Florida Personal Injury Magazine • Apr-Jun 2022

PIP REPEAL UPDATE

CODING & COMPLIANCE

TIPS FOR THE HEALTH OF YOUR PRACTICE

TRAITS OF YOUR NEXT PARTNER

THE POST CAR

ACCIDENT HEADACHE

SHOULD YOU CASH THOSE “FULL & FINAL” CHECKS?

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WELCOME TO THE FLORIDA PERSONAL INJURY MAGAZINE!

It’s hard to believe that it has already been a year since we first launched our first issue. We saw the opportunity for this very unique type of publication in the Personal Injury market and have witnessed the appetite and excitement for this new platform that is specifically tailored to the PI businesses in Florida. I am extremely grateful for the wonderful support of all of our sponsors and motivated by the outpour of positive feedback we’re getting from our readers.

And now, I am beyond excited to announce the growth of this venture: as of our next issue, we will be distributing the magazine not only to MiamiDade, Broward and Palm Beach counties, but we will also make our introduction to the areas of Orange, Hillsborough and Duval! That expansion also means double the distribution, increasing it from our current 500 to a total of 1,000 Personal Injury businesses, including carefully handpicked medical providers and law firms from around the state.

We believe the magazine to be a great vehicle for all PI businesses be aware of and connect with one another, benefiting each other while at the same time making Florida’s PI network stronger. If you have been considering advertising with us, now is the time. We will be offering special introductory prices just for our next issue, giving you a chance to lock-in the lower prices. Our goal with this offer is to help you make an investment in what is the only publication in Florida dedicated to the PI industry, allowing your advertising dollars to be spent wisely in a very specific target market.

I encourage you to browse thru all the ads, read all the articles and connect with the professionals featured in this issue. We have a variety of interesting articles by experts in the industry and have now added a very convenient QR code at the end of each article for you to quickly save the author’s contact information to your device. Everyone in this publication will be looking forward to your calls and emails (including myself!), as we work towards our goal of unifying our PI market while complementing each other’s work. I can’t wait to hear from all of you!

Sincerely yours,

Angely C. Maria EDITOR IN CHIEF envelope-square editorial@floridapimag.com

PIPREPEALUPDATE

By James D. Underwood, Esq. & Christopher M. Tuccitto, Esq.

Here in Florida, we know that the new year is well under way when:

1. The horde of slow-driving snowbirds is gradually replaced by a horde of unruly college spring breakers.

2. The normally warm temperatures get even warmer.

3. PIP repeal bills are introduced in the Florida Legislature.

Florida’s 2022 regular legislative session began January 11, 2022 and ended on March 11, 2022. This year PIP repeal was back up for discussion in both the Florida Senate and House of Representatives. The bill in the Senate was SB150 and was sponsored by Senators Danny Burgess (R- District 20) and Darryl Earvin Rousin (D- District 19). The House’s version of the bill was HB 1525, sponsored by Representative Erin Grall (R- District 54). Both bills would have repealed Florida’s mandatory no-fault law and replaced it with mandatory 25/50 bodily injury coverage. The Senate bill contained bad faith reform while the House bill did not. Both bills contained optional Medpay coverage at an insured’s choosing. While both bills were passed by at least one committee in the Senate and the House, they weren’t brought up by the necessary second committee in order to be brought to their respective floors for a vote.

There have been indications that Florida Governor Ron DeSantis does not want a PIP repeal bill brought to his desk this legislative session. In 2021, PIP repeal was passed by the Florida Legislature, but the effort was thwarted in the 11th hour by Governor Ron DeSantis’s veto. In his decision to veto the bill, the Governor concluded that the financial impact of the legislation on Florida drivers would be too costly. This year, it appears that we may avoid such high drama, as all indications point to at least two more years of mandatory PIP in Florida, with both bills languishing and most likely dying in committees.

There remains the possibility that a special session could be called by the Governor to deal with insurance issues, primarily in homeowner’s insurance. Although unlikely, such a special session could include motor

vehicle insurance. The financial impact of repealing Florida’s mandatory no-fault law on Florida drivers is still being debated as there has not been a definitive study of the financial impacts of such a repeal to date using the currently proposed language. One Senator indicated voting for the current PIP repeal in SB150 would be “legislative malpractice” without knowing the real impacts on Floridians.

