Tips For Doctors On How To Fly Under The Radar

So, you want to treat personal injury patients & want to stay out of trouble right???...(say yes)... Then Here are some important points on how to fly under the radar:

►Confirm coverage on the first date of treatment. Make sure the insured listed all residents on the application for insurance and the insured does not use the vehicle for business purposes


►Disclosure & acknowledgment must be properly filled out. Put on line one a minimum of “initial consultation” or what you always do on the first day so you do not forget. You can always add more services if needed but this keeps you from leaving line one completely blank. This line must be accurate.

►CMS (formally HCFAs) must be properly filled out. Make sure your credentials, license number, signature and tax ID are on every form (double check).

►Have patient sign an assignment of benefits. Please use the one provided after putting your full legal name and address on top.

► Keep a patient log and it would be best if the patient initialed each service provided

►Make sure your patients go to all IMEs and EUOs and if they cannot/ failed to attend send a letter by mail or fax to the insurer with a reasonable excuse and ask for it to be rescheduled in writing. Keep a copy. Have patient bring the ledger to the EUO. Do NOT rely on a telephonic conversation or message.

►Don’t waive co-pays or deductibles unless part of a 3rd settlement

►If you do everything right, you do not have to accept reductions, IME cut offs, or negotiate your bills with the PIP insurers. You can file a PIP suit.

►Medical records must be well written and clearly and legibly provide proper documentation as required by Florida law. See below. Justify ordering any tests, order prior medical records, be careful where there is limited property damage and gaps in treatment. If there is an IME note in your records the patient was informed of the suspension, the current complaints and findings and that the patient wants to keep treating.

►In your initial report explain the benefits of the therapies you order

►Do not indicate the patient has a lawyer in your letters. Avoid using the express attorney, lawyer, or esquire. Send letters to the patient and “cc” the lawyer. That can be easily crossed out if needed. A letter to the lawyer hurts you.

►Put your impairment ratings on a separate report

►Respond to all requests made by the insurer. Read their explanations of benefits.

►Avoid using a level 5 office visit (Evaluation and management codes) unless you can justify that high code. It should be avoided, especially by Chiropractors, unless you meet the time requirements and properly document the notes as stated in the CPT book. If it is time based you MUST state it in the records.

►Don’t send your PIP suits to anyone that asks for one. You may be responsible if you lose for the insurers fees and costs.

►Remind patients that PIP pays for household services

►Stay properly licensed and procure a masage establishment license.

►Remember to protect the patient’s privacy. Don’t allow surprise inspections by insurers when you have patients in your office. You can tell them to make an appointment to come back at another time. If they don't like it, too bad!

►Out of State, out of car, out of luck - tell your patients if they leave the State of Florida and leave their car at home PIP will most likely not follow them.

►Multiple accidents - if a person is involved in more than one accident in a short period of time you cannot bill under two separate claim numbers unless the injuries and treatment is distinguishable. You should bill under ONE claim number unless you can differentiate the injuries. If you can then you bill for the injuries that were attributable to each injury without double billing.

►Avoid having your bills for therapy from becoming excessive otherwise the insurers will send all of your patients for an IME. Insurers keep track of providers they deem to over utilize treatment.

►Use proof of mail when sending in bills and know what dates of service are in the envelope.

►30 day pre-suit demand letters are not sent to the adjuster. You must go on line and send it to the correct person. Use the attached form and try to be as detailed as possible. The more specific as to the amount at issue the better.

►Do not cash checks that say full and final unless you are positive you are being paid in full. If you cash the check you waive the right to suing for the balance.

►At a deposition or trial never state what percent of your business is car accident or accident of any kind related.

►Keep a copy of the police report and patient’s identification in the file

►Have a note in the file stating your office cleared coverage with the adjuster

►Always show improvement otherwise stop treating after a reasonable time.

►Do not have a cookie cutter treatment plan (or cookie cutter SOAP notes) for your patients. State Farm sued a group of doctors and recovered $3.9 million for using this practice.

OK, now have at it...

Tips from: http://www.floridapersonalinjuryblog.net/