Who is responsible for payment after pip is exhasted

I have a patient that has exhausetd all pip benefits and now the attorney is telling me to bill the health insurance plan. Will Medicare pay for claims resulting in an auto accident? Also does anyone have information on pip billing. Please help!!!!

Medicare payment for MVA

You will need to furnish any and all documentation regarding settlement reached and how payments were disbursed. Include name of payee and amount. You will need to include whether you filed a claim, to whom, date filed, and whether you received funds. Follow up on the progress of settlement will need to be reported. If you followed the 120 day requirements as established by Medicare for 3rd party liability situations, then you can submit the claim with accompanying documentation.

Pip billing

Settlement has not been reached and is no where in sight. As for sending my claim to Medicare. What do I need to include on my hcfa form? Box 10b should indicate yes to auto accident? Thanks

Pip billing

This is a difficult answer, as sometimes it is a state-by-state law. In some areas, the insurance company will subrogate the claim when the case is settled, some will recoup your payment and have you go after it. It is a very confusing and time-consuming process to treat these patients, and you rarely are paid your charges. I recommend, if you bill the insurance and are a participating provider, that you advise the insurance that this is a case under litigation with an attorney, and ask for advice from them on how to handle it.

Thanks!

Martha

Martha C. Callaghan, CPC PCA
Accounts Receivable Manager
University Orthopedics Inc.
17 Virginia Avenue
Providence RI 02903
401-457-2136
MCallaghan@universityorthopedics.com

pip

Medicare will have to be updated before they will process a claim since they would be considered a secondary payor. Once the PIP has exhausted then the primary health insurance carrier should pick up but they have to be advised that it is a liability/injury claim. Make sure that the policy will cover before you file your claim. More than likely the primary will pay then subrogate against any settlement the attorney is able obtain. If it is non covered under the primary policy(not medicare) then bill the patient.

I would file a lein if you do not file to health insurance to make sure you do not get left out of the loop.

Who is Responsible for Payment After PIP is Exhausted?

If Medicare is the 2nd payer: Upon establishing that a 3rd party liability situation exists, a claim should be sent to either the attorney handling the case or 3rd party liability payer, If they will accept a claim directly from the provider. The key is to get a claim out to establish your financial interest. Medicare is aware that often these cases move into litigation and may be ongoing for an extended time with no settlement in sight. If you have followed up periodically with the case, you can submit the claim to Medicare after 120 days of sending the claim to the party handling the matter. Include complete contact information for the attorney, your follow up efforts and that no resolution is in sight. Request a conditional payment. If Medicare decides to make the conditional payment, they usually place the attorney on notice that they are making conditional payment. If & when settlement is reached, the Medicare program must be reimbursed in the funds disbursement.