Florida Personal Injury Magazine • July-Sep 2023

USING KPIS TO ENSURE THE SUCCESS OF YOUR LAW FIRM

JULY-SEPTEMBER 2023

PROTECTING YOUR PRACTICE: ESSENTIAL CYBERSECURITY STRATEGIES

TIPS FOR LICENSING WITH AHCA

PREPARE FOR THE ‘TORT-ALLY’ NEW RULES REGARDING PI IN FLORIDA THE CLAWS ARE OUT!

VALIDATING INJURY SEVERITY THROUGH OBJECTIVE FUNCTIONAL TESTING

CLAW-BACK LETTERS AND LAWSUITS FROM INSURERS

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WELCOME

TO THE FLORIDA PERSONAL INJURY MAGAZINETM !

It’s hard to believe that it’s now been two years since our first edition of the magazine was published, and what an unprecedented two years they have been! Even though we are finally out of the worst of the pandemic, we are now facing a new challenge, the Tort Reform. It is a struggle for both medical and legal professionals in the PI industry to figure it out, but the truth is that we’ll just have to wait to see how things play out. In the meantime, we’ll strive to provide useful content that benefits both doctors and attorneys in the PI field through expert articles. We are constantly contacted by our readers with questions and concerns about matters impacting their businesses, and we use that feedback to shape the type of content we provide in each edition.

That being said, I’d love to hear from you and understand the challenges you’re facing, the problems you are trying to tackle. This magazine is for you, and this feedback will only help us provide you with the content you are looking for. I’m happy that we have been able to maintain this publication free of charge to the PI professionals, and that is mainly due to the support of our wonderful advertisers. They are experts in their fields, and I encourage you to get in touch with them so that you can find out how they can help improve your business, no strings attached. You may also just contact me directly, and I’d be happy to introduce you to the best professional that can help you achieve your particular business goals.

Lastly, I want to thank all of you who attended our Personal Injury Summit™ held on June 3rd, 2023 in Fort Lauderdale! If you were there, you felt the amazing energy in the room and the valuable connections we were all able to make. I feel we really accomplished our goals of providing a professional environment for doctors and lawyers in the PI world to come together for a day of learning and networking. The feedback was so positive that we are already coordinating our next Personal Injury Summits for the Spring and Summer of 2024! If you are interested in attending, teaching a class or sponsoring, feel free to contact us right away for more information as spaces are limited and fill up fast.

I hope you enjoy this edition of the Personal Injury Magazine and I look forward to your feedback,

Truly yours,

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

USING KPIs TO ENSURE THE SUCCESS OF YOUR LAW FIRM

By Matthew Shiebler, CPA

To start, key performance indicators (KPI) are tools used to help measure and ensure the success of your law firm. They help answer questions about your firm’s performance and your clients. KPIs can be used to measure how financially productive each lawyer in your firm is and the profit to work ratio that goes into each of your clients.

Clients

Dealing with clients is arguably the most critical and complex part of running a company regardless of the business. An important statistic to know is the number of matters opened. Client acquisition is essential for a law firm because while it is good to earn client loyalty, you cannot rely on existing clients to bring in enough revenue to keep operations at standard levels.

Along with matters opened, your firm should also consider the number of matters referred to the firm. Understanding our clients and their individual needs helps guide our firm or any other company, even within our own business.

Finances

Knowing how much revenue your firm brings in is vital to keep up with expenses and plan for the future. Other financial KPIs to measure include costs, collections, and overhead. One KPI to focus on when looking at your finances is how much your clients are costing you and the return on that investment (ROI) you should see. Keeping your books in order and knowing how much money is coming and going is one of the keys to success. Law firms have many variable expenses and profits going on all the time. Having an effective system to help keep track of and manage these numbers is necessary to remain afloat. One manageable KPI is to keep your labor expenses under 50% of your overall company revenue. Labor makes a human company run, but it is essential not to let it detriment your profits.

Productivity

The most essential and helpful term to hold onto when thinking about productivity is billing. This centers around work done and the billing attached to it, whether that means billable hours or the rate at which work is split up or financed. Equating your work with a billable number is how you maximize your productivity because once you know how much work you’re doing, you know how much to charge. A good practice is to know your average billing rate and how it will apply to your work, your assistant’s billable hours, and your clients, especially if specific changes need to be made. Additionally, the percentage of partner hours logged in your firm is a needed variable to know. Knowing your partner’s hours will not only tell you how much they are making, but also it is an excellent reference to see the work they are putting in and see if it is where it needs to be ■

To truly understand the numbers behind your clients, it is essential to look at more than just how many you have and how much your business is making from each one. Knowing how and why you are getting the clients you are is a great way to see your business’s message indirectly. A final KPI to practice when dealing with clients is to get a net promoter score (NPS); this is done by asking your clients how satisfied they are with your work and how likely they are to recommend you in the future. A simple way to do this is on a scale of 1-10.

