No-Fault and Healthcare Law Lawyers
What is No-Fault?
Technically speaking, No-Fault refers to claims arising under The Comprehensive Motor Vehicle Insurance Reparations Act, more commonly known as PIP (personal injury protection) or MVA (motor vehicle accident). The No-Fault law was created to ensure that insurance companies would promptly pay for medical expenses, lost wages, and other costs resulting from MVAs, no matter who was to blame for the accident. Unfortunately, many healthcare providers have found it difficult to collect payment from No-Fault carriers after rendering medically necessary services.
As a healthcare provider, when your claims are consistently denied, it is an economically challenging situation, frustrating your ability to continue to provide appropriate services to your patients. Furthermore, once No-Fault has been identified as the primary payer and an assignment of benefits has been accepted, your right to seek recovery directly from the patient is extremely limited. As such, the only viable way for healthcare providers to seek recovery of their unpaid/underpaid No-Fault billing is to pursue No-Fault carriers in either arbitration or court.
Why Us?
Horn Wright, LLP specializes in No-Fault collections, consulting, and compliance. We are the largest provider of legal services to New York State hospitals in this specialized area. To date, we have recovered over $100,000,000.00 for our clients on their unpaid/underpaid No-Fault claims. [1]
At present, we represent over 60 hospitals, 100 physician practices, 30 EMS providers, as well as ambulatory surgery centers and radiology practices. We have developed protocols and systems specifically designed to maximize voluntary payments received and, in the event of a refusal or failure to pay, to pursue post-denial recovery. Our one-of-a-kind proprietary software gives us the capacity to handle the high volume of No-Fault claims that are referred to us for arbitration. We seek recovery on all viable bills, no matter the size, setting us apart from other No-Fault collection firms. Additionally, we provide our clients with “the next step”, identifying other avenues for potential collection when reimbursement cannot be obtained from the No-Fault carrier.
For those healthcare providers that have not previously had representation in this area, there is the possibility of obtaining recovery on unpaid/underpaid bills that are up to six years old. Furthermore, once a claim is filed in arbitration, statutory interest begins to accrue at the rate of 2% per month (i.e., 24% per year). As such, by conducting an analysis of a new client’s aged Accounts Receivable (AR) and identifying denials that are ripe for arbitration, we have the ability to turn prior write-offs into income.
Who We Represent?
- Hospitals – ranging from small community critical access hospitals to the largest health system in New York State.
- Ambulatory Surgery Centers
- Ambulance/EMS Providers
- Radiology Practices
- Physician Groups
- Anesthesiology
- Internal Medicine
- Orthopedics
- Pain Management
- Physical Medicine & Rehabilitation
- Neurology
- Physical Therapists
- Acupuncturists and Chiropractors
- Suppliers of Durable Medical Equipment (DME)
- Pharmacies
What Services Do We Provide?
The lawyers of Horn Wright, LLP provide collection, consulting, and compliance services. However, from time to time, a practice will receive notices and lawsuits that are unique to No-Fault, and which require the assistance of counsel familiar with all aspects of No-Fault and secondary billing. Our attorneys are well versed in and routinely handle these issues, some of which are outlined below. We are All Things No-Fault.
- Restitution/Subrogation Lawsuits - If a healthcare provider mistakenly bills an MVA related claim to a secondary payer and receives payment, said provider may later receive a lawsuit seeking restitution. These types of lawsuits may be commenced by the patient, the secondary payer (i.e., Medicare, Medicaid, etc.), or by a third-party subrogation company, like The Rawlings Company.
- Examinations Under Oath (EUO) and Verification Requests
- On-site Inspections
- Article 75s, De Novo, and Declaratory Judgment Actions
- Civil RICO Defense
- Corporate counsel services: corporate formation, vendor contracts, compensation agreements, and lease negotiations.
- Interaction with the Department of Financial Services (DFS) and American Arbitration Association (AAA) on issues impacting our clients.
Why Our Hospital Consulting Services Work
In recent years, we’ve seen significant changes in the fields of No-Fault and Healthcare. Through these changes, we have been able to ensure that our clients’ rights remain protected with every passing trend. With our guidance, professionals in the hospital industry can successfully collect the money due to them for the treatment rendered to their patients.
The Firm offers the following No-Fault consultation services to hospitals:
- In-depth educational seminars
- Revenue cycle consultations
- Analysis of write-offs and aged accounts receivable (AR)
- Billing practice protocols
- Intake processes
Today, we are recognized as leaders in the movement to arm hospitals and other medical providers with the tools needed to combat non-paying, No-Fault carriers and to obtain optimal results in the collection process. We understand that the No-Fault billing may not account for a significant amount of your practice’s revenue. And, before deciding to engage in the collection effort, we would expect that the aged accounts receivable and non-fee schedule write-offs would be reviewed. We assist in this endeavor. In order to see if there is the possibility of meaningful recovery for your practice, the Firm offers a complimentary analysis of your aged No-Fault Accounts Receivable and write-offs.
Turn to our New York law firm today so that we can begin working on your case immediately! Contact us now.
Frequently Asked Questions
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Which claims should I send to the Firm for collections, and when should I send them?
