Re: MVA's

[Guest guest]

Diane,

Our clinics use an auto lien AND a letter of protection....the auto lien

requests auto insurance info. but the letter of protection must come from the

representing attorney. We issue a letter of protection request to all patients

who have any case in litigation or believe they will seek legal representation.

The letter of protection request essentially asks for a letter from their

attorney that states that if a settlement is reached, we will be paid out of the

settlement....we have had circumstances where the settlement took a few years to

be reached....and then, the attorney asks for a discount. On one such occasion,

the attorney was to get 1/3, the client 1/3, and ALL of the health care

providers were to get 1/3......and 1/3 is not much when it gets broken down

again amongst all the providers. We actually were able to negotiate for more,

and it did hold up the settlement process......Also, some attorneys refuse to

provide the letter. If that happens, we request that the patient pay

approximately 50% of the daily charges on the day of the visit.....this usually

prompts them to request the letter a little more forwardly from their

attorney....Hope this helps

Hill, PT

>

>

> Date: 2006/08/21 Mon PM 02:53:06 EDT

> To: " PT MANAGER " <PTManager >

> Subject: MVA's

>

> A few weeks ago, the topic of MVA's. Balance Billing, Bankruptcy, Med-Pay,

> etc. came up.

>

>

>

> We too have the on-going scenario, where a patient is in an MVA, they are

> not at fault, hires an attorney who advises them to only give their private

> health insurance info. to us. If we use their private health insurance, we

> cannot balance bill the patient and we have to take approx. 60% write off as

> per our contract with the insurance, ie. BCBS, Humana, etc.

>

>

>

> Months or even years later, the attorney contacts us requesting records and

> the attorney and patient receive a settlement based on our " full " charges.

> They both receive their percentages of the amount that we had to write off.

>

>

>

> What is the main consensus for a solution for this? Is a lien the best

> protection?

>

>

>

> Also, what do you do in the cases when an attorney asks you to take less?

> If you say no, do you run the risk of not getting anything or does your

> saying no, hold up the settlement of the case and encourage the attorney to

> offer more to you?

>

>

>

> Thanks

>

>

>

>

>

>

>

>

>

> Diane Skaff

>

>

>

> Phone:

>

> FAX:

>

> Valley Rehabilitation, Ltd.

>

> 13460 N. 94th Drive

>

> Suite G-1

>

> Peoria, Arizona 85381

>

>

>

>

>

>

[Guest guest]

Yep, don't you just love it when an attorney pops up years later and asks

for records and bills? We ask everybody up front if they were injured in an

accident, (what type), is an attorney involved, etc.

Anyways, got a new one you guys are sure to love.

I treat a husband and wife for injuries after an MVA back in late 2004 and

we had a letter of protection from an attorney named " " . The combined

bills are about $5,500.00 Well, we recently find out that " " doesn't

represent the client anymore and they went to another attorney named " " who

desires us to take his letter of protection. We politely refuse and offer our

letter of protection which he refuses to sign. We send a bill to the patient.

So, he calls me yesterday and states that we should take the patient's Medicare

and supplement. We refuse and state that Medicare is not primary and that auto

insurance is primary. He states that we should have to take the auto insurance

and if we continue billing his client and send them to collections, etc. that he

will personally take their case and sue me for harassment! Wow that's pretty

good.

Heck, I don't even know if we could bill Medicare if we wanted due to timely

filing.

Anyways, I have the information about Medicare as a Secondary Payer (thank

you Ken Mailly) but do I HAVE TO bill the Medicare in these situations and then

work it out afterwards? I don't think so but would like some feedback.

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

(Making friends with attorneys)

Kiln and Bay St. Louis, Mississippi

MVA's

A few weeks ago, the topic of MVA's. Balance Billing, Bankruptcy, Med-Pay,

etc. came up.

