Florida Personal Injury Magazine • July-September 2024
THE FINANCIAL IMPACT OF AGING RECEIVABLES: STRATEGIES FOR MEDICAL PRACTICES
SAFEGUARDING
CLIENT DATA: 8 EASY CYBERSECURITY STRATEGIES FOR THE PI INDUSTRY
KEY WAYS TO MAXIMIZE YOUR UBER/LYFT PI CLAIMS
FL SUPREME COURT DECISION REGARDING BILLED AMOUNT
V. PIP FEE SCHEDULE
NAVIGATING REFUND REQUESTS FROM FLORIDA PIP INSURANCE COMPANIES: UNDERSTANDING THE LEGAL DEFENSE OF DETRIMENTAL RELIANCE
PERSONAL INJURY SUMMIT TM
PERSONAL INJURY SUMMIT TM
SOUTH FLORIDA HIGHLIGHTS
SOUTH FLORIDA HIGHLIGHTS
SUCCEEDING UNDER TORT REFORM PART 4
◦ 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
From the Editor
WELCOME
TO THE PERSONAL INJURY MAGAZINETM !
If there is one thing we all learned from our recent Personal Injury Summit® in Fort Lauderdale is that our industry is very much alive. It is very encouraging to see how many medical and legal professionals have stayed true to their commitment to provide essential services to their communities, and it serves as both inspiration and confirmation that all of our efforts at AMB Group are needed now more than ever. We are proud of what we were able to accomplish with our two Personal Injury Summits in 2024 so far, and are already planning our 2025 schedule to ensure we can continue providing valuable content and facilitating fruitful connections throughout the state.
We’re also committed to our goal of becoming the number one trusted resource all PI professionals can turn to when looking for much needed information to grow their practices. And in the interest of making our digital magazine as user-friendly as possible, you will now see on our website an article index page to help you find exactly what you’re looking for! Simply click on floridapimag.com/articles, and you will see a list of articles starting on the first issue of 2024 and on (articles for issues from 2021-2023 can still be found by clicking on the “View All Digital Issues” option). You will also see a search box where you can enter a keyword to direct you straight to the right article. Make sure to bookmark this page on your favorite browser and get in touch with us if you have any particular topics that you’d like for us to address in future issues. We are here to support your growth in Personal Injury, so help us help you!
Sincerely,
Angely C. Maria EDITOR IN CHIEF
envelope-square amaria@ambgroupcorp.com
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ASSISTANCE NETWORK
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
credibility and recognition. In addition, our members can now
their
and connections. Contact us today to learn more.
KEY WAYS TO MAXIMIZE YOUR UBER/ LYFT PI CLAIMS
By Michael Mills, Esq.
It seems that filing claims against Uber and Lyft vehicles is a current trend in the Personal Injury world. However, before you jump on the bandwagon, there are a few things you should know. Before ride sharing became as popular as it is today, the big two, Uber and Lyft, provided much more comprehensive coverage for both their drivers and the passengers that utilized their services.
It wasn’t unheard of for there to be an Uber or Lyft policy that carried $250,000 in UM coverage and $1 Million in BI coverage. This literally made riding in an Uber or Lyft vehicle a better option, as far as coverage was concerned, than riding in most individual’s personal vehicles in Florida.
However, over the years, with all of the direct marketing to individuals injured in a car accident while riding in an Uber or Lyft, or struck by an Uber or Lyft driver, both companies have significantly reduced coverage limits available for the uninsured motorist coverage provided to the state minimum limit of $10,000. Additionally, both these companies are currently using either Progressive or State Farm to insure their ride share drivers. So, this means that the when you have a client that’s been injured by an Uber or Lyft driver, it’s more important than ever to make sure that you stay aggressive with the claims adjusters.
You should make sure that your client begins treatment as soon as possible after the accident. However, not just any chiropractor or orthopedic doctor will do. It’s important that your client treats with medical providers who understand the recent change in the law. You should make sure your client treats with medical providers who will not only provide them with top notch treatment but also provide you, the attorney, with the medical records you need to be able to aggressively litigate the case. This also means, the medical providers should understand that accurate and reasonable billing is becoming even more important. Additionally, if your client has health insurance, finding providers that can bill your client’s health insurance, even if they get denied, is important in this post-Tort Reform environment. We don’t want the insurance company to be able to successfully argue that your client did not mitigate his/her medical expenses because
they did not attempt to use their health insurance.
