Florida Personal Injury Magazine • Jul-Sep 2022

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WELCOME TO THE FLORIDA PERSONAL INJURY MAGAZINE!

I am happy to see that our magazine has made its way to several areas of Florida that are crucial to the PI industry. This is our magazine’s fifth issue, and we are now making it into the hands of PI law firms and clinics in Miami-Dade, Broward, Palm Beach, and for the first time, we are also distributing to Collier, Lee, Orange, Hillsborough and Duval counties! In just a little over a year, we were able to double our distribution from 500 to 1,000 PI businesses! I am very grateful to all of our loyal sponsors, without whom none of this would have been possible.

And as we continue on our road to expansion, we hope to take you with us! Whether you are in the medical or legal profession, you could use this magazine as your platform to take your business all around Florida, opening up new relationships and increasing your revenue. All the advertisers and authors in this publication are well versed in the world of Personal Injury, and making connections with each of them could become a great resource to help each other grow.

Take advantage of our special introductory prices, which are available for a limited time only. We offer several advertising options, which will help you maximize your investment by giving you exposure to a very specific target audience. Our deadline to reserve your space on our next issue is Friday, August 19th, 2022, so make sure to reach out to us and we will help you find the best option for featuring your business with us and make good use of your marketing dollars.

I look forward to hearing from all of you, getting your feedback and helping you make fruitful connections.

Sincerely yours,

Angely C. Maria EDITOR IN CHIEF

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VERTIGO WHIPLASH-ASSOCIATED THE CHALLENGE OF

By Michael Minett, D.C.

In addition to more common symptoms like neck pain and stiffness, the Whiplash-Associated Disorders (“WAD”) patient may also experience vertigo or dizziness. However, the link between vertigo and WAD is somewhat controversial. In 2021, a team of international researchers published a meta-analysis (a review of previously published studies) entitled “The Enduring Controversy of Cervicogenic Vertigo, and its Place among Positional Vertigo Syndromes.” In the paper, the authors note that despite considerable scrutiny and research, little progress has been made to clarify the cause and underlying mechanisms of the disease.

The term “cervicogenic” implies that the problem stems from the cervical spine. A Cervicogenic Vertigo (“CV”) patient will either experience neck symptoms in addition to dizziness or will have a history of neck injury that precedes the onset of vertigo. An issue the authors cite is that most “neck” injuries are not focal but involve more than just the neck. Whiplash is a great example, as post-WAD vertigo usually involves several structures that can affect balance, including the otolith system (inner ear/balance organ), the brain (cortical and subcortical structures), the brainstem, the vertebral arteries, and the various structures in the neck and upper back.

Despite many attempts (and failures) at finding a single diagnostic test to solidify the diagnosis of vertigo, the good news is that chiropractic care helps a lot! There is strong evidence that spinal manipulation of the neck and midback helps by stimulating the mechanoreceptors located in the neck muscles and ligament insertions. More specifically, the muscle spindle cells located in the deep short neck muscles and the sensory fibers connecting the facet joint proprioceptors with the spinal cord that feeds information to and from the vestibular (balance) system and other parts of the brain all play important roles in helping to resolve vertigo in WAD patients.

In 2011, a group of Australian researchers uncovered 14 prior studies that reported improvement in dizziness using both unimodal (manual therapy only) or multimodal (more than one) therapy interventions. They cited improvements in postural stability, joint

positioning, range of motion, muscle tenderness, neck pain, and vertebrobasilar artery blood flow velocity in their systematic review. A more recent 2020 systematic review that included 22 clinical trials identified manual therapy, vestibular rehab (eye exercises), Tai Chi, and canal repositioning exercises as effective for the management of cervicogenic vertigo. Doctors of chiropractic may incorporate these methods into a treatment plan for the CV patient as well as team up with allied healthcare providers when appropriate.

From a legal perspective, the addition of a dizziness/ balance disorder diagnosis adds another level of value to the personal injury case. Proper documentation and follow up treatment is of paramount importance when caring for this type of patient. Fortunately, at our clinic, we provide all the modalities mentioned in the research that aides in the recovery of vertigo/dizziness symptoms. ■

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Michael Minett, D.C.

Practicing chiropractic in Boca for over 22 years, after relocating from New York. His multidisciplinary team focuses on treating victims of car accidents. His own remarkable chiropractic experience as a teen following significant injuries from a car accident, inspired him to become one.

map-marker-alt 8903 Glades Rd. Suite A11

Boca Raton, FL 33434

phone-alt (561) 482-7575 — mobile (561) 350-8689

envelope DrMinett@TotalHealthandRehab.com

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DE MI NI MI S”

By Victor Demesmin Jr, Esq.

