6540824, 69L-7.602 - Florida Administrative Rules, Law, Code, Register

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Notice: 6540824

Notice of Rule Development

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Workers' Compensation

Chapter:

WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW

Overview

RULE:

69L-7.602

Florida Workers' Compensation Medical Services Billing, Filing and Reporting Rule

PURPOSE:

To amend the rule to adopt revised reference manuals for medical billing, filing, and reporting, including the Florida Workers’ Compensation Medical EDI Implementation Guide (MEIG), 2008; the 2008 ICD-9-CM Professional for Hospitals, Volumes 1, 2 and 3, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2007, Ingenix, Inc. (American Medical Association); the Physician ICD-9-CM 2008, Volumes 1 & 2, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2007, Ingenix, Inc. (American Medical Association); the National Uniform Billing Committee Official UB-04 Data Specifications Manual 2009, version 3.00, July 2008; and the Current Procedural Terminology (CPT®), 2008 Professional Edition, Copyright 2007, American Medical Association. The proposed amendment also transfers ambulatory surgical centers billing from Form DFS-F5-DWC-9 (CMS-1500 Health Insurance Claim Form) to Form DFS-F5-DWC-90 (UB-04 CMS-1450, Uniform Bill), effective 04/01/2009, incorporates by reference a revised hospital billing instruction form, Form DFS-F5-DWC-90-B (Completion Instructions for Form DFS-F5-DWC-90 for use by hospitals) and a new ambulatory surgical center billing instruction form, Form DFS-F5-DWC-90-C (Completion Instructions for Form DFS-F5-DWC-90, for use by ambulatory surgical centers), both of which supply guidance regarding the completion of Form DFS-F5-DWC-90. The proposed amendment also adds statutory definitions for “Home Health Agency” and “Nursing Homes”, and provides new billing forms and completion instructions for each respective application. Form DFS-F5-DWC-90-D (for Home Health Agencies) and Form DFS-F5-DWC-90-E (for Nursing Homes), including their respective completion instructions, Form DFS-F5-DWC-90-D (Completion Instructions for Home Health Agencies), and Form DFS-F5-DWC-90-E (Completion Instructions for Nursing Homes), have been incorporated by reference. The proposed amendment further clarifies the meaning of “Recognized Provider” and changes “Principal Physician” to “Primary Physician” when referring to the treating physician responsible for oversight of medical care, treatment and referrals for injured employees. A definition for “Explanation of Bill Review Code” has also been added. The electronic record layout for form DFS-F5-DWC-90 in the Florida Workers’ Compensation Medical EDI Implementation Guide (MEIG), 2008, also adds new fields for the submission of a facility’s Florida Agency for Health Care Administration ambulatory surgical center number and National Provider Identifier (NPI) number. New fields are also provided for the submission of data regarding procedures, service and supply codes, and code modifiers, as paid by the insurer. These changes, in conjunction with the introduction of refined edits, provide enhanced medical data submission and facilitate the Department’s ability to monitor and promote compliance by insurers and submitters with the requirements associated with electronic submission, filing, and reporting of data to the Division of Workers’ Compensation. The proposed amendment deletes subsection (7), “Insurer Administrative Penalties and Administrative Fines for Untimely Health Care Provider-Payment of Medical Bills”. That subsection shall be consolidated into Rule Chapter 69L-24, F.A.C., “Workers’ Compensation Insurers’ Standards and Practices”, as part of a restructuring and realignment of rules that consolidates disparate rule elements into their most appropriate chapter. The proposed amendment also provides new language which clarifies billing instructions for dentists and oral surgeons who dispense medications, as well as for those entities that are neither physicians nor recognized health care providers. New language is also added which emphasizes that insurers, or entities acting on behalf of insurers, are responsible for correcting and resubmitting previously accepted data later deemed inadequate by the Division. Finally, the proposed amendment deletes obsolete references and language, renumbers the rule, and makes ministerial changes where necessary.

SUBJECT:

Health care provider, insurer, and submitter responsibilities for medical billing, filing, and reporting.

RULEMAKING AUTHORITY:

440.13(4), 440.15(3)(b), (d), 440.185(5), 440.525(2), 440.591, 440.593(5) FS.

LAW:

440.09, 440.13(2)(a), (3), (4), (6), (11), (12), (14), (16), 440.15(3)(b), (d), 440.185(5), (9), 440.20(6), 440.525(2), 440.593 FS.

PRINT PUBLISH DATE:

12/19/2008 Vol. 34/51

RELATED STATUTES
AND LAWS:

440.13(4), 440.15(3)(b), (d), 440.185(5), 440.525(2), 440.591, 440.593(5) FS., 440.09, 440.13(2)(a), (3), (4), (6), (11), (12), (14), (16), 440.15(3)(b), (d), 440.185(5), (9), 440.20(6), 440.525(2), 440.593 FS.

OVERSIGHT COMMITTEE:

Joint Administrative Procedures Committee
Florida Administrative Law Central Online Network (F.A.L.C.O.N.)

RELATED COURT CASES:

Division of Administrative Hearings

FEDERAL eRULEMAKING
WEB PORTAL:

Regulations.gov

HOW TO LINK TO
THIS NOTICE:

http://flrules.org/gateway/ruleno.asp?id=69L-7.602&PDate=12/19/2008&Section=1

REFERENCE MATERIALS:

No reference(s).

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