THE PROS AND CONS OF PARTICIPATING IN CLASS ACTIONS FOR FLORIDA PIP CLAIMS
5 WAYS YOUR FRONT DESK STAFF CAN HELP IMPROVE YOUR PIP COLLECTIONS IN 2025 BENEFITS OF DISPENSING ORTHOPEDIC BRACING IN YOUR PRACTICE
5 WAYS YOUR FRONT DESK STAFF CAN HELP IMPROVE YOUR PIP COLLECTIONS IN 2025 BENEFITS OF DISPENSING ORTHOPEDIC BRACING IN YOUR PRACTICE
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From the Editor
WELCOME TO THE PERSONAL INJURY MAGAZINETM ! AND HAPPY NEW YEAR 2025!
We can’t wait to share with you everything we have lined up for you this year. We continue to have wonderful new partners supporting the Personal Injury Magazine, who are providing important contributions on topics that matter to PI professionals, as you’ll see by the articles in this issue. We will also be hosting our fifth and sixth Personal Injury Summits in Central Florida on Saturday, March 8th and South Florida on Saturday, June 7th, 2025. The experience for guests and vendors alike has been extremely positive in these events, so we hope you’ll get a chance to join us this year! Make sure to get all details and a sneak peak of past events on our website, www.PiSummitFL. com and take advantage of the discounts we offer to register your team. We really want to make it as easy and affordable as possible for all of you to attend!
I want to personally thank all of you, our wonderful readers who have followed us throughout the years since we started this unique publication for the PI industry in 2021. It’s been a very interesting as well as rewarding journey, and we look forward to continuing to provide value to all PI practitioners, from medical and legal practices alike. And of course, we couldn’t have done it without the partnership with all of our loyal vendors who continue to support us as advertisers or sponsors of our events. I highly suggest you reach out to every one of them and find out how they can help make your PI practice more profitable and efficient, we are all here to serve you!
Sincerely,
Angely C. Maria EDITOR IN CHIEF
IDENTITY MANAGEMENT IN LAW FIRMS: PROTECTING AGAINST FRAUD WITH ADVANCED DATA TECHNOLOGY
By Tiffanny J. Anghel, MHA
In today’s fast-paced, data-driven world, law firms face increasing risks associated with identity fraud. Handling vast amounts of sensitive client information, including protected health information (PHI), puts legal practices at the forefront of cybersecurity challenges. As healthcare data grows exponentially, accounting for approximately 30% of the world’s total data as of 2023, it is expected to grow at a compound annual growth rate of 36% by 2025, far surpassing sectors like manufacturing, financial services, and media. This rapid growth highlights the urgent need for law firms to implement robust identity protection measures to safeguard sensitive data and enhance operational efficiency.
The
Growing Threat of Fraud and Cyberattacks
Data breaches and cyberattacks have become more sophisticated, targeting vulnerabilities in identity verification systems. According to a 2023 study by Cybersecurity Ventures, global fraud losses are projected to exceed $40 billion annually, emphasizing the importance of proactive security measures. Law firms, particularly those managing personal injury, malpractice, or other cases involving medical records, are prime targets for cybercriminals. A single breach can expose sensitive client data, leading to legal, ethical, and financial repercussions.
The 2024 Change Healthcare ransomware attack is an example of this vulnerability. The attack compromised the PHI of 100 million individuals, making it the largest healthcare-related breach reported in the United States. This incident prompted heightened scrutiny from federal and state regulators, who have imposed stricter requirements on organizations handling sensitive data. Noncompliance with regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and the General Data Protection Regulation (GDPR) can result in significant penalties, extending beyond healthcare providers to include law firms.
Legal professionals have already faced disciplinary action for lapses in identity verification. For example:
1. Robert Kaufman (New Jersey, 2006): In this case, the attorney failed to verify the legitimacy of client-provided documents, facilitating a real estate fraud scheme. The court ruled that Kaufman’s lack of diligence violated professional conduct rules, highlighting the importance of identity checks to prevent fraud.
2. McQueen v. State of New York: A federal case where an attorney overlooked suspicious identifications provided by clients involved in a wire fraud scheme. Although McQueen was not criminally prosecuted for accepting fake IDs, his failure to adhere to due diligence practices subjected him to scrutiny (DOJ Case Report).
