Guest guest Posted April 28, 2011 Report Share Posted April 28, 2011 Maureen I noticed that you live in Vermont. You will probably want someone from Vermont to respond to your post. While the rest of us can give you a general idea of how things might work, should work, probably work, etc., your state laws govern this transaction. So unless a poster has dealt with Vermont's auto liability laws, they would provide you with very insightful and useful information..., but it might not be worth spit, because it is the law in the state where they reside. I recently wrote a point of view on this topic for the American Physical Therapy Association's Private Practice Section magazine Impact (April 2011 edition). It is also posted on the PTManager blog which you can find by clicking this link: http://ptmanagerblog.com/ You will have to scroll down to find the article ( is constantly adding insightful content to this blog). At the time I posted the above link, the article was the 4th one down. What I can tell you is that some states have subrogation laws (i.e., subrogation establishs a pecking order for who is responsible). In most cases the party that is responsible for the accident will ultimately pick up 100% of the liability. However, they usually have a legal option of declining to pay anything until the full liability is determined. If they choose that option, then the patient's auto policy becomes liable..., up to the policy maximum medical rider. So if a patient has a $10,000 auto medical rider, then once $10,000 worth of services have been paid out by that policy, they are done. Then comes the patient's commercial insurance policy. Some states have laws that require a commercial policy pay for all medical and the auto carriers then have to reimburse the commercial insurance carrier when the accident has been resolved. These are nice guidelines for you, but if someone within the state of Vermont responds to your post, I would recommend you take that as gospel! Jim Hall, CPA <///>< General Manager Rehab Management Services, LLC Cedar Rapids, IA 319/892-0142 Visit our website at: www.rehabmgmt.com Auto Accidents Hello Friends, I am a newbie to PT so please forgive my naïve question… We have a patient who was seriously injured in an auto accident where the ther driver was at fault. We have been treating him since February and ave been paid by Medicare. Just recently, Medicare has denied claims due o the accident. Of course, his $5,000 Med pay through his auto insurance was exhausted mmediately through the hospital so there is no money for us. The other driver’s insurance is refusing to pay until the patient settles he claim with them. The patient does not want to settle the claim until is care is complete, so he can determine the damage level, etc. So, please help me out here…what recourse do we have? We want to treat the atient to improve his condition, but we can’t continue to float his ervices. In your vast experiences, who pays here? Thanks, in advance, for any advice you can share!! aureen =================================== *Maureen Whitney* *Business Manager* Essex Physical Therapy Essex, VT maureen@... Non-text portions of this message have been removed] ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and our location or else your message will not be approved to send to the full roup. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our rofessions. PTManager is not available to support POPTS-model practices. The escription of PTManager group includes the following: PTManager believes in and supports Therapist-owned Therapy Practices ONLY " essages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, OTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. TManager blog: http://ptmanager.posterous.com/ ahoo! Groups Links Individual Email | Traditional http://docs.yahoo.com/info/terms/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 28, 2011 Report Share Posted April 28, 2011 Maureen I noticed that you live in Vermont. You will probably want someone from Vermont to respond to your post. While the rest of us can give you a general idea of how things might work, should work, probably work, etc., your state laws govern this transaction. So unless a poster has dealt with Vermont's auto liability laws, they would provide you with very insightful and useful information..., but it might not be worth spit, because it is the law in the state where they reside. I recently wrote a point of view on this topic for the American Physical Therapy Association's Private Practice Section magazine Impact (April 2011 edition). It is also posted on the PTManager blog which you can find by clicking this link: http://ptmanagerblog.com/ You will have to scroll down to find the article ( is constantly adding insightful content to this blog). At the time I posted the above link, the article was the 4th one down. What I can tell you is that some states have subrogation laws (i.e., subrogation establishs a pecking order for who is responsible). In most cases the party that is responsible for the accident will ultimately pick up 100% of the liability. However, they usually have a legal option of declining to pay anything until the full liability is determined. If they choose that option, then the patient's auto policy becomes liable..., up to the policy maximum medical rider. So if a patient has a $10,000 auto medical rider, then once $10,000 worth of services have been paid out by that policy, they are done. Then comes the patient's commercial insurance policy. Some states have laws that require a commercial policy pay for all medical and the auto carriers then have to reimburse the commercial insurance carrier when the accident has been resolved. These are nice guidelines for you, but if someone within the state of Vermont responds to your post, I would recommend you take that as gospel! Jim Hall, CPA <///>< General Manager Rehab Management Services, LLC Cedar Rapids, IA 319/892-0142 Visit our website at: www.rehabmgmt.com Auto Accidents Hello Friends, I am a newbie to PT so please forgive my naïve question… We have a patient who was seriously injured in an auto accident where the ther driver was at fault. We have been treating him since February and ave been paid by Medicare. Just recently, Medicare has denied claims due o the accident. Of course, his $5,000 Med pay through his auto insurance was exhausted mmediately through the hospital so there is no money for us. The other driver’s insurance is refusing to pay until the patient settles he claim with them. The patient does not want to settle the claim until is care is complete, so he can determine the damage level, etc. So, please help me out here…what recourse do we have? We want to treat the atient to improve his condition, but we can’t continue to float his ervices. In your vast experiences, who pays here? Thanks, in advance, for any advice you can share!! aureen =================================== *Maureen Whitney* *Business Manager* Essex Physical Therapy Essex, VT maureen@... Non-text portions of this message have been removed] ------------------------------------ In ALL messages to PTManager you must identify yourself, your discipline and our location or else your message will not be approved to send to the full roup. Physician Self Referal/Referral for Profit {POPTS} is a serious threat to our rofessions. PTManager is not available to support POPTS-model practices. The escription of PTManager group includes the following: PTManager believes in and supports Therapist-owned Therapy Practices ONLY " essages relating to " how to set up a POPTS " will not be approved PTManager encourages participation in your professional association. Join APTA, OTA or ASHA and participate now! Follow Kovacek, PT on Facebook or Twitter. TManager blog: http://ptmanager.posterous.com/ ahoo! Groups Links Individual Email | Traditional http://docs.yahoo.com/info/terms/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2011 Report Share Posted May 3, 2011 We file to a Part A Intermediary so I am not sure if it would be different for a Part B carrier; however, you can file to the liability carrier and if you have not been paid after 120 days, you can then file to Medicare and request a conditional payment with an occurrence code of 24 and a claim note indicating you are requesting a conditional payment. Hope this helps. Auto Accidents Hello Friends, I am a newbie to PT so please forgive my naïve question... We have a patient who was seriously injured in an auto accident where the other driver was at fault. We have been treating him since February and have been paid by Medicare. Just recently, Medicare has denied claims due to the accident. Of course, his $5,000 Med pay through his auto insurance was exhausted immediately through the hospital so there is no money for us. The other driver's insurance is refusing to pay until the patient settles the claim with them. The patient does not want to settle the claim until his care is complete, so he can determine the damage level, etc. So, please help me out here...what recourse do we have? We want to treat the patient to improve his condition, but we can't continue to float his services. In your vast experiences, who pays here? Thanks, in advance, for any advice you can share!! Maureen =================================== *Maureen Whitney* *Business Manager* Essex Physical Therapy Essex, VT maureen@... Quote Link to comment Share on other sites More sharing options...
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