Florida Personal Injury Magazine • Jan-Mar 2023

PERSONAL INJURY

JANUARY-MARCH 2023

10 POINTS TO ENSURE SOAP NOTE COMPLIANCE HOW TO REDUCE PIP DENIALS IN 2023

UNDAMAGED CAR BUT INJURED PATIENT IN LOW SPEED CRASHES

FIRE THE LASER & GET PIP TO PAY FOR IT!

BRICK-AND-MORTAR VS. VIRTUAL LAW FIRMS

AMIDST THE GREAT RESIGNATION

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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,

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HOW TO REDUCE PIP DENIALS IN 2023

By Christopher M. Tuccitto, Esq.

Beginning every January 1st, many of us will pledge to stick to New Years’ resolutions that we believe will improve our lives in some meaningful way. If you are a medical provider who treats automobile accident victims and submits claims for Personal Injury Protection insurance (PIP) reimbursement, at least one of your New Years’ resolutions should be to do your best to reduce your PIP denials. Fortunately for you, this article will provide some helpful advice on how to do just that.

While I could probably write a book on this topic, unfortunately, my space is limited, so I’m going to touch on a few of the best ways to avoid PIP denials.

SUBMIT YOUR BILLS ON TIME

Section 627.736(5)(c), Florida Statutes, requires billing to be postmarked or electronically transmitted within 35 days of the date the service was provided, or 75 days if a notice of initiation of treatment is provided within 21 days of the first treatment date. A notice of initiation of treatment is any documentation that sufficiently puts the insurance company on notice of the claim. The notice is sufficient as long as it includes, at a minimum, the patient’s name, the claim number, the accident date and the named insured. If you’re submitting your bills electronically, make sure there is a way to confirm receipt by the insurance company and keep a record of this confirmation. If you’re mailing the bills, you should

send them via certified mail, return receipt requested. This way, not only will you have proof of the post-mark date, but you will also have proof that the bills were received by the PIP insurer.

OBTAIN A POSITIVE EMERGENCY MEDICAL CONDITION (EMC) DETERMINATION

Section 627.736(1)(a)(3), Florida Statutes allows for reimbursement under PIP coverage up to $10,000.00 if a Medical Doctor, a Doctor of Osteopathy, a Dentist, a Physician’s Assistant, or an Advanced Practice Registered Nurse determines that the injured person has an emergency medical condition. If such a determination is not made by a qualified medical provider, then the PIP insurer has the right to limit benefits to $2,500.00. Therefore, it’s so important to obtain a positive EMC determination, as long as the medical records support such a determination. Remember, as I’ve previously advised in this fine publication, you do not need to send the patient to be physically examined for the EMC. An EMC determination based on a review of a patient’s medical records is just as valid as a physical examination.

MAKE SURE THE PATIENT IS AWARE OF ANY PENDING STATEMENTS AND EXAMINATIONS SCHEDULED BY THE INSURER

Many times, the medical provider is copied when the insurer sends out notice to the patient (or their attorney) regarding the need to attend an Examination

Under Oath (EUO) and/or an Independent Medical Examination (IME). If the patient misses a properly noticed EUO without previously contacting the insurer to reschedule, the insurer is going to deny the entire claim. If the patient misses a properly noticed IME without previously contacting the insurer to reschedule, then any medical bills received after the scheduled date for the IME will be denied. Therefore, it is vital to make sure that the patient and/or their attorney are aware of the scheduled EUO and/or IME and have either made plans to attend or have contacted the insurer in writing to reschedule if the patient is unable to attend on the proposed date(s).

These are a few of the best ways to avoid PIP denials in 2023 and beyond. For more information or for any questions on this topic, you may contact me at chris@fladvocates.com. ■

FIRE THE LASER & GET PIP TO PAY FOR IT!

By Jeremy Dover, Esq.

In a recent decision from the 4th District Court of Appeals released on November 30, 2022, it was ruled that if a company bills for a low-level laser, which may arguably be billed under CPT code 97039 or code S8948, they will be entitled to compensation under the PIP statute. The Court reaffirmed an old decision that compensation would be determined based on the services rendered by a company rather than the CPT code as insurers are required to reimburse services, supplies, and care, not CPT Codes. Resultantly, whether billing for a low-level laser under CPT code 97039 or CPT code S8942, these services are required to be reimbursed to providers under PIP coverage.

