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Billing Requirements of PIP Benefits

Florida is one of the select number of states that require all registered drivers to purchase a minimum of $10,000.00 in auto insurance coverage. This mandatory requirement is referred to as Personal Injury Protection benefits, which is Florida’s version of a no-fault law. Personal Injury Protection (“PIP”) extends coverage to drivers no matter who was at fault in the accident. Since PIP does not take into account who was liable for the accident, it is intended to reduce the amount of litigation for a relatively small amount of damages at stake. This is an ideal system to quickly allow injured drivers to obtain medical coverage without having to fight over who was at fault.

However, as swift as this law was intended to be, Florida’s PIP statute is very detailed and technical. Fla. Stat. 627.736 provides a number of requirements that a provider must follow when billing their patient’s PIP policy. For example, all charges for treatment and services provided to the insured must be submitted within 35 days of have rendered such services. If the bills are submitted outside this window, they will be rightfully denied by the insurer. The law also requires that any provider submitting a bill for PIP benefits must do so using a properly completed Centers for Medicare and Medicaid (CMS) 1500 form or a UB 92 form. Moreover, the law also mandates that providers must follow the Physicians’ Current Procedural Terminology (CPT) or Healthcare Correct Procedural Coding System (HCPCS) for the year in which services are rendered and comply with the CMS 1500 form instructions and the American Medical Association CPT Editorial Panel. After complying with these requirements, the insurer then has 30 days from receipt of the bill to pay. If they do not pay within those 30 days, then the provider’s bill is overdue.

MEDICAL PROVIDERS MUST STRICTLY ADHERE TO INSURANCE BILLING RULES 

Medical providers who are treating a patient subject to PIP benefits must be aware of how technical the billing requirements are. Even a minor mistake, like submitting your bills on the 36th day, can bar their right to being reimbursed. Providers should also take proper steps to prevent an insurer from denying payment of a properly submitted bill. I always advise my clients to keep a copy of all their bills and send them using certified mail. This ensures that there is a proper record that the bills were submitted timely and properly. There has been countless times that our office has overcome a denial for untimely billing by simply providing the insurer with a copy of the certified mailing receipt. Had the providers not kept track of their bills, they would have never been reimbursed.

Another provision of the PIP statute affecting provider’s billing is Fla. Stat. 627.726(6)(b). This section of the PIP statute enables the insurer with statutory authority to request additional information to support the medical necessity of the services performed. Providers are at times not aware that if the requests are ignored, their bills are not technically overdue. In fact, overlooking this request can become a very big issue, especially if the provider takes any subsequent legal action to enforce the original payment. For example, if the provider ignores a 627.736(6)(b) request and retains counsel to send the insurer a demand letter, that demand letter is pre-mature. Thus, providers should understand that they should always make a good faith attempt to provide the requested documentation before taking any legal action to enforce the payment of their bills. I also advise my clients that when they are responding to these requests, they should retain some form of proof that they honored these requests.

CONTACT FLORIDA PIP SUIT ATTORNEYS DOLMAN LAW GROUP 

For more information on personal injury protection and claims, your legal rights, bad faith insurance practices, and what you should do to protect yourself from the wrongdoing of others, contact the experienced personal injury protection lawyers at Clearwater’s Sibley Dolman Gipe Accident Injury Lawyers, PA for a free consultation and case evaluation.

We can guide you through the process of making a PIP claim and getting you the compensation you deserve for being injured due to someone else’s negligence.

Sibley Dolman Gipe Accident Injury Lawyers, PA
800 North Belcher Road
Clearwater, FL 33756
727-451-6900 

https://www.dolmanlaw.com/legal-services/personal-injury-attorneys/pip