6293959, 69L-7.020 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 6293959

Notice of Proposed Rule

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Workers' Compensation

Chapter:

WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW

Overview

RULE:

69L-7.020

Florida Workers' Compensation Health Care Provider Reimbursement Manual

PURPOSE:

To amend the rule to adopt the 2008 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual and implement the 2008 conversion factors issued by the Centers for Medicare and Medicaid Services, as approved by the Three Member Panel, pursuant to Section 440.13(12), Florida Statutes. Additional proposed amendments to the rule will adopt the CPT® 2008 Current Procedural Terminology Professional Edition, Copyright 2007, American Medical Association and the “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes, HCPCS 2008”, American Medical Association, Twentieth Edition, Copyright 2007, Ingenix Publishing Group. The 2008 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual also provides new language addressing issues relating to co-payments, insurer reimbursement responsibilities, and reimbursement disputes. Specifically, it states that while health care providers are entitled to collect a $10.00 co-payment from injured workers who have reached maximum medical improvement, such co-payments are not in addition to any maximum reimbursement allowance or fee agreement, and that the reimbursement amount otherwise payable by the insurer shall be reduced by the amount of the co-payment. It further specifies that such co-payments do not apply in cases involving emergency care or service to injured employees. The 2008 Manual also provides new language recognizing National Correct Coding Initiative Edits as an appropriate resource for insurer use in the bill review process. On the subject of reimbursement disputes, new language provides that where an insurer has disallowed or adjusted payment for services rendered pursuant to an authorized workers’ compensation managed care arrangement, a health care provider may not elect to petition the Department of Financial Services pursuant to Section 440.13, Florida Statutes.

SUMMARY:

Addresses proposed revisions to the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2008 Edition, implements the 2008 conversion factors issued by the Centers for Medicare and Medicaid Services, provides guidelines detailing the circumstances under which providers may collect co-payments from claimants, provides new language recognizing the National Correct Coding Initiative Edits as an appropriate resource for insurer use in the bill review process, and provides that a health care provider may not elect to petition the Department to resolve a reimbursement dispute where services were rendered pursuant to an authorized workers’ compensation managed care arrangement.

RULEMAKING AUTHORITY:

440.13(14)(b), 440.591 FS.

LAW:

440.13(7), (12), (14)(c) FS.

PRINT PUBLISH DATE:

10/17/2008 Vol. 34/42

COMMENTS:

From 10/17/2008 To 11/7/2008 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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