Those whose practices are impacted by PIP coverage are well aware that future attempts will surely come around to repeal mandatory PIP coverage in Florida, however that does not appear to be the reality this year. For now, it appears that PIP coverage will survive another year in Florida, leaving those who depend on it for their livelihoods and those who depend on it for low-cost automobile insurance coverage, breathing a huge sigh of relief. ■

Florida Advocates PA.

map-marker-alt Florida Advocates

45 East Sheridan Street

Dania Beach, FL 33004

phone-alt (754) 263-4252

envelope chris@fladvocates.com

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SHOULD YOU CASH THOSE “ FULL & FINAL” CHECKS?

By Jeremy Dover, Esq.

We are all very busy practicing a in pressure-filled high-volume business. Mistakes are inevitable, but one way you can insulate yourself from making mistakes and losing money is to be more aware about the language printed on the checks you are cashing. The language can be the deciding factor if you will receive further payment or if cashing the check discharges their duty to further compensate you for your services under the Doctrine of Accord and Satisfaction. If you are using a third-party outside billing company, it is in your best interest to educate them about this topic. Remember, “Can’t get no Accord and Satisfaction if you want further payment!”

First, let’s go over what Accord and Satisfaction is. Accord and Satisfaction results “when a creditor accepts payment tendered on the expressed condition that its receipt is deemed to be a complete satisfaction”. A common example is receiving a check from someone who owes you money, but you believe the check doesn’t reflect the full amount owed to you. Cashing the check, under the doctrine of Accord and Satisfaction, may preclude your ability to file suit for the remaining balance you believe you are still owed.

How would one know whether it’s safe to cash a check? The Third District Court of Appeals ("DCA") of the State of Florida gives us guidance. The Court explains that it depends on whether an instrument (ex. the check) or an accompanying written communication contained a conspicuous statement to the effect that the instrument was tendered as full satisfaction. What is considered “conspicuous” in the eyes of the court?

The 3rd DCA states that the ultimate test is whether the language on the instrument is “so written, displayed, or presented that a reasonable person against which it is to operate ought to have noticed it.” This may include a heading in capitals equal to or greater in size than the surrounding text, or in contrasting type, font, or color to the surrounding text of the same or lesser size. Additionally, language in the body of a record or display in larger type than the surrounding text or set off from surrounding text of the same size by symbols or other marks that call attention to the language are considered conspicuous as well. It’s important to note, language including “FULL & FINAL PAYMENT OF PIP BENEFITS” displayed on the payee line of the front of the check was

definitively found to satisfy the “conspicuous statement” requirement.

In order to better understand what would NOT satisfy the conspicuous requirement, we look to the Fourth District Court of Appeals of the State of Florida. In the 4th DCA Opinion, the Court stated that a check only including language “Dwelling, LO, MH COV A EMS Limit” does NOT put a reasonable person on notice that the amount tendered was in full satisfaction of a claim. Furthermore, accompanying written communication stating “that the insurer did not receive or approve a request required by the policy” fails to meet the conspicuous requirement as well. This Court makes it extremely clear that for the accompanying written communication to be conspicuous, it must include language that “makes explicit, without question, the insurer’s position that there are no further benefits due under the policy and it does not intend to make any further payments”.

Overall, what we want you to take away from this article is that if you receive a check which you believe doesn’t reflect the full amount owed to you, DO NOT cash it right away. Not cashing the check may lead to more money and will preserve your right to recover any remaining balance. If you have any questions about your checks or would like an experienced attorney to take a look, it’s our advice that you consult with our attorney, Jeremy Dover at jdover@dd-legal.com. Remember, “Can’t get no Accord and Satisfaction if you want further payment!” ■

BILLING AND TRAINING SOLUTIONS TO FIT EVERY BUDGET

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THE POST CAR ACCIDENT HEADACHE

Is it Just A Headache or is it an Mild Traumatic Brain Injury?

