7255617, 69L-7.602 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 7255617

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-7.602

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), 2009; the 2009 ICD-9-CM Professional for Hospitals, Volumes 1, 2 and 3, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2008, Ingenix, Inc. (American Medical Association); the Physician ICD-9-CM 2009, Volumes 1 & 2, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2008, 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®), 2009 Professional Edition, Copyright 2008, 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 03/22/2010, 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 Practitioner” 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), 2009, which details the Revision E layout requirements, also provides 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, as well as 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 also provides new language which specifies that a health care provider shall bill multiple services, rendered on the same date of service, on a contiguous bill and also clarifies billing instructions for dentists and oral surgeons who dispense medications, and for those entities that are neither physicians nor recognized health care providers. Such entities are required to bill on their invoice or letterhead rather than using Department forms. New language provides that insurers, or entities acting on behalf of insurers, are responsible for correcting and resubmitting previously accepted data which is later deemed inadequate by the Division. The proposed amendment also clarifies the reciprocal responsibilities between health care providers and insurers regarding requests for the submission of any supporting documentation which is outside the requirements of this rule and applicable manual. Finally, the proposed amendment deletes obsolete references and language, renumbers the rule, and makes ministerial changes where necessary.

SUMMARY:

Rule amendment reflecting changes and updates to forms, reference materials, EDI requirements, and billing instructions for providers and insurers associated with the Florida Workers’ Compensation Medical Services Billing, Filing, and Reporting Rule.

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:

6/12/2009 Vol. 35/23

COMMENTS:

From 6/12/2009 To 7/3/2009 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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