Tampa Bay Florida PIP Billing

Florida PIP & Personal-Injury Medical Billing for Tampa Bay

Specialized auto-injury billing built around Florida Statute 627.736 — the 14-day rule, the $10,000 benefit, fee-schedule accuracy, LOP tracking and aged-claim recovery — for chiropractic, PT, pain management, orthopedic and PI-attorney practices across Pinellas, Hillsborough and Sarasota counties.

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~95%

First-pass clean claim (established accounts)

$10K

PIP benefit we track per patient

14-day

Treatment window we protect

Florida Statute 627.736

How Florida PIP actually works

No-fault Personal Injury Protection is its own animal. Getting paid means knowing the numbers cold — and billing to them before benefits run out.

Medical benefit

$10,000

Available when a qualifying provider documents an emergency medical condition (EMC).

Non-emergency sublimit

$2,500

The medical cap when no EMC is determined — a common, and costly, surprise.

Treatment window

14 days

Initial care must begin within 14 days of the accident or PIP will not cover it.

Payment rate

80%

PIP pays 80% of reasonable medical expenses, typically at 200% of Medicare Part B, after the deductible.

Figures reflect Florida’s no-fault statute (§627.736). An emergency-medical-condition determination unlocks the full $10,000; only certain providers (MD, DO, PA, ARNP or dentist) can make it. This is billing guidance, not legal advice — confirm coverage specifics against the current statute and the individual policy.

The $10,000 problem

Benefits exhaust fast — so we track them in real time

Between imaging, injections and a full course of therapy, a $10,000 (or $2,500) PIP benefit disappears in weeks. Deliver care past zero and you write it off; stop short and you leave covered treatment unbilled. We keep a live benefit ledger per patient and coordinate every payer in the right order.

Live exhaustion ledger — every patient’s remaining PIP balance, updated as EOBs post, so providers know what’s left before the next visit.
Deductible applied correctly — taken off the top before the 80% is calculated, so you aren’t shorted twice.
EOB reconciliation — each line checked against the statutory fee schedule to catch underpayments and mis-applied co-shares.
Exhaustion hand-off — when PIP hits zero we shift the balance to the next payer without a coverage gap.

The coordination waterfall

PIP → MedPay → health insurance → Letter of Protection. Getting the order and timing right is how the full charge gets paid instead of written off.

1
1. PIP (primary for the auto injury)
Pays 80% of the allowable amount up to the $10,000 / $2,500 medical cap, after the deductible. This is where the file starts.
2
2. MedPay (if the auto policy has it)
Optional medical-payments coverage can pick up the 20% co-share or costs beyond exhausted PIP — often overlooked, so we check for it up front.
3
3. Health insurance
Once auto coverage is exhausted, the patient’s health plan may be secondary. We coordinate benefits so charges aren’t double-billed or dropped.
4
4. Letter of Protection / lien
Whatever remains rides on a Letter of Protection against the injury settlement. We age and reconcile it against the attorney’s disbursement.

LOPs, demand letters & interest

The parts of PIP that get abandoned

Most practices bill the easy 80% and let the rest slide. That’s exactly where the money is.

Letter of Protection billing

We record each LOP, age those balances separately from insurance A/R, and reconcile them against the settlement so the clinic is made whole when the attorney disburses. No more balances lost between two ledgers.

Pre-suit demand letters

When a PIP claim is overdue or underpaid, Florida’s no-fault statute contemplates a pre-suit demand letter before an insurer can be sued. We prepare the demand and document the overdue amount so the carrier’s clock starts.

Statutory interest on late pay

PIP payments are overdue if not paid within the statutory window after the insurer receives the claim. Where the facts support it, we pursue the interest owed — not just the principal the carrier finally coughs up.

What We Handle for Florida PIP Practices

Accurate PIP Claim Coding

CPT and ICD-10 coding for auto-injury care — chiropractic, PT, pain management and orthopedic services — tied to the crash date, mechanism of injury and the treating provider so every clean claim survives a PIP adjuster review.

PIP Exhaustion & Benefit Tracking

A running ledger of the $10,000 (or $2,500 non-emergency) benefit per patient, so you know exactly how much PIP is left before you treat — no surprise write-offs, no care delivered past a zero balance.

EOB Reconciliation & Fee-Schedule Audit

We reconcile every PIP Explanation of Benefits against the Florida statutory fee schedule (commonly 200% of Medicare Part B) and flag underpayments, mis-applied deductibles and 80% miscalculations line by line.

