69L-30.008. Billing and Reimbursement for Expert Medical Advisor Services  


Effective on Tuesday, March 1, 2016
  • 1(1) Within 30 calendar days following submittal of the written report, the EMA must submit billing, per the contract with the Department or JCC, for services, documenting total number of hours and total dollar charges for the contracted services.

    40(2) If additional diagnostic testing is required for the EMA to render a medical opinion, charges for diagnostic testing shall:

    60(a) Require prior authorization from the JCC or the Department; and,

    71(b) Be billed in accordance with Rule 7869L-7.730, 79F.A.C.; and,

    81(c) Be reimbursed in accordance with the appropriate Florida Workers’ Compensation reimbursement manual in effect on the date services were completed.

    102(3) Within 45 calendar days from receipt of both the written report and invoice, reimbursement shall be rendered to the EMA pursuant to paragraph 126440.13(9)(f), F.S.

    128(4) Hourly reimbursement for EMA services shall be for all services rendered except specialty-diagnostic testing.

    143(5) Reimbursement, pursuant to an EMA Contract, in accordance with subsections 15469L-30.005(2) 155and (3), F.A.C., shall be as follows:

    162(a) Except as provided in paragraph (b), reimbursement shall not exceed $300.00 per hour, per case, not including reasonable expenses associated with travel, when applicable, which will be reimbursed in accordance with Section 195112.061, F.S. 197The review shall not exceed 8 hours per case unless specifically approved in writing by the Department or JCC, as applicable.

    218(b) When an examination of an injured employee is required for the EMA to render a medical opinion, charges for an examination shall:

    2411. Require prior authorization from the requesting party;

    2492. Be billed in accordance with Rule 25669L-7.730, 257F.A.C.; and,

    2593. Be reimbursed in accordance with the appropriate Florida Division of Workers’ Compensation reimbursement manual in effect on the date services were rendered.

    282(c) An EMA shall be reimbursed for travel and other administrative expenses consistent with the terms of the contract between the EMA and the Department.

    307(d) Fees for EMA deposition testimony are limited to $200 per hour, pursuant to subsection 322440.13(10), F.S.

    324Rulemaking Authority 326440.13(9), 327440.591 FS. 329Law Implemented 331440.13(9) FS. 333History–New 1-23-95, Formerly 38F-54.008, Amended 10-11-06, Formerly 34059A-30.008, 341Amended 3-1-16.