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Cover Story: Ged Lawyers: Helping Providers Recover Millions of Dollars in PIP Benefits

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performing revenue stream for hospitals. sure they capture the necessary informa- was unpaid,” says Ged. “This hurts cash benefits under the No-Fault Law. At this
tion.” flow and exposes the provider to point in the process, the Statutory
Collecting PIP Benefits Next, they will assist the provider by exhausting the medical benefits that are Demand letter is sent to the insurance
for Providers seamlessly gathering all the necessary available.” carrier. If necessary, Ged says they will
The law firm can help providers records, including: file a lawsuit to collect overdue benefits
become more proactive in collecting PIP • Assignment of Benefits (AOB) Conducting Retrospective Audits and litigate through final judgment.
benefits in several ways, first by educat- • Explanation of Benefits (EOB) and of Unpaid PIP Claims For one hospital system in Florida,
ing and training the provider’s admis- Billing Ledger In addition to recovering this lost rev- Ged and his team were able to collect
sions staff. They will review the intake • Auto Insurance Information enue for current claims, Ged says they over $2.8 million. They deployed mobile
forms to ensure the provider is capturing Sometimes the carrier will deny claims can also help with the recovery of forgot- scanner vehicles and an audit team to
all necessary information. based on the following: ten PIP receivable accounts through a scan over 10,000 boxes of medical and
“Hospitals are missing a significant • Reduced according to an alleged retrospective audit. billing records. They also helped an
stream of revenue under the No-Fault usual and customary charge or based “Under the Florida statute, we can go imaging center in Florida collect over
Law because they are not asking the right upon geographic region back five years and audit these unpaid $3.7 million using the same method.
questions on the intake forms,” says Ged. • Denied based upon an IME cut–off bills because the claim is based on a What distinguishes the law firm from
“This is a simple fix.” • Denied for failure to appear at a EUO breach of contract,” says Ged. others in regards to recovering PIP
Some providers only ask if the injured • Denied based upon an alleged mate- “Sometimes, we can go in and find hun- claims is that they have a dedicated team
patient owns a vehicle. If the patient rial misrepresentation dreds of millions of dollars for clients.” solely focused on PIP.
answers no, they could still be covered • Paid at 200% of Federal Medicare This retrospective audit is relatively “Many people try to do this type of
under the No-Fault Law if they were a Fee Schedule or Florida Workers simple. The healthcare provider author- work for providers, but they don’t have
passenger in the vehicle, live with a rela- Compensation Fee Schedule izes access to the Ged Lawyers’ audit specialists as we do,” says Ged. “Our staff
tive who owns a vehicle in Florida, or If they do not pay within 30 days, Ged team for their PIP billing cases. If the of lawyers who handles these claims used
was a pedestrian. But some intake forms Lawyers will send a Statutory Demand records have not been electronically pro- to work for insurance companies. We
do not ask these other questions mean- letter on behalf of the providers giving vided, then the audit team will have the make the process seamless and take the
ing that the provider can lose out on the carriers another 30 days to pay. As a files delivered to the law firm’s 85,000 sq. burden off hospital employees who can
$10,000. result, Ged says about 80 percent of the ft. offsite facility and deploy mobile scan- focus on other things.”
“If you have 100 patients come time; the bill gets paid. ner vehicles to scan the files. The audit
through, that’s one million dollars of lost “Providers lose revenue as well process begins by indexing each case and For more information,
revenue,” adds Ged. “We offer a free because they were not sending a applying its internal algorithm. Through visit www.gedlawyers.com.
evaluation of their intake forms to make Statutory Demand letter when the bill this process, they can identify overdue

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Visit us online at
UM-NSU CARD Launches
www.southfloridahospitalnews.com
Free Early ASD Screening and

Parent Coaching Program

With one in 59 children diagnosed with autism spectrum disorder (ASD),
research buttresses the fact that early identification and family support have long-
term, positive benefits for children.
Now parents in South Florida have a new resource to help them screen toddlers
from 12 to 24 months old, for developmental delays and may also be eligible to par-
ticipate in a national research program aimed at closing the gap between early iden-
tification of ASD and access to early intervention programs.
“With small children, pediatricians and parents often take a wait and see
approach,” says Dr. Michael Alessandri executive director of the University of
Miami - Nova Southeastern University Center for Autism and Related Disabilities
(UM-NSU CARD). “But what ends up happening is that some kids fall through the
cracks. They are either misdiagnosed or diagnosed later, which research shows often
results in longer and more intensive intervention. But that’s not necessary, because
we have the researched-backed tools that allow us to screen for early signs of ASD.”
Funded by the National Institute of Child Health and Human Development
(NICHD) and developed by UM-NSU CARD along with Florida State University,
Boston University, and the University of Massachusetts Boston, UM-NSU CARD has
launched the ACTION Network program to close this gap.
The ACTION Network, which stands for Autism Adaptive Community-based
Treatment to Improve Outcomes using Navigators – provides parents with the
coaching and skills they need to support their child’s development. Once enrolled
in the research program, specially trained family navigators meet with parents in
their home, up to two times per week for six months, to learn new ways to help
their child develop social interaction, language and play skills, and manage chal-
lenging behavior. These home-based parent-coaching style interventions are tai-
lored to daily activities, routines, and problem solving on issues important to the
individual family. The program is offered in English, Spanish and Creole in the tri-
county area at no charge.
“We don’t have to wait until children enter school or are sidelined in their devel-
opment to give them the help they need,” Alessandri added. Families and health
care providers can access the free initial screening tool for communication delays
online at the My First Words Project website,
https://my.firstwordsproject.com/study/ace-action-miami.
“We are excited to be able to offer this tool and assistance to families and physi-
cians, which will allow many more families to access much-needed evidence-based
early interventions and related resources,” says Alessandri.

To learn more visit parents and doctors can also contact the research program
directly at aceaction@miami.edu or call (305) 284-6894.

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