By Todd M. Narson, DC, DACBSP

After treating thousands of patients over the years, headaches are quite a common symptom following a variety of traumas, auto accidents included. However, during a routine history we may uncover other symptoms that the patient doesn’t really consider part of their headache but are indications that are more severe injury may have occurred. There are even times when a concussed patient may have these other symptoms in the absence of a headache.

When it comes to all injuries, especially a headache following a trauma, the physician needs to consider all other symptoms to see if they are related. After a motor vehicle trauma, it is common to have a headache, however, if that headache is accompanied by any of the following symptoms, you should now be thinking about a possible mild Traumatic Brain Injury (mTBI):

Common Concussion Symptoms:

• Ringing in the ears (tinnitus)

• Nausea

• Vomiting

• Fatigue or drowsiness

• Blurred vision

• Brain fog

• Indigestion/abdominal bloating

• Confusion

• Balance problems

• Dizziness

• Seeing “stars”

• Slurred speech or delayed response when asked a question

• Appearing dazed or “out of it”

• Forgetfulness (often people will repeatedly ask the same question)

• Difficulty concentrating/ focusing

• Poor memory recall

• Irritability and other personality changes

• Sensitivity to light and noise

• Sleep disturbances

• Psychological adjustment problems and depression

• Altered taste and smell

Combining one or more of these symptoms along with a post traumatic headache and mTBI should be in the doctor’s list of differential diagnoses. Referral to a neurologist is warranted for further neurological testing, as well as strong consideration for referral of Brain CT or MRI and a Diffuse Tensor Imaging (DTI) scan.

In order to calculate an impairment for injuries of the central (or peripheral) nervous system such as those associated with an mTBI or TBI, Chapter 13 of the 6th Edition of the AMA Guides To The Evaluation of Permanent Impairment is where to look.

The most important aspect of this is paying attention to the symptoms and recognizing when a headache is more than a headache. Then again, what if the patient doesn’t have a headache, but still has a few of those symptoms? Let’s say they complain of ringing in their ears, nausea and brain fog? Then the diagnosis of mTBI is still very much on the table. So, it is very important to be aware of the diversity of symptoms that could indicate a concussion.

Copy down the list of common concussion symptoms and keep them handy to better help you recognize when a headache is not just a headache and an mTBI may be sitting in front of you. Make sure that the patient, the patient’s family or anyone with whom the patient lives is aware of the symptoms and that everyone involved is on the lookout for symptoms worsening! If the headache, nausea or other concussion related symptoms worsen, call 911 and get them straight to the local emergency department as this can on occasion, spiral into a true-life threatening emergency. ■

Todd M. Narson, D.C., D.A.C.B.S.P.®

Diplomate, American Chiropractic Board of Sports Physicians • USA Triathlon Certified Coach

map-marker-alt Miami Beach Family & Sports Chiropractic Center 975 Arthur Godfrey Road #102 Miami Beach, FL 33140

phone-alt (305) 672-2225

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TRAITS OF YOUR NEXT PARTNER

There are 10 traits that law firms should consider when identifying and offering an associate the partner track.

By Bianca Moreiras, CEO Bianca Moreiras & Associates

Honesty

We would hope that all attorneys are honest however even stretching the truth when keeping timesheets is an act of dishonesty. Missing deadlines and making excuses perhaps is an oversight or an exaggeration, however, it lowers the trust factor. Clients need to feel they are always in honest and trustworthy hands.

Committed

Willing to accomplish any task without conditions. An attorney will spend about 25% (7-12 years) of their working life as an associate developing and crafting their skills, building trust, developing customer service habits, and creating confidence with the firm, partners and clients. The remainder of their career should be seeking and obtaining a partner/ownership role within the firm.

Enjoy the job and be enthusiastic

Every day is an experience. Enjoying the environment, co-workers, clients and the work performed is part of it. Having and bringing the best attitude each day to the office along with a smile and a kind word will help to achieve a robust and enthusiastic journey. Become the client’s most dependable advisor and provide great ethical service.

