can be done from patients’ smartphone while at HOME or anywhere convenient
◦ We bill PIP directly at no cost to you
◦ We send the reports to you within 24 hours of patient exam
◦ We emphasize the importance of injury rehab and YOUR facility
◦ HIPPA-Compliant Portal where your patients’ medical reports can be accessed 24 hours a day, 7 days a week
◦ Referral form available on website and/or we can send a copy via email or fax
◦ Call to discover how easy and convenient our exam process is
We aim to inspire “Hope” and contribute to our patient’s healthcare and wellbeing by providing quality medical care to every patient through an integrated clinical practice of chiropractic, physical therapy, and medical services.
-Dr. Andrew Hope, President & Founder
31 years of expert depos and trial testimony.
Catastrophic and soft-tissue cases.
8,000 square feet of services designed to accurately diagnose, document and treat crash victims.
Immediate notes and reports sent out without asking.
Vertical spinal decompression and other unique approaches to documenting and providing care.
And for the first time since our magazine was born, I give a special welcome to our online viewers! It has been just over two years since we launched our first issue, and in line with our goal to continue to expand our outreach and support of the PI industry, adding online access to our content was naturally the next step for us to take. Starting with this edition, our readers can now go online to our beautiful and streamlined website at www.FloridaPiMag.com to enjoy full access to each issue, full of valuable content and clickable hyperlinks for the readers convenience. Everyone will be able to browse through all of our past editions, as well as subscribe to receive each new quarterly issue by mail free of charge. We are very excited to bring this to all of you, and cannot wait to hear your feedback!
We’re also working very hard in planning our Personal Injury Summits™ for the Spring and Summer of 2024. Make sure to join our mailing list by visiting our brand new website www.PiSummitFL.com so that you get notified as soon as the details are available. Our PI Summits are always a great environment for medical and legal professionals to come together for a full day of learning, networking and making fruitful connections with one another, and you won’t want to miss being a part of it. If there’s any particular topic you’d like us to address that you think is relevant to the industry, please e-mail me your suggestions. We want to make sure we provide the best educational program to help doctors and lawyers advance in the PI industry, and your input is very important to us. I hope you enjoy this edition of the PI Magazine™ and I look forward to hearing from all of you.
Sincerely,
Angely C. Maria EDITOR IN CHIEF envelope-square editorial@floridapimag.com
Well, it’s that time of year again where we start to think about how we can minimize our tax bite with Uncle Sam (aka the IRS). Having worked with owners of law firms and healthcare providers for over 25 years now, here is a list of the top ten things that notoriously get overlooked before year end:
1. Get all your unreimbursed expenses submitted to your company in an expense report! Whether you’re the owner or staff, not every expense makes it way onto the corporate card.
2. If you plan on doing any holiday giving, gift cards in $25 denominations are a great way to do so. You can deduct the cost of business gifts you give directly to each person, if no more than $25. Check our IRS Publication 463 for more info on this.
3. Team building events are a wonderful idea to implement. Whether it’s heading to a team retreat abroad or just to an escape room experience, team building is important and is a great tax write off!
4. Bonus depreciation and Section 179 depreciation can be used for tangible property your business acquires. Even certain vehicles qualify for these tax rules. If your company is planning on any upgrades to its office equipment, get it done before year end!
5. Educational expenses necessary to maintain your license are tax deductible, so make sure you are expensing all your Continued Education costs. You may even consider reimbursing staff for these costs as a retention tool if you are not already doing so.
6. Maximizing your retirement account. If you can afford to, make sure you are maximizing your allowed contributions into your Company’s sponsored plan. And if that plan has outgrown its usefulness, then it’s time to start shopping for a new one!
7. Home office reimbursements are growing in popularity, and some states even require them now. Employees and owners of the your company can accept reimbursement from the employer and these reimbursements will be not be counted as taxable income to the employee.
8. Be sure to get your charitable donations in before the end of the year. Whether you make them directly to a charity, a donor advised fund or through a charitable investment fund, be sure to do them before December 31st and keep records of your transactions.