In this ever-changing Personal Injury Protection landscape, there is a new, yet old, emerging defense being asserted by the insurance companies to keep them from appropriately reimbursing providers yet again. Many attorneys are now arguing that the recovery of certain unpaid benefits is barred under the doctrine of “de minimis non curat lex.” This doctrine refers to the legal maxim that the law is not concerned with insignificant or minor matters. These attorneys are attempting to argue that some of the amounts at issue in these PIP suits are too small to be considered by the Court. This is just another attempt by Insurance Companies to minimize their liability when they fail to properly reimburse the hard-working providers of Florida. However, if you delve into some further research, it becomes clear that this attempt by the insurance companies is misguided.

The PIP Defense bar has been excited to reproach this age-old argument of “de minimis” in the PIP realm based upon recent case law that has come out. However, the Defense attorneys seem to put the cart before the horse and misread the recent caselaw on De Minimis. The Court clearly interpreted “de minimis” in a very narrow context in a recent 4th DCA case, but they try to stretch the ruling to fit their needs at the expense of Florida’s providers.

“De minimis” has never truly become pronounced in the PIP community because we look at these cases and underpayments by these insurance companies not as a “one off” error, but rather a routine, automatic reduction affecting hundreds of thousands of claims. For an insurance company to avoid having to deal with minimal underpayments to providers, then they could routinely do so in an effort to save money and uniformly harm insureds and providers across the state. While it may only be $1.00, $2.00, or $3.00 at issue in a specific claim, the aggregate of having done this reduction across hundreds of thousands of claims would save the insurance companies millions. Courts have, and continue even after recent case law, to understand this concept and understand the Florida Small Claims Court and the PIP Statute was enacted specifically to address these issues and to rule otherwise would be to deny a constitutional right of equal access to the Courts to Plaintiffs in PIP Cases. We will continue to fight vigorously for the rights of the providers of this state and will not settle for less than the full amounts owed to our clients. ■

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WHAT TO EXPECT WHEN YOU’RE EXPECTING… A (TELEMEDICINE) EMC REPORT

By Todd M. Narson, DC, DACBSP

Here in Florida chiropractic physicians are unable to certify a patient as having an emergency medical condition (EMC). As such, chiropractors need to refer patients out to an MD, DO, NP or PA for an examination to determine EMC status. The Covid-19 pandemic gave rise to the telemedicine industry, which has made it easy to refer a patient for a telemedicine exam for a variety of reasons, including to determine if their injuries qualify as an EMC. Even though as a chiropractic physician I cannot certify an EMC for a patient, I have done several dozens telemedicine consults/exams and have guided patients through home therapy and rehab sessions. When it comes to musculoskeletal injuries such as the ones patients suffer in a motor vehicle collision, there are some things you should expect. I’ve seen some good exam reports and I’ve seen some that are quite lacking. This is what I feel we all should expect from any telemedicine exam report, EMC or not.

When conducting a musculoskeletal examination through telemedicine, the history remains king. As they said in school, 80% of your diagnosis comes through the patient history. A review of systems can be done with a questionnaire filled out along with their new patient paperwork. Then, simply review it with the patient during the consultation and transcribe it into your report. Up to now, it’s almost no different than doing a consultation in person.

Now comes the trick. How do you conduct a musculoskeletal physical examination without being able to get your hands on the patient? Here are some ideas to help you get some good information from your patient, arrive at a working diagnosis and make some reasonable recommendations for your patient.

•

OBSERVATION OF RANGE OF MOTION (ROM).

In the office, you will typically move around the patient to observe and test ROM. Through the lens of a video camera, you’ll need to have the patient adjust their position so you can observe them as they move their neck, back, shoulder, etc., through ranges of motion. Make note of the restrictions you observe, which ROMs are painful and the pattern of pain produced. Radiating pain or paresthesias on ROM could indicated nerve root compression/HNP, while localized pain could indicate facet sprain/ edema, muscular strain or ligamentous sprain.

• CERVICAL SPINE: You can guide the patient through Maximum Foraminal Compression test by simply asking the patient to turn their head, and then lean it back. Does it produce localized pain? Does it produce radiating pain or paresthesia? This could mean a facet sprain/facet syndrome versus a pinched nerve of herniated disc.

• LUMBAR SPINE: Have the patient position their phone or computer so you can observe them doing a Seated SLR (straight leg raise), then laying supine and performing an SLR. Localized pain could mean facet or sacroiliac involvement, radiating pain or paresthesias could indicate nerve root compression and herniated disc. Then, have them stand and perform a Kemp’s test. You can verbally guide them through these, note their pain, pain patterns, etc.

