Question
I practice medicine in Florida where there is mandatory PIP insurance for MVAs. I have occasion to treat some of these patients, many of which are already represented by an attorney by the time they call for an appointment. Many of these patients also sign a Letter of Protection allowing for deferment of payment for services until their legal matter is settled, however in most cases their PIP is exhausted by the time they see me. It is my understanding that we must first bill the patient's auto insurance even if they also have Medicare. Is that correct? If the PIP is exhausted are we then obligated by law to bill the patient's Medicare, or are we allowed to treat the patient under the LOP, especially if the patient has requested that we accept the LOP?
A problem that I have run in to on these Medicare-MVA cases has been that if I bill Medicare and check box 10 on the HCFA form identifying that this patient's condition is related to an auto accident, I receive a denial of payment from Medicare. Have you heard of this as well?
Answer
Hi Paul
Medicare is not the primary, the liability insurance is. Medicare will not pay until after the liability has been played out. Sometimes they will pay because of the hardship for the families, but then when the lability settlement arrives, the amount paid by Medicare must be returned to Medicare. To pay any unpaid bills, Medicare must have proof the the other Insurance action has been completed.
John
