|
|
|
|
|
|
|
|
|
P.I.P. LITIGATION
Guide to P.I.P. Billing:
When your business undertakes the process of billing a P.I.P. insurance company, please make sure you are familiar with the following areas of the P.I.P. Statute.
Disclosure and Acknowledgment Form
A provider must fill out a disclosure and acknowledgment form. This form:
1. Must be on the form provided by the Office of Insurance Regulation. This form can be found at http://www.floir.com/pcfr/PIPFormsHealthCareProviders.aspx
2. Must be completed on the patient’s first visit and list all procedures performed on the first visit. The patient and the provider both must sign and date this form.
3. The original form must be sent to the insurance company with the first set of bills.
Certified Mail
Everything sent to an insurance company, especially P.I.P. billing, should be sent via certified mail, return receipt requested. You, as the provider, should keep all receipts and coordinate a system for identifying which claims were sent with which return receipt. One method that we recommend is to write those dates of service included in the bills submitted at the bottom of the green card so it is clear which bills were submitted on which day.
Timely Billing
All claims must be postmarked no later than 35 days after the earliest date of service.
If, however, you decide to send an “Initiation of Treatment” letter, the provider has 75 days after earliest date of service to postmark bills.
Calculating Benefits
For policies issued or renewed after October 2003, take the total bills, subtract the deductible and multiply by 80%.
As an example:
Total Bills ............... $11,500.00
Minus Deductible of __1,000.00
................................$10,500.00
Multiplied by 80%
Total Benefits Owed : $ 8,400.00
Incorrect Insurance Company
If you receive the wrong initial insurance information, you need to perform the following steps:
1. You must re-submit all of the billing to the correct insurance company within 35 days of the date you (the provider) obtained the correct insurance information.
2. You must also include in your new submission of bills the following: The erroneous information given to you by the patient AND either the Denial Letter from the incorrect insurance company OR the proof of mailing of the original bills, reflecting timely mailing of the bills to the incorrect address or insurer.
COOPERATION
REMIND YOUR PATIENTS TO ATTEND INDEPENDENT MEDICAL EXAMINATIONS AND EXAMINATIONS UNDER OATH (preferably with counsel)
|
|
|
|
|
|
|
|
|
|
|
|
