Florida Personal Injury Magazine • Oct-Dec 2022

FIRM RETREATS

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WELCOME TO THE FLORIDA PERSONAL INJURY MAGAZINE!

We are excited to bring you this unique publication dedicated exclusively to the Personal Injury industry in Florida. Inside our magazine you will find expert articles on topics that are important to you, offering in-depth information to help you run your business in a more efficient and profitable way. All articles include a convenient QR Code linking directly to its author, making it easy for you to get in touch with them if you have further questions on the topic or would like to make a connection to grow your PI network. Make sure to also check out our Upcoming Events page, in which you’ll find a monthly guide to sponsored events that could be of benefit to your business.

What is best of all, we do this at no cost to our readers. Thanks to the loyal support of our sponsors, we will continue to send our magazine to your mailbox every quarter without requiring a subscription fee or membership to any organization. Our recipients include 1,000 PI medical offices and law firms in eight counties all over Florida, and growing. If you would like to get exposure for your business with an ad or article, simply reach out to us and we’ll find the best option to fit your needs and your budget. We want to help you grow!

As we continue on our road to expansion, we are keeping our introductory rates for a limited time, so don’t wait to reach out to us. I can’t wait to get your feedback on this publication and to discuss how we can feature your business to give it the spotlight it deserves.

Sincerely yours,

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

THE SKINNY ON EMCS

By Christopher M. Tuccitto, Esq.

What is an Emergency Medical Condition (“EMC”) determination, who is qualified to make the determination, and what are the medical reporting requirements for it? These are questions that still arise, even though it’s been ten years since the Florida Legislature amended Section 627.736, Florida Statutes (“The PIP Statute”), to provide a lesser coverage amount ($2,500.00) for certain non-emergency medical conditions.

Pursuant to Section 627.733(16), Florida Statutes, an EMC is defined as “a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following: (a) Serious jeopardy to patient health; (b) Serious impairment to bodily functions; (c) Serious dysfunction of any bodily organ or part.”

A PIP insurer may limit benefits at $2,500.00 instead of $10,000.00 if the medical records do not include an EMC determination made by a certain type of medical provider, which may only include the following: Orthopedic Physicians (MD), Osteopathic Physicians (DO), Dentists (DMD), Physician Assistants (PA), Advanced Registered Nurse Practitioners (ARNP). Unfortunately, Chiropractors (DC) are prohibited from providing EMC determinations.

A physical examination of the patient is not required to obtain an EMC determination.

There is no specific timeframe to obtain an EMC determination. Contrary to popular belief, a patient does not have to receive an EMC determination within the first fourteen days of the motor vehicle accident.

For chiropractors seeking an EMC determination from a qualified physician/provider to receive PIP benefits beyond the $2,500.00 limit, I would advise that they first obtain and review the PIP insurer’s payment log (PIP log) to make sure that the excess benefits won’t be paid to another medical provider whose billing was received prior to the chiropractor’s bills and denied for no EMC. If that provider is owed $7,500.00 or more in benefits, then the chiropractor will receive nothing for obtaining the EMC,

because this provider would be owed the benefits since their billing was submitted before the chiropractor’s bills.

An EMC determination does not need to be made by the patient’s treating physician. The reason for this confusion is that the language of Section 627.736(1)(a)(4) states that coverage reduces from $10,000.00 to $2,500.00 if one of the named treating “providers” determines that there is no EMC. However, the preceding subsection, Section 627.736(1)(a)(3), Florida Statutes, provides that benefits shall be available up to $10,000.00 if a qualified “physician” determines that the patient had an EMC.

An EMC determination may be made by a qualified medical provider based on a review of the patient’s medical records. A physical examination of the patient is not required to obtain an EMC determination.

The PIP Statute does not require a specific form for reporting an EMC. Medical providers can utilize their own forms for reporting EMCs. If the report contains the following words, or something equivalent, then the report is sufficient: “I (qualified provider’s name & credentials) rendered care or treatment to patient (patient’s name) for injuries sustained in a motor vehicle accident on or about (date of accident) and I have determined that this patient had an Emergency Medical Condition resulting from the accident.”