One of the injuries that often is overlooked is when the client suffers a traumatic brain injury (TBI). Making sure you familiarize yourself with the symptoms of TBI allows you to be able to ask your client pertinent questions and ascertain whether a TBI evaluation could be beneficial for their health. Additionally, you can get invaluable information from reviewing ER records, which are often overlooked if the subsequent providers do not request them or are unaware that the client was seen at the ER.
Finally, once your client has been evaluated and treated for all of their injuries, and have reached maximum medical improvement, then it’s time to send the demand letter to the adjuster. Be sure to include all the medical bills and treatment records. Be sure to thoroughly explain your theory of liability and explain how the injury has impacted your client’s life and include any future medical expenses or care that they will need. These companies and the insurance companies that insure them are adept at devaluing your client’s claim. Don’t allow that to happen, with the proper medical providers, medical records and you having a comprehensive knowledge of client’s injuries, you can be sure to obtain the maximum amount of compensation for your client’s injuries. ■
SAFEGUARDING CLIENT DATA:
8 EASY CYBERSECURITY STRATEGIES FOR THE PERSONAL INJURY INDUSTRY.
By Andrew Renck
Sharing data has become easier, but securely sharing that data remains elusive for many providers and attorneys. Email is ubiquitous – everyone has it, and patients and clients want to use it. You may think that HIPAA says you cannot, but you can – if you secure it. The main goal here is to protect your client or patient data and send data securely. However you also want to protect your organization from other risks – phishing, business email compromise, reputation loss, and more. Here’s an easy 8-step guide on how to ensure you’re sharing your client’s data safely:
1. Use Email Encryption when sending email. Software vendors like Sophos allow you to send encrypted emails simply by adding “SECURE:” at the front of the subject line. This also protects against business email compromise (BEC) which is crucial for lawyers handling sensitive information. Sending encrypted emails is the only way to meet HIPAA for sending email – you can’t send data securely without it.
2. Use MFA for all of your email accounts. Google and Office365 have it. In fact, if you don’t have it, you may have voided your cyber liability policy by not enabling it for all users. Multifactor Authentication means that if someone gets your credentials they still need the code from your phone to log in. In fact, use MFA on all of your accounts, not just email.
3. Use a filtering service before your email hits your provider. This will stop junk, spam, and malware from reaching your mailbox. If its not in your inbox, you can’t be phished or scammed.
4. Enable “external sender” policies so you know when emails are coming from outside your domain. You will see a message cautioning the email was sent from outside your organization.
5. Enable VIP protection policies so that you know if someone is pretending to be a user from a different email address.
6. Verify if any “typo” domains exist, for example an “i” when capitalized will look like a lowercase L and can be used to target your clients and patients. Go buy those domains so no one else does and then uses them against you or your clients.
Email is ubiquitous –everyone has it, and patients and clients want to use it. You may think that HIPAA says you cannot, but you can – if you secure it.
7. Audit your IT services. If you use internal staff or an outside company make sure that you audit the work. Any decent IT person should not be fearful of their work being wrong or improved by audits.
8. Do regular security and compliance training. This teaches your staff how to recognize scams, phishing attempts, and other threats. Training should include compliance requirements to ensure adherence to legal and regulatory requirements. ■
Andrew Renck is the owner of RootPoint, an IT services and Cybersecurity Provider located in Miami, FL. Andrew Renck is a 2003 graduate of the University of Miami with multiple degrees including Finance and Economics. While attending the University he created his computer consulting firm RootPoint. He has been providing secure systems integration long before “Cybersecurity” became a recognized term. Renck is an ethical hacker and has provided services for both offensive and defensive cybersecurity projects.
Andrew Renck ROOT POINT
phone-alt (305) 726 9091
envelope arenck@rootpoint.com
info-circle www.RootPoint.com
THE FINANCIAL IMPACT OF AGING RECEIVABLES: STRATEGIES FOR MEDICAL PRACTICES
By Theresa Giordano
While the primary focus of healthcare providers is patient care, the economic health of a medical practice is equally crucial, as it ensures the practice's continuity and existence to keep providing quality healthcare to patients. One effective strategy to maintain a steady cash flow is to prioritize the timely management of medical receivables.
