ROIG Lawyers Miami Attorney Successfully Opposes Summary Judgment on application of Medicare Coding Policies and Payment Methodologies

August 18, 2016

Raquel D. Campos, an attorney in the Miami office of ROIG Lawyers, successfully opposed a Motion for Summary Judgment on behalf of national insurance carrier. Ms. Campos effectively argued that the insurance carrier’s policy allowed the use of Medicare Coding Policies and Payment Methodologies.

The case centered on a vehicle accident where the insurance carrier paid for treatment rendered by a physician’s assistant. The insurance carrier paid the medical provider, a physician assistant, 85 percent of what a physician is paid under the Medicare Physician Fee Schedule. The plaintiff’s suit had claimed breach of contract and sought additional insurance money. A motion for summary judgment was filed by the plaintiff alleging that the policy of insurance was ambiguous as it failed to provide the insured with notice of the use of the Medicare Coding Policies and Payment Methodologies.

Ms. Campos prevailed in opposing the summary judgment. The court said the insurance carrier’s policy provided sufficient notice that it elected the use of Medicare Coding policies and payment methodologies, which includes the physician’s assistant reduction.