Use the following criteria when determining whether to refer an overdue or denied claim to the
Firm to file in arbitration:
- Bills that have been submitted to the insurer and to which no response has been received by
- the healthcare provider after 45 days from the date of submission;
- All claims for which an NF-10 Denial of Claim Form has been received by the healthcare provider, based on one of the following enumerated grounds:
- Fees Not in Accordance with Fee Schedule;
- Duplicate Procedures
- Lack of Medical Necessity (Peer Review or IME Cut-Off)
- Lack of Causation (Peer Review or IME Cut-Off)
- Treatment Not Related to the Use and Operation of a Motor Vehicle
- Treatment Not Related to Accident
- Result of an Investigation
- 45-day Rule (if healthcare provider has proof that it either timely mailed the bill or sent a reconsideration letter a.k.a. an appeal letter to the insurer)
- 30-day Rule
- IME No-Show
- EUO No-Show
- Benefits Exhausted/Exhausted Policy
- 120-day Rule (if healthcare provider has proof that it responded to the verification requests)
- No Coverage
- Fraud
- Fraud in Procurement
- Staged Accident
- Non-Cooperation
- Concurrent Care
- Excessive Care
- PPO
- Material Misrepresentation
- Driving While Intoxicated
- Application of Deductible
- One-Year Rule
If you are ever unsure about whether a claim should be referred to the Firm for arbitration, please contact Erin S. Stamper, Partner, No Fault & Health Care Law Department. Ms. Stamper can be reached by email at ess@hornwright.com or by telephone at (516) 355-9684.
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What is the timeframe to submit claims to the Firm for arbitration?A 6-year statute of limitations applies to No-Fault insurance claims filed against private insurance companies (e.g. Geico, State Farm, Allstate, etc.), whereas No-Fault insurance claims against self-insured entities are subject to a 3-year statute of limitations. Self-insureds include municipalities, buses, trains, rental cars (where bills are sent to third party administrators), and MVAIC. The statute of limitations begins to run when the payment of the no-fault claim becomes “overdue”.
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What documents do I need to provide so that my claim can be filed in an expeditious manner?
The documents needed to file in arbitration varies based on the type of healthcare provider that rendered the underlying services. Below are links to our filing Checklists.
- Hospital No-Fault Filing Checklist
- Hospital Physician Services No-Fault Filing Checklist
- Ambulance No-Fault Filing Checklist
- Non-Hospital No-Fault Filing Checklist
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How do I submit new files to the Firm for arbitration?
The Firm can accommodate your office’s preferred method for transferring collection files to Horn Wright, LLP, including the following:
- Citrix ShareFile (preferred)
- E-mail;
- USB Flash Drive;
- USPS Mail;
- Drop-Off;
Be assured that all files delivered to Horn Wright, LLP for collection, regardless of the transfer method, are entered into the Firm’s proprietary, HIPAA compliant system. Thereafter, the files are reviewed for both completeness and collectability. To the extent that additional information/documentation is required, you will be contacted by Horn Wright, LLP. Any files that are deemed “non-collectable” shall be marked “Closed—Unopened/Returned to Client” in the Firm’s system. If you wish to utilize the Firm’s preferred file transfer method—Citrix ShareFile—we will provide Citrix ShareFile access to your chosen staff member(s).
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How long does the arbitration process take?
The length of time that an arbitration can take varies greatly from case to case and is dictated largely by the American Arbitration Association’s (AAA) own calendar. Although developmentsduring an arbitration proceeding can contribute to the speeding up or slowing down of a case, we make sure that all deadlines are met to ensure as speedy a process as possible.
It currently takes the AAA upwards of 18 months to assign a first-time hearing date. During the period from filing to the hearing date, this office has had past success in conciliating and settling matters with advantageous terms. Such resolutions consider, not only the type of denial present, but the proofs provided by your office.
Should we find pervasive practices influencing initial non-payment, we will share same in an effort to increase your practice’s voluntary recovery rate.
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How do I check the status of my file(s)?
Through the Client Portal on the Firm’s website, you can discern the status of each case, from the Firm’s initial intake of documents to the case’s ultimate resolution. Copies of all past and future invoices, check images, arbitration awards, and other important information regarding your account are also available through the Client Portal.
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After reviewing one of my files in the Client Portal, I noticed a discrepancy (e.g. missing date of service, incorrect claim amo
Please contact our Intake Supervisor by email.
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When can I expect to receive payment following an arbitration settlement? Is the timeline for payment different following an arb
After settlement or an award, payment can generally be expected within 30-60 days. Under the Regulations, the No-Fault Insurer is given 30-days within which to pay a final settlement or Arbitration Award (with a few additional days for mailing). Once received, the check must get posted, scanned, deposited, and clear the Firm’s escrow account (if applicable).
Provider accounts are reconciled and closed by the Firm on a monthly basis. If all the foregoing occurs prior to the completion of the monthly closeout, then the check will be remitted to the client with that month’s closeout report. If not, then the payment will be remitted to the client the following month.
If, however, the No-Fault Insurer requests a master arbitration appeal, the timeframe for payment may increase to 121 to 180-days.
If the No-Fault Insurer files either an Article 75 or a De Novo action after losing a master arbitration appeal, the timeframe for payment may increase to 365+ days.
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Who should I contact to discuss an issue related to my monthly closeout check and/or related invoice?
Please contact Erin S. Stamper, Partner, No Fault & Health Care Law Department. She can be reached by email at ess@hornwright.com or by telephone at (516) 355-9684.
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Who should I contact to discuss a claims related issue, not connected to a pending arbitration?
Please contact Erin S. Stamper, Partner, No Fault & Health Care Law Department. Ms. Stamper can be reached by email at ess@hornwright.com or by telephone at (516) 355-9684.
What Sets Us Apart From The Rest?
Horn Wright, LLP is here to help you get the results you need with a team you can trust.
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Client-Focused ApproachWe’re a client-centered, results-oriented firm. When you work with us, you can have confidence we’ll put your best interests at the forefront of your case – it’s that simple.
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Creative & Innovative Solutions
No two cases are the same, and neither are their solutions. Our attorneys provide creative points of view to yield exemplary results.
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Experienced Attorneys
We have a team of trusted and respected attorneys to ensure your case is matched with the best attorney possible.
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Driven By Justice
The core of our legal practice is our commitment to obtaining justice for those who have been wronged and need a powerful voice.