3. Robert Perez v. State of New York: This disciplinary case involved an attorney who failed to verify the identity of clients using fake IDs in real estate closings, which were part of a mortgage fraud scheme. Perez’s negligence in conducting due diligence led to identity theft and mortgage fraud, resulting in professional discipline.
These cases illustrate the significant legal and ethical risks law firms face when they neglect identity management.
Health Data and Its Importance in Future Growth Health data’s increasing volume and value make it a prime target for fraud. With the adoption of electronic health records (EHRs), telemedicine, and other digital health technologies, the need for robust identity verification systems has never been greater. For law firms handling medical cases, mishandling or failing to protect health data exposes them to heightened risks of fraud and regulatory violations. Identity verification is critical in ensuring that only authorized personnel can access sensitive health information. Without strong identity management protocols, law firms remain vulnerable to schemes exploiting gaps in their systems. Effective measures not only protect against breaches but also ensure compliance with evolving regulations, safeguarding client trust and firm reputation. ■
Tiffanny J. Anghel, MHA HEAD OF PARTNERSHIPS YOCIERGE & YC API
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BENEFITS OF DISPENSING ORTHOPEDIC BRACING IN YOUR PRACTICE
By Matt Synder
1. Improved Patient Care and Outcomes
Orthopedic braces are designed to support and stabilize injured or weakened joints, ligaments, and muscles. By dispensing bracing products directly within your practice, you can ensure that patients receive immediate and appropriate care. Braces can prevent further injury, reduce pain, and speed up the recovery process. Custom-fitted braces also improve comfort and function, encouraging patients to adhere to prescribed treatments.
By offering a wide range of orthopedic braces, such as knee, wrist, ankle, or back supports, you allow patients to receive personalized care tailored to their specific needs. This approach often results in better clinical outcomes, as patients are more likely to follow the doctor’s recommendations and wear the brace consistently.
2. Convenience for Patients
Having a wide selection of orthopedic braces available at the point of care offers unparalleled convenience for patients. Instead of requiring patients to visit a medical supply store or wait for a prescription to be filled, your practice can immediately provide the required brace. This eliminates delays in treatment and gives patients the confidence that their injury is being addressed promptly.
Moreover, patients are more likely to comply with a recommended brace when they can receive it during their visit, as they can begin the healing process right away. The convenience factor also builds patient satisfaction, contributing to improved retention and referrals.
3. Increased Revenue and Practice Efficiency
Dispensing orthopedic braces in your practice can also provide a revenue stream. Medical practices can purchase braces in bulk and sell them to patients, marking them up at a reasonable price to cover costs and generate a profit. With proper coding and insurance billing practices, bracing can be reimbursed by insurance providers, ensuring financial sustainability for the practice.
Additionally, having braces available in-house streamlines operations. Practices can better manage inventory, ensuring they have the right products on hand without having to rely on external suppliers. This results in less waiting time for patients and reduces the need for additional administrative tasks related to outside orders and deliveries.
4. Enhancing the Doctor-Patient Relationship
Dispensing orthopedic bracing in your practice fosters a deeper level of trust between you and your patients. By offering a solution that directly addresses their pain or injury, you are demonstrating a commitment to their well-being. Patients value personalized care and providing a custom-fit or carefully chosen brace strengthens your credibility as their healthcare provider.
In addition, patients often have questions or concerns about the proper use of orthopedic braces. By providing them with the brace directly, you have the opportunity to educate them on how to wear, adjust, and maintain the brace. This added layer of care reinforces patient confidence in your expertise.
5. Better Control Over Treatment Plans
When bracing is dispensed in-house, the healthcare provider has better control over the quality of the products used in patient care. This allows for more consistent outcomes and reduces the chances of patients receiving subpar products from third-party retailers. Additionally, the provider can monitor the progress of treatment closely and recommend adjustments or modifications to the brace as needed.
This also opens opportunities for follow-up appointments, where patients can be re-evaluated and provided with new or adjusted braces if necessary.