CPT Code 97039 is listed as a Contractor-Priced Code under Medicare Part B for unlisted therapeutic services. This appeal stands for the fact that while CPT code 97039 is identified as a general code, it now includes low-level lasers for compensation. It is important to note that when a company is trying to bill under code 97039 that you must keep detailed notes that must be submitted to the insurer when seeking reimbursement. Please, when billing for this service: identify exactly on what area the treatment was performed; the amount of time spent treating the area with the low-level laser; and lastly, the medical necessity of performing that type of therapy on a patient.

Lasers, which are considered an experimental treatment, can be covered under PIP, especially in cases where laser therapy is deemed a necessary treatment to help the accident victims. Providers have been helping patients for years, while the insurers have routinely been denying reimbursement for these services, even

to this day; however, these providers deserve to be paid for this necessary, innovative service.

If a company decides to bill the service under CPT code S8948, they can bill 1 unit per 15-minute increment. It is also important to note that this code is not recommended for payment by both Medicare and Florida Workers’ Compensation. Again, while CPT codes help identify services that are reimbursable under the PIP statute, this recent appeal affirms that a CPT code alone does not dictate whether a service is reimbursable.

In any case, a low-level laser is reimbursable under either CPT Code 97039 or CPT Code S8948. Any code switches between 97039 and S8948 for billing should be the responsibility of the insurance company to reclassify if need be; however, remember to submit proper notes to receive reimbursement. In conclusion, based upon current case law, low-level laser therapy is a covered service under the PIP Statute. ■

UNDAMAGED CAR BUT INJURED PATIENT IN LOW SPEED CRASHES

showing any visible damage. However, the threshold for soft tissue injury is well within the range of G-forces created during low-speed collisions within this range. Although the vehicles we drive are designed to withstand the forces seen in lower speed collisions, our bodies are not. Our bodies don’t transfer the energy like bumpers do, they absorb the force causing injuries to various structures and tissues in the body. Depending on the specific mechanics and direction of forces on the body, occupant body type and positioning within the car, and any underlying conditions; can suffer a simple sprain/strain or have more severe injury or injuries involving injuries to the intervertebral discs and even cause neurological deficits.

To truly know if the picture is worth more than a thousand words, you must have context. This is why one of the most important factors about a positive MRI is the “clinical correlation” that puts those images in context.

1. Has the patient had complaints in this area prior to the motor vehicle crash (MVC)?

2. Are there positive findings upon ROM and orthopedic testing?

3. Are there spasms in the area?

By Todd M. Narson, DC, DACBSP

Over the course of the past (nearly) 30 years on (let’s just say) more than a few occasions, I received pictures of cars, their bumpers and a note from an insurance adjustor for a particular patient of mine that says “how could their injuries come from such little damage? You Can’t even see it”. I would look at the 8” x 10” glossy photo and wonder to myself the same thing.

Then my next thoughts drifted to my childhood and some of my favorite sports and games I played growing up, namely baseball and pool. I only hit 2 out of the park home runs, one as a teenager, and the other when I played adult league baseball. With pool, I have a special shot that with a moderate amount of luck and a lot of force behind the Q-ball, will sink the 8-ball and win the game for me off the break. In all my years of hitting baseballs and playing pool, have I ever damaged a ball. A ball has never been dented, broken or deformed. Yet, the ball would fly off the bat or the pool cue with great intensity and never once broke.

The entire point of this is to say that energy is transferred from one object to another object. Just look at how the pool balls fly around the table after the break. In the case of baseballs, pool/billiard balls and modern automobiles, they are designed to handle a certain amount of force without deforming, breaking or failing in some fashion. Which brings us full circle to the pictures I was sent by the insurance adjustors of a large well known auto insurance carrier. How could my patient have suffered “such injuries” when the picture clearly shows no damage.

The answer is quite simple. Modern day cars are built with (typically) 5 mph-rated bumpers. Which means two cars can collide at less than 10mph without

4. Are there any neurological deficits associated with the level of injury seen on MRI?

When it comes to MRI pictures, it’s the history, past medical history and physical examination that gives those results context. And, it’s all the above, give context to the 8” x 10” glossy photo you may have received in the mail, questioning whether the patient in your office could have suffered such an injury.

To put it all in context, are quite a few scientific papers that conclude there is a lack of relationship between the damage a motor vehicle suffers and the injuries suffered by the vehicle occupant. I have 8 scientific references that support that injuries can occur at lower speed collisions, whether you can see damage to a vehicle or not.

