Substantial Revision Proposed For Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule

 

A substantial overhaul of Rule 69L-7.710, F.A.C., (formerly Rule 69L-7.602, F.A.C.), entitled “Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule” will be the subject of a Florida Division of Workers’ Compensation (“DWC”) Rule Development Workshop scheduled for June 18, 2014 from 9:00 a.m. to 12:30 p.m. in Tallahassee, Florida.

Existing Rule 69L-7.710, F.A.C. has been rewritten and re-organized into five proposed Rules that are intended to replace it under existing Chapter 69L-7, entitled “Workers’ Compensation Medical Reimbursement and Utilization Review.”

The proposed new Rules would be:

69L-7.710  Definitions
69L-7.720  Forms Incorporated by Reference for Medical Billing, Filing and Reporting
69L-7.730  Health Care Provider Medical Billing and Reporting Responsibilities
69L-7.740  Insurer Authorization and Medical Bill Review Responsibilities
69L-7.750  Insurer Electronic Medical Report Filing to the Division

To view the text of each, click here.

The proposed Rules incorporate updated versions of Form DFS-F5-DWC-9 and related instructions, including revised instructions for dispensing practitioners when billing for dispensed medications, and for pharmacists billing on Form DFS-F5-DWC-10. 

Likewise, the proposed Rules incorporate revised form completion instructions for pharmacies and pharmacists, hospitals, ambulatory surgical centers, health care providers, work-hardening programs, nursing homes and home health agencies.  In addition, there are new, revised and deleted definitions that support the implementation of SB 662, Ch. 2013-131, L.O.F. and, upon federal implementation, use of the ICD-10.  This proposal would also incorporate Revision F to the Florida Medical EDI Implementation Guide (MEIG).

The proposed Rules transfer an entire section of the former Rule, entitled “Materials Incorporated by Reference,”  to proposed new Rule Chapter 69L-8, F.A.C., “Selected Materials Incorporated by Reference,” which would be organized under proposed new Rule 69L-8.074, F.A.C., “Materials for use throughout Rule Chapter 69L-7, F.A.C.” 

The proposed creation of Rule Chapter 69L-8, F.A.C. is intended to facilitate future timely and efficient revisions to materials used in the billing and adjustment of Florida workers’ compensation medical services, such as the Current Procedural Terminology (CPT) Manual, thereby enabling the DWC to more effectively update incorporated materials.

The June 18 Workshop will be held in Room 102 of the Hartman Building, which is located at 2012 Capital Circle Southeast, Tallahassee.

Workshop documents are hyperlinked below:

• 69L-7.710–.750 – NOTDEV 6-2-2014 – Notice and proposed Rule language for dividing 69L-7.710 into multiple Rules.
• 69L-8.074 – NOTDEV 6-2-2014 – This is the proposed language that would move 69L-7.710(3), Materials Incorporated by Reference, into a new section (Rule 69L-8.074).
• MEIG Rev F 2014 6-3-2014 – Proposed Medical EDI Implementation Guide, Revision F (MEIG, Rev. F).
• 2014 Draft Billing Rule Revision – Strike-Through Version – A document illustrating the revisions in a more user-friendly way.  While the revisions appear as all new language, the DWC points out that they are actually revisions of existing language.  This document shows strike-through language to emphasize the revisions and is for informational purposes only.  The DWC notes that this version does not conform precisely to rulemaking guidelines.

 

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