I hope this article provides clarity on the EMC issue, but if anyone has any additional questions about this issue or any other PIP issue, please feel free to email me at chris@fladvocates.com. ■

SETTLING UM CLAIMS WITH CIVIL REMEDY NOTICES

By Christian Lexima, Esq.

Car accidents happen almost every single day, especially in our Sunshine State. According to the National Highway Traffic Safety Administration, in 2019 there were nearly seven million police-reported crashes in the United States. Florida, ranked well above the national average in terms of deaths from motor vehicle crashes per capita with over 3,000 crashes that year. Motor vehicle accidents’ survivors may face major financial hardships due to high medical bills, lost earning capacity or property damage, which is why the state administers a PIP statute. However, Florida does not require Bodily Injury coverage for car insurance policies. For that reason, we often encourage our clients to include Uninsured/Underinsured Motorist (“UM”) on their auto insurance plans when selecting coverages. The purpose of UM is to ensure that there is full auto insurance coverage when an at-fault motorist has insufficient liability insurance, or in a hit-and-run accident or other situations where the at-fault driver cannot be identified. Even when there is UM coverage available however, we sometimes encounter resistance from our client’s insurance companies when they act in bad faith. THERE IS A SOLUTION FOR THESE PUSHBACKS AND THAT IS A CIVIL REMEDY NOTICE (“CRN”).

WHAT IS A CIVIL REMEDY NOTICE (CRN)?

In Florida, an insured can bring a first-party bad-faith claim based on a UM claim and place the UM insurance company on the hook above the limits. However, a CRN must first be filed with the Florida Department of Financial Services (“DFS”); this is the prerequisite to any Florida first-party bad-faith action. Filing a CRN gives the insurance company a last opportunity to “cure” an alleged violation of Florida Statute §624.155 “Bad-Faith” and avoid a bad-faith lawsuit by investigating its handling of the claim, correct any misdeeds, and reach an amicable settlement with the insured. DFS plays an administrative role by monitoring any progress; they do not get involved in any communications or pre-suit negotiations with the insurer.

HOW AND WHEN TO FILE A CRN?

Insurance companies are notorious for denying, delaying, or underpaying their insureds when they are trying to collect what they are entitled to under their policies, after paying thousands in monthly premiums. When customers are dealt with these types of treatments from their insurance companies, they can use a bad-faith civil action to remedy their situation. After weeks or months in attempting to resolve our clients’ UM claim, we are sometimes left with no choice but to go down that path. To commence such action, a

CRN must be filed. To file a CRN, simply access the DFS website’s “Division and Offices” tab, select “Consumer Services”, and select “Civil Remedy/Litigation Notices” under the quick links tab, this should direct you to the CRN page to file or search an entry. A valid CRN must contain the following information:

• detailed facts and considerations supporting how the insurance company violated the statute

• specific statutory provision and language of the statute;

• name of the specific individual(s) you interacted with at the insurance company after filing your claim (such as adjusters, supervisors, etc);

• if applicable, specific language from the insurance policy relating to the specific violation;

• detailed, clear language outlining the purpose of the notice

Once submitted, the insurance company has 60 days to respond before a bad-faith claim can be filed against them on day sixty-one.

IMPORTANCE OF FILING A CRN

As outlined earlier, filing a CRN is fairly simple and low-cost. Insurance companies often times deny minor claims hoping they won’t be bothered with any action against them since the cost of litigation may be too high with little return. A CRN gives the insurance companies an incentive to move the claim up to a more experienced adjuster or representative and taken more seriously. This results in a prompter response and resolution. ■

Demesmin & Dover

map-marker-alt 1650 SE 17th Street

Fort Lauderdale, FL 33316

phone-alt 866-954-6673

envelope Jclexima@dd-legal.com

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WHEN TO ORDER AN MRI?