6. Education and Patient Empowerment
Dispensing orthopedic bracing provides an ideal opportunity for patient education. By offering the right products and guidance, you empower patients to take an active role in their recovery process. Understanding how a brace supports the healing process gives patients confidence in their treatment plan, promoting long-term health benefits. ■
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5 WAYS YOUR FRONT DESK STAFF CAN HELP IMPROVE YOUR PIP COLLECTIONS IN 2025
By Angely C. Maria, Senior Biller & Consultant, AMB Group
Recent changes in the PI industry have emphasized the importance of ensuring your billing practices are more efficient than ever. As the PIP suit attorneys still struggle to find the best way to continue helping medical providers collect balances owed on their behalf, making sure you bill PIP claims correctly from the start plays a key role in ensuring you maximize your PIP recovery on every PI patient. Here’s some of the best strategies that all medical practices should train their Front Desk and intake staff on to help increase PIP collections in 2025:
1. Collecting all accident information prior to the patient’s first visit
This includes date of accident, whether the patient has received treatment by any other provider (including paramedics) within 14 days, and the correct PIP carrier and claim number that covers the patient. If you wait too long to get all these details, you might find yourself with hundreds if not thousands of dollars’ worth of treatment only to find out later that the patient has no insurance coverage to pay your bills. Try to discuss all these details during your first interaction with the patient while setting up the initial appointment to ensure that by the time they come to your office for the first visit, they have all the information needed and have already discussed with their attorney any questions they may have.
2. Track the status of required tasks for every new patient
This is one of the toughest strategies for clinics to implement if they’re not used to it, but it is by far one of the most efficient if you want to increase your collections. Take advantage of tools such as spreadsheets or EMR software to keep track of missing information or processes that will impact your ability to get paid. As soon as a new patient starts treatment, make sure to add them to your list and keep track of items such as data entry, PIP coverage verification, BI limits, Notice of Initiation submission, 14-day treatment confirmation, EMC determination, and PIP suit status. You can customize it according to your office requirements.
3. Ensure your patient signs all required paperwork
It is crucial to get all required paperwork properly filled out before the patient leaves your office. Forms such as the Assignment of Benefits, Standard Disclosure & Acknowledgement and an Automobile Insurance Questionnaire are specially important for all your PIP files. Do a thorough review to confirm that every page was filled out properly and completely before scanning them into your EMR or putting them on the file.
4. Promptly enter all data into the EMR/billing system
Part of your closing tasks before the end of each shift should include entering all data for every new patient file as much as possible. This will help all the other processes by the rest of the team to be completed smoothly and avoid mistakes. If your patient filled out their intake electronically, make sure to review all information entered is correct, particularly the data related to the accident and insurance information.
5. Schedule the patient in advance to comply with their treatment plan
Having all the prior steps done properly can only go so far in helping increase PIP collections. Once the file has been properly processed and the insurance coverage confirmed, all your Front Desk staff has to do is make sure your patient is scheduled according to the doctor’s prescription. Do not allow anyone to deviate from the prescribed treatment plan without scheduling the patient for a re-eval or consult with the doctor. Use your scheduling system to set up appointments for 2-4 weeks at a time and you’ll see your patient compliance and collections significantly improve!
Don’t miss our article in the next magazine issue where we’ll discuss the top ways in which your billing staff can help improve PIP collections for your medical practice. ■
By George A. David, Esq
Both chiropractors and orthopedic surgeons alike will perform manual muscle testing billed under either CPT codes 95851 or 95832 along with a 99205, 99204 or 99203 office visits. Insurance companies regularly deny manual muscle testing CPT codes on the grounds that the manual muscle testing is bundled into office visits and therefore is not a separate billable medical service. For both CPT codes, there must be a separate manual muscle testing report that specifically sets forth the results of each manual muscle test, the need for the muscle test and the signature of the physician.
There is an appellate opinion from the Fourth District Court of Appeal that interprets manual muscle testing billed under CPT code 95832 and the Court required a separate manual muscle test report consisting of specifying each measurement of the muscle testing, the need for a muscle testing and a signature of the physician. The District Court of Appeal frowned on an office visit report that specifically referred to manual muscle testing. The District Court of Appeal found that under those facts, the manual muscle testing was part of the initial office visit report and therefore could not be separately billed.
For CPT code 99851, I have seen that some insurance companies claim that the Medicare guidelines requires a manual muscle testing to take place and to be billed on a separate day from office visits. I have read the Medicare guidelines and it is ambiguous as to whether the manual muscle testing is required to take place and to be billed on a separate day from office visits.