We too have the on-going scenario, where a patient is in an MVA, they are

not at fault, hires an attorney who advises them to only give their private

health insurance info. to us. If we use their private health insurance, we

cannot balance bill the patient and we have to take approx. 60% write off as

per our contract with the insurance, ie. BCBS, Humana, etc.

Months or even years later, the attorney contacts us requesting records and

the attorney and patient receive a settlement based on our " full " charges.

They both receive their percentages of the amount that we had to write off.

What is the main consensus for a solution for this? Is a lien the best

protection?

Also, what do you do in the cases when an attorney asks you to take less?

If you say no, do you run the risk of not getting anything or does your

saying no, hold up the settlement of the case and encourage the attorney to

offer more to you?

Thanks

Diane Skaff

Phone:

FAX:

Valley Rehabilitation, Ltd.

13460 N. 94th Drive

Suite G-1

Peoria, Arizona 85381

[Guest guest]

It is my understanding that in Louisiana if the patient has an attorney and at

any time, within the timely filing limits of that insurance, requests that you

file the claims with their insurance you legally have to do so.

Then because of the contracts we have signed with the insurance company we can

not balance bill the attorney. I can bill and lien the attorney for the

patients portion but can't collect the contractual discount.

I know what BXBS is going to pay me, so I change my fee schedule to be exactely

what I am going to be allowed. When the attorney requests a bill I have no

discount therefore they are not collecting the difference between my normal

charges and what BXBS allowed and paid me.

I always use a E812 for Medicare as a MVA diagnosis and any of the others that

apply to the other insurance companies. That way the insurance can't say they

did not know it was a MVA and most of the time they will subrogate it and I am

not in the middle and don't have to mess with the paperwork. They go straight to

the source of where they are going to get there money back from.

I also file liens in all MVAs...............No matter who they are or how small

the injury starts out to be.

C. Castille

Office Manager

Trey Duhon Physical Therapy

119 Arnould Blvd.

Lafayette, LA 70506

Phone:(337)769-1281

Fax: (337)769-1283

This e-mail contains information which (a) may be PROPRIETARY IN NATURE OR

OTHERWISE PROTECTED BY LAW FROM DISCLOSURE, AND ( is intended only for user of

the addressee(s) named above. If you are not the addressee(s), you are hereby

notified that reading, copying, or distributing this email is prohibited. If you

received this e-mail in error, please contact the sender immediately. If you

have received this communication in error, please notify Trey Duhon Physical

Therapy at immediately.

MVA's

A few weeks ago, the topic of MVA's. Balance Billing, Bankruptcy, Med-Pay,

etc. came up.

We too have the on-going scenario, where a patient is in an MVA, they are

not at fault, hires an attorney who advises them to only give their private

health insurance info. to us. If we use their private health insurance, we

cannot balance bill the patient and we have to take approx. 60% write off as

per our contract with the insurance, ie. BCBS, Humana, etc.

Months or even years later, the attorney contacts us requesting records and

the attorney and patient receive a settlement based on our " full " charges.

They both receive their percentages of the amount that we had to write off.

What is the main consensus for a solution for this? Is a lien the best

protection?

Also, what do you do in the cases when an attorney asks you to take less?

If you say no, do you run the risk of not getting anything or does your

saying no, hold up the settlement of the case and encourage the attorney to

offer more to you?

Thanks

Diane Skaff

Phone:

FAX:

Valley Rehabilitation, Ltd.

13460 N. 94th Drive

Suite G-1

Peoria, Arizona 85381

[Guest guest]

It is my understanding that in Louisiana if the patient has an attorney and at

any time, within the timely filing limits of that insurance, they request that

you file the claims with their insurance you legally have to do so.

Then because of the contracts we have signed with the insurance company we can

not balance bill the attorney. I can bill and lien the attorney for the

patients portion but can't collect the contractual discount.

I know what BXBS is going to pay me, so I change my fee schedule to be exactely

what I am going to be allowed. When the attorney requests a bill I have no

discount therefore they are not collecting the difference between my normal

charges and what BXBS allowed and paid me.

