DEPARTMENT OF FINANCIAL SERVICES
Division of Workers' Compensation
RULE NO.:RULE TITLE:
69L-7.100Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 48 No. 164, August 23, 2022 issue of the Florida Administrative Register.
The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, incorporated by reference into Rule 69L-7.100, is amended as follows:
On Page 8, under the heading “Billing to Carriers,” the fourth bullet point is deleted and replaced with: Any copies of medical records required by the employer or carrier, that the ASC received written notification from the employer or carrier as being a required component for reimbursement, when the services were authorized.
On Page 12, under the heading “Determining Surgical Implant Acquisition Cost,” the language is amended to read: When determining the acquisition invoice cost for Surgical Implant(s), the ASC must subtract any and all price reductions, offsets, discounts, adjustments, or refunds which accrue to, or are factored into, the final net cost to the ASC, only if the price reductions, offsets, discounts, adjustments, or refunds appear on the acquisition invoice, before increasing the acquisition invoice amount by the percentage factor described under Surgical Implant Reimbursement in this Manual.
On Page 16, under the heading “Minimum Partial Payment Required,” the second paragraph is deleted entirely and the first paragraph is amended to read as follows: When a carrier denies, disallows, or adjusts payment for ASC charges, in accordance with the time limitation and coding requirements established by statute and by rule, the carrier must remit a minimum partial payment of the ASC’s charges. Minimum partial payment means payment of all non-disputed charges for which there is no dispute as to the medical necessity. The payment must accompany the Explanation of Bill Review (EOBR).
On Page 18, under the heading “Codes and Modifiers for Billing,” the paragraph that reads “Note: ASCs must utilize the Workers’ Compensation Unique Modifier CZ with any billed CPT® code that is not listed in Appendix A in this Manual.” is deleted.