Understanding the Servicing of Medical Receivables
Medical receivables refer to the outstanding amounts owed to a healthcare provider for services rendered, typically by patients or insurance companies. These outstanding balances can accumulate for various reasons, including insurance claim denials, patient co-pays, or deductibles. As these receivables pile up, it can create significant financial strain for healthcare providers. Effective receivables management ensures that these outstanding bills are converted into cash promptly, thus improving the practice's cash flow and financial stability.
What is the Servicing of Medical Receivables?
The process of Servicing medical receivables can be broken down into several key components:
• Billing and Coding Accuracy: Ensuring that all medical services are accurately billed and coded is the first step in managing receivables.
• Claim Submission and Follow-up: Timely submission of claims to insurance companies and consistent follow-up on unpaid claims are critical.
• Patient Billing and Collections: Efficient patient billing systems and proactive follow-up on unpaid patient balances are essential to minimize aging receivables.
• Payment Posting and Reconciliation: Accurate posting of payments and reconciliation of accounts ensure that all received payments are correctly applied to the corresponding receivables.
• Monitoring and Reporting: Regular monitoring and reporting of receivables provides insights into the practice's financial performance.
Key Strategies for a Medical Practice’s Financial Health
Here are key strategies healthcare providers can implement to enhance their practice’s finances.
• Optimize Revenue Cycle Management (RCM): Streamlining the billing process and reducing errors can significantly improve cash flow.
• Monitor Key Financial Metrics: Keeping days in A/R under 30 to 40 days is crucial for financial health.
• Implement Robust Financial Planning: It’s vital to have a financial plan that includes budgeting, cash flow management, and investment strategies.
• Leverage Technology: Utilize advanced software for billing, scheduling, and financial reporting to reduce administrative workload and improve accuracy.
Benefits
of Professional Receivables Servicing
Engaging a professional receivables management provider can offer several advantages:
REDUCED ADMINISTRATIVE BURDEN: By delegating the collections process to experts, healthcare providers can focus more on patient care and other core activities.
REGULATORY COMPLIANCE: Collection experts are well-versed in healthcare finance regulations, ensuring compliance and reducing the risk of legal issues.
EXPERT DEBT COLLECTION: Professional providers are experienced in recovering outstanding debts efficiently (even in the most challenging cases) and bring specialized expertise and advanced technology for tracking and managing accounts precisely.
COST EFFICIENCY: Despite the fees involved, outsourcing your collections to experts can be more cost-effective than managing them in-house, considering the time, effort, and resources required for effective debt recovery.
ENHANCED CASH FLOW: Practices can accelerate cash flow by converting aging receivables into capital quickly.
ENHANCED FINANCIAL HEALTH: By keeping receivables current and minimizing aging accounts, practices can maintain a healthier financial position, reducing the risk of bad debts and financial instability.
In summary, the servicing of medical receivables is a critical component of effective healthcare practice management. Effective management of receivables not only ensures compliance, improves cash flow, and reduces administrative burdens but also enhances the overall financial health of a medical practice. For healthcare providers, partnering with a professional receivables management service can be a strategic move to concentrate on delivering high-quality patient care, and ensure long-term financial stability and success. ■
Theresa Giordano
QUANTUM OUTSOURCING GROUP
map-marker-alt 2963 Gulf to Bay Blvd Suite 120 Clearwater, FL 33759
phone-alt (813) 725-2466 Ext. 225
mobile (813) 507-1349
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Over 26 years providing evaluation, management and treatment of the injured.
Open Monday through Thursday 8:30 – 6:30 and on call Friday through Sunday
High Frequency (Digital) X-ray on Premise
Medical doctor on sta for EMC determinations and pre-exams before IME’s
Prompt scheduling of MRI’s and ortho/neuro consultations of your choosing
Rehab available: EMS, Hot/Cold therapy, mechanical traction, therapeutic exercise, spinal decompression and Class IV laser therapy
SUCCEEDING UNDER TORT REFORM
By Aaron Proulx, Esq.