Denial Management & Pre-Suit Demand Letters

We work "reasonable, related and necessary" disputes, missing-EMC denials and 14-day-rule rejections — and, where a claim is overdue or underpaid, prepare the statutory pre-suit demand letter and pursue interest owed.

Letter of Protection (LOP) & Lien Billing

We bill and age LOP and lien balances separately from insurance A/R and reconcile them against the settlement disbursement, keeping the clinic and the personal-injury attorney on the same page from intake to payout.

Aged A/R Recovery (Contingency)

For stale, denied and underpaid PIP claims we run a contingency recovery track — you only pay when we collect. We re-open the file, re-price it against the fee schedule and chase what the insurer still owes.

The Florida PIP Billing Problems We Solve

The 14-Day Rule

Florida Statute 627.736 requires initial medical care within 14 days of the accident, or PIP will not cover it. We build intake alerts so the first date of service is captured and billed inside the window.

A $10,000 Ceiling That Fills Fast

PIP medical benefits cap at $10,000 (only $2,500 without an emergency-medical-condition finding). Between imaging, injections and a course of therapy, benefits exhaust quickly — so real-time tracking is the difference between getting paid and eating the balance.

"Reasonable, Related & Necessary" Disputes

PIP carriers routinely challenge whether care is related to the crash or medically necessary. We assemble the documentation — mechanism of injury, EMC determination, treatment rationale — that holds up.

The 80% / 20% Split & Deductibles

PIP pays 80% of the allowable amount after the deductible; the remaining 20% has to be coordinated, not written off. We route it to MedPay, health insurance or the LOP instead of leaving money unbilled.

Coordinating Multiple Payers

A single injury file can touch PIP, MedPay, the patient’s health plan, and a settlement lien. Getting the order and timing right — and not double-billing — takes a workflow built for auto injury, not general medicine.

Overdue & Underpaid Claims

PIP payments are overdue if not paid within the statutory window, and underpayments against the fee schedule are common. Most practices never circle back — we do, with demand letters and interest claims where warranted.

Built for Tampa Bay

Who we serve

Auto-injury and personal-injury practices across Pinellas, Hillsborough and Sarasota counties.

Chiropractic

The front line of auto-injury care — where the 14-day clock and benefit exhaustion bite hardest.

Physical Therapy

Multi-visit plans of care that burn through the $10,000 cap fast if benefits aren’t tracked.

Pain Management

Injections, imaging and interventional care that draw the closest carrier scrutiny on necessity.

Orthopedics

Higher-dollar procedures where fee-schedule accuracy and coordination decide what you collect.

PI Attorney Billing Liaisons

One reconciled ledger of LOP balances so the law firm and the clinic settle clean.

Multi-Provider Injury Clinics

Groups running several disciplines under one roof against a single shared PIP benefit.

Where we work

Pinellas County — St. Petersburg, Clearwater, Largo, Pinellas Park
Hillsborough County — Tampa, Brandon, Plant City
Sarasota County — Sarasota, Venice, North Port
Broader Tampa Bay auto-injury and personal-injury practices

Specialty pages: our chiropractic billing services and physical therapy billing services cover the CMT, therapy-unit and modifier rules behind every PIP claim.

Straightforward pricing

Two tracks. You only pay on what’s collected.

Fees on what’s collected, not billed — and no upcoding to inflate them. Our incentives are pointed the same direction as yours.

Ongoing billing

of collections

Full-cycle PIP billing — coding, clean-claim submission, EOB reconciliation, benefit tracking, 80/20 coordination and denial work — for a flat percentage of what actually lands in your account.

A/R recovery

20%

contingency — no recovery, no fee

For aged, denied and underpaid PIP claims. We re-open the file, re-price it against the fee schedule, and pursue what the carrier still owes. If we don’t collect, you don’t pay.

Not sure how much of your old PIP A/R is recoverable? Ask for a free recovery review before you commit to anything.

Why Tampa Bay PIP Practices Work With Us

Fewer Write-Offs on Exhausted Benefits

Live benefit tracking means your front desk and providers know how much PIP is left before the next visit — so covered care gets billed and you stop absorbing avoidable write-offs.

Paid the Full Fee-Schedule Amount

We reconcile every EOB against the Florida statutory fee schedule and pursue the difference when a carrier underpays — you collect what the statute actually allows, not what the adjuster defaults to.

