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PIP SUBROGATION LOSS TRANSFER
MEDICAL BILL ANALYSIS


Medical Management Group of New York, Inc.ís (MMG) PIP Subrogation Medical Bill Analysis system is a powerful loss mitigation tool. Substantial cost savings can be gained by assuring that all of the medical bills presented by the applicant were paid in accordance with applicable Fee Schedule and Medical Billing Rules. The applicant is held accountable for their own mistakes.

MMG offers:

Prompt and effective mitigation of medical losses where possible on the PIP subrogation claims made against you via loss transfer.

All of the medical bills and reports received as components of a PIP Subrogation claim will be reviewed and processed by MMG incorporating a state-of-the-art medical bill review system. Our process reviews all treatment for:

  Appropriateness of care - Confirmation that the treatment or service matches the diagnosis.
 
  All medical reports and notes will be reviewed to confirm whether services billed were actually ordered and appropriate.
 
 

 

Unbundling - on occasion, a provider will invoice separately for a service or supply that was billed under a "global" code. Since the supply or service was already allowed under a previous billing, the "unbundled" code should be denied.
 
  Over Utilization - While payment may not be denied based solely upon over utilization, a warning may appear on the Explanation of Benefits (EOB) when the individualís treatment exceeds that which other patients with the same injury have received. This warning alerts the adjuster to potential over treatment.
 
  Level of Service - Many times providers will submit billing for a level of service that does not correlate to the severity of the injury. For example, when the diagnosis of sprains and strains of the neck (ICD-9 847.0) is submitted along with a high level of service (CPT 99215), the service would be reviewed as 99214 or 99213. The service 99215 requires a diagnosis that carries a high level of medical decision-making and a high risk of death or permanent disability and is therefore inappropriate.
 
640 Johnson Avenue Suite 101B Bohemia
New address effective September 9th:
1 Corporate Drive
Suite 104
Bohemia, NY 11716
Phone: 631.467.7766
  800.424.6461
Fax: 631.589.2331
Email: info@mailmmg.com
 

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