If you’re interested in the scientific references regarding low-speed collisions and occupant injury, feel free to email or call me. ■

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

BRICK-AND-MORTAR VS. VIRTUAL LAW FIRMS AMIDST THE GREAT RESIGNATION

By Bianca Moreiras, CEO Bianca Moreiras & Associates

Happy New Year and welcome 2023!!

What’s new or not so new to discuss? Where is your law firm in this ever-pivoting world of change? What’s your pain point and how are you addressing the obvious issue, staffing!

Where have all the employees gone? Read on for some much-needed relief as I share my observations and solutions.

Since 2004 my business has changed, grown and the way we do business has altered its appearance.

enticed to join our competitor law firms. It was hard to compete with outrageous amounts of compensation(20-50% increases), substantial benefits with no cost to the employee, flexible schedules and hybrid or virtual positions. It has been and still is an “employees” market.

A hybrid workforce is no better for the employer. You still need to have a brick-and-mortar environment even if the staff is only occupying the space half-time or less. Hiring staff looking for a flexible, work-fromhome schedule is somewhat better but adapting to the firm and training is almost impossible. My solution to this issue is to have the new employee fully engaged

My clients are for the most part still brick and mortar, a large percentage are now hybrid, and the brave are fully vested in a virtual platform.

Navigating business alternatives comes with a new perspective and great challenges never encountered before. Let’s take a deep dive into each of the pros and cons of these environments and how the “employee” reacts to each.

Brick-and-mortar the “traditional” way business has been operating for centuries. The good old days, but NOT when it comes to staffing issues. Over the last 3 years we witnessed the great resignation which was made up of the most knowledgeable, seasoned, and skilled staff. Granted, many were reaching retirement age or surpassed retirement eligibility and finally had enough. The pandemic shined a reality that time is the most precious commodity of all. Employees weren’t the only ones to resign. The pandemic and its uncertainty forced firms to close their doors especially as the owners/partners were coming of retirement age, they too did not want to trade health or money for time.

Resignations were also made up of employees being

by coming to the office full-time for one month. The employee would receive training on software programs, learn policies, understand the files, familiarize themselves with the client needs, meet with all the partners, associates, and staff (who only come in 2 or 3 days a week, if that) and feel part of the organization. Without this foundation, many employees will not stay for the long term. Without this foundation and the engagement with the team, not only is the employee set up for failure, so is the position and inevitably you’ll be seeking a replacement.

This leads me to the fully virtual firm. The benefit to the employer is downsizing the brick & mortar or eliminating it all together which can result in hundreds of thousands of dollars a year in the pockets of the shareholders. We think only the younger generation can make this happen. The truth is the younger generation has already been virtual for years prior to 2020. My clients that have moved to virtual or decided to leave large law firms or firms that would not consider a hybrid or a virtual alternative, are well seasoned leaders in the legal community.

With the help of specific technology software programs, a very sound investment in cyber security (less than office rent for sure) and monitoring systems which are installed on laptops provided by the firm to their virtual employees, law firms are thriving in the virtual space. Training, collaboration and staying informed are successfully being manipulated with YouTube training videos, Teams, Zoom, Slack and many other programs. Technology is changing faster than we can even embrace all that technology has to offer.

Whichever environment style your firm now embraces, it is important to consider employee retention, examine your policies & procedures, investigate other viable benefits, and find ways to engage at every level. Everything has changed and it’s time to especially revisit your Office Handbook.

Build your law firm around learning, growing and open discussions about the future. I am a fan of bringing your entire workforce together for a day retreat or a team-building program. What about a retreat for a weekend. In the long run you will build a solid foundation and a caring environment. People want to know they are appreciated and acknowledged for what they contribute to the organization. Defining programs and making sure they include CLE credit for the attorneys and paralegals is a win-win situation.

The foundation of any law firm are the employees.

If you take care of them by providing the tools, they need to work smarter not harder, offer an attitude of gratitude and mutual respect, you will inherit loyalty, respect, and gratitude in return. Promise! All the best in 2023

.

If you are looking for a way to strengthen your workforce, or you’d just like to brainstorm, and set goals for the future, I am only too happy to help. You can find me at www.biancamoreiras.com ■

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

info-circle www.biancamoreiras.com

10 POINTS TO ENSURE SOAP NOTE COMPLIANCE

By Marty Kotlar, DC, CPCO, CBCS

QUESTION

Dr. Kotlar, I do not think my SOAP notes would pass an insurance audit. How do I know if they’re good enough? What can I do to ensure SOAP note compliance?

