11 Fla. L. Weekly Supp. 842a
Insurance — Personal injury protection — Coverage — Magnetic resonance imaging — Medicare Part B limiting charge — MRI provider’s status under Medicare as having assigned or unassigned claim is not determinative of its reimbursement rate under PIP — Limiting charge under Medicare Part B is allowable amount that may be charged by PIP statute
MDC DIAGNOSTICS INC. a/a/o ADAM COLLINS, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. 2003-CC-12625-RF, Civil Division: RF. May 14, 2004. Joseph Marx, Judge. Counsel: Robert Cooney. Steven Robinson.
ORDER GRANTING THE PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT CHARGE PURSUANT TO F.S. 627.736(5)(b)(5)
This case came before the court for hearing on the Plaintiff’s Motion for Summary Judgment. The sole legal issue is whether the limiting charge under Medicare Part B is an allowable amount that may be charged pursuant to F.S. 627.736(5)(b)(5).
FACTS
The Plaintiff in this case provided an MRI to Adam Collins as a result of injuries he sustained in an auto accident. The bill was sent directly to the defendant who is the personal injury protection insurer for Mr. Collins. Although the charged amount exceeded the limiting charge, the defendant reimbursed the Plaintiff at the participating Physician Fee-Schedule Rate and contends that the limiting charge is not an allowable amount that may be charged by statute.
ANALYSIS
The Medicare Framework recognizes claims that are assigned and unassigned. Assigned claims are sent directly to Medicare for reimbursement and are governed under the Participating and Non-participating fee schedules. 42 U.S.C. 1395u(i), 42 U.S.C. 1395u(h) Both the Participating and the Non-participating fee schedules represent amounts Medicare pays on claims assigned to Medicare. Unassigned Medicare claims are governed under Medicare’s limiting charge. 42 U.S.C. 1395w-4(g)(2). The limiting charge under Medicare part b represents the limit that may be charged on an unassigned Medicare claim. 42 U.S.C. 414.48.
The express language of section F.S. 627.736(5)(b)(5) instructs MRI providers as to allowable amounts that may be charged under Medicare part B and in no way indicates that charge limits should be restricted to payment amounts Medicare makes on Medicare assigned claims.
The broad language in F.S. 627.736 (5)(b)(5) is clear and unambiguous and conveys specific instruction to the MRI provider, billing either PIP insurers or insured’s, as to the limits on charges. Their exists no language express or otherwise which indicates that payment allowances Medicare makes on Medicare assigned claims is the limit that may be charged, nor that allowable charges on unassigned Medicare claims, represented by the Limiting charge was intended to be precluded as an allowable charge. The Florida Supreme court in Holly v. Auld, 450 So. 2d 217, 219 (Fla. 1984) stated that “our Florida Courts are without power to construe an unambiguous statute in a way which would extend, limit, or modify the express language of the statute. To do so would be an abrogation of legislative power.
F.S. 627.736(5)(b)(5) was created to reduce the amount that MRI providers treating PIP patients could charge. While the legislature decided to limit MRI charges to what is allowable under Medicare part B they did not express any intention to impose the Federal Medicare Regulations and laws on a PIP case.
The plain meaning rule requires this court to determine if the limiting charge is an allowable amount that may be charged under Medicare part B. An analysis requiring an MRI provider’s status under Medicare to be determinative of its reimbursement rate under PIP was not expressed by the legislature and would be a departure from the plain meaning rule.
Based on the foregoing, it is
ORDERED AND ADJUDGED that the plaintiff’s motion for summary judgment on the issue of whether the limiting charge applies is granted.
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