BAA-Backed Data Handling

We sign a Business Associate Agreement with every practice and follow BAA-backed safeguards for protected health information. Your files are handled by experienced PIP billing specialists.

You Pay on What’s Collected, Not Billed

Our fee is a percentage of what actually lands in your account — never a percentage of charges, and never with upcoding. Incentives stay aligned: we get paid when you get paid.

One Ledger for Insurance and LOPs

Insurance A/R and Letter-of-Protection balances live in one reconciled view, so nothing falls through the gap between the clinic’s books and the attorney’s settlement ledger.

Transparent Monthly Reporting

Monthly reporting on collections, days in A/R, denial reasons, benefit exhaustion and open LOPs — built for auto-injury practices, not a generic dashboard.

Our Florida PIP Billing Process

1
Intake & 14-Day Verification
We confirm the accident date, verify the PIP policy and deductible, and make sure the first date of service lands inside the 14-day window before care is billed.
2
EMC & Benefit Setup
We record the emergency-medical-condition determination (which unlocks the full $10,000) and open a benefit ledger so exhaustion is tracked from visit one.
3
Coding & Clean-Claim Submission
Experienced coders build accident-specific claims and submit them clean the first time — we run ~95% first-pass clean claim on established accounts, which means faster PIP reimbursement.
4
EOB Reconciliation & 80/20 Coordination
We reconcile each EOB against the fee schedule, post payments, and coordinate the remaining 20% to MedPay, health insurance or the LOP.
5
Denial Work & Demand Letters
Denials and underpayments are worked immediately — documentation disputes, statutory pre-suit demand letters and interest claims on overdue payments.
6
LOP Reconciliation & Settlement Payout
LOP and lien balances are reconciled against the settlement so the practice is made whole when the case resolves — with clear reporting throughout.

Florida PIP Billing FAQ

What is Florida’s 14-day rule?

Under Florida Statute 627.736, an injured person must receive initial medical care within 14 days of the motor-vehicle accident to be eligible for PIP medical benefits. Care that begins after day 14 is generally not covered by PIP. We build intake alerts so the first date of service is captured and billed inside that window.

How much does Florida PIP actually pay?

PIP provides up to $10,000 in medical benefits when a qualifying provider documents an emergency medical condition (EMC); without an EMC finding the medical limit drops to $2,500. PIP pays 80% of reasonable medical expenses — typically measured against the statutory fee schedule, commonly 200% of Medicare Part B — after any policy deductible is applied.

What happens when PIP benefits are exhausted?

Once the $10,000 (or $2,500) is used up, the PIP carrier stops paying. Remaining and future charges then shift to MedPay if the policy has it, the patient’s health insurance, or a Letter of Protection / lien against the injury settlement. We track the running benefit balance so you know before you cross zero — protecting you from writing off covered care or treating past available benefits.

Do you bill Letters of Protection (LOPs)?

Yes. We record the LOP, bill and age those balances separately from insurance A/R, and reconcile them against the settlement and attorney disbursement so nothing falls through the gap between the clinic and the personal-injury attorney.

How does the 80% / 20% split work?

PIP pays 80% of the allowable amount (after the deductible). The remaining 20% — plus anything above the fee-schedule allowable — is the patient’s responsibility. Rather than leaving it unbilled, we coordinate that balance to MedPay, the patient’s health plan, or the LOP so the full amount is pursued.

Can you recover underpaid or aged PIP claims?

Yes, on a contingency basis — 10% of what we recover, so you keep 90%, with no recovery, no fee. We re-review EOBs against the fee schedule to identify underpayments and overdue claims, then pursue them, including the statutory pre-suit demand letter and interest on late payments where the facts support it.

How do you protect patient data (PHI)?

There is no official "HIPAA certification," and we don’t claim credentials we don’t hold. What we do is sign a Business Associate Agreement (BAA) with every practice and follow BAA-backed safeguards for protected health information. Your billing is handled by experienced PIP specialists.

What does ClaimCarePro charge for PIP billing?

Two tracks. Ongoing billing is 6% of collections with a $1,000/month minimum — month-to-month, no long-term contract. Aged or underpaid A/R recovery is 10% contingency — you only pay when we collect. Either way, our fee is on what’s actually collected, not what’s billed, and we never upcode to inflate it.

Stop Leaving PIP Money on the Table

Get a free review of your aged PIP A/R and current billing. We’ll show you what’s recoverable before you commit to anything.