Proposed Workers Comp Hospital Reimbursement Manual, Health Care Billing Rules to be Considered On December 2
Nov 18, 2009
DFS Rule Workshop-Florida Workers’ Compensation Billing Requirements and Violations
The Florida Department of Financial Services (“DFS”), Division of Workers’ Compensation has issued a Notice of Rulemaking Development regarding the following proposed Rules that would require workers’ compensation carriers to report all instances of health care provider over-utilization, as well as improper billing and billing errors:
- 69L-34.001: Definitions
- 69L-34.002: Mandatory Carrier Reporting
- 69L-34.003: Referral of Alleged Health Care Provider Violation
- 69L-34.004: Timeliness of Referral
- 69L-34.005: Referral Investigation
- 69L-34.006: Invalid Referrals
The proposed Rules would also:
- Clarify that workers’ compensation carriers may fulfill their mandatory reporting requirements by filing the medical claims data elements required in Rule 69L-7.602, F.A.C.; and
- Provide a method by which carriers may report other health care provider violations, such as failure to submit medical records and reports, failure to refund an overpayment of reimbursement, collecting payment from an injured employee or failure to follow standards of care.
If a Rule Development Workshop is requested in writing and not deemed unnecessary by the agency head, one will be held at the date, time, and place shown below:
Date: Wednesday, December 2, 2009
Time: 9:00 a.m.
Place: Room 104-J of the Hartman Building, 2012 Capital Circle Southeast, Tallahassee
Proposed Rule Hearing-Florida Workers’ Compensation Manual for Hospitals
The DFS, Division of Workers’ Compensation has issued a Notice of Proposed Rule regarding Rule 69L-7.501: Florida Workers’ Compensation Reimbursement Manual for Hospitals (“Reimbursement Manual”).
The proposed Rule amendments would use Medicare’s Hospital Outpatient Prospective Payment System to reimburse hospitals for outpatient bills. Payment adjustment factors of 1.74 times the Medicare allowed amount for scheduled surgeries and 3.95 times the Medicare amount for other specified compensable charges would be applied. Additional changes to the Reimbursement Manual would include recognition of the Integrated Outpatient Code Editor, National Correct Coding Initiative edits and updates from the Centers for Medicare and Medicaid Services in the Medicare Hospital Outpatient Prospective Payment System. Technical formatting changes to the Reimbursement Manual also would be made.
If a Rule Hearing is requested in writing and not deemed unnecessary by the agency head, one will be held at the date, time, and place shown below:
Date: Wednesday, December 2, 2009
Time: 1:30 p.m.
Place: Room 104-J of the Hartman Building, 2012 Capital Circle Southeast, Tallahassee
Should you have any questions or comments, please contact Colodny Fass.
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