Treat everyone with respect and dignity

This is key to being noticed and recognized as a great leader. Off-colored remarks, bad behavior, and a condescending attitude will get noticed for all the wrong reasons. Treat your firm, clients, advocates and adversaries with the greatest respect and dignity regardless of their behavior. Learn how to control your emotions, walk away from a bad situation. Stand out from the rest. Ethical behavior always.

Look for a mentor and don't wait for a mentor

Stepping up and seeking a mentor you admire without being invited is a mark of a true leader. Being a partner means being an owner. It comes with great responsibility. Be mindful of the time the partner will be investing if they accept the invitation. Set up early morning or late day meetings at least 3 times a week as to not interfere with the work schedule. If a partner is willing to stretch themselves to be a mentor it is because they have checked off 8 out of 10 traits making for a good mentee. A partner generously giving back with their knowledge, fortitude and experience is the secret allowing an associate to flourish and move towards the partner track.

Confident – Always in control

Always in control does not mean “controlling.”

Knowing the answers when asked the question is a result of investing time and perfecting the craft. Having done the research and presenting the information on point and eloquently will exude confidence. Practice good, sound judgement. Take ownership. Being prepared in all areas of one’s career and life will build confidence. Confidence and self-control will contribute to positive results.

Build an excellent reputation and protect it

“Say what you mean and mean what you say!” Be prepared. Understand the abilities, limitations and outstanding qualities fostered within will help build reputation. Want to be the very best. Concentrate on building your reputation. Protect it at all cost. In life we own our integrity, honesty and reputation. Never compromise any of these traits.

Work hard and always be available

Stand out from the rest. Hard work does pay-off. Exceed working requirements. Consistently working hard is the key. Not just for a period of time but throughout one’s career. Partners will concur that hard work is the end to the means. Not saying work harder, work smarter. With the help of technology much can be achieved. Know the firm’s culture. Life and work balance is important, however, as I stated before only 25% of an associate’s working career should be spent getting to partnership. A small investment resulting in the reward of ownership. Be available when needed. An important characteristic of an owner.

Keep busy

Purposely keep busy. Challenge yourself. Have goals and a plan in place. Keeping a full plate of work; asking for additional work; helping others within the firm; willing to take on administrative responsibilities to assist the partner; networking and marketing with a purpose, volunteering, probono opportunities, and community involvement.

Always learn and improve

Developing skills in a specific practice area and mastering that area of practice can directly contribute to the firm’s growth. Become certified in that area of practice. Keep-up with continuing education. Read periodicals related to areas of practice, new areas of practice and emerging technology. Read for pleasure. Include books

on history and the law. Enroll in management and business courses to strengthen leadership skills. Never stop learning and evolving. ■

NOTE: This document is a useful tool and can be used as the foundation for associates to follow a partner track. Add additional traits that are unique to your firm. Knowing what is expected is the first step in achieving the goals to become a partner/owner of a firm. Knowledge is power!

Bianca Moreiras

Bianca has been helping law firms achieve success in all areas of their business. Over 38 years of law firm experience in operations, mergers and acquisitions, practice area development, cross-selling and marketing. A retreat facilitator, speaker and keynote presenter. One-on-one coaching and development specializing in networking and social skills.

phone-alt (305) 986-0905

envelope moreirasbianca@gmail.com

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HELPING ATTORNEYS AND LAW FIRMS TO

TAKE THEIR BUSINESS TO THE NEXT LEVEL.

At Bianca Moreiras & Associates, we are laser focused on improving what you already have in place. Your firm has many moving parts and the same way you are hired by your clients as a skilled professional, we are hired by attorneys and firms as their business consultant and coach.

Bianca has 38 years of hands-on experience working exclusively with attorneys and law firms improving productivity, increasing revenue, and raising employee morale. In addition, she can help with ensuring sustainability and succession www.biancamoreiras.com

planning for a secure future. What are your goals and plans for 2022? Who is holding you accountable to reach your potential?

