SUCCEEDING UNDER TORT REFORM PART 6 - THE PRICE OF THE SALE OF AN ACCOUNT RECEIVABLE IS NOT A CAP ON DAMAGES, IS NOT ADMISSIBLE, AND IS NOT DISCOVERABLE
THE IMPACT OF FLORIDA TORT REFORM ON PIP LAWSUITS WHAT
EVERY BILLER SHOULD DO TO MAXIMIZE PIP COLLECTIONS
HOW TO CHOOSE THE RIGHT MEDICAL SUPPLY COMPANY FOR YOUR PRACTICE
PERSONAL INJURY SUMMIT TM MAY 31ST, 2025 FORT LAUDERDALE
COORDINATED CARE FOR PERSONAL INJURY (PI) HEALTHCARE: STRATEGIES FOR PROVIDERS, ATTORNEYS AND INVESTORS EMPOWERING PATIENTS THROUGH EHR INTEGRATION AND INDIVIDUAL ACCESS LAWS
PERSONAL INJURY SUMMITTM
MAY 31ST, 2025 FORT LAUDERDALE, FL WHAT EVERY BILLER SHOULD DO TO MAXIMIZE PIP COLLECTIONS
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From the Editor
WELCOME TO THE PERSONAL INJURY MAGAZINETM !
It’s hard to believe that we’re already in the second quarter of 2025. Just a few weeks ago we hosted our Personal Injury Summit in Orlando on March 8th, 2025, and if you were there, you know what a special day it was for all. We had a diversity of expert speakers, sponsors and guests that helped make the event memorable, full of learning and meaningful networking with the best in the industry. If you weren’t able to join us in Orlando, do not miss the chance to join our 6th Personal Injury Summit to be hosted in Ft Lauderdale on Saturday, May 31st, 2025. You can see pictures of past events and information about upcoming ones inside this issue or at www.PiSummitFL.com Make sure to take advantage of the wealth of information we share in this edition of the Personal Injury Magazine. We work together with our wonderful partnering advertisers to bring you content that will help your medical and/or legal practice grow in efficiency and profitability. Every one of our contributing authors is readily available for any questions or comments you may have, and connecting with one another just helps our industry become a stronger community. Let us know if there are any topics or challenges that you’d like us to address in an upcoming issue and we’ll work with our expert contributors to help you thrive!
Sincerely yours,
Angely C. Maria EDITOR IN CHIEF
We
WHAT EVERY BILLER SHOULD DO TO MAXIMIZE PIP COLLECTIONS
By Angely C. Maria
Whether
your PIP billing
is done by a billing company or handled by your in-house staff, there are certain tasks that you must ensure are done consistently in order to get what you deserve for the services you provide patients with PIP coverage.
1. Verify all PIP information directly with the insurance carrier
This is the first and one of the most crucial steps in ensuring proper payment for your services. A good biller would first verify that all the information in the system for each patient is accurate, including data such as carrier name, contact information, claim number, date of accident, coverage limits, deductibles and PIP adjuster’s information. Make sure to keep notes on each account with the verification process and follow up until coverage is confirmed.
2. Notify the carrier of the initiation of treatment within 21 days of the first Date of Service (“DOS”)
According to Florida PIP Statutes, medical providers have up to 35 days of each DOS to submit claims to the PIP carrier. However, if you send a notice to the carrier within 21 days of the first DOS, the billing deadline gets extended to 75 days of the DOS. This is especially helpful if you are a new clinic or if you know you might need extra time to finish your first visit reports and documentation before you submit your billing. Make sure you keep proof of submission on each file in case there are disputes where the carrier incorrectly denies your claims due to “late filing”.
3. Submit an EMC determination right away
Whether you take care of your Emergency Medical Condition ("EMC") determination in-house by one of your providers, or refer the patient to another office for an evaluation, this should be set up as soon as treatment starts. You want to be proactive about this and not wait until the PIP benefits are capped at $2,500 for lack of an EMC. Do not assume that just because the patient went to the hospital or saw another provider before you, that the carrier has an EMC on file and the full PIP benefits are available. As usual, keep proof of your submission and contact a PIP suit attorney if you don’t get payment for any overdue claims after 10 days of sending the EMC to the carrier. Keep in mind that most carriers automatically apply the $2,500 cap unless the EMC has been submitted.
4. Review all claims and SOAP notes for accuracy before submission
I cannot stress how crucial this process is. As perfect as your processes could be, there are always some claims where there are discrepancies between the services performed, the SOAP notes and the charges submitted. That’s why it is important to implement a process where all these entries are cross-checked to correct any errors and avoid denials for services billed that are not properly documented, or vice-versa.