By Todd M. Narson, DC, DACBSP

Have you ever had a patient come in and demand an MRI? I remember several occasions where patients have asked for full body MRIs. I was blown away by the request. Basically, they wanted an MRI atlas of their body. Of course, there was no medically necessary reason to do so, they were in pain and thought an MRI would find the root of their ills. It’s not always a full body MRI, sometimes it’s simply an MRI of a neck, shoulder or lower back and the reason is also very simple. They’re in pain.

Pain itself is not a reason to refer someone for an MRI. It can be, but not always. We need more context to determine that. Patients end up in my office as well as other chiropractor’s offices because they are at the end of their medical rope. They’ve tried everything and we seem to be the last resort. When reviewing the prior medical records, it seems like physicians nowadays prescribe an MRI in lieu of a physical examination. When I’m finished with my history and physical examination on this patient, I’ve realized the other doctor probably didn’t do a physical examination, because if they had, they would have treated or done an MRI to a different area. Or maybe not prescribed an MRI at all.

Currently, there’s a well-known auto insurance company taking physicians to task over their MRI prescribing habits. Patients are being referred out without the physician proving medical necessity for the MRI. Then, when the results of the MRI come back, the report is put in the patient’s file with not so much as a mention in the medical records, nor is there a signature or date indicating the physician even read the results.

When prescribing an MRI (or any diagnostic test for that matter), there must be a reason you’re prescribing it. The reason must be based on the patient’s medical necessity and the results of the MRI are going to alter your treatment plan one way or another. If the results come back positive, what are you going to do? If the MRI is completely normal, what are you going to do? This is all information you need to describe in your medical records when prescribing an MRI.

Over the years of prescribing MRIs, I’ve had numerous occasions to discuss with a physician radiologist reviewer why I am requesting an MRI for my patient. Through this process I realized that insurance companies have certain check boxes they must check off before they will approve an MRI.

This is what I’ve discovered are what’s considered medically necessary reasons for prescribing an MRI examination:

• After 4-6 weeks of conservative treatment & anti-inflammatory agents fail and the patient is otherwise unresponsive to care.

» Conservative care includes

▸ Physical therapy

▸ Chiropractic with physiotherapy

▸ Non-prescription and/or prescriptions pain medications, anti-inflammatories and muscle relaxers.

• Radiating pain reproducible with orthopedic tests

• Worsening of their condition

• There are neurological deficits such as:

» Loss of peripheral sensitivity

» Motor weakness/muscle weakness

» Reflexes deficits such as reduction or loss of deep tendon reflexes

• Severe-intractable pain (pain that is so severe the patient cannot function)

• Loss or alteration of bowel or bladder habits (such as constipation, inability to urinate, loss of bladder control)

• Inability to achieve or maintain an erection

• Perineal paresthesias

As you can see from the list above, there are a few things that would warrant sending a patient for an MRI on the very visit you examined them. Inability to achieve or maintain an erection, perineal paresthesias, loss or bowel or bladder control, neurologic deficits such as motor, sensory or reflex deficits as well as severe intractable pain all get you the golden ticket for an MRI. If you think the patient is having severe-intractable pain, then you may want to verify the definition of severe-intractable pain before prescribing an MRI based on that alone.

So, now you’ve determined that an MRI is appropriate for your patient. You need to document your referral appropriately. It should look something like this:

Mr. Smith was referred for MRI of the lumbar spine to R/O HNP or other space occupying lesion. Depending on the results of the MRI, we will (1) continue him on conservative care (2) refer for orthopedic or neurological consultation (3) begin rehabilitation or (4) some combination of the above.

…or whatever other option you decide is in the best interest of your patient.

Once you receive the MRI results and you’ve read the report and reviewed the findings AT THE VERY LEAST, sign and date the bottom of the report. This will indicate to anyone reviewing your records that you’ve read the report for the MRI examination you prescribed and considered the results. However best practice is to transcribe the findings into the body of your next office note (SOAP), then, describe what actions you are taking as a result of the MRI findings.