• SHOULDER: The Painful Arc Test is basically asking the patient to abduct their arm/shoulder and noting at what ROM pain occurs. Pain between 45-120 degrees is generally glenohumoral (Labrum/slap tear), pain above 170 is acromioclavicular (AC joint) related. Neer’s sign can be performed by having the patient hold their arm in front of them (900 flexion), then maximally internally rotate (thumb pointing down), then, instead of you lifting their arm into full flexion, verbally guide them to raise their internally rotated arm/ shoulder into flexion and note if it produces their shoulder pain and gives you information as to an impingement syndrome of the shoulder.

• THE KNEE: Observation can tell you a lot. Is there gross edema? If the patient’s knee is swollen, did the swelling occur rapidly (within 3 hours)?

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CONTINUATION

What To Expect When You’re Expecting…

Think ACL or PCL or was there mild/moderate swelling that slowly took place over the course of a day? Think meniscus or collateral ligament injury. Thessaly test can be performed with verbal cues by having the patient stand in a corner of the room so they can use their hands for balance. Then guide them through the test. Have them bend the knee 20 degrees, then have them rotate right, then left on the knee being tested. Pain

These tests are simple and quick, and they can give your telemedicine examination report greater validity. Spending a few more minutes and talking the patient through these orthopedic maneuvers can give you greater clarity to make better medical decisions regarding appropriate modalities, exercises, stretches, medicines and other procedures to benefit your patient. When used for the purposes of making a determination of an emergency medical condition, it gives your report greater authority.

For me, I want useful information. I am not just looking for a piece of paper with a signature on it. I want information that will help me, help my patient. That is what I expect when I get any report from any medical specialist for any reason. ■

Todd M. Narson, D.C., D.A.C.B.S.P.®

Diplomate, American Chiropractic Board of Sports Physicians

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

phone-alt (305) 672-2225

envelope miamibeachdoc@yahoo.com

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How to Maximize Reimbursement from Every PIP Carrier?

What State Farm Investigators Look For?

The Florida Pre-Pay $1,500 Max Rule?

How to Get Paid for Laser & Decompression?

The PIP Fees According to The Medicare & FL WC Fee Schedules?

How to Prevent AmBetter Audits?

How to Get Paid by Medicare for Back & Knee Braces?

How to Transform Your Insurance Practice to an All CASH Practice?

How to Hire Nurse Practitioners to do Trigger Point & Knee Injections?

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SUSTAINABILITY & SUCCESSION PLANNING FOR LAW FIRMS

Plan today for tomorrow. It will be here sooner than you think!

By Bianca Moreiras, CEO Bianca Moreiras & Associates

To say that the last 2 years have been a disruption is an understatement. Since March 2020, I have seen a variety of law firms close, downsize, merge and be acquired. Seasoned rainmakers are approaching retirement age and some continued to work beyond their retirement age. Many seasoned attorneys have decided it is “time to go” and that “Life is too short!” The pandemic has shed light on an enviable situation: retirement.

Unfortunately, because there was no succession planning in place for many firms, or they weren’t ready just yet, firms had no choice but to close their doors. Other firms made the decision to make a lateral move, merge or be acquired by another firm. Although one of the above situations comes with stipulations, perhaps loss of control or the termination of most of their staff, it can be a better alternative than closing the firm especially if you’re not ready to retire. It can be a great transition to retirement, and securing continued revenue, if the plan is laid out correctly.

After all, you have put in several years of outstanding service for the legal community. There should be a reward beyond sitting behind a desk. The good news is there is!

My consulting business has led me to work with some outstanding attorneys in the age range of 50-60 years old. The main reason to engage was to explore keeping the business relative and sustainable for the future as well as implementing a succession plan and securing it in place.

It’s a shame when a viable firm decides to dissolve because the partners have come of age and feel that’s their only choice. You have choices.

1. PREPARE AND PLAN: The best way to leave a legacy is to groom, mentor and train someone 15-20 years your junior. Identifying an associate or young partner to become the rainmaker and/or managing partner of the firm over time will benefit you greatly and allow succession to take place through growth naturally.

2. TRANSITION: Five years before you anticipate retiring or semi-retiring, meet with a seasoned consultant and recruiter to begin your process of merging or making a lateral move, moving your book of business into the new firm, and integrating your clients into the new environment seamlessly. It takes a few years to find the right fit, so begin early.

It can be a great transition to retirement, and securing continued revenue, if the plan is laid out correctly.

3. LEAVE A LEGACY THROUGH YOUR FAMILY OF ATTORNEYS. It’s a wonderful tribute when your children, or other family members decide to become an attorney. This could be a seamless transition. I never recommend having your family member(s) join your firm without gaining experience outside the family practice for at least 3-5 years or more. Why you ask? By working in another established firm, it will give the attorney the chance to develop their style, skills, and business acumen without the veil of mom or dad over them. This opportunity will allow for growth and prepare them for their lifelong mission to eventually acquire the firm.