5. Update your Fee Schedule regularly
Perform a periodic review of your fees to ensure that what you are charging for a service is reasonable, at least on an annual basis. There are a few factors that you should consider when reviewing your fee schedule, such as your expenses, the prices charged by peers in your area for similar services and the fee schedule allowed by PIP. Before you add any new service to your practice, have your biller research the most up to date fee schedule allowable by PIP to use as a reference before deciding your prices on each service.
6. Review your files for PIP suit regularly
Don’t get picky about this. Leverage your relationships with efficient PIP attorneys to have them review every file to ensure you were properly paid. If you have them come to your office for an audit, set up a follow up review at least every 3 months so that they have a continuous flow of pre-suit demands going out for you and you have a regular inflow of PIP suit checks coming in your office. If you prefer to handle the PIP suit referrals yourself, then use a system to keep track that every file has been sent for review. And no, you do not have to wait for the patient to finish treatment to have a file reviewed by a PIP attorney. Keep in mind that our favorite attorneys’ fees for collecting on demands and lawsuits might have drastically changed since the Tort Reform became effective on March 2023, so request an updated PIP Attorney Retainer so that you understand the legal fees that you’d be charged for these services. ■
EMPOWERING PATIENTS THROUGH EHR INTEGRATION AND INDIVIDUAL ACCESS LAWS
By Tiffanny J. Anghel, MHA
In the digital age of healthcare, the power of information is shifting— firmly placing patients at the center. Thanks to advancements in Electronic Health Record (EHR) integration and evolving individual access laws, patients are no longer passive recipients of care but empowered advocates for their own health data.
At the core of this transformation is medical record aggregation, a process that consolidates patient data from multiple providers into a single, unified view. EHR systems are increasingly interoperable, enabling patients to access everything from lab results and imaging to specialist notes and hospital discharge summaries— regardless of where that care occurred. This is particularly critical for individuals involved in complex care journeys, such as those managing chronic conditions, recovering from serious injuries, or navigating legal claims related to personal injury.
Driving this capability is the legal foundation established by the Health Insurance Portability and Accountability Act (HIPAA), further strengthened by the 21st Century Cures Act. Under these regulations, patients have the right to obtain an electronic copy of their medical records without delay or unreasonable cost. The Information Blocking Rule, effective as of April 2021, prohibits healthcare providers, developers, and health information networks from interfering with a patient’s access to their own health data.
This shift is more than regulatory—it’s transformative. Patients now have the legal and technical ability
to aggregate their own health data to support second opinions, better treatment planning, care coordination, and even legal advocacy in the case of injuries or malpractice.
The future lies in deeper EHR integration with personal health apps, digital wallets, and APIs that allow seamless, secure data sharing. Tools like FHIR (Fast Healthcare Interoperability Resources) enable developers to build platforms that connect directly to provider systems—bridging the gap between clinical silos and patient empowerment.
But challenges remain. Many patients are still unaware of their rights, and some providers remain reluctant to fully cooperate due to operational burden or fear of liability. That’s why education, enforcement, and continued innovation in user-friendly interfaces are key to fulfilling the promise of patient-directed data access.
In a healthcare landscape where information is power, enabling patients to own and access their medical records isn’t just a compliance requirement—it’s a cornerstone of truly patient-centered care. ■
Tiffanny J. Anghel, MHA HEAD OF PARTNERSHIPS YOCIERGE & YC API
envelope ta@ycapi.health phone-alt 862-209-0195
info-circle yocierge.com
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HOW TO CHOOSE THE RIGHT MEDICAL SUPPLY COMPANY FOR YOUR PRACTICE
By Matt Synder
Running a successful medical practice requires more than skilled staff and a solid patient base—it demands reliable tools and supplies to deliver top-notch care. Selecting the right medical supply company is a critical decision that impacts your practice’s efficiency, budget, and patient outcomes. With countless options available, how do you ensure you’re partnering with a supplier that meets your needs? Here are key factors to consider when making this choice.
1. Assess Product Quality and Range
The foundation of any medical supply company is the quality of its products. Your practice depends on equipment and materials that meet industry standards and ensure patient safety. A good supplier should also provide a broad range of products—from basic disposable items used in daily practice to durable medical equipment. This reduces the need to juggle multiple vendors, streamlining your procurement process.