Matthew Shiebler, CPA INTERACTIVE ACCOUNTANTS

phone-alt (305) 517-3977 ext. 104

mobile (914) 263-9806

envelope Matt@ia.tax

info-circle interactiveaccountants.com

Keeping your books in order and knowing how much money is coming and going is one of the keys to success.

PREPARE FOR THE ‘TORT-ALLY’ NEW RULES REGARDING PI IN FLORIDA

By Victor Demesmin, Jr, Esq.

HB 837 has forced a massive overhaul of tort reform through statute, which has introduced substantial changes in the personal injury field, presenting new challenges for providers and plaintiffs alike. It is vital to grasp the impact of these reforms on different aspects of personal injury cases, such as comparative/contributory negligence, the statute of limitations, damages, bad faith law, and letters of protection (LOPs).

One of the most discussed changes under HB 837 affects the allocation of responsibility for accidents or negligent acts causing harm. If a plaintiff is determined to be more than 50% at fault, they are prohibited from recovering any damages in a lawsuit from another party.

HB 837 also brings modifications to the statute of limitations for personal injury claims. The filing time limit has been shortened from four to two years. Failure to initiate the lawsuit within this timeframe or reaching a settlement before the two-year mark expires can result in the forfeiture of your the to seek compensation for a claim. Seeking guidance from an attorney is crucial to ensure the timely filing and protection of the case.

Moreover, HB 837 expands the evidence that is admissible to prove past and future medical treatment. The evidence that is admissible includes: the amount a health care provider charged; the amount(s) actually paid; the amount(s) health insurance would be responsible for (even if health insurance was not billed); in the event of a sale of an LOP, the amount it was sold for; and, in the event the patient does not have health insurance, or for patients who currently have Medicare or Medicaid, 120% of the Medicare reimbursement rate

or 170% of the Medicaid reimbursement rate if a service is not reimbursable under Medicare.

LOPs have been a significant topic of discussion within the context of the tort reform bill. Under HB 837, all LOPs and the agreed-upon amount between the third-party factoring company and the doctor must be disclosed during personal injury or wrongful death lawsuit proceedings. Additionally, doctors’ bills must be itemized and include procedure codes whenever feasible. ■

Victor Demesmin, Jr, Esq.

DEMESMIN & DOVER

map-marker-alt 1650 SE 17th Street

Fort Lauderdale, FL 33316 phone-alt 866-954-6673

envelope vdemesmin@attorneysoftheinjured.com

info-circle www.youraccidentattorneys.com

THE CLAWS ARE OUT! CLAW-BACK LETTERS AND LAWSUITS FROM INSURERS

By James D. Underwood, Esq.

Increasingly, the Personal Injury Protection (PIP) realm is seeing more and more claw-back letters and resulting litigation from PIP insurers seeking a refund of PIP benefits paid to PIP providers, claiming the services were not payable based on clinic licensure or unlawful treatment. These letters and sometimes a lawsuit is seeking tens of thousands of dollars in reimbursement and sometimes millions. The letters or suits routinely seek reimbursement based on straw ownership of the clinic facility or because the services were unlawfully rendered for a myriad of reasons. For medical services, billed to a PIP insurer, to be payable the services must have been rendered lawfully and have been rendered by a clinic compliant with the licensure requirements in the PIP statute.

Florida Statute 627.732 defines “lawful” or lawfully” as in substantial compliance with all relevant applicable criminal, civil, and administrative requirements of state and federal law related to the provision of medical services or treatment. Under Florida Statute 627.736(5)(h) an entity excluded from having to be licensed under the Health Care Clinic Act under Florida Statute 400.9905 shall be deemed a clinic and must be licensed under part ten of chapter 400 to receive reimbursement under PIP however there are exemptions. A few of the exemptions under PIP from having to be a licensed Health Care Clinic are those facilities that are wholly owned by a physician, a dentist, or a chiropractic physician or by that licensed physician, dentist or chiropractor and the spouse, parent, child or sibling of those doctors.

