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If you're a healthcare provider treating auto accident patients in Florida, you already know the frustration. You deliver the care. You submit the bills. And then the insurance company finds every reason not to pay. Coverage denials, lowball reimbursements, and...
A practice manager in Wesley Chapel called us about what she described as a peer review denial. When the file arrived, it was not a peer review. It was a code audit — a vendor product that had rebundled two CPT codes and paid the difference. There was no physician...
If you're a medical provider in Florida, you already know how frustrating the PIP reimbursement process can be. Between tight statutory deadlines, insurer pushback, and the sheer volume of claims that need to go out, it's easy for unpaid PIP balances to pile up —...
Months after you treated the patient, a doctor you have never met sits down with your file. The patient is long gone. The insurer is not looking for reasons to pay — it is looking for reasons not to. And the only thing standing between your practice and a denial is...
The denial does not say your coding was debatable, or that a date needs correcting, or that a modifier was off. It says something far more alarming: fraud. On the strength of that single word, a Florida PIP insurer refuses to pay your HCFA-1500 claims — sometimes an...
The letter arrives on a Tuesday. Four paragraphs of clinical-sounding prose, a physician's signature at the bottom, and a conclusion stated as though it were a finding of fact: the treatment your practice rendered was not reasonable, not related to the motor vehicle...
The worst version of a peer review denial is the clean one. Not a reduction, not a partial payment, not a dispute over three codes. The carrier obtains a report, declares that none of the treatment was reasonable, related, or necessary, and pays nothing at all. Your...
A billing manager at a chiropractic office in Brandon noticed it first. Two peer review reports, two different patients, two different accidents eleven months apart, two different mechanisms of injury. Same reviewing physician. And in the middle of each report, a...
Two practices, two letters, same week. A chiropractic office in Riverview had been paid on eleven dates of service over about seven weeks. Then a peer review report landed, and the payments stopped cold. A physical medicine practice in Largo submitted its first bills...