Florida Workers’ Compensation Health Care Provider Reimbursement Manual: Rule Development Hearing Report
Sep 10, 2008
The Florida Department of Financial Services (“DFS”), Division of Workers’ Compensation held a Rule Development Hearing on September 9, 2008 to discuss Rule 69L-7.020: Florida Workers’ Compensation Health Care Provider Reimbursement Manual. To view a copy of the meeting Notice, click here.
While most of the proposed revisions to the Manual were administrative, the main change was in Section II: Basic Program Requirements, which would allow insurers to be able to utilize the National Correct Coding Initiative edits as part of the bill review process.
Technical changes also were proposed to Appendix C modifiers and other reference material.
The Hearing was held to review proposed Rule amendments adopting the 2008 Edition of the Florida Workers’ Compensation Health Care Provider Manual and implement the 2008 conversion factors issued by the Centers for Medicare and Medicaid Services and approved by the three member Panel.
Additional proposed amendments to the Rule would 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 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 would 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 of injured employees.
New language relating to reimbursement disputes 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 DFS pursuant to Florida law.
The Hearing was then adjourned.
Should you have any questions or comments, please do not hesitate to contact Colodny Fass.
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