Straw-ownership is where a clinic is owned on paper by a licensed medical provider exempt from having to be licensed as a Health Care Clinic under the PIP statute but is actually owned by a non-licensed individual or group of individuals. Indicia of straw-ownership can be that the clinic owner on paper does not have keys to the facility, does not have signature authorization on the clinic’s bank accounts, did not hire any of the

staff directly, or is not a signatory to the lease where the clinic is located, or doesn’t have final authority over the clinic’s business decisions. Insurers may learn this fact be either conducting a deposition of the provider or through other investigative means.

Unlawful treatment can range from treatment that was never rendered but billed to the insurer, unlawfully self-referred (STARK) to being unlawfully supervised under the statute or administrative regulations. Whether the insurer’s claims are based on straw-ownership or unlawful services, providers who receive these letters or suits, must not ignore them. Seek out representation immediately upon receipt of a claw-back suit or letter. Providers may need to engage coding experts, health care licensure specialist or other practice specialists to deal with these issues and become compliant. ■

Seek out representation immediately upon receipt of a claw-back suit or letter.

VALIDATING INJURY SEVERITY THROUGH OBJECTIVE FUNCTIONAL TESTING

By Erik Groberg

Consider the following example: a patient is involved in an auto accident which results in the treating physician confirming through diagnostic tests the presence of alteration of motion segment integrity (ligament laxity) in the cervical spine, resulting in a whole person impairment rating of 28% according to the AMA Guides.

Now consider if that same patient also has grip strength deficits of 30% and presents moderate losses in Range of Motion in the Lumbar spine and shoulder, which according to the AMA Guides now results in the patient having a whole person impairment rating of 43%. Over 50% greater of an impairment rating than what this patient actually has according to the AMA Guides and what this patient will receive compensation for… and you simply missed it by not taking into account and documenting these functional deficits and limitations?

If you are the treating physician or attorney representing this patient and those functional losses are missed and not taken into account in determining what that patient deserves based on their actual injuries and functional deficits sustained according to the AMA Guides, did you do your job in representing this patient and ensuring they receive a fair and accurate case settlement based on the injuries they sustained and how these injuries will affect them in their day to day lives moving forward? What if that patient is your mom or your sister or your wife or someone else close to you who gets lowballed in their case settlement based on an inaccurate impairment rating of 28% instead of their true impairment rating of 43?

One of the largest factors affecting case settlement values is injuries and severity of injuries sustained and the extent of resulting losses, including medical bills, lost wages, pain and suffering. In order to maximize case settlement values, it’s essential to have medical documentation which validates not only injuries but to a large degree the severity of the injuries sustained and how these injuries affects their day to day life, including interference with ADL’s, ability to perform job tasks, lost wages and future lost earning capacity, etc. The amount of medical documentation you have supporting your personal injury case will largely impact the final value of your claim. Insurance company need to see clear and strong evidence of your injuries but also the severity of injuries and how this translates into loss in function, impairment, and disability.

The AMA Guides take into account various contributions and their relative weight in the calculation of whole person impairment ratings. Similarly, auto

insurance companies use claims processing software programs to determine settlement values, which calculate value of a claim by using medical decision points or value drivers to assign a value for the injuries sustained. Many of these Value Drivers also have multipliers assigned to them based on severity of injuries. These Value Drivers or Medical Decision Points largely follow the AMA Guides and the different factors taken into account by the AMA in calculating whole person impairment ratings, which are:

1. Losses in Range Of Motion

2. Motion nerve impairment (determined by the AMA guides through bilateral muscle testing deficits).

3. Loss in Grip strength

4. Pain

If you are not objective documenting functional losses in accordance to the AMA Guides in how they determine whole person impairment ratings, you are not taking into account the factors used by the insurance companies in determining case settlement values. ■

PROTECTING YOUR PRACTICE: ESSENTIAL CYBERSECURITY STRATEGIES

By Jairo Avila

Law firms and medical offices are prime targets for cybercriminals due to the vast amount of confidential and sensitive information they possess. To fight the increasing threat of cybersecurity breaches, Internos Group has developed 10 best practices to help protect these institutions and limit their exposure.

Conduct regular risk assessments, vulnerability scans, and system and network monitoring. These are essential for detecting suspicious activity and points of compromise for data breaches. It’s important to note that standard Antivirus software is not enough to detect sophisticated attacks and that more robust tools/services are required for protection.

Defend the network perimeter and restrict data access. Monitoring and testing security controls, implementing secure configurations and ongoing security patch management, and strictly controlling employees’ access to sensitive and confidential information is necessary. Properly configured perimeter defenses only allow activities required to conduct business.

Manage passwords and user privileges. A strong password consists of at least 14 characters, including letters, numbers and symbols. Limiting the number of privileged accounts, monitoring user activity and implementing Multi-Factor Authentication (also known as 2-Factor Authentication) are all effective steps toward bettering your security posture.

