Personal Injury Protection – Provider Revenue Recovery Opportunity
Conticello PA (Tallahassee) is happy to announce that it has teamed up on a specific and targeted area of revenue recovery for Florida medical providers, with a leading revenue recovery law firm to offer an exciting new PIP auto insurance revenue program as essentially no out of pocket cost.
The issue stems back from a change in the PIP laws in Florida several years ago which reduced the rates that insurance companies paid for medical services by 25%. The insurance companies jumped on the rate reduction. However, subsequent case law stated that in order to avail themselves of the rate change, the insurance companies needed to update their policies to reflect the reduced rate. Most insurance companies have updated their policies by now, but there is a gap of time when most insurers have exposure. This gap of time closes every day as the statute of limitations (SOL) runs on the affected claims.
Typically the best candidates for recovery are:
- Emergency Room Physician Groups,
- MRI groups,
- Chiropractors; and
- Revenue Cycle Recovery firms (with clients listed above).
But other provider types can benefit too.
This opportunity is especially interesting since hospitals and emergency healthcare providers will experience very tight budgets over the next several years. The process that we offer is simple and free for the provider. We work off of a mutually agreeable HIPAA business associate agreement and the provider’s HIPAA practices, and can take the needed information via a data dump or send representatives to review claims in your office at no cost to you. What sets this process apart is the automated process used to scrub the data and identify claims which are subject to the reduction payback, which in turn will process and issue demand letters to the insurance companies. The insurance company can either fight it or pay the claim. This has been such an effective process that several insurance companies have set up funds for this type of repayment.
What happens if the insurance company denies the demand? Then the Provider can choose to litigate it (we can handle that) or let it go.
The best part is that we do this on a contingency basis. Typically the provider gets 100% of the wrongfully denied claim or portion of the denied claim that is paid as a result of the demand (minus any fee you charge your clients). The Attorneys fees are solely based upon the mandatory penalty and interest on the claim. If the Provider billed the wrong insurer then the fee is 25% of the gross recovery. If there is litigation then we can represent your clients in litigation on a contingency basis and the insurance companies can be liable for attorneys fees, court costs, and interest.
The risk to the Provider is virtually nothing except the time and effort that it takes to get their electronic data gathered. The benefits could be a large and unexpected stream of recovery. However, the 5 year SOL are closing and every day a portion of these recoveries become time barred.
If you are a provider or revenue recovery firm that thinks they have a client that can benefit from this type of process please feel free to call me. I would even be willing to set up a webinar if there seems to be a large demand. My firm’s telephone number is 850-888-2529, or email me at Tony@conticellolawfirm.com
Mr. Conticello’s practice includes, Healthcare law, Corporate governance, Administrative law, and Civil and Commercial Litigation. His primary office is in Tallahassee, but he has client’s in various parts of the state.