Whether your PIP billing is done by a billing company or handled by your in-house staff, there are certain tasks that you must ensure are done consistently in order to get what you deserve for the services you provide patients with PIP coverage.
1. Verify all PIP information directly with the insurance carrier
This is the first and one of the most crucial steps in ensuring proper payment for your services. A good biller would first verify that all the information in the system for each patient is accurate, including data such as carrier name, contact information, claim number, date of accident, coverage limits, deductibles and PIP adjuster’s information. Make sure to keep notes on each account with the verification process and follow up until coverage is confirmed.
2. Notify the carrier of the initiation of treatment within 21 days of the first Date of Service (“DOS”)
According to Florida PIP Statutes, medical providers have up to 35 days of each DOS to submit claims to the PIP carrier. However, if you send a notice to the carrier within 21 days of the first DOS, the billing deadline gets extended to 75 days of the DOS. This is especially help ful if you are a new clinic or if you know you might need extra time to finish your first visit reports and docu mentation before you submit your billing. Make sure you keep proof of submission on each file in case there are disputes where the carrier incorrectly denies your claims due to “late filing”.
3. Submit an EMC determination right away
Whether you take care of your Emergency Medical Condition (“EMC”) determination in-house by one of your providers, or refer the patient to another office for an evaluation, this should be set up as soon as treatment starts. You want to be proactive about this and not wait until the PIP benefits are capped at $2,500 for lack of an EMC. Do not assume that just because the patient went to the hospital or saw another provider before you, that the carrier has an EMC on file and the full PIP benefits are available. As usual, keep proof of your submission and contact a PIP suit attorney if you don’t get payment for any overdue claims after 10 days of sending the EMC to the carrier. Keep in mind that most carriers automatically apply the $2,500 cap unless the EMC has been submitted.
4. Review all claims and SOAP notes for accuracy before submission
I cannot stress how crucial this process is. As perfect as your processes could be, there are always some claims where there are discrepancies between the services performed, the SOAP notes and the charges submit ted. That’s why it is important to implement a process where all these entries are cross-checked to correct any errors and avoid denials for services billed that are not properly documented, or vice-versa.
5. Update your Fee Schedule regularly
Perform a periodic review of your fees to ensure that what you are charging for a service is reasonable, at least on an annual basis. There are a few factors that you should consider when reviewing your fee schedule, such as your expenses, the prices charged by peers in your area for similar services and the fee schedule allowed by PIP. Before you add any new service to your practice, have your biller research the most up to date fee schedule allowable by PIP to use as a reference before deciding your prices on each service.
6. Review your files for PIP suit regularly
Don’t get picky about this. Leverage your relation ships with efficient PIP attorneys to have them review every file to ensure you were properly paid. If you have them come to your office for an audit, set up a follow up review at least every 3 months so that they have a continuous flow of pre-suit demands going out for you and you have a regular inflow of PIP suit checks coming in your office. If you prefer to handle the PIP suit referrals yourself, then use a system to keep track that every file has been sent for review. And no, you do not have to wait for the patient to finish treatment to have a file reviewed by a PIP attorney. Keep in mind that our favorite attorneys’ fees for collecting on demands and lawsuits might have drastically changed since the Tort Reform became effective on March 2023, so request an updated PIP Attorney Retainer so that you understand the legal fees that you’d be charged for these services.
Angely C. Maria
Senior Biller & Consultant, AMB Group