2. Evaluate Reliability and Delivery Timelines
In healthcare, timing can be a matter of life and death. A supplier’s ability to deliver on time is non-negotiable. Research their track record—do they have a reputation for consistent, punctual deliveries? Check their Google reviews and social media reviews. Ask about their inventory management and whether they maintain sufficient stock to avoid backorders. For urgent needs, confirm if they offer expedited shipping options. A company with a robust logistics system and clear communication about delivery schedules will help keep your practice running smoothly.
3. Compare Pricing and Value
While cost shouldn’t be the sole deciding factor, it’s a significant consideration for any practice. Be wary of deals that seem too good to be true—rock-bottom prices might signal compromised quality. Look beyond the sticker price to assess overall value: Does the supplier offer bulk discounts? Factor in hidden costs like shipping fees or minimum order requirements to get a true picture of affordability.
4. Check Customer Support and Responsiveness
When issues arise—whether it’s a defective product or a delayed shipment—you’ll need a supplier that
responds quickly and effectively. Test their customer service before committing: Call or email with questions and note how promptly and professionally they reply. A dedicated account manager can be a bonus, providing personalized support and simplifying reordering. Read reviews or ask colleagues about their experiences to gauge how the company handles complaints or returns.
6. Consider Technology and Ordering Convenience
In today’s digital age, a supplier’s online platform can make or break your experience. Look for a company with an intuitive website or app that allows easy browsing, ordering, and tracking. Also, make sure the supply company you are using can adapt to the ordering process of your office. Some practices prefer to call, text or email orders. Make sure the company you partner with is flexible on the ordering process to avoid inventory issues.
7. Seek Recommendations and Test the Partnership
Finally, tap into your network. Ask other healthcare professionals which suppliers they trust and why. Once you’ve narrowed your options, start with a small order to evaluate the company firsthand. Assess the quality of the products, the accuracy of the delivery, and the overall experience before fully committing. Choosing the right medical supply company is about finding a partner that aligns with your practice’s goals and values. By prioritizing quality, reliability, and support, you’ll ensure your team has the resources needed to thrive— and your patients receive the care they deserve. ■
Matt Snyder PRESIDENT, JMS MED SUPPLY
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
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SUCCEEDING UNDER TORT REFORM
Part 6 - The Price of the Sale of an Account Receivable is Not a Cap on Damages,
is not Admissible, and is not Discoverable
By Aaron Proulx, Esq.
This is the sixth article in a series that lights the way to success under Florida Tort Reform’s Section 768.0427. This article focuses on what may now be the most misunderstood impact of the statute: how a facility’s sale of an account receivable impacts a personal injury case. Based on the plain language of the statute, the sales price is certainly not a cap on damages and should not even be discoverable or admissible. There are two portions of the statute that address sales of bills – Subsection (2)(b)(4) and Subsection (3)(c). These will be addressed in turn.
First, as we know, Section 2 addresses the admissibility of evidence offered to prove the amount of damages for past or future medical treatment. Subsection (2) (b) addresses “evidence offered to prove the amount necessary to satisfy unpaid charges.” Subsection (2) (b)(4) expressly applies to sales of bills and states that the following is admissible:
If the claimant obtains medical treatment or services under a letter of protection and the health care provider subsequently transfers the right to receive payment under the letter of protection to a third party, evidence of the amount the third party paid or agreed to pay the health care provider in exchange for the right to receive payment pursuant to the letter of protection.
Is the sales price a cap on Damages? No. As detailed in prior articles, Subsections (2)(a) and (2)(b) are materially different. Subsection (2)(a) does state that the only evidence admissible to prove the amount of damages for past medical treatment that has been satisfied is evidence of the amount actually paid. While the sale by definition “pays” the seller for the bill, that bill still exists in the purchaser’s hands. Thus, from the perspective of the plaintiff/patient, the bill is still owed, i.e. not “satisfied.” This is why the Legislature did not place sales of accounts receivable in Subsection (2)(a). Instead, the sale of accounts receivable is deemed a Subsection (2)(b) “unpaid charge.” Accordingly, the sales price of an account receivable is not a cap on damages. See also Articles #3 and #5 of this series.
Is the sales price admissible? No. Subsection (2) (b)(4) expressly limits admissibility of the sales price to situations where the medical treatment or services were provided “under a letter of protection” and the payment was received “pursuant to the letter of protection.” The Legislature has expressly defined “Letter of Protection” as “a promise of payment . . . from any judgment or settlement.” That definition trumps the common law definition. As detailed in a prior article,
no medical providers should use written or verbal letters of protection. See Article #3. So long as there is no letter of protection, the defense will not be able to satisfy the critical “if” that begins Subsection (2) (b)(4) and thus will not be permitted to introduce the sales price to the jury.