This is the fourth article in a series that lights the way to success under Florida Tort Reform’s Section 768.0427. This article will explain how Subsection (2)(e) can be used to prevent the insurance defense industry from presenting the health insurance reimbursement rates discussed in Subsections (2)(b)(1), (2)(b)(2), and (2)(c)(1).
Section 2 deals with evidence that may be offered to prove the amount of damages for medical services. Subsection (2)(b), more specifically, deals with evidence offered to prove the amount necessary to satisfy unpaid charges for past medical services. Subsection (2)(c) deals with evidence offered to prove the amount of future medical services.
Within these subsections, the Statute further discusses three scenarios in which the defense is permitted to present insurance reimbursement rates to the jury.1 First, Subsection (2)(b)(1) tells us (as to past medical services) that if the patient has commercial health insurance and the provider submits the bill to that insurer, the jury may consider evidence of the amount the insurer is obligated to pay the provider.”
Second, Subsection (2)(b)(2) tells us (as to past medical services) that if the patient has commercial or governmental health insurance, but does not submit charges to that insurer, the jury may consider evidence of the amount the insurer would pay the provider had the patient obtained medical services pursuant to the coverage. Finally, Subsection (2)(c)(1) tells us (as to future medical services), that if the claimant has or is eligible for commercial health insurance, the jury may consider evidence of the amount at which future charges could be satisfied if submitted to the insurer.
After the Statute provides these three scenarios in which the defense is permitted to present insurance reimbursement rates to the jury, the Statute then tells us in Subsection (2)(e) that contracts between providers and commercial insurers and HMOs are not discoverable.
This is curious because the supposedly admissible reimbursement rates discussed in Subsections (2)(b)(1), (2)(b) (2), and (2)(c)(1) can all be found only in the fee schedules contained within the supposedly undiscoverable contracts. Something has to give between the admissibility of reimbursement rates and the non-discoverability of the contracts that contain those reimbursement rates.
There are several ways this can play out in the courts, but there is not enough space in this article to discuss all of them. The following appears to a likely scenario:
When the defense seeks reimbursement rates under Subsections (2)(b)(1), (2)(b)(2), or (2)(c)(1), the provider should file a motion for protective order (MPO) under Subsection (2)(e). The defense will argue that granting the MPO would unconstitutionally delete Subsections (2)(b)(1), (2)(b)(2), and (2)(c)(1) from the Statute. But the provider should point out the error in this argument –under all those subsections, the defense can still present the reimbursement rates when a provider or health insurer volunteers them and when the defense has already obtained the reimbursement rates in another case. Note that the defense does not have a similar response to the provider’s claim that denying the MPO unconstitutionally deletes Subsection (2)(e) from the Statute.
...contracts between providers and commercial insurers and HMOs are not discoverable
Because the provider’s argument allows for a consistent reading of Subsections (2)(b)(1), (2)(b)(2), (2)(c)(1), and (2)(e), and the defense argument does not, the court should grant the MPO. If the provider prevails on the MPO, the defense will not discover reimbursement rates, and if the defense does not discover reimbursement rates, the defense has no way to admit them to the jury. ■ 1
In a recent decision, the Florida Supreme Court actually strengthened the billed amount statute of FS §627.736(5)(a)(5) which states:
“An insurer may limit payment as authorized by this paragraph only if the insurance policy includes a notice at the time of issuance or renewal that the insurer may limit payment pursuant to the schedule of charges specified in this paragraph… If a provider submits a charge for an amount less than the amount allowed under subparagraph 1., the insurer may pay the amount of the charge submitted.” (Emphasis added)
This Florida Supreme Court opinion makes the billed amount doctrine alive and well
In simple terms, this statute means that if the medical provider submits a claim form billing an amount for a CPT code that is less than 80% of what the fee schedule would allow, then the insurance company is required to pay the full billed amount of the CPT code on a medical provider’s claim form without any reductions.
In the recent Florida Supreme Court case, after rendering services to the patient, the medical provider submitted a HCFA with a CPT code charging $100.00.