I always use a E812 for Medicare as a MVA diagnosis and any of the others that

apply to the other insurance companies. That way the insurance can't say they

did not know it was a MVA and most of the time they will subrogate it and I am

not in the middle and don't have to mess with the paperwork. They go straight to

the source of where they are going to get there money back from.

I also file liens in all MVAs...............No matter who they are or how small

the injury starts out to be.

C. Castille

Office Manager

Trey Duhon Physical Therapy

119 Arnould Blvd.

Lafayette, LA 70506

Phone:(337)769-1281

Fax: (337)769-1283

This e-mail contains information which (a) may be PROPRIETARY IN NATURE OR

OTHERWISE PROTECTED BY LAW FROM DISCLOSURE, AND ( is intended only for user of

the addressee(s) named above. If you are not the addressee(s), you are hereby

notified that reading, copying, or distributing this email is prohibited. If you

received this e-mail in error, please contact the sender immediately. If you

have received this communication in error, please notify Trey Duhon Physical

Therapy at immediately.

MVA's

A few weeks ago, the topic of MVA's. Balance Billing, Bankruptcy, Med-Pay,

etc. came up.

We too have the on-going scenario, where a patient is in an MVA, they are

not at fault, hires an attorney who advises them to only give their private

health insurance info. to us. If we use their private health insurance, we

cannot balance bill the patient and we have to take approx. 60% write off as

per our contract with the insurance, ie. BCBS, Humana, etc.

Months or even years later, the attorney contacts us requesting records and

the attorney and patient receive a settlement based on our " full " charges.

They both receive their percentages of the amount that we had to write off.

What is the main consensus for a solution for this? Is a lien the best

protection?

Also, what do you do in the cases when an attorney asks you to take less?

If you say no, do you run the risk of not getting anything or does your

saying no, hold up the settlement of the case and encourage the attorney to

offer more to you?

Thanks

Diane Skaff

Phone:

FAX:

Valley Rehabilitation, Ltd.

13460 N. 94th Drive

Suite G-1

Peoria, Arizona 85381

[Guest guest]

Matt

Regarding Medicare statute of limitations. You have approximately two years.

The specifics are as follows:

Treatment dates of service Statute of

Limitations Expiration date

1/1/04-09/30/04

12/31/2005

10/01/04-09/30/05

12/31/2006

10/01/05-09/30/06

12/31/2007

Two other points-if you are a PTIPP and bill one year after the date of

service, many carriers impose a 10% withhold penalty for late filing fee (I've

not

seen this charge with a Medicare Intermediary before). Second, I have

appealed some extenuating circumstances after the statute of limitations had

passed

on a patient (letters to senators/congressman) and been paid for services.

Usually the appeals involved proving the claim was originally filed in a timely

manner, but Medicare denied the claim for some reason-but it took longer than

the statute of limitations to get an issue resolved.

Hope this helps!

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/892-0142

[Guest guest]

Is Lousiana still under the Napoleonic Code for their legal system? I know

back in the mid 80's when I studied business law for the CPA exam, 49 states

used the Uniform Commercial Code. Louisiana was the only exception to the rest,

they used Napoleonic Code for their law. Cannot tell you how it differs from

UCC, but I suspect your answers will be different than legal answers to the

same question for the rest of the U.S.

Jim <///><

[Guest guest]

Everyone dealing with MVAs should check their state laws with the SCC

regarding who is primary and what funds can be recouped later. Each state may

be a little different. Virginia is one of the worst. If a pt. requests, health

insurance is primary, we take the write off, and pt. pays the balance. The

patient can later collect in full from their settlement. We have one patient

from 2002 that collected our payment from her auto insurance and kept it. We

then had to bill her health insurance and collected about 30% with the patient

still owing copays. She then settled with the third party and was paid again.

Our bill was now paid 3 times, twice in full, and once 30%. Virginia law states

she can keep all that money. I cannot, nor can the other insurance companies,

ask for their money back since the 3rd party insurance paid the pt. With laws

like that no wonder we need attorneys. Oh, by the way, she still hasn't paid

her copays and is in collections.