Is the sales price discoverable. No. The other subsection addressing sales of accounts receivable is Subsection (3)(c). Section 3 governs discoverability, not admissibility. Thus, Subsection (3)(c) has bearing only on the discoverability of the sales price. But before we even get there, the introductory language of Section 3 itself terminates the right to discover the sales price: “In a personal injury or wrongful death action, as a condition precedent to asserting any claim for medical expenses for treatment rendered under a letter of protection, the claimant must disclose . . . .” Thus, the defense will have to establish the existence of a letter of protection before it can even discover the purchase price. As with admissibility, so long as there is no letter of protection, the defense will have no right to discover the sales price.
The skeptics keep saying: “But the Legislature intended to make sure all of this stuff gets in front of the jury.” So?! Because of the separation of powers that is the bedrock of the United States and Florida Constitutions, the number one rule of statutory construction is that legislative intent does not come into play unless there is an ambiguity in the statute. There is no ambiguity in Subsection (2)(b)(4) or Subsection (3)(c). Yes, some trial judges will fail to apply the plain language of this statute. We saw this in the now-rejected obtuse trilogy of trial court orders finding tort reform retroactive. But we should not be planning on this failure because the appellate courts are likely to correct the trial courts on so simple an issue. ■
Aaron Proulx, Esq. THE DOCTOR’S LAWYER, PLLC.
phone-alt (813) 486-7321
envelope aaron@doclawfirm.com
info-circle www.doclawfirm.com
COORDINATED CARE FOR PERSONAL INJURY (PI) HEALTHCARE: STRATEGIES
By Ron Reed
FOR PROVIDERS, ATTORNEYS AND INVESTORS
The emerging integrated multi-region coordinated care model is fueled by improving patient care, financial model evolution, regulatory changes, and investor interest.
PI Healthcare Providers Multi-Region Coordinated Care Business Model
Reliance on medical liens or letters of protection (LOPs) delays payment until a final claim settlement, requiring strong balance sheets or a discounted sale of liens. These challenges intensify as providers consolidate into coordinated systems.
Integrated Coordinated Care facilitates financial stability and consistent margins but requires well-managed revenue cycles. The seamless integration among care providers, patients, and claims attorneys supports delivery in four areas: 1) Centralizing Patient Care: Emerging, multi-modal coordinated care typically places a dedicated physician at the center of a patient’s recovery. 2) Comprehensive Medical Documentation: The model consolidates injury assessments, imaging, and treatment plans under one system, boosting reimbursements, and quality control that improves legal documentation. 3) Managing Medical Liens: Historically selling discounted liens for cash flow increasingly well-capitalized organizations hold them until settlement, capturing full margins rather than accepting 40-60% of a claim’s value. 4) Collection Risk Reduction: Strategic partnerships with PI attorneys streamline the claims process, improving collection efficiency. Providers collaborating with reputable law firms can improve margins, modestly accelerating payments within the typical 9-14-month settlement cycle.
PI Attorney Practices
PI attorneys help drive PI healthcare providers’ financial success. As settlement fund fiduciaries, they advocate for clients while overseeing proceed allocation.
Attorneys can improve efficiency and maximize case value through Early Case Valuation & Medical Partnerships which help smaller firms compete amid increased marketing by larger firms. Aligning with a coordinated, multi-modal network enhances patient access, improves documentation, strengthens claims, and drives better outcomes.
Back-Office Costs—As larger firms expand marketing and case volumes grow, tighter alignment with coordinated care organizations can enhance information flow, streamline processes and decrease costs.
Efficient Claim Processing—A well-structured quality claims package, including detailed medical reports, streamlines the claims process. Attorneys and providers are beginning to automate and coordinate the processes for improved efficiency.
Investment and Business Development Strategies
The $34 billion PI healthcare sector is attracting professional administrative management, private equity, institutional capital, and consolidators seeking operational scale. Investors and business owners can leverage key profitability and market positioning strategies such as:
Multi-State PI Healthcare Expansion & Vertical Integration—offering coordinated chiropractic, pain management, orthopedic surgery, and rehabilitation services—capture a larger share of settlement proceeds while enhancing efficiency and patient outcomes.
