing reasonable billing practices, thoroughly documenting services, and being prepared to justify charges, providers will increase the likelihood of PIP reimbursement for these unlisted services. This not only ensures they receive fair compensation but also enhances the overall integrity of the healthcare system in Florida. 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/

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The Integration Of EMR And Case Management Software

COMPLIANCE, INTEROPERABILITY, AND THE 21ST CENTURY CURES ACT As the legal industry increasingly relies on technology to streamline operations, the Integration of physi- cian electronic medical record (EMR) retrieval with case management software has emerged as a critical advancement. This integration not only enhances efficiency but also plays an important role in ensuring compliance with regulatory standards, particularly those related to Information Blocking Rules, healthcare and legal interoperability, and the 21st Century Cures Act. The healthcare information technology sector is highly regulated so law firms should seek to support vendors who are HIPAA compliant and maintain SOC2 and ISO certifications. The Evolution of EMR Retrieval in Legal Case Management Traditionally, obtaining medical records for legal cases was a labor-Intensive process, fraught with delays and errors. Law firms and legal professionals often had to navigate through a maze of paperwork, manual requests, and follow-ups with healthcare providers. However, the advent of digital transformation has changed this landscape. Leading case management software platforms now offer Integrated EMR retrieval services, enabling legal professionals to access critical medical records swiftly and accurately. These Integrations allow for seamless data transfer, reducing the time spent on administrative tasks and minimizing the risk of errors. As a result, law firms can focus more on case strategy and client service, and enhance overall productivity. Compliance with the 21st Century Cures Act and Information Blocking The 21st Century Cures Act, enacted in 2016, has been a driving force behind promoting greater interoperability in healthcare by mandating secure and accessible elec tronic health information (EHI). A key provision prohibits Information Blocking practices that unreasonably obstruct access, exchange, or use of EHL. The Office of the National Coordinator for Health Information Technology (ONC) and the FDA can Impose substantial fines for violations. To comply, medical records must be securely shared without undue interference, withall data requests starting with consent obtained through state-approved, HIPAA compliant forms. Integrated EMR retrieval systems within case management software enable law firms to access medical records efficiently, with automated workflows, timely requests, follow-ups, and alerts to prevent delays. Enhancing Legal Interoperability Legal Interoperability, the ability of different Information systems to work together within and across organizational boundaries, is a cornerstone of the 21st Century Cures Act. In the context of EMR retrieval, interoperability ensures that law firms can access and utilize medical records from various healthcare providers without compatibility issues. This capability ensures that medical records from disparate sources can be accessed, analyzed, and incorporated into legal cases without unnecessary delays or technical hurdles. By minimizing compatibility Issues and technical hurdles, Interoperability reduces delays in legal processes and ensures that all relevant medical information can be incorporated into legal cases promptly and accurately. What to Ask an Electronic Medical Record Retrieval Vendor Law firms should also engage in due diligence by reviewing the vendor’s certification status, asking for audit reports, and ensuring that the vendor’s prac- tices align with the firm’s Internal compliance policies. Regular audits and assessments should also be conducted to ensure ongoing compliance and security. In a sector as regulated and sensitive as healthcare information technology, law firms cannot afford to take risks with their data security. When selecting a vendor for electronic medical record retrieval and other health- care-related services, law firms should prioritize those that hold SOC2, and ISO as these certifications are not just checkboxes but are Indicative of a vendor’s dedica-tion to maintaining secure, compliant, and high-quality operations. Tiffanny J. Anghel, MHA HEAD OF PARTNERSHIPS YOCIERGE & YC API. ta@ycapi.health 862-209-0195 yocierge.com cal.read.ai/tiffanny-a5xwi/

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