Florida Division of Workers’ Compensation Holds Workshop On Hospital Reimbursement Manual Proposed Changes

Sep 19, 2013


The Florida Division of Workers’ Compensation (“DWC”) held a Rule Development Workshop today, September 19, 2013, on proposed Rule 69L-7.501 relating to the Florida Workers’ Compensation Reimbursement Manual for Hospitals (“Manual”). 

DWC Assistant Director Andrew Sabolic explained that the proposed changes to the Manual would implement recommendations made to the Three-Member Panel at its meeting on January 9, 2013.  The changes represent a 16.5 percent increase for per-diems for acute hospital surgical and non-surgical care, trauma hospital surgical and non-surgical care, and for stop-loss threshold. 

Mr. Sabolic also noted that the changes revise the hospital outpatient reimbursement payment methodology.  Under the proposed changes, usual and customary charges are to be reimbursed based on statewide average charges of outpatient hospital bills, by CPT code and HCPCS Level II code in a specific geographic area.

Representatives of the Florida Hospital Association and a hospital group asked questions about the methodology for the increased per-diems and stop loss-threshold.  DWC officials explained that the increase was based on the aggregated Consumer Price Index.

A Florida Hospital Association representative also asked whether the DWC had plans to update the base rate prior to the final Rule hearing.  The DWC officials indicated that there are no plans to do so.   Further, additional changes in the base rate would need to be presented to the Three-Member Panel for future Manual revisions.

It was advised that the record will be left open for comment for 10 business days.

Attached are copies of the Draft Manual, index of proposed changes, and the data and methodology for the reimbursement schedule.


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