The 80% of the fee schedule under FS §627.736(5)(a) (1) for the CPT code charged was $149.92. So, 80% of the maximum charge under the fee schedule was $119.94 which was higher than the submitted $100.00 charge. Because the charge of $100.00 was less than $119.94, FS §627.736(5)(a)(5) expressly allowed the insurance company to pay the $100.00 amount billed.
Instead of paying the $100.00 amount billed, the insurance company chose to pay 80% of the amount billed which was $80.00.
The Florida Supreme Court allowed the insurance company to pay 80% of the $100.00 billed amount or $80.00 because the insurance company’s policy had specific language that allowed the insurance company to make that reduction. The Florida Supreme Court allowed insurance company to pay less than the billed amount if the insurance company’s policy specifically allowed it to:
“pay 80% of a submitted charge if that charge is less than the amount reimbursable under the schedule or other statutory provisions, may the insurer pay 80% of the charge submitted by a medical provider.”
The good news is that this also means if the insurance policy does not have this specific language in it, then they would have to pay the billed amount under FS §627.736(5)(a)(5). This case is positive for medical providers because trial courts have used cases from the District Courts of Appeal to claims that the billed amount doctrine was gone for good. This Florida Supreme Court opinion makes the billed amount doctrine alive and well. I have not seen many insurance company policies with this specific language mentioned in the Florida Supreme Court opinion. So, it is important to review the insurance policy before determining whether the insurance company erred in not paying the billed amount. ■
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.
LEGAL DEFENSE OF DETRIMENTAL
RELIANCE
NAVIGATING REFUND REQUESTS FROM FLORIDA PIP INSURANCE COMPANIES: UNDERSTANDING THE
By Christopher M. Tuccitto, Esq.
While it doesn’t occur too often, it’s practically inevitable if you’re a Florida medical provider who treats patients for Personal Injury claims that you will eventually receive a request from a Personal Injury Protection (PIP) insurance carrier for a refund of a supposed overpayment. In the realm of PIP insurance, medical providers often find themselves grappling with refund requests from insurance companies. These requests can be daunting, prompting providers to question their legal standing and obligations. However, it's crucial for Florida medical providers to understand their rights and defenses, particularly the concept of detrimental reliance.
Detrimental reliance, also known as detrimental estoppel, is a legal principle that comes into play when one party reasonably relies on the actions or representations of another to their detriment. In the context of medical providers and PIP insurance companies, this principle holds significant weight.
When a medical provider renders services to a patient covered by PIP insurance, they do so under the assumption that they will be compensated for their services in accordance with the terms of the insurance policy. This reliance on the insurance coverage is not only reasonable but also essential for the provider to continue offering care to injured individuals.
However, complications arise when PIP insurance companies retroactively seek refunds for previously paid claims. In such cases, medical providers may invoke the defense of detrimental reliance to resist these refund requests. By demonstrating that they reasonably relied on the representations of the insurance company regarding coverage and payment, providers can assert their right to retain the compensation they received for services rendered.
It's important to note that detrimental reliance is not a blanket defense and must be supported by evidence. Medical providers should maintain thorough documentation of all communications with the insurance company, including claim submissions, payment receipts, and any correspondence regarding coverage or reimbursement policies.
Additionally, medical providers should be prepared to demonstrate the detrimental consequences they would face if forced to refund payments already received. This may include financial losses, disruption of patient care, and/or damage to professional reputation.
Complications arise when PIP insurance companies retroactively seek refunds for previously paid claims
In navigating refund requests from Florida PIP insurance companies, medical providers should also be mindful of legal requirements and procedures. Consulting with experienced attorneys specializing in PIP Insurance claims can provide valuable guidance and representation throughout the process.
Ultimately, the defense of detrimental reliance serves as a crucial safeguard for Florida medical providers facing refund requests from PIP insurance companies. By understanding and asserting this defense, providers can protect their rights, uphold their professional integrity, and continue to prioritize the care of their patients.
In conclusion, while refund requests from Florida PIP insurance companies can be challenging, medical providers have legal recourse in the form of the defense of detrimental reliance. By leveraging this defense and seeking appropriate legal counsel, providers can navigate these requests with confidence and uphold their commitment to patient care. ■