9. Review your tax structure. Some companies still file taxes under partnership rules, and some solo owners are still filing a schedule C. A review of your tax structure may be the ticket to see if perhaps S-corporation status or even filing as a traditional corporation (commonly referred to as a C-Corp) may be a better bet for you. Tax may not even be the motivating factor here!
10. For owners that are in the top tax tier, start some research on restricted property trusts. These are complicated tax deductions that require specific tax structuring but can be very beneficial for highnet-worth owners.
And always remember that tax avoidance is legal, but tax evasion is criminal! Be sure to speak to a tax professional before you implement any of the above suggestions, as everyone’s tax matters are different. ■
phone-alt (305) 517-3977 ext. 104
mobile (914) 263-9806
envelope Matt@ia.tax info-circle interactiveaccountants.com
Injury Assistance Network is Florida’s leading online service providers’ directory. This initiative, led by Michael Mills, Esq., serves as a meeting hub where personal injury attorneys connect with doctors and medical providers. The directory also helps patients and victims in need of personal injury medical and financial services find high-quality providers.
For years, this platform has supported skilled personal injury attorneys find great medical and service providers for their clients. Now, we are excited to announce that we are bringing this service to personal injury attorneys as well, allowing victims who have been injured at no fault of their own to find top notch personal injury Attorneys to assist them with their case.
Thanks to our verified provider profiles, we assist personal injury Attorneys and medical providers in expanding their client base and gaining instant credibility and recognition. In addition, our members can now use our digital marketing services to improve their online presence and connections. Contact us today to learn more.
This is the first of several articles paving the road to success in our industry under Florida Tort Reform’s (FTR) Section 768.0427. That road is laid by a three-tiered response to the statute. First, medical providers must replace pre-FTR new-patient forms. Second, these new forms dovetail into strong motions for protective order filed by medical providers’ attorneys in the discovery phase. Third, the first two tiers dovetail into winning evidentiary motions and closing arguments by PI firms in trial.
This introductory article broadly surveys the statute and provides a few critical practice pointers. Subsequent articles in this series will provide deeper analyses of specific statutory subsections and discuss powerful action to be taken under the three-tiered response to Section 768.0427.
“LOP” is defined broadly but requires “a promise of payment . . . from any judgment or settlement.”
PRACTICE POINTER 1: Medical providers should (a) create new financial agreements that do not meet the statutory definition of “LOP,” (b) exclude the terms “letter of protection,” “LOP,” “litigation lien,” from billing and new-patient documents, and (c) never list the PI firm as a payor, insurer, or guarantor.
1. For past medical bills paid before trial, the only evidence the jury may consider is the amount of the payment.
PRACTICE POINTER 2: Medical providers should consider avenues (discussed in later articles) to avoid pre-trial payment. This will allow PI firms to present evidence establishing the reasonableness of the bill to the jury.
2. For past medical bills not paid before trial, the jury may consider:
• If the patient has commercial health insurance and the bill is submitted to that insurer – the amount the insurer is “obligated to pay.”
• If the patient has any kind of insurance, but the bill is not submitted to that insurer – the amount the insurer “would pay” had the patient used that insurance.
• If the patient has no health coverage at all or has just Medicare/Medicaid – 120% of the Medicare reimbursement, or if not applicable, then 170% of the Medicaid reimbursement.
• If the medical provider sells the bill – the purchase price.
• Any other evidence tending to prove or disprove reasonableness of the bill.
PRACTICE POINTER 3: PI firms should introduce the charged amount and other evidence (discussed in later articles) justifying the bill.
3. For future medical treatment, the statute is substantially similar to past medical treatment.
4. Unless the patient is insured by an entity with whom the medical provider has a contract, the patient need not seek bill reductions.
