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PIP SUBROGATION LOSS TRANSFER |
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Medical Management Group of New York, Inc.’s (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. |
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| All medical reports and
notes will be reviewed to confirm whether services billed were actually
ordered and appropriate. |
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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. |
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| 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 individual’s
treatment exceeds that which other patients with the same injury have
received. This warning alerts the adjuster to potential over treatment.
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| 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. |
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