CODING & COMPLIANCE TIPS FOR THE HEALTH OF YOUR PRACTICE

By Marty Kotlar, DC, CPCO, CBCS PART 1 of 2

QUESTION

Dr Kotlar, “My insurance reimbursements have been gradually decreasing. I provide high-quality care and help a lot of patients get better, however, I am not getting paid what I deserve. Can you provide a few good strategies to remove these reimbursement roadblocks?”

ANSWER

Yes, there are certain data benchmarks that you should obtain and analyze in order to monitor your practice growth and success. Let’s begin with your Cost Per Visit (CPV). This amount is calculated by dividing your monthly overhead expenses (e.g., rent, payroll, equipment leases, malpractice, taxes) by the number of visits per month. Example: If your monthly overhead is $10,000 and you see 400 visits/month (100/ week), then your CPV is $25.00. Next is the Patient Visit Average (PVA). This amount is calculated by dividing the number of visits per month by the amount of new patients per month. Example: If you see 600 visits/ month (150/week) and 20 new patients per month, then your PVA is 30. Next is the Patient Case Average (PCA). This amount is calculated by dividing the amount of revenue per month by the amount of new patients per month. Example: If your monthly revenue is $50,000 and see 20 new patients per month, then your PCA is $2,500.

ANOTHER DATA EXERCISE TO DO IS TO FIGURE OUT HOW MUCH REIMBURSEMENT YOU’RE RECEIVING PER VISIT PER HEALTH PLAN. HERE’S HOW TO DO IT:

• Pull the last 25 patients that have come in with Health Plan A for your care

• Calculate how many total visits all of these 25 patients received

• Calculate the total amount of money collected for all 25 patients

• Divide the total amount collected by the number of total visits to get the amount collected per visit

• Example: 25 patients received a total of 100 visits. The total amount collected for all 100 visits is $3,000

• $3,000 divided by 100 visits = $30 collected per visit

Analyze EOBs

Analyze your insurance Explanation of Benefits (EOBs). There are 5 “amounts” that appear on EOBs. They are the charged amount, allowed amount, writeoff amount, patient responsible amount and the amount paid to the provider. Billing managers should meet with the business owner 3-4 times per year and do a concentrated dive into these amounts to ensure that they are being processed properly. We have noticed providers leaving a lot of money “on the table” when this isn’t made a priority or doesn’t get analyzed properly.

In-Network vs. Out-of-Network

There are pros and cons to being an “in-network” provider. One of the benefits is the ability to analyze the participating provider reimbursable amounts per code. Some providers are in-network with many plans and if precise tracking of payable amounts does not occur, it will stall the growth of a practice. One of the negatives of being in-network with multiple plans is that it’s hard to track and this causes frustration in the

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billing department. Some offices get “stuck” billing for limited procedures because they didn’t know other services were available for coverage or only bill for passive modalities (e.g., hot pack, e-stim). They do not do a deep dive into the fee schedules and do not realize all the services that may be authorized within the plan. Also make sure to be collecting the proper co-pay amounts. If you do not collect the proper amounts and the patient does not return for care, you then may have to “chase” after the patient by sending statements in the mail. It’s important to get patients to understand what their financial responsibility is. Analyze the data and track how much should be paid per visit while the patient is actively being treated. While some offices may find it easier to simply mail patient statements, there are usually hidden costs associated with this. It may cost between $5-$10 per patient to send and process each statement by mail, plus once you mail a statement you are decreasing your chances of receiving payment. Studies show that the chance of collecting from a patient drops almost 20% as soon as the patient becomes inactive. Do your best to track and analyze your fee schedules. Start with a simple spreadsheet and enter the name of the plan and the payable amounts per service provided along with the deductible and co-pay amounts per group plan. ■

Look out for this magazine upcoming issue for thepart 2 of this article, where we will cover ICD-10 code bundling, Florida Pre-Pay Law & medically necessary care vs. wellness care.

Marty Kotlar, DC, CPCO, CBCS

Over the last 12 years, Dr. Kotlar has helped hundreds of Florida chiropractors with compliance as it relates to billing, coding, documentation, Medicare, HIPAA & DME accreditation. Dr. Kotlar is certified in compliance, a certified coding specialist, a contributing author to many coding and compliance journals and a guest speaker at many Florida state association conventions.

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