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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