There are several opportunities available for spine surgeons, pain specialists and ASCs willing to add personal injury patient care to their practice. Lawyers are in need of good specialists to provide quality care to their clients, and they can provide valuable return for the specialist’s business.
"As surgeons and specialists expand and develop their practice, a savvy physician realizes you should never put all your eggs in one basket. Treating personal injury patients provides ample opportunity to diversify your practice," says President of MedPort Billing Steven Ainbinder, MD. "Each state has their own specific laws related to personal injury cases, but these cases can be a valuable part of the specialist physicians practice."
Especially as reimbursement rates drop and coverage is changing for classic health insurance cases, specialists are looking for reliable payers that pay fair prices; personal injury cases deliver just that. Patients who do not have health insurance or the physician is not contracted with the health insurance carrier can be treated on a medical lien or letter of protection (LOP) provided by an attorney. This means that the treatment rendered today will be paid for from the proceeds of the settlement. These settlements are generally through automobile and general liability insurance carriers. An added benefit to this type of works is that physicians can also serve as consultants and are often asked by the attorneys to write reports and perform depositions in which the physician is directly compensated.
"There is a patient population of individuals injured at work or during a third-party accident, and any injury where there is a liability insurance attached to it is an opportunity for physicians to care for these injured patients and be compensated," says Dr. Ainbinder.
Some of the concerns related to medical liens/LOP work relates to the prolonged payment cycle. It can take up to five or six years for cases to resolve hence, waiting to be paid. Also, during this period, between the date of service and case settlement, the physician's staff needs to status their case in order to remind the attorney that medical bills remain outstanding. Healthcare finance companies such as Medport Billing offer an alternative for the physicians and medical facilities.
"We pay the physicians and ASCs immediately after care through customized financial services that best fit their practice," says Dr. Ainbinder. "Also, physicians and facilities don't have to increase their overhead to take on these cases, we are a finance company specific for this industry. We service our clients by screening their cases, status the law firms and subsequently collect payments for them. This generates revenue through an alternative to general healthcare insurance thus providing patients access to healthcare who may otherwise not have received care."
Payers in these cases are also more willing to compensate for a higher level of care and new technology, not just what the health insurance or Medicare approves. This places the patient care management back into the hands of the physician.
"As healthcare continues to be more restrictive, this is one of the last frontiers that allows physicians to make their own decisions regarding patient care," says Dr. Ainbinder. "For example, there are many healthcare insurance carriers that won't allow physicians to do spinal arthroscopy or artificial disc implants; this is at the physician's discretion if considered reasonable and necessary care within their medical community."
To develop a personal injury arm within their practice, specialists and ASCs often consider:
• Working closely with orthopedic specialists, pain specialists, primary care physicians or chiropractors to broaden services
• Keeping their charge master reasonable
• Detailed and complete patient medical records which can be used in legal proceedings.
• Whether they are comfortable being deposed
• Financial resolve to wait out the collection period.
• Designate staff to contact attorney’s office before and after procedures.
• Work with a finance company to service and/or finance the accounts
"In medicolegal cases, the automobile insurance company or liability insurance company evaluates whether the care is reasonable, necessary and related to the injury," says Dr. Ainbinder. "The physician will need to opine for those three questions. Equally as important is to keep the charges reasonable as they will be evaluated by billing specialists."
There is an entire industry focusing on the medical expert work associated with these cases says Dr. Ainbinder. Specialists on average charge around $500 to $1,000 per hour for these cases. Attorneys for the plaintiff and defense will expect surgeons to provide information about their services before entering into the relationship, such as:
• Updated CV
• Med-legal rate sheet with charge per hour for case reviews, deposition testimony and trial.
The medical professional is typically paid prior to or at the time their report is turned over at the deposition. This is yet another way to increase revenue without increasing overhead.
Since the individual mandate requires everyone to have health insurance, some have wondered whether personal injury cases will disappear. Although, no one can predict the future, high copays and many quality physicians not accepting healthcare insurance leads many to believe that for now this patient population remains an attractive addition to point of service payment.
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