When it comes to MRI, not all machines are created equal. Use highest Tesla (3T) unit you can find so long as your patient can tolerate a closed MRI machine. Some of them have wider openings nowadays so patients don’t feel so claustrophobic yet can get in a closed machine. If they have issues with claustrophobia, then go to an open unit with the highest strength available. Clearer images result in more accurate diagnoses. Your obligation is to the patient and getting the most accurate results possible.

Finally, let’s remember that the MRI gives us a structural diagnosis, and as such, you must correlate the results with your clinical findings. Then, when all is said and done, you must make a clinical decision based on those results. Does your treatment plan change? Does it stay the same? Do you need to refer to an outside specialist such as a neurologist, orthopedic surgeon, or neurosurgeon? Or do you need to do a combination of all of these? After all, referring a patient for an MRI is about finding answers that were previously unclear to you, that will ultimately help you, help your patient. ■

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 info-circle www.NaturalSportsMedicine.com

FIRM RETREATS

RE- CONNECT, RE-VISIT, RE- CHARGE”

By Bianca Moreiras, CEO Bianca Moreiras & Associates

Here we are in the last quarter of the year. Are you looking forward to ending the year with a big win, big closing, big client? I wanted to ask our readers, how has 2022 gone so far? Was it a productive year? A challenging year? A year better than projected? Or did you hit a bump in the road?

Sometimes law firms practice in a bubble. The only person(s) that know what is going on is the owner, managing partner or managing Board, while the rest of the firm is left in the dark only to execute what is provided to them to carry out.

A highly skilled, highly educated community also is a plethora of ideas, emotions, and opinions. You never know where your next best idea will come from. You might be asking while you are reading this, what does

this have to do with a retreat? If you’ve held retreats in the past, you know where this is going, but for the novice, please let me explain.

I have had the good fortune to plan several retreats for small to large law firms. The outcome of all had lasting effects on one of the following:

• Associates and partners stepping up their game

• New business development occurs

• Marketing strategies and alliances with other practice groups can flourish

• And lifelong bonds had been created (even spouses leading to referrals-go figure) and flourished

Not a bad outcome all stemming from a 2-day wellplanned retreat.

Learning is on-going. When we stop learning, we stop growing. Mentoring, coaching, and business development are all at the core of a thriving law firm. The willingness of our seasoned successful attorneys to develop our future successors is key to sustainability.

A well developed and structured retreat can prove to ready your firm to reach goals, develop 1-3 years of planning, growth, and direction. The chance to reinforce, revisit or even change the goals that might not be important any longer or have changed over time.

Goal-setting is not new, it is just not practiced or measured properly. The change in the bottom line on the Profit and Loss statement is not the only measurement. Goals kept close to the vest by the visionaries (the top members/owners) and not shared, the vision does not make sense to the rest of the firm. Sharing the goals will allow them to accelerate the focus and direction of

“

the firm for years of success. However, a one and done retreat will not do it! A one and done annual planning meeting will not suffice.

Retreat = repeat and measure on an annual or semi-annual basis. Never losing sight of the big picture and allowing to “tweak” and make room for agreeable changes, a mind shift, a community shift, a world economic shift or even a change in the environment and culture of the firm. Through growth, death or dissolution.

Planning is the key and goal-setting a way to change a thought into an action.

Planning is the key and goal-setting a way to change a thought into an action. A retreat with a well-planned out agenda, leaving time to socialize and have fun, put into practice team building, cross-selling and obtaining the tools to promote Associates to Partners and construct a sustainable succession plan which will give peace of mind. The next generation of rainmakers are to be developed now to carry your law firm into the future.

Knowing where you are, where you are going and how you will get there is the GPS to success. Retreat facilitating and pre-planning will help take your firm in the direction it needs and shares the plan with everyone. The sum of the parts makes up the whole picture.

If you’re interested in planning, developing, and designing a retreat specifically for your firm to reach their goals and expand their knowledge as a team, practice group or whatever you are currently facing, let’s talk. I love what I do! ■

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?