5. Contracts between medical providers and health insurers are not discoverable or admissible.
When there is an LOP, the patient must disclose the following: (a) the LOP, (b) billing for the patient in the case, (c) if the medical provider sells the bill, the identity of the purchaser and the sales price (d) the identity of the patient’s health insurer, (e) the patient’s referral source –and if the PI firm is the source, then the referral is admissible and the patient must also disclose the number of referrals between the PI firm and the medical provider, the frequency of such referrals, and the amount of money paid by the PI firm to the medical provider.
PRACTICE POINTER 4: See Practice Pointer 1.
The jury award can never be higher than is justified by the evidence that the jury was permitted to consider in Subsections (1)-(3). ■
phone-alt (813) 486-7321
envelope aaron@doclawfirm.com
info-circle www.doclawfirm.com
Aaron Proulx, Esq. THE DOCTOR’S LAWYER, PLLC.
House Bill 837 (HB 837) was signed into law on March 24, 2023, and it stands to dramatically alter the landscape of Florida Personal Injury Protection (PIP) and Personal Injury claims going forward. Despite the law’s passage nearly six months ago, there’s still some confusion about whether medical providers will still be able to file PIP Suits.
HB 837’s passage did not alter Section 627.736, Florida Statute (The PIP Statute) in any way, shape, or form. PIP coverage is still required for all private passenger automobiles registered in the State of Florida. The benefit limits are still the same, the requirements to qualify for coverage are still the same, the billing requirements are still the same, the reimbursement amounts are still the same.
Medical providers still have legal standing to bring a cause of action on a PIP claim if the patient has executed a valid Assignment of Benefits (AOB). As the assignee of a PIP claim, medical providers are still able to file pre-suit demands for unpaid or underpaid, overdue charges. If the insurance company pays benefits in response to pre-suit demands, they still are required to pay the statutory penalty, along with interest and postage cost reimbursement. Medical providers who have accepted an AOB may still file PIP Suits if the insurance company doesn’t pay all the benefits owed after receiving a pre-suit demand letter.
Now, I realize that at this point in the article, I may have confused you with what I’ve stated so far. At this point, you may be saying to yourself: “If the PIP Statute wasn’t altered or abolished, and if medical providers can still file PIP Suits, then why is everyone panicking?” The answer to this question is simple. While the PIP Statute in and of itself wasn’t changed, what was changed was the medical providers’ ability to collect attorney’s fees and costs when prevailing in a PIP Suit. How was this changed? Don’t worry, I will explain.
Section 627.428, Florida Statutes, allowed for one-way prevailing party attorney’s fees for the Plaintiff in a lawsuit against their insurance company. This statute was repealed with the passage of HB 837. Repealing Section 627.428, Florida Statutes, literally takes the teeth out of the ability to enforce the PIP Statute, because without the prospect of collecting separate attorney’s fees and costs, it becomes impossible from an economic standpoint for an attorney to litigate PIP claims. It is unlikely an attorney can work off an acceptable percentage of the PIP recovery because of
the relatively small balances being pursued. The legislature did this with the explicit intent of drastically reducing the volume of PIP litigation in Florida.
There is one instance where one-way prevailing party attorney’s fees for the Plaintiff are available; however, this doesn’t apply to PIP claims that have been assigned to medical providers. HB 837 created Section 86.121, Florida Statutes. This new statute states that it will permit an award of attorney’s fees to a named insured, omnibus insured, or beneficiary under a policy in a declaratory relief action after an insurer has made a total coverage denial of the claim. The right is not transferable or assignable to anyone other than the named insured, and a “reservation of rights” is not considered a “coverage denial” under this section.
The legislature made it clear that HB 837 does not impair any right under an insurance contract in effect on or before March 24, 2023. This means that, even if an automobile accident giving rise to a PIP claim occurs after March 24, 2023, HB 837 would not apply if the underlying insurance contract commenced or renewed prior to March 24, 2023. The Statute of Limitations for PIP breach of contract claims is still five years, so at this time, there’s still a window of approximately 4 ½ years’ worth of older PIP claims that may be pursued with the ability to collect prevailing party attorney’s fees and costs for the Plaintiff in litigation.
