Florida PIP providers must pay close attention to how they bill medical services. Recent Florida Supreme Court case law confirms that billing below the Medicare fee schedule directly reduces what you get paid, even when the insurer has elected to use the statutory fee schedule. The Florida Supreme Court decision in Allstate Insurance Company v. […]
How Geographic Location Directly Affects Your Reimbursement Medical reimbursement under Medicare and Florida PIP is not a single statewide amount. Instead reimbursement is based on Medicare fee schedule localities which adjust payment amounts depending on the county where the provider is located. These geographic adjustments directly affect how much an insurer is required to reimburse […]
When a patient receives medical treatment after a motor vehicle accident in Florida, the amount ultimately paid to the medical provider is often not the same as the amount billed. This is because insurers frequently reimburse providers based on fee schedules, rather than the provider’s full charges. Understanding how Medicare fee schedules works is essential […]
The Provider’s Billing Deadline: 35 Days Under Florida PIP rules, medical providers must submit their bills within 35 days of the date of service, unless they qualify for the extended 75-day timeframe. This 35-day deadline is strict for providers who do not submit an NIT. ✔ Bill submitted within 35 days → Claim is valid […]
In Florida’s Personal Injury Protection (PIP) system, one of the most important documents a medical provider can obtain from a patient is an Assignment of Benefits, commonly called an AOB. This simple form determines whether the provider has the right to bill the insurer directly and receive payment for treatment. Without a proper AOB, providers […]
In Florida’s Personal Injury Protection (PIP) system, one of the most important and often misunderstood requirements is the Emergency Medical Condition (EMC) determination.For medical providers, understanding EMC is essential because it directly affects how much PIP coverage is available for an injured patient. Without an EMC, insurers limit benefits to $2,500, not the full $10,000. […]
