Proposed PIP Regulations Amendments would have a significant impact on PIP Providers:
On August 1, 2011, the Department of Banking and Insurance issued proposed regulations amending the current Personal Injury Protection (“PIP”) system.
They have extended the comment period until October 17, 2011 due to the overwhelming responses. Public Comments can be submitted to:
Robert J. Melillo
Legislature and Regulation
New Jersey Department of Banking and Insurance
20 West State Street
PO BOX 325
Trenton, NJ 08625
The following is an overview of some of the proposed changes:
· New mandatory uniform internal appeals level process for PIP disputes.
· New arbitration organization selected. Some arbitrations will be decided “on papers” rather than “in person” if less than $1,000 is in dispute.
· Implementation of a multiple procedure discount, Approximately 1,100 new CPT codes were added to the fee schedules, CPT codes that do not appear on the outpatient facility fee schedule are not eligible for reimbursement.
· Proposal will amend and clarify non- emergency room services provided in hospitals are subject to the fee schedule. According to the proposal these types of services that are on the fee schedule are similar those provided by doctors’ offices.
· ASC fee schedules repealed and ASC fees are next to the corresponding CPT code on the physician’s fee schedule as an outpatient facility fee, the same fee schedule will apply to outpatient surgical services provided by hospitals.
· Reimbursement for outpatient facility fees is based on 300% of the 2011 Medicare base rate and wage index for Bergen County for the North Jersey region and Atlantic County for the South Jersey region,
· Recognition of FAIR HEALTH as a national UCR database.
If you have any questions or would like more information please feel free to contact:
Keri Fessler
President
O: 973-305-8830x108 | F: 973-305-8818 
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