Tuesday, November 23, 2010

Florida PIP: Changes in Medicare Fee Schedules Affect Insurance Payments

Since January 1, 2008, insurance companies providing personal injury protection benefits (PIP) have been able to utilize a permission fee schedule to reduce payments to medical providers. The fee schedule is largely based on 200% of the Medicare Part B Participating Physicians Fee Schedule.

The Medicare Fee Schedule is typically updated at least annually. This year, however, there were several anomalies that affected both insurers and medical providers. The fee schedule was not updated in January of 2010. Instead, a retroactive update was issued in May, and applied to all services provided from January 1, 2010 to May 31, 2010. Another retroactive update was passed in June, effective for dates of service June 1, 2010 through November 31, 2010.

This created payment problems for the PIP insurers who based reimbursement on Medicare. Most did not update their payment files quickly, and refused to reprocess prior claims. As a result, many medical providers have not been paid the proper amount on PIP claims. While the individual amounts may be small, they do add up over the course of a claim – and certainly with numerous claims. Medical providers are encouraged to review their PIP payments to ensure that their services were properly compensated.

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4 comments:

  1. 1976 The intent of PIP was to provide value equal to the cost of a new Cadillac. 2012 the intent should be unchanged; a new Cadillac costs $50,000.00

    The economics of premiums from 1976-2012 reveal premiums have gone up, inflation of medical care 1980-$800 billion, 2012-$2.6 trillion, and the value of the PIP stayed at $10,000.00. This is an intentional deception made for corporate/industry gain (fraudulent). Legislators have chronically failed at protecting their constituents from the insurance industry exploitation.

    The magnitude of this scheme is appreciated when you consider the number of car owners in Florida required by law to purchase PIP from 1976-2012.

    The number of fraud cases in 2010 was 5,216 and the number of convictions was 240; a 0.04601%. This is reported by the Florida Insurance Regulation: Report on Review of 2011 PIP Data dated April 11, 2011.

    John McCarthy, D.C.
    Orlando, FL.

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