Personal Injury Protection, or "No-Fault" car insurance, is mandated by the state of Florida for all drivers to carry. PIP pays for injuries you sustain in an accident regardless of who was at-fault in the accident. Just like other states that mandate PIP however, Florida has its own set of special laws and regulations.
What is Covered by Florida PIP?Like in New Jersey and Michigan, Florida PIP covers medical costs, lost wages and death benefits.
Medical CostsMost medical costs will be covered by PIP with the exception of popular, but not widely accepted practices such as acupuncture. In other states, PIP will generally cover the injuries of anyone in your household, but in Florida you can choose whether you want your PIP to cover just yourself or other residents in your household. The following are eligible for a PIP claim:
Florida PIP and Economic BenefitsIf you are injured in an accident, and are disabled, Florida PIP will pay for 60% of your lost wages, subject to a $10,000 limit. This payment also includes services you would normally do, but now cannot because of the accident. These services include daily chores like doing laundry, cleaning the house, taking care of pets, etc.
Death Benefits of Florida PIPIf the policyholder were killed, PIP would pay for their funeral and burial expenses in addition to the benefits listed above. You, or your next of kin, are entitled to $5,000 for those associated costs.
When and How to File a PIP Claim in FloridaFlorida has strict rules to follow when filing a claim for PIP. The most important is that treatment for any injuries must happen within two weeks of the car accident to be eligible for PIP reimbursement. Your claim will not be accepted after 2 weeks. Due to a high incidence of insurance fraud in the state of Florida, your insurer has up to 60 days to investigate your claim for any falsehood, but must pay for your damages within 30 days, even if there is suspicion.
The evaluation and management (E/M) patient visit is the core of most family physician practices. Family physicians and other qualified providers can maximize payment and reduce stress associated with audits by understanding how to properly document and code E/M patient visits.
Evaluation and management services are a category of CPT codes and are used for billing purposes. The majority of patient visits require an E/M code. There are different levels of E/M codes, which, among other things, are determined by the visit complexity and documentation requirements.
Basic Components of E/M Codes
**Verify with your local Medicare Administrative Contractor and other payers to determine the amount and complexity of the exam components required.
The Oklahoma Department of Insurance (OID) says its new auto insurance verification system targets uninsured drivers. The Oklahoma Office of Management and Enterprise Services (OMES) has awarded a contract for the new Oklahoma Compulsory Insurance Verification System (OCIVS). The new system, hosted by MV Solutions, Inc., will be overseen by the OID. The current system has been managed by the Department of Public Safety (DPS). Senate Bill 115, passed in 2017, transferred authority of the system from DPS to OID.
“This will go a long way toward solving Oklahoma’s uninsured driver problem,” said Oklahoma Insurance Commissioner John D. Doak. “This brings us one step closer to creating a real-time, reliable database for law enforcement officers, court clerks, district attorneys and tag agents to verify auto insurance coverage. Those trying to drive without insurance are about to get a rude awakening.”
Commissioner Doak will notify all private passenger auto insurance companies in Oklahoma they are required to participate in OCIVS using a web service that allows access to the insurer’s real-time book of business. The previous system allowed companies to upload data on a weekly or monthly basis, making it difficult for OCIVS users to access current policy information. In order to create the most effective system possible, Commissioner Doak is committed to using every regulatory tool at his disposal to ensure that insurance companies comply with the requirements of the system.
Sen. Ron Sharp, R-Shawnee, was the principal Senate author of SB 115.
“Oklahoma has one of the highest rates of uninsured drivers in the nation,” said Sharp. “We have to change that. A better verification system can make a big difference. OID has the resources and regulatory authority to ensure compliance and manage the system efficiently.”
SB 115 was coauthored by Rep. Lewis Moore, R-Arcadia.
“Our state’s high number of uninsured drivers leads to higher premiums for everyone,” said Moore. “Once people realize this database is accurate and updating in real time, they’ll be much more likely to keep their auto insurance current instead of risking a costly fine.”
The new law authorizes the insurance commissioner to initiate an administrative proceeding against an insurance company that is not providing vehicle insurance policy information to the online verification system. It also allows for license plate numbers to be used for verification.
Commissioner Doak’s letter to private passenger auto insurance companies notifying them of the new requirements is linked below and attached to this email.
Source: Oklahoma Department of Insurance
On January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released MLN Matters Number: MM10176. In this notice, CMS identified certain services subject to the therapy cap. The revision became effective on January 1, 2018. Due to this revision, some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following:
"Services furnished under the Outpatient Therapy (OPT) services benefit – including Speech Language Pathology (SLP), Occupational Therapy (OT), and Physical Therapy (PT) – are subject to the financial limitations, known as therapy caps, originally required under Section 4541 of the Balanced Budget Act (1997)."
We have received confirmation that this edit is also in effect for chiropractors. Even though therapy services are statutorily non-covered in Medicare, the "claim hard-code editing" does not have any exclusions for certain specialties, this means chiropractors will need to report the appropriate therapy modifier (GP) with HCPCS code G0283 (or any code in the list in the article) in order to receive the appropriate denial for secondary insurance purposes. If both modifiers GP and GY are reported, the service would continue to deny as a noncovered service and a statutory exclusion (which occurred prior to the implementation of the aforementioned CMS instruction).
It is recommended that any claim filed with the affected codes, contain the modifier GPGY if performed by a chiropractic physician or their staff, under delegation of duties. Since this edit is from CMS and not a local carrier, this will affect all chiropractic care in the United States, unless modifications are made in the future.
The therapy codes affected by this edit are as follows:
97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034,
97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140,
97150, 97530, 97533, 97535, 97537, 97542, 97750, 97755, 97760, 97761,
97762*, 97799, G0281, G0283
*Note: code 97762 was deleted this year and replaced by 97763.
CMS is proposing several coding and payment changes intended to reduce administrative burden and improve payment accuracy for evaluation and management (E/M) visits. Some of these proposed changes include:
The Employee Retirement Income Security Act (ERISA) was enacted in 1974. It governs how private employers and pension or insurance companies must administer employee benefit plans, including employee healthcare plans.
ERISA governs benefits such as pension plans, health and disability insurance, death benefits, severance plans, plans providing pre-paid legal services, scholarship funds, apprenticeship and training programs, and employer-operated day care centers. ERISA does not cover plans that are required and administered by state laws, such as workers' compensation or unemployment compensation.
Remember that the law does not require an employer to provide its employees with any particular benefits, such as healthcare plans. However, ERISA mandates that once an employer decides to offer such a plan, it must be run in accordance with certain standards designed to protect the interests of employees and other plan beneficiaries (such as family members).
Requirements Under ERISA
ERISA generally provides that benefit plans must be operated in a fair and financially sound manner. Employers and entities that manage and control employment benefit plan funds are required to:
Claims for Benefits
A plan administrator may not wrongfully deny a claim for benefits under a plan governed by ERISA. Once a plan participant files a claim, the plan has ninety days to inform the participant whether the claim is accepted or denied. If the claim is denied, the plan must tell the participant how to submit the denial for a full and fair review, and must give the participant sixty days to do so. Once the participant submits a request for review, the plan must review the denial and make a decision within 120 days. If the participant still believes that the denial was wrong, may file suit against the plan under ERISA.