Although the Fourth District Court of Appeal opinion involves CPT code 95832 instead of CPT code 95851, both codes are manual muscle testing and the Fourth District Court of Appeal opinion should apply to CPT code 95851 and CPT code 95832.
As a belt and braces tactic to avoid denials of manual muscle testing on the grounds of improper bundling, a medical provider should perform and bill manual muscle testing on different dates that there is an office visit. However, it is not mandatory. The long and short of it is that if an insurance company declines paying manual muscle testing CPT codes for not being billed on the same day as an office visit, there is an opinion from the District Court of Appeal that does not make that requirement. As a PIP suit lawyer, I have run across this issue on various occasions and have been successful in getting medical providers paid for their services. ■
GEORGE A. DAVID P.A
George A. David P.A.
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.
THE PROS AND CONS OF PARTICIPATING IN CLASS ACTIONS FOR FLORIDA PIP CLAIMS
By Christopher M. Tuccitto, Esq.
As a Florida medical provider, the work often involves treating patients injured in car accidents and submitting bills to Personal Injury Protection (PIP) insurers. When insurers fail to pay claims in full or act unfairly, providers might find themselves drawn into class action lawsuits. These lawsuits aim to address widespread insurer misconduct, but they aren’t always the best path for every provider. Let’s examine the pros and cons of participating in, and opting out of, class actions involving PIP claims.
The Pros of Participating in PIP Class Actions
1. Strength in Numbers A key advantage of a class action is the collective power it provides. When numerous medical providers join forces, the sheer volume of claims strengthens the case against the insurer. This collective pressure often leads to settlements that may not be achievable through individual lawsuits.
2. Minimal Time Investment By joining a class action, you delegate much of the legal work to the class attorneys. You won’t need to appear in court or handle extensive documentation. This is particularly appealing for busy providers who lack the resources to manage a prolonged legal battle.
3. Access to Experienced Counsel PIP Class actions are handled by attorneys with significant experience in PIP litigation and insurance law. This ensures the case is in capable hands, increasing the likelihood of a favorable outcome.
The Cons of Participating in PIP Class Actions
1. Limited Control As a class member, you have little say in how the case is managed. Decisions about settlements, legal strategy, and court filings are made by the lead plaintiffs and their attorneys. If the provider is dissatisfied with these decisions, there is limited recourse.
2. Potentially Lower Recovery Class actions aim to distribute settlements equitably among all members, which can result in lower payouts compared to pursuing an individual lawsuit. For providers with substantial claims, this might be a significant disadvantage.
3. Lengthy Process Class actions often take years to resolve. If a provider is seeking a quick resolution to their PIP disputes, this route may test their patience.
4. Release of Claims Settling a class action typically requires the provider to release the insurer from
liability for all related claims, even those not fully compensated by the settlement. This may bar the provider from seeking additional remedies in the future.
The Pros of Opting Out of PIP Class Actions
1. Greater Control By opting out, the provider retains complete control over the case. The provider and their attorney can decide on legal strategies, whether to settle or litigate, and what recovery amount is acceptable.
2. Potential for Higher Recovery Individual lawsuits often yield higher payouts, especially for providers with substantial claims. The case won’t be diluted by the need to share a settlement with numerous other providers.
3. Tailored Representation Opting out allows the provider to hire an attorney who’s fully focused on the case and specific concerns. This personalized approach often leads to better outcomes.
The Cons of Opting Out of PIP Class Actions
1. Time-Consuming Unlike class actions, individual lawsuits require active involvement. The provider may need to provide extensive documentation, attend court hearings, and spend significant time on your case.
2. Weaker Bargaining Position Standing alone, the provider lacks the collective weight of a class. Insurers may be less inclined to settle or offer favorable terms when negotiating with individual providers.
Final Thoughts
Whether to participate in or opt out of a PIP class action depends on the provider’s specific circumstances. If the provider’s PIP claims are relatively small and they are looking for a low-risk, low-effort resolution, joining a class action might be the best option. On the other hand, if the claims are substantial and the provider is willing to invest time and resources, opting out and pursuing an individual case may yield a better outcome. ■