Leveraging Data & Technology— Advanced billing and analytics tools improve collection rates by tracking claim approval and denial patterns. Predictive analytics can assess the likelihood of case success, allowing providers to prioritize high-value claims. Coordinated data and systems enable attorneys, providers, and patients to share more consistent and accurate information earlier, enhancing overall coordination.
Exit Strategies and Mergers and Acquisitions—
The fragmentation within the PI healthcare sector is driving consolidation, allowing investors to acquire high-margin, scalable assets, while smaller providers gain opportunities for liquidity. Industry investors consider factors like geography, referral sources, and the sophistication of financial reporting as key drivers of valuation. As capital markets acknowledge this consolidation trend, it becomes easier for institutional investors to enter the market, attracting larger amounts of capital at lower costs.
Conclusion
The PI healthcare market is shifting due to legal complexities, consolidation, and rising investor interest. Providers are faced with this how they’ll react and participate in this emerging business model. Attorneys face pressure as larger firms increase marketing and streamline operations, while investors focus on datadriven scaling. As consolidation accelerates, those with efficient business models and strong financial management will lead in delivering quality care. ■
Ron Reed MANAGING DIRECTOR, CASCADE PARTNERS
phone-alt 734-646-1061
info-circle cascade-partners.com
envelope ronreed@cascade-partners.com
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 IMPACT OF FLORIDA TORT REFORM ON PIP LAWSUITS
By Christopher M. Tuccitto, Esq.
The “Tort Reform” ushered in by the passage of House Bill 837 (HB 837) on March 24, 2023, marked a significant shift in Florida tort law, particularly in the realm of Personal Injury Protection (PIP) lawsuits. Among the most impactful changes introduced by the bill was the elimination of one-way attorney’s fees for plaintiffs, a provision that had long been a cornerstone of Florida’s PIP litigation framework. The removal of this benefit has altered the strategies of personal injury attorneys, medical providers, and insurance companies, reshaping the way PIP claims are handled and litigated.
Before HB 837, Florida’s one-way attorney’s fee provision allowed plaintiffs who prevailed in PIP lawsuits to recover their legal fees from the defendant insurance companies. This provision, governed by Florida Statutes §627.428, incentivized attorneys to take on PIP claims since they could litigate cases without worrying about their clients’ ability to pay. The law was designed to level the playing field, ensuring that individuals and medical providers had access to legal recourse against insurance companies that underpaid or denied legitimate claims.
However, insurance companies and lawmakers argued that the one-way attorney’s fee rule contributed to excessive litigation and inflated claims. HB 837’s enactment removed this provision, fundamentally changing the dynamics of PIP lawsuits.
With the elimination of one-way attorney’s fees, plaintiffs, including medical providers pursuing unpaid claims, must now shoulder the cost of their own legal representation, regardless of whether they win or lose. This creates significant challenges as many claimants are unable to afford legal fees, discouraging them from pursuing litigation. Smaller medical practices that previously relied on PIP lawsuits to recover unpaid bills are now struggling to take legal action against insurers. In addition, attorneys have become extremely selective in the PIP cases they accept, focusing only on those with high-value claims and clear-cut liability.
Previously, insurers faced strong financial incentives to settle PIP claims quickly to avoid paying the
plaintiff’s attorney’s fees. Without this pressure, insurers are now more inclined to delay or deny claims, knowing that claimants now bear the full cost of litigation. Disputes over medical bills and coverage are taking longer (if ever) to resolve, leading to increased financial strain on healthcare providers. In addition, policyholders injured in car accidents are finding it more difficult to obtain fair compensation for their medical expenses.
Without the safety net of one-way attorney’s fees, Florida has seen a sharp decline in PIP lawsuits. This has had several ramifications. Fewer legal challenges have emboldened insurers to take a stricter approach to claims processing. The volume of PIP-related court cases have decreased precipitously, limiting claimants’ ability to fight unfair denials. While the overall cost of PIP litigation declined, it has come at the expense of injured parties and medical providers who lack the resources to litigate.
The elimination of one-way attorney’s fees under HB 837 has dramatically altered Florida’s PIP litigation landscape, shifting financial risks onto plaintiffs and reducing the pressure on insurers to settle claims expediently. While this change was intended to curb excessive litigation, it also presents new challenges for injured parties, medical providers, PIP attorneys, and personal injury attorneys. Stakeholders must adopt proactive strategies, from improving documentation to strengthening negotiations with insurers. Understanding these shifts is essential for ensuring fair outcomes for those affected by motor vehicle accidents in Florida. ■
