Florida Division of Workers’ Compensation Reviews Proposed Amendments to Medical Services Billing, Filing and Reporting Rule
Aug 6, 2012
On August 3, 2012, the Florida Department of Financial Services (“DFS”) Division of Workers’ Compensation held a hearing on Rule 69L-7.602, entitled “Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule.” This proposed Rule (which applies to dates of injury occurring on or after October 1, 2003) clarifies that an insurer must provide health care providers with prior notification of a decision to apply apportionment in the payment of reimbursement for medical services. To view the complete text of the proposed Rule and meeting notice, click here.
Further, under the provisions of the proposed Rule, an insurer shall, at the time of authorization or, if the decision to apportion the reimbursement is made after authorization, but prior to the rendering of services, provide each health care provider with written or electronic notification of its decision to apply apportionment in the payment of reimbursement for medical services. The proposed Rule would also transfer to Rule 69L-24 the language pertaining to penalties and fines for untimely payments to health care providers. A preliminary economic analysis prepared by the agency estimates that each carrier would incur programming costs of $1,125 to comply with the new Rule.
At the hearing, the DFS officials provided brief opening comments and moved the proceedings into the public comment portion of the agenda. An Ambulatory Surgical Centers (“ASC”) representative who had requested the hearing provided testimony. He suggested that the second sentence in the new subparagraph 69L-7.062 (5)(b)(2) of the Rule be removed. The language provides for carriers to be allowed to apportion care attributable to a pre-existing condition after authorization. This provision could prevent ASC from being paid for the services rendered, he explained.
Eric Lloyd noted that the purpose of that sentence is to ensure that a carrier is not barred from apportioning care after authorization, which is consistent with the statutes. However, Mr. Lloyd indicated he is open to addressing the concerns of the ASC representative, although he did not provide specific solutions at the hearing. If changes to the Rule are made, a Notice of Change will be issued, he said.
The record will remain open for 10 days for additional written comments.
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