PROPER TYPES OF BILLS UNDER PIP STATUTE
You, the medical provider, MUST submit proper bills to get the money you truly deserve. You cannot simply send in a letter indicating what is to be paid and what has already been paid. We suggest that you call us, as we have a database of forms we can furnish to you for FREE! The law is very clear, send the bills on approved forms and get paid.
WHAT FORMS DO I NEED TO ENSURE PAYMENT?
What to do: You need a CMS 1500 form, which is basically identical to an HCFA (Health Care Finance administration form 1500), or a UB 92 form which is typically utilized by a hospital or any other form that is approved by the Centers for Medicare and Medicaid or adopted by the commission.
WHAT HAPPENS IF I DON’T TURN IN THE PROPER FORM
A recent case, State Farm Mutual Automobile Insurance Co. vs. Isabel Gonzalez, provides us with a terrible result if a provider fails to submit a proper bill. The Court in State Farm Mutual Auto. Ins. Co. held that a claim is not ripe for litigation until the medical provider submits the correct type of medical bills containing the proper CPT coding. If you fail to utilize a CMS 1500/HCFA form, a UB92 or another approved form, you cannot sue for unpaid bills. Sending an improper form/bill is the equivalent of failing to send the bill/form at all.
ICD-9 AND 10
Another important aspect of the bill submission process involves the Physician’s Current Procedural Terminology (CPT) or ICD-9 (10 at this point), or Health Care Correct Procedural Coding System (HCPCS). You must utilize the correct coding to properly submit a bill. The Center for Medicare and Medicaid Services offers explanations regarding the coding and form submission. Moreover, we can explain the proper CPT coding to use for medical treatment rendered. We offer these services for FREE! We will ensure your bills are paid and you do not pay us anything.
If a particular CPT code is no longer covered by PIP/CMS, fear not, because we can still get you reimbursed! A recent case in the 2nd District Court of Appeals held that a service CAN be reimbursed if the service is still recognized by Medicare. The court explained PIP will cover the service so long as the nature of the service is covered. Allstate Fire & Cas. Ins. Co. v. Perez ex rel. Jeffrey Tedder, M.D., P.A. 111 So. 3d 960 (Fla. 2d DCA 2013).
FOR EXAMPLE
CPT Code 99244 is no longer recognized by Medicare as of January 1, 2010. CPT Code 99244 refers to an initial consultation of a patient. However, Medicare/CMS continues to reimburse medical providers for initial consultations, despite the Code number no longer be recognized.
It is essential for your office to send in the proper billing forms with the proper billing codes. Our litigation team has the tools to ensure you are paid. We have forms, billing manuals, and litigation prowess to ensure reimbursement. Give us a call to discuss your pressing PIP needs for no charge!
