ICD-10 will help physicians treat the “whole patient” | EHRintelligence.com#_

ICD-10 will help physicians treat the “whole patient” | EHRintelligence.com#_

MVAIC- Who qualifies

 

Do-you-qualify? Click here or read below

 

 

Official requirements for MVAIC benefits;

• You were involved in a motor vehicle accident in New York.
• You were a resident of New York when the motor vehicle accident occurred.  Under special circumstances, residents of other states may be eligible for MVAIC benefits.  If you were not a resident of New York when the accident occurred and have questions pertaining to eligibility, please contact us by phone at (646)205-7800, or via email at HelpDesk@mvaic.com. 
• You have no other automobile insurance available to you. If you or any of your household relatives own an insured motor vehicle, you will be required to file a claim with that insurance company to see if you are covered under that policy for benefits.
• You were NOT the owner of the uninsured vehicle that was involved in the accident.
• You were NOT the spouse of the uninsured vehicle’s owner, and a passenger in that uninsured vehicle.

Additionally, there are timeframe requirements that must be adhered to.  If these timeframes are not met, your eligibility could be affected...

• The motor vehicle accident must be reported to the Police (Peace Officer) within 24 hours of the accident occurring.
• A Notice of Intention (NOI) is submitted to MVAIC within 90 days of the accident, if the accident was with a Hit & Run or unidentified motor vehicle.
• A Notice of Intention (NOI) is submitted to MVAIC within 180 days of the accident, if the accident was with an identified motor vehicle. 

The requirements above are set forth in Article 52 of the New York Insurance Law.

All claims submitted to MVAIC are reviewed for eligibility.  If you have any questions, please contact us by phone at (646) 205-7800, or via email at HelpDesk@mvaic.com. 

 

 

Completing The NF-2 Form Within 30 days - One of the most important first steps

The Application for No-Fault Benefits officially notifies the insurance carrier of your claim. It also is usually the first written document associated with the injury details of your car accident. When listing your injuries, don't leave anything out. What you consider to be minor in the beginning  can become problematic over a few days or weeks.** I know of someone who didn't file  NF-2 form until months later- then wanted treatment to be billed to No Fault-but their carrier specifically told me the claim was closed because of the patient failing to file his form within the required time frame. It is important to file the NF-2 form as soon as possible .

 If you have an injury recorded on file from the beginning on your paperwork, this helps to make medical claims processing easier for your insurance carrier when they receive treatment bills from your health care provider's office.  Some health care provider's offices have these forms available for you to fill out at the time of your treatment and can assist you with the form should you have questions with any part of it .  They can send it directly to your insurance carrier too.


Healthcare Provider can send out your NF-2 Form.
"Therefore, it is clear that the regulation does permit a health care provider to send, on behalf of an EIP, the NF-2 directly to the insurer, which may help in ensuring that the EIP meets the written notice requirement necessary to receive No-Fault benefits."

Calling your insurance carrier after the car accident is highly recommended. They will issue you a claim number and the name of the person handling your claim after you report the accident to them. This is important information for when you go to seek medical treatment.  Keep the claim number and the insurance claim representative's name with phone number handy when going to any medical care facility for treatment of your injuries. There is a spot on the NF-2 Form where you will need to provide this information.

You have only 30 days from the date of the accident to file a No-Fault Application (NF-2) Form with your insurance company – and only under certain circumstances will a grace period be allowed.
A serious injury where the injured party is hospitalized for weeks may be given an additional 30 days to get their form in, but don't depend or expect a grace period from your carrier. Carriers like to deny claims and it's an easy denial to issue if your NF-2 form was never received or received too late.


Access pages 5-7 to view and print out from this link :  NF2- Form

Coding Topic - Consult Downcoded to a lower E/M level ?

What Documentation Is Required?

In order for an E/M service to be considered a consultation, the following criteria must be met and documented:

• A request for a consultation, along with the reason  for a consultation, must be documented by the consultant in the patient's medical record and included in the patient's medical record of the referring practitioner.
• An opinion is rendered by the consulting practitioner. This opinion, along with any other service provided, is documented in the patient's health record.
• A written report of the consultant's findings and opinion or recommendation is communicated back to the requesting practitioner. This report is known to  include a thank-you letter for the consultation request and state exactly what the consultant's opinion is concerning the patient's medical problem.

CPT Assistant, July 2007 indicates that “there may be circumstances when a consultation is initiated by sources other than a physician, such as a physician assistant, nurse practitioner, doctor of chiropractic, … social worker, lawyer, or insurance company.” This helps to explain who can be considered another provider or healthcare entity. Reporting a consultation would be appropriate if the service was at the request of one of these professionals. -

Documentation is the key to getting paid for the consult done.

