To adopt the new version of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2006 Edition, to implement the reimbursement rates authorized by the Three-Member Panel pursuant to Section 440.13(12), F.S., at its ...

 

DEPARTMENT OF FINANCIAL SERVICES
Divsion of Worker's Compensation

RULE NO: RULE TITLE
69L-7.100: Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)
PURPOSE AND EFFECT: To adopt the new version of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2006 Edition, to implement the reimbursement rates authorized by the Three-Member Panel pursuant to Section 440.13(12), F.S., at its meeting on December 14, 2006. In addition, the proposed Rule 69L-7.100 will adopt updated versions of the American Medical Association Current Procedural Terminology, CPT® 2007 Professional Edition, Copyright 2006, the American Medical Association “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes Manual” HCPCS® 2007, Nineteenth Edition, Copyright 2006, and the American Dental Association Current Dental Terminology, CDT® 2007/08, Copyright 2006, and the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2006 Edition.

SUMMARY: Rule amendment reflecting changes to certain reimbursement levels, policy instructions, and, reference materials as authorized by Florida’s Three-Member Panel.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COST: No Statement of Estimated Regulatory Cost was prepared.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

SPECIFIC AUTHORITY: 440.13(4), (14), 440.591 FS.
LAW IMPLEMENTED: 440.13(7), (12), (14) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: Tuesday, February 13, 2007; 9:00 a.m.

PLACE: 104J Hartman Building, 2012 Capital Circle, S.E., Tallahassee, Florida

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Don Davis, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4226, phone [phone]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

69L-7.100 Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs).

(1) The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2006 2005 Edition, (ASC Reimbursement Manual) is incorporated adopted by reference as part of this rule. The ASC Reimbursement Mmanual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to Section 440.13 (12), Florida Statutes and establishes reimbursement policies, guidelines, codes and maximum reimbursement allowances (MRAs) for ambulatory surgical facility services, which are items and services provided to an injured worker in connection with a surgical procedure performed in an Ambulatory Surgical Center. The ASC Reimbursement Mmanual is available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida 32399-0311, or via the Department’s web site at http://www.fldfs.com/wc. contains basic instructions and information for all ambulatory surgical centers and insurers concerning reimbursement of claims for ambulatory surgical facility services.

(2) The ASC division has incorporated in the Florida Workers’ Compensation Reimbursement Manual refers to a number of for Ambulatory Surgical Centers, 2005 Edition, procedure codes and modifiers that are consistent with the Physicians’ Current Procedural Terminology (CPT®), developed and published by the American Medical Association.  When a service or procedure is performed that does not have a code listed in the ASC Reimbursement Manual, the Ambulatory Surgical Center shall refer to the Current Procedural Terminology (CPT®), 2007 Professional Edition, Copyright 2006, American Medical Association, 2005 Profession Edition, Copyright 2004, American Medical Association. This which is hereby incorporated publication is adopted by reference as part of this rule. When a  procedure is performed which is not listed in the manual, the ambulatory surgical center must use the appropriate code and descriptor contained in the Physicians’ Current Procedural Terminology (CPT®), 2005 Professional Edition, Copyright  2004, American Medical Association.

(3) The Current Dental Terminology (CDT-2007/2008), Copyright 2006, American Dental Association, and the Healthcare Common Procedure Coding System, Medicare’s National Level II Codes, HCPCS 2007, Nineteenth Edition, Copyright 2006, Ingenix Publishing Group, are incorporated by reference as part of this rule, for dental D codes, injectable J codes, and other medical services or supply codes as specified in the ASC Reimbursement Manual. The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2005 Edition, incorporated above, is available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida 32399-0311, or via the Department’s web site at http://www.fldfs.com.

(4) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2006, incorporated by reference into Rule 69L-7.020, F.A.C., is also incorporated by reference into this rule.  The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2006, is available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida 32399-0311, or via the Department’s web site at http://www.fldfs.com/wc.

Specific Authority 440.13(4), (14), 440.591 FS. Law Implemented 440.13(7), (12), (14) FS. History–New 8-7-91, Amended 12-31-92, Formerly 38F-7.100, 4L-7.100, Amended  9-4-05,_________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Don Davis, Office of Data Quality and Collection, Division of Workers’ Compensation

NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Dan Sumner, Assistant Director, Division of Workers’ Compensation

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: October 6, 2006

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: October 20, 2006