So does all of this mean that PIP Suits will go “extinct,” like the dodo? I would say no, but their numbers will be drastically reduced without the ability to collect attorney’s fees and costs. ■
In today's rapidly evolving legal landscape, where information is power and data breaches loom as a constant threat, personal injury practice management must navigate the complicated path of compliance to ensure success and protect both clients and their sensitive information.
We asked Jairo Avila, a seasoned partner at Internos, to shed light on the critical aspects of data privacy and compliance in personal injury practice management.
How critical are data privacy and compliance in personal injury practice management? What are the potential consequences of noncompliance?
Personal injury firms deal with a wealth of confidential client data, Avila advises, and any compromise could lead to severe legal penalties and a loss of trust from clients. “Confidential client data should not be disclosed,” he says. “Whether it comes down to PHI or PII, it’s really about protecting data at rest and in transit. You want to have encryption technology.”
What are the key regulations and standards that personal injury practice management professionals should adhere to for data privacy and security?
The primary industry regulations and standards institutions should follow include HIPAA (Health Insurance Portability and Accountability Act), which ensures the protection of health information, GDPR (General Data Protection Regulation) and CCPA (California Consumer Privacy Act), which guard personal data and grant clients more control over their information.
“It’s all about security and privacy,” Avila notes. “It’s about asking ourselves where we store this information. Where does it stay? How is it accessed? Can access be audited? Is there access control?”
How do managed service providers (MSPs) assist personal injury firms in developing a comprehensive data privacy policy that aligns with industry regulations and best practices?
An MSP can play a pivotal role in assisting personal injury firms in developing robust data privacy policies. “We see the role of an MSP in this space as helping to
enforce control and policy,” Avila explains. “We have experience assisting other firms. We regularly talk with HIPAA professionals and can help clients successfully navigate the waters of an audit.”
What technologies and tools do you recommend for enhancing data security measures and maintaining compliance?
In the digital age, technology becomes a crucial ally in maintaining data security and compliance. However, Avila offers some unexpected insights regarding people and technology:
“We don’t start with what technology we use. Encryption can come in many ways. The reality is that the right technology depends on a company’s infrastructure, design and other factors,” he says. “We want to ensure continuous training happens. Let’s empower the firm’s team, let’s give them awareness, and keep them cognizant of the important elements of security.”
Avila's insights demonstrate that mastering the art of compliance in personal injury practice management requires a comprehensive approach. As personal injury firms strive for success, a strong commitment to data privacy and compliance serves as an essential foundation. With the guidance of experts like Jairo Avila and the utilization of cutting-edge technologies, personal injury practice management can move more easily through the complex terrain of compliance, protect client interests and thrive in an ever-changing legal landscape. ■
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
By Matt Snyder
Incorporating DME in your practice is a great way to increase patient outcomes, while also increasing your bottom line.
These orthopedic bracing products can provide patients with the relief they need between appointments. In the State of Florida, PIP pays up to 200% of the Medicare allowable for certain DME products that have an active HCPCS Code. It is important to make sure when prescribing these orthopedic braces, that they have this HCPCS code. What is a HCPCS code? This is the billing code assigned to a particular brace by PDAC (Pricing, Data Analysis and Coding). Every bracing supplier should be able to supply you with a PDAC letter proving valid coverage. These billable products must meet certain qualifications to fit a specific code. For example, the L0642 Lumbar Brace must have rigid anterior and posterior panels that extend from L-1 to Below L-5. The fee schedules for these products are public information and are listed on my website. You simply type in the code and the fee schedule will pop up by state. These fees are set by Medicare and have historically increased each year.
Each brace, whether it be a lumbar, knee or wrist brace, requires certain diagnosis codes to prescribe. At JMS, we can provide samples of these letter of medical necessity forms with the corresponding diagnosis codes, therefore you are able to prescribe the proper brace. These diagnosis codes are also listed on Medicare’s site as LCDs (Local Coverage Determination). LCD’s are a determination by Medicare regarding whether or not a particular item is covered.
