PIP billing in Florida: what practices need to know

Florida is a no fault state. Most drivers carry personal injury protection, known as PIP, which pays part of the medical costs after a motor vehicle accident regardless of who caused it. For practices that treat auto injury patients, PIP billing has its own rules and deadlines that differ from health insurance.

The basics of Florida PIP

Under Florida law, PIP generally covers 80 percent of reasonable medical expenses up to the policy limit, commonly 10,000 dollars, along with other benefits such as lost income. The rules are set out in Florida Statute 627.736. Policies and facts vary, so always confirm the details of each claim with the insurer.

The 14 day rule

To qualify for PIP medical benefits, the injured person must receive initial services and care within 14 days after the accident, from a provider type the statute allows. Patients who wait longer may lose PIP medical benefits. Practices should record the accident date and the date of first care clearly.

Emergency medical condition

The amount available depends on whether an emergency medical condition, often called EMC, is determined. When a qualified provider such as a physician, physician assistant, or advanced practice nurse determines the patient had an EMC, benefits can be available up to the policy limit. When a provider determines the patient did not have an EMC, reimbursement can be limited to 2,500 dollars. Chiropractors cannot make the EMC determination, which matters for chiropractic practices that treat auto injuries.

What practices should collect

• Accident date and a short description of how it happened.
• Auto insurer, policy number, claim number, and adjuster contact.
• The patient's own health insurance, in case PIP is exhausted or denied.
• Attorney information, if the patient is represented, as provided by the practice.
• Documentation of first care within 14 days and any EMC determination.

Billing and follow up

1. Bill the PIP carrier with correct codes and documentation that supports medical necessity.
2. Track payments against the available benefit so you know when PIP is close to exhausted.
3. Respond to insurer requests for records promptly.
4. Review denials and reductions, and follow up or dispute where appropriate under the statute.
5. When PIP is exhausted, move to the next payer as the patient's coverage allows.

A quick example

A patient starts chiropractic care eight days after an accident and is later seen by a physician who records an emergency medical condition. The practice records both dates, bills the PIP carrier with notes that support each visit, and tracks payments against the available benefit. When the benefit nears its limit, the front desk is told in advance so the patient's next payer is ready.

Where Afiable helps

Afiable supports Florida practices with PIP claim preparation and submission, documentation and coding checks, exhaustion tracking, and follow up on denials. Book a free audit and we will review a sample of your PIP claims and show you where payments are getting stuck.

This article is general information for practice owners and managers. Payer policies and regulations change, so confirm current rules with each payer before acting.