ANSWER

To begin with, the main objective of Subjective, Objective, Assessment, Plan notes is to document the entire encounter, regardless of patient clinical condition or financial ability to pay. I’ve some heard doctors say, “I adjusted the shoulder, but didn’t document it because the patient’s insurance doesn’t pay for it.” This is not the correct thought process.

Whether you document in an electronic health record, on paper or dictate your notes, most likely at some point in your career, you’ll make an error and/or omit documentation in the record for that treatment visit. When this occurs, clearly identify any amendment, correction or delayed entry as such, and indicate the date and author of any amendment, correction or delayed entry and identify all original content, without deletion

If a change to paper records is required, use a single line strike-through so the original content is still readable, and have the author of the alteration sign and date the revision. Amendments or delayed entries to paper records must be clearly signed and dated upon entry into the record. For EMR records containing amendments, corrections or delayed entries must distinctly identify any amendment, correction or delayed entry and provide a reliable means to clearly identify the original content, the modified content, and the date and authorship of each modification of the record.

Here’s my 10-Point SOAP Note Checklist to ensure compliant documentation:

1. Make sure every page of your SOAP notes clearly lists your name, address, e-mail and telephone number.

2. Make sure the patient name is legible. You may need to assign an account/file number to every patient (check with your state Board).

3. Enter the date the service was rendered, not the date the note was signed. The notes should be completed and entered into the patient record on the day the service was rendered. (S)

4. List all the symptoms/signs the patient verbally states, writes or digitally enters into your EHR system. Document all items such as pain scales, frequency of pain, what has occurred since the last visit, etc.

5. Document any additional items provided by the patient. Example, “this is the first time in 6 months I do not have numbness in my right hand.” (O)

6. Document the examination findings. To document a subluxation, Medicare in particular recommends the P.A.R.T. method. Make sure your documentation and objective findings satisfy the P.A.R.T. method subluxation requirements.

• Pain/Tenderness: The perception of pain and tenderness should be documented in terms of location, quality, and intensity.

• Asymmetry/Misalignment: This may be identified on a sectional or segmental level through one or more of the following: observation (posture and gait analysis), static palpation for misalignment of vertebral segments, diagnostic imaging, etc.

• Range of Motion Abnormality: Changes in active, passive, and accessory joint movements may result in an increase or a decrease of sectional or segmental mobility. Range of motion abnormalities may be identified through one or more of the following: motion palpation, observation, stress diagnostic imaging, range of motion measurements(s), etc.

• Tissue Tone, Texture, Temperature Abnormality: Changes in the characteristics of contiguous and associated soft tissues including skin, fascia, muscle, and ligament may be identified through one or more of the following procedures: observation, palpation, use of instrumentation, tests and length and strength, etc. (A)

7. The assessment provides an opportunity to provide an impression of what’s ahead for the patient based on the present status. Report any significant changes to the short or long-term goals. Document recommendations for additional testing, and/or treatment plan revisions, etc.  Describe when and why the next re-evaluation should be performed. Describe any significant changes in status relative to each goal currently being addressed in the treatment plan. Assessment of improvement, extent of progress (or lack thereof) toward each planned clinical goal. Plans for the continuation of treatment or anticipated discharge date. Did the patient meet a goal? Are they making progress towards the goals? Did any measurements get better?  The assessment

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provides the chance to update the link between the patient-identified functional limitations and the measured impairments. Are the present diagnoses (ICD-10) and procedures (CPT) still appropriate? Examples, a) Patient is now able to put on shoes and socks without assistance, b) The patient's ability to sit at the computer is now up to 45 minutes without pain. Originally it was only 10 minutes, c) The patient is improving better than expected, d) The patient is not responding well to care and will be sent for additional testing (e.g., MRI, EMG, Neurologic consultation), e) The patient has responded very well to care, has achieved maximum therapeutic benefit and will be discharged from active treatment next week. (P)

8. List every procedural service/product provided to the patient. List the specific bones that are being adjusted/manipulated. List the specifics for every modality/therapeutic procedure provided (e.g., time, anatomic location, muscles, protocols).

9. The doctor must electronically sign or provide a hand-written signature on the date the service was rendered. The chart notes must identify the provider/staff member responsible for the care of the patient.

10. Enter the date the service was rendered.

Good quality patient care involves documenting everything that occurs during every patient encounter. Good documentation is important if your files are ever asked to be reviewed by an insurance company, state board, malpractice case or if the patient simply asks for a copy of their notes. Good documentation is the only way for you to substantiate that the care you provided was actually performed.

If you would like to see a sample completed SOAP Note, send an email to info@targetcoding.com. ■

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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