When choosing a brand or model of orthopedic bracing there are a few key factors to consider: quality, durability and functionality. Quality brands such as Aspen Medical Products and Trend Medical are going to provide patients with quality bracing products at an affordable cost. Many of these braces are offered with a universal fit so they require a bit of sizing and
fitting. This is where functionality comes into play. A brace that can be taken apart in multiple pieces can cause confusion when patients have the brace at home. When the sizing and fitting is kept simple it also helps increase patient compliance. Durability should also be considered when purchasing bracing. Since these
braces have a specified billing code, they are expected to last longer than the typical elastic wrap around or slip on knee brace.
For a full list of orthopedic bracing costs and reimbursements, you can visit my website at www.jmsmedsupply.com. ■
Matt Snyder PRESIDENT, JMS MED SUPPLYWhen choosing a brand or model of orthopedic bracing there are a few key factors to consider: quality, durability and functionality.
Know your rights when insurance companies want your client or patient to appear to an examination under oath (EUO) or so-called “independent” medical examination (IME). Blindly sending an insured or a patient to an EUO or an IME is a serious mistake. EUOs are not designed to obtain “the truth” but designed to trick your client or patient. It is crucial to know that EUO testimony can forever be used against a medical provider, even in different cases. Central to many “clawback” Federal lawsuits against medical providers is EUO testimony. An “independent” medical examination is the furthest thing away from being “independent”. Insurance companies use doctors for their IME who have proven track records in issuing opinions favorable to an insurance company.
So what do you do when an insurance company wants your client or patient to appear to an EUO or IME? It is highly recommended that any medical provider or attorney who is not familiar with the intricacies of attending an EUO or an IME consult with an attorney who has many years’ experience in handling EUOs and IMEs. You have the right to review the insurance company’s insurance policy before appearing to an EUO and make sure that the insurance company properly follows its insurance policy terms in scheduling and taking an EUO. The terms of the insurance policy might allow avoidance of an EUO as they might be contrary to what an insurance company requires in their letter scheduling an EUO or IME. You also have the right to choose dates in which to appear to an EUO or IME.
You can also negotiate with an insurance company as to whether an EUO appearance is actually necessary. Remember you have the same rights under an insurance policy as an insurance company and should make sure that an insurance company complies with
your rights under an insurance policy in reference to an EUO or IME. IMEs have strict requirements as to the location of the IME and no appearance is required if the IME is not scheduled accordingly. You are not required to appear on the date appointed by the insurance company and you can reschedule the date. Attorneys can attend the EUO and IME, and even video record them. If your patient or client is Spanish-speaking then that person is entitled to a party independent interpreter to be present. So the next time an EUO or IME request comes in, the last thing you should do is blindly send your client or insured to the EUO or IME. ■
George A. David, Esq.phone-alt 305-569-9980
envelope gadeservice@gmail.com
You can also negotiate with an insurance company as to whether an EUO appearance is actually necessary
We are the law firm that is not afraid of difficult cases. We handle all cases, including the more difficult cases such as where insurance companies deny claims because:
◦ $10,000.00 policy limits are exhausted
◦ Material misrepresentation
◦ Fraud
◦ Invalid reductions in medical bills
◦ Failure to appear to examinations (EUOs) under oath or “independent” medical examinations (IMEs)
We work with medical providers in EUO and IME requests from insurance companies. We also will co-counsel with personal injury attorneys in making a special appearance in scheduling and appearing to EUOs and IMEs. We are available to answer any PIP questions. Just call or email us.
George David represented insurance companies from 1991 up until 2001. Since 2001 George David has been representing medical providers in PIP suits. We know all the insurance companies’ tricks. We handle cases throughout Florida and have suits filed in the Tampa, Tallahassee and South Florida areas. Our main office is in Coral Gables.
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