Amy Marshall, PT

Back In Action PT

biapt000@...

__________________________________________________

[Guest guest]

After much looking last night I finally found it on the CAHABA website:

Automobile/No-Fault or Liability Insurance: When Medicare is the secondary

payer to automobile medical/no-fault or liability insurance, you may, but are

not required to, (highlights are my own) bill Medicare for conditional payment.

Conditional payment means Medicare will pay the claims as if we had primary

responsibility. We will, however, actively pursue recovery of the funds paid by

Medicare from the responsible person's auto or liability insurance. When you

have reason to believe that you have provided services to a beneficiary for

which payment under liability insurance may be available:

---Bill only the liability insurer during the 120-days after you have provided

services unless you have evidence that the liability insurer will not pay within

the time period.

---If you have evidence that the liability insurer will not pay within 120-day

timeframe, you may, but are not required to, bill Medicare for conditional

payment. If you bill Medicare within the 120-day time period, supply

documentation to support that payment will not be made promptly.

---After the 120-day timeframe has ended, you may, but are not required to, bill

Medicare for conditional payment if the liability insurance claim is not

resolved. At this point, the 120-day payment documentation is no longer

required; we still need the liability insurer's name and address.

*Note the 120-day timeframe is defined as the earlier of the following:

---The date a claim is filed with an insurer or a lien is filed

against a potential liability settlement.

---The date the service was furnished or, in case of inpatient

hospital services, the date if discharge.

Sometimes providers file liens in auto and liability cases ans wait for a

settlement before submitting a bill to Medicare-this is not considered a

conditional payment, as you are not requesting that Medicare pay. However, the

120-day timeframe is still to be followed. If you choose to bill Medicare after

the 120-day period you must withdraw claims against the liability insurer or

liens placed on the beneficiary's settlement. The Medicare reimbursement must

be accepted as payment in full and you may charge the beneficiary only for

applicable deductible, coinsurance, and non-covered services. When the claim

you are filing includes a trauma diagnosis and and auto or liability insurance

is involved, please include the name, policy number and address of the

liabililty insurer if requesting a secondary or a conditional payment. If

liability insurance payment is made, Medicare will not pay secondary unless

benefits are exhausted.

Well guys, that is straight from the horses mouth at www.cahaba.com At least

that is good for Mississippi, and whomever else uses CAHABA. Take care, it's

gonna be a beauuuuutiful day!

Oh yeah, , please tell Trey I said hello.

Matt Capo, PT

Acclerated Physical Therapy and Occupational Health, Inc.

Kiln and Bay St. Louis, Mississippi

MVA's

A few weeks ago, the topic of MVA's. Balance Billing, Bankruptcy, Med-Pay,

etc. came up.

We too have the on-going scenario, where a patient is in an MVA, they are

not at fault, hires an attorney who advises them to only give their private

health insurance info. to us. If we use their private health insurance, we

cannot balance bill the patient and we have to take approx. 60% write off as

per our contract with the insurance, ie. BCBS, Humana, etc.

Months or even years later, the attorney contacts us requesting records and

the attorney and patient receive a settlement based on our " full " charges.

They both receive their percentages of the amount that we had to write off.

What is the main consensus for a solution for this? Is a lien the best

protection?

Also, what do you do in the cases when an attorney asks you to take less?

If you say no, do you run the risk of not getting anything or does your

saying no, hold up the settlement of the case and encourage the attorney to

offer more to you?

Thanks

Diane Skaff

Phone:

FAX:

Valley Rehabilitation, Ltd.

13460 N. 94th Drive

Suite G-1

Peoria, Arizona 85381

[Guest guest]

Jim,

Yes. Louisiana is under Napoleanic Code. Thank you

for pointing that out to the rest of the board.

Trey Duhon, MPT, MS

Trey Duhon Physical Therapy