Develop a reliable backup strategy to ensure business continuity. Routine backups of your data can help address a response to potential threats like malware and ransomware. All backups should be encrypted with a user-defined encryption key and periodically tested for their viability. Backups should also be replicated offsite securely to immutable storage in order to strengthen the probability of a full recovery in the event of an incident.

Provide cybersecurity awareness training. Mandatory training for all users at least once a year and periodic simulated phishing exercises are recommended. Remember, your people are your #1 method of entry for cybercriminals. Not knowing the signs of phishing, reply chain email attacks or weak password management practices could cost you dearly.

Conduct an inventory of data. This allows for assigning specific data ownership and risk categorization. The higher the sensitivity of the information, the stronger the security protections and access controls must be.

Use encryption for transmitting sensitive data. Personally identifiable information (PII), protected health information (PHI) and other sensitive, confidential data should be sent securely via an encrypted email or secure file sharing services in order to prevent costly data breaches.

Manage your third-party vendors. Law firms and medical offices should carefully vet every vendor and request their cybersecurity procedures and policies to ensure they exercise the same security precautions as the firm. Vendor agreements should be reviewed for issues regarding indemnification, cyber liability insurance and time periods for providing notice of a vendor’s “event/incident” or “breach.”

Create and implement an incident response plan (IRP) and team (IRT). A cross-organizational IRT should be in place to develop and implement a plan for breach management and detection.

Invest in a standalone cyber liability insurance policy. This can cover first- and third-party losses in the event of a cyber event. Consulting with an insurance broker well-versed in cyber liability coverage is essential to procure sufficient coverage and limits.

Implementing these cybersecurity best practices can help protect your law firm or medical office from malicious cyber events. Want to learn about a bonus cyber security tip? Scan the QR code below to find out! ■

Jairo Avila

PARTNER

AT INTERNOS

map-marker-alt 5781 B NW 151st Street, Miami Lakes, FL. 33014

phone-alt (305) 590 5333

envelope javila@gointernos.com

info-circle www.gointernos.com

Remember, your people are your #1 method of entry for cybercriminals.

Is your trust being reconciled in line with State/Local Bar requirements?

Is your CPA introducing tax strategies designed for High-Net-Worth individuals?

Is your firm receiving timely financial statements?

TIPS FOR LICENSING WITH AHCA

By Matt Snyder

Most of the required documents are subject to interpretation by a state analyst and will be accepted with the proper explanation. For example, to obtain a Home Medical Equipment provider license, one of the required documents is the proof of Professional Liability. Almost all of our physician clients have Professional Liability in the form of Malpractice coverage. A state analyst may look at this proof of Professional Liability and send an omission requiring a valid form of coverage. This is an example, where

Communication is key when filing these licenses with AHCA and timely responses are critical.

the provider will need to simply explain to the analyst that this is an accepted form of professional liability, and the omission will typically be accepted pending the proof checks all boxes needed to prove coverage. Insurance documents, zoning verification and office leases come in all different formats. Trying to put each one of these required documents into a standard format is not realistic. AHCA analysts have acknowledged this and are more apt to have accept different forms of documentation.

Diving further into the AHCA application process, one of the most common reasons providers have trouble passing the licensure process is the Proof of Financial Ability to Operate. There are some misconceptions regarding this 12+ page Excel Spreadsheet required by Florida Statute. Compiling these projections can be confusing for both providers and CPAs. Just to clarify as simply as possible, AHCA wants each provider, no matter the application type, to compile a business plan in the form of a financial spreadsheet. Something very important to understand when creating these projections is to only use numbers that pertain to the application you are submitting. For example, if a provider is submitting a Home Medical Equipment provider application, the financial projections should ONLY reflect the use of HME products. Let’s say the office is dispensing TENS units and back braces, the only revenue and expense numbers should be derived from those two products. A common misconception is that an applicant needs to submit numbers that reflect their overall business. AHCA wants to see the financial projections for the application being reviewed.

One important item to always remember is that there is a person on the other end of the application review process. Communication is key when filing these licenses with AHCA and timely responses are critical. AHCA timelines for responses and/or changes during licensure period are abided by very closely. All documentation must be filed on time and correctly to avoid costly fines. Any time there are changes such as ownership, name change or address change, the provider must contact their consultant or file those changes as soon as possible.. ■

Matt

- President

Over the last 10 years, there have been many changes to the required documentation to obtain licenses with the Agency for Healthcare Administration. Navigating these changes can be time consuming and many times require multiple attempts causing unnecessary expenses.

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