Most Doctors Were Underpaid For Every Cold Pack That They Billed From 2008 to 2012
Yes, most doctors who billed PIP between 2008 and 2012 were UNDERPAID by about $30 for every cold pack (97010) that they billed.
If a doctor charged $40 for a cold pack then that doctor could be owed an additional $30 for each cold pack billed since 2008!!!
In 2008 the the PIP law was changed to give insurance companies the option
of limiting the amounts that doctors get paid from PIP to:
-200% of Medicare Part B; or
-if Medicare doesn’t pay for a CPT code then whatever the Work Comp fee schedule is.
The problem is that the insurance companies (with all their lawyers and money) forgot to change their insurance policy (a contract)!
Most insurance policies said that they would pay 80% of a reasonable amount. Their policies did not say that they could pay at Medicare or Work Comp rates. Assuming most doctors in a community charged $40 per cold pack then that would be the reasonable amount. Not the $10 per cold pack allowed by the insurance companies (which is the Work Comp amount allowed).
Imagine how many cold packs (97010) your office billed from 2008 to 2012! My office can help your office. My goal is to help your office figure out which PIP claims you are owed money on.
This scenario doesn’t just apply to hot packs! It applies to all of the codes your office billed which was more than 200% of Medicare/ Work Comp