BILLING MEDICARE FOR CHIROPRACTIC AFTER PIP IS EXHAUSTED

The

By Marty Kotlar, DC, CPCO, CBCS

QUESTION

Been Met…

Dr. Kotlar, I recently had a few PI patients request that I bill Medicare because they have reached their PIP $10,000 coverage benefit limit. Can I bill Medicare and will I get paid for all the services that were rendered?

ANSWER

Let’s begin with a few key points about the differences between traditional Medicare Part B, a.k.a. original Medicare and Medicare Advantage plans, a.k.a. Medicare Part C. Medicare Part B covers chiropractic care. However, it is limited to chiropractic spinal manipulation for active treatment. The Medicare Part B carrier for Florida is First Coast Service Options (FCSO). The only CPT codes that FCSO will reimburse chiropractors for are 98940, 98941 and 98942.

FCSO is precluded from making payments where payment has been made, or can reasonably be expected to be made from self-insurance, personal injury, No-Fault insurance or Workers’ Compensation insurance. Medicare is not permitted to make payment for such associated claims unless all other insurance plans have terminated or exhausted. All claims must first go to the liability insurance, including self-insurance and personal injury.

Medicare Advantage (“MA”) plans also cover chiropractic care. MA plan patients must first enroll in traditional Medicare, then choose an MA plan. MA plans include HMOs, PPOs and Private Fee For Service (PFFS) plans. There are hundreds of MA plans administered by many traditional insurance companies such as Florida Blue, United Healthcare, AmBetter, Kaiser, etc. Some

MA plans mimic Part B and only cover spinal manipulation. However, some will pay for examinations (e.g., 99203, 99204), re-examinations (e.g., 99213, 99214), extremity adjustments (98943), maintenance care (S8990), X-rays, therapies, foot orthotics and diagnostic testing, as well as chiropractic spinal adjustments.

recommend to continue reporting the M99.0X subluxation diagnosis codes as primary and secondary ICD-10s for Part C plans. Make sure to contact all MA plans for reimbursement specifics prior to beginning care.

If you would like a sample FL PIP forms and Medicare Part B forms for chiropractic maintenance care, send an email to info@targetcoding.com ■

Marty Kotlar, DC, CPCO, CBCS

Proper modifier use is vital to getting your claims processed quickly the first time. For MA plans continue to use modifiers AT and GP appropriately as you are presently doing with your Part B patients. In my opinion, there is no need to use modifiers GY and GA with Part C plans. As a reminder, the GA modifier means you have a signed ABN form on file. The ABN form can only be used by enrolled Medicare Part B providers. Chiropractors not enrolled in Medicare Part B cannot issue ABNs to Medicare Part B patients. The ABN scope states that only healthcare providers and suppliers who are enrolled in Medicare can issue ABNs to patients. We

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

Proper modifier use is vital to getting your claims processed quickly the first time.

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UPCOMING EVENTS

OCT 4 comment-alt-smile

TUESDAY

Prime Time Business Networking Weston Chapter

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7:30 AM – Every other Tuesday

Comfort Suites

2201 N. Commerce Parkway, Weston, FL 33326

Target Coding clock user-plus SATURDAY OCT 15 presentation

Documentation & Coding For The Health of Your Practice – Webinar

8:00am - 2:00pm ET (6 CEUs)

targetcoding.com/webinars.php

TUESDAY OCT 18 presentation 1:00 pm - 2:30 pm ET clock

BC/BS Common Modifier Denials

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natasha@targetcoding.com

Influencer Connectors

THURSDAY

OCT 20 comment-alt-smile

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Influence businesses, create synergy & build relationships

5:30 pm–7:30 pm (Zoom)

moreirasbianca@gmail.com

TUESDAY NOV 15 presentation 1:00 pm - 2:30 pm ET clock

The 2023 New CPT & ICD-10 Billing & Coding Updates

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natasha@targetcoding.com

SATURDAY DEC 3 presentation 8:00am - 2:00pm ET (6 CEUs) clock

Chiropractic Recordkeeping, Coding, FL Laws, Ethics & Medical Errors

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natasha@targetcoding.com

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