 It is a lack of proper documentation that leads to a carrier  determination  to downcode  consultation codes to a lower E/M level of service.

If you documented a consult properly and still received a downcode, appeal it immediately and attach the report made out to the referring physician.  Point out to the carrier the referring physician requesting the consultation, the report on record and the rendered opinion given from the physician performing the consultation.

Don't settle for the downcode amount when a consultation has been performed.Appeals that show full proof of the consultation performed will be reconsidered by the insurance carrier for the full payment due.



Julie Pisacane, CCA, CEMC

Member of AHIMA and AAPC

No Fault -Independent Medical Examinations (IME's)

Can you ask for another IME from your  no fault insurance carrier ?

Yes. You can call your No Fault insurance claims representative and  request another IME.  Demand it.Explain why you are not satisfied with the outcome when your No Fault benefits are cutoff. I have known patients to do this and successfully get another exam set up.  Not all requests are answered with a yes. It depends on your carrier and how well you address your complaint. I hear it all the time of a 5 minute exam or less where there is almost no conversation between the Independent Medical Examination physician and the patient regarding the injuries that were sustained in the MVA and the treatment that still needs to continue. The IME physician works for the insurance carrier. They are not your treating physician. They are paid for an opinion and the carrier often stands on that opinion.

I have denials routinely come in on a patient's treatment claims this year - due to an IME that happened last year. This patient made enough phone calls to his carrier that when I call to ask for a payment reconsideration on a denied insurance claim, they do so and without hesitation.

You can open the door to more treatment if you boldly and firmly make your requests known to the insurance carrier claim representative. Don't stay silent on a treatment issue. This is about your health and getting the continued treatment you need.

30 Days to Pay or Deny a No Fault Medical Insurance Claim - How to File A Complaint

Information for Healthcare Providers

No Fault insurance carriers have a responsibility to pay a medical treatment claim that is without issue in 30 days time from receipt of the claim . Make sure you keep an official record of mailing proof - whether it be certified mailing or claims mailed out on all your no fault patients in a mailbook log officially date stamped by your local post office.

 Don't get comfortable with the numerous delay tactics sent out by insurance carriers. When you are told by the insurance claim rep. in a sweet, calm tone that  "the claim was processed and the check is in the mail" ... for two months straight-  it is time to file your official written complaint.

 I actually communicate on a regular basis with one particular carrier who refuses to pay any claim sent in -until they hear from me via the New York State Department of Financial Services .  When I have sent everything in twice -by mail and fax and made my follow up phone call to the carrier - in which there is never a written or verbal response given - I file a complaint online requesting assistance for this claim to now be paid with interest. I attach all my proof to the complaint sent in . Thanks to today's technology, The Department of Financial Services gets my online complaint to the insurance carrier the same day. My phone rings from the carrier  later that same day for me to finally hear the spoken words, " Hey Julie, I got your message today. "  :*)  This is how we communicate. This is how I get the claim paid . It is a sad truth, but truth nonetheless and I am very thankful that the majority of complaints I filed this year with The Department of Financial Services were rapidly and successfully  handled.    (JP)

Click link below to file a complaint at the Department of Financial Services.

Complaint Link


You can file a No Fault, Workers Compensation or Prompt Pay Complaint  using our Online Complaint Form. You will receive immediate confirmation and be assigned a file number.
You will have one hour to process the complaint form. If you do not complete the form within one hour you will be prompted to refresh and the information you have entered before refreshing will be lost.
The form will contain a series of questions. If you do not understand any of the requested information, you can click on the question and a help box will appear to offer an additional description.

The costs of copying records is the responsibility of the health service provider.

 

No Fault Verification Requests For Copies Of Medical Records

Please click link for full article found at The Department of Financial Services.

 

Question Presented:

When a health service provider has submitted a bill to an automobile insurer for No-Fault insurance benefits, after receiving an assignment of benefits from an eligible injured person, and the insurer delays payment of the bill pending receipt of requested verification of the of the claim, is the health service provider responsible for reproduction costs incurred in providing the verification?

 

 

Conclusion:

 

Yes.

The eligible injured person's application for No-Fault benefits and all documentation and information provided to the insurer are components of the required "written proof of claim". The obligation to supply the "written proof of claim" consistently remains with the party claiming No-Fault benefits. Accordingly, the obligation to bear the costs of copying records to comply with a verification request will always remain with the eligible injured person or assignee health service provider.