In light of the recent amendments to Florida’s PIP Statute, Florida’s chiropractic community will need to start thinking of manipulations of the legal sort, as the legislative changes are inevitably set to take effect on January 1, 2013. At the start of 2013, chiropractic physicians will be limited to reimbursement of up to a maximum of $2,500.00 for services rendered to automobile accident patients, unless it is determined by a medical doctor, a doctor of osteopathic medicine, a physician assistant, a registered nurse practitioner, or dentist, that the injured person has experienced an “emergency medical condition” as defined by Fla. Stat. §627.732(16). If the patient is determined to have an “emergency medical condition”, the maximum reimbursement amount increases to $10,000.00.
The legislative intent behind the PIP amendment was to limit the amount of fraudulent billing often resulting from chiropractic services prescribed by a chiropractic physician and rendered at chiropractic facilities. But whether these amendments to the PIP statute will serve to further the legislature’s intent is yet to be seen. The amendments require an injured party to seek initial treatment within fourteen (14) days of the motor vehicle accident and preclude chiropractic physicians from being the provider of that initial treatment if the services are not secondary to an “emergency medical condition.”
The legislature has defined an “emergency medical condition” as “a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in . . . (a) serious jeopardy to patient health; (b) serious impairment to bodily functions or (c) serious dysfunction of any bodily organ or part.” But what exactly does this mean and will the “emergency medical condition” requirement pose a sufficient enough of a barrier to reduce PIP related fraud?
At minimum, these amendments and the definition of “emergency medical condition” will certainly give rise to an ambit of new legal issues. The imperative question will no longer just be whether or not the treatment was reasonable, related and medically necessary, but will now include whether or not the chiropractic treatment was related to an “emergency medical condition.” No matter how this term is defined, it will be the subject of debate and litigation among doctors, physician assistants and nurse practitioners who will be eagerly waiting to render their expert opinions on the issue.
Plaintiff attorneys may require their clients to first treat with a “friendly” doctor, physician assistant or nurse practitioner, who will either determine that the injury suffered qualifies as an “emergency medical condition” and then refer the patient to a chiropractic physician. In the alternative, the patient will simply bypass the doctor, physician assistant or nurse practitioner and treat immediately with the chiropractor, only to have what amounts to a retroactive rubber stamp identifying the patient’s injury(s) as an “emergency medical condition.” This will also give rise to the need for doctors, physician assistants and nurse practitioners to act as experts on the
defense side, providing independent medical examinations or rendering peer reviews to counter the conflicting determinations made by the providers on the opposite side. So, as you can see, these amendments may not result in the intended effect of reducing fraud, but rather they will create a new battleground with new soldiers needed to fight the war. If you thought that chiropractors could exhaust benefits quickly, just wait until medical doctors get into the game and attempt to cut out the chiropractors all together.
Stay tuned for more insurance coverage issues on our next blog.
Leave a Reply