Keep in mind that the book of business you generated as a rainmaker is only as portable as you are. Clients always have the decision to stay with you, the person they know, like and trust, or to bring their business elsewhere. Although there are no guarantees, staying with your clients through the transition, introducing them and having them slowly work with the lateral, new firm, or offspring, helps maintains sustainability and allows fora stable succession plan. ■

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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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?

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CODING & COMPLIANCE TIPS FOR THE HEALTH OF YOUR PRACTICE

(For Part 1 of this article, refer to our 2Q2022 issue)

By Marty Kotlar, DC, CPCO, CBCS PART

QUESTION

2

of 2

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, in Part 1 we covered how to analyze insurance company EOBs (explanation of benefits), ICD-10 code bundling and in-network vs. out-of-network pros and cons. Today, we’re going to go over medical necessary care vs. wellness care and Florida pre-pay plans.

Medically Necessary Care vs. Wellness Care

In my opinion, all patients can be categorized into either Active Care or Wellness/Maintenance Care. During active care or active treatment the patient has pain, restricted motion, inability to perform normal daily activities, muscle spasm, sprains/strains and decreased functional performance. Active Care/Active Treatment is typically covered by health insurance because it is considered “medically necessary.” On the other hand during wellness care, the patient has very little or no pain, has good motion and can perform most/all normal

daily activities. Once a patient has plateaued or reached maximum therapeutic improvement, this is considered Maintenance Care. Wellness and Maintenance Care is not typically covered by health insurance because it is considered “not medically necessary.” Make sure the patient has a clear understating of the difference and you will see improved reimbursement.

Florida Pre-Pay Plans

Florida allows providers to have patients “pre-pay” for services rendered. However, there is a $1,500 limit. For example, according to the Florida Chiropractic Board Statute 460.413, failing to preserve identity of funds and property of a patient, the value of which is greater than $501. As provided by rule of the board, money or other property entrusted to a chiropractic physician for a specific purpose, including advances for costs and expenses of examination or treatment which may not exceed the value of $1,500, is to be held in trust and must be applied only to that purpose. Money and other property of patients coming into the hands of a chiropractic physician are not subject to counterclaim or set off for chiropractic physician’s fees, and a refusal to account for and deliver over such money and property upon demand shall be deemed a conversion. This is not to preclude the retention of money or other property upon which the chiropractic physician has a valid lien for services or to preclude the payment of agreed fees from the proceeds of transactions for examinations or treatments. Controversies as to the amount of the fees are not grounds for disciplinary

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Active Care/Active Treatment is typically covered by health insurance because it is considered “medically necessary.”

proceedings unless the amount demanded is clearly excessive or extortionate, or the demand is fraudulent. All funds of patients paid to a chiropractic physician, other than advances for costs and expenses, shall be deposited into one or more identifiable bank accounts maintained in the state in which the chiropractic physician’s office is situated, and funds belonging to the chiropractic physician may not be deposited therein except as follows:

1. Funds reasonably sufficient to pay bank charges may be deposited therein.

2. Funds belonging in part to a patient and in part presently or potentially to the physician must be deposited therein, but the portion belonging to the physician may be withdrawn when due unless the right of the physician to receive it is disputed by the patient, in which event the disputed portion may not be withdrawn until the dispute is finally resolved.

Every chiropractic physician shall maintain complete records of all funds, securities, and other properties of a patient coming into the possession of the physician and render appropriate accounts to the

patient regarding them. In addition, every chiropractic physician shall promptly pay or deliver to the patient, as requested by the patient, the funds, securities, or other properties in the possession of the physician which the patient is entitled to receive. ■

Marty Kotlar, DC, CPCO, CBCS

Over the last 12 years, he has helped hundreds of chiropractors, physical therapists and acupuncturists with compliance as it relates to billing, coding, documentation, Medicare & HIPAA. 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 state association conventions. phone-alt 1-800-270-7044

envelope drkotlar@targetcoding.com info-circle www.TargetCoding.com

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Let others know about your next event and how they can join you! Send us an email to editorial@floridapimag.com to add your upcoming events into our next magazine issue.

TUESDAY JUL 12 calendar

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SATURDAY JUL 16 presentation

Sailboat Cay Building 13499 Biscayne Blvd, #106 North Miami, FL 33181

Fundraising reception to keep Judge Lody Jean Florida Advocates envelope-square

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Documentation & Coding For The Health of Your Practice – Webinar

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8:00 am–2:00 pm (6 CEUs)

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THURSDAY JUL 21 presentation

Chiropractic SOAP Notes – Webinar

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TUESDAY JUL 26 presentation

DC-MD-PT-NP-ACU

Integration – Webinar

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1:00 pm–2:30 pm

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SATURDAY AUG 6 10:10 am clock

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Wyndham Orlando Resort in Kissimmee, FL

https://myfcpa.org/ce-seminar

Deadline to reserve your spot in the next edition is Friday, August 19th, 2022

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