The purpose of these proposed rules is to adopt the 2010 version of the Florida Workers’ Compensation Reimbursement Manual for Health Care Providers and the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, ...

DEPARTMENT OF FINANCIAL SERVICES
Division of Worker's Compensation

RULE NO.: RULE TITLE:
69L-7.020: Florida Workers' Compensation Health Care Provider Reimbursement Manual
69L-7.100: Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)
PURPOSE AND EFFECT: The purpose of these proposed rules is to adopt the 2010 version of the Florida Workers’ Compensation Reimbursement Manual for Health Care Providers and the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, respectively. These rule making activities will also result in publication of the reimbursement rates authorized by the Three Member Panel, pursuant to Section 440.13(12), F.S., at its public meeting held on December 18, 2009. In addition, both proposed rules will adopt updated versions of the American Medical Association’s Current Procedural Terminology, CPT© 2010 Professional Edition, Copyright 2009, the American Medical Association’s “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes Manual” HCPCS 2010, Copyright 2009, Ingenix Publishing Group, and the American Dental Association Current Dental Terminology, CDT® 2009/2010, Copyright 2008. In addition, the 2010 ICD-9-CM Professional for Hospitals, Volumes 1, 2 and 3, International Classification of Diseases, 10th Revision, Clinical Modification, Copyright 2009, Ingenix, Inc. (American Medical Association); the Physician ICD-9-CM 2010, Volumes 1 & 2, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2009, Ingenix, Inc. (American Medical Association).
SUMMARY: The proposed rules address revisions to Rules 69L-7.020, (Florida Workers’ Compensation Health Care Provider Reimbursement Manual) and 69L-7.100, F.A.C. (Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers). Each proposed rule incorporates an updated (2010) edition of its respective reimbursement manual, which publishes the maximum reimbursement allowances (MRAs) as established by the Three Member Panel, pursuant to Section 440.13(12), F.S. The rules also incorporate updated reference materials, guidelines regarding the medical billing process, and utilize efficient new formats. Additionally, the ASC Manual, as amended, incorporates certain policy language currently contained within Rule 69L-7.602, F.A.C. (Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule).
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. An SERC has been prepared by the agency.
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.
RULEMAKING AUTHORITY: 440.13(4), (14), (14)(b), 440.591 FS.
LAW IMPLEMENTED: 440.13(7), (12), (14)(c) 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: Wednesday, July 13, 2011, 9:00 a.m. – 10:30 a.m. (HCP Rule), 11:00 a.m. – 12:30 p.m. (ASC Rule)
PLACE: 104J Hartman Bldg., 2012 Capital Circle S.E., Tallahassee, Florida
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Eric Lloyd, [phone] or [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Eric Lloyd, Program Administrator, Office of Medical Services, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4225, [phone]

THE FULL TEXT OF THE PROPOSED RULE IS:

69L-7.020 Florida Workers’ Compensation Health Care Provider Reimbursement Manual.

(1) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2010 2008 Edition, is adopted by reference as part of this rule. The manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to Section 440.13(12), F.S., and establishes reimbursement policies, guidelines, codes and maximum reimbursement allowances for services and supplies provided by health care providers. Also, the manual includes reimbursement policies and payment methodologies for pharmacists and medical suppliers.

(2) The CPT^® 2010 2009 Current Procedural Terminology Professional Edition, Copyright 2009 2008, American Medical Association; the Current Dental Terminology, CDT-2009/2010 2007/2008, Copyright 2008 2006, American Dental Association; and in part for D codes and for injectable J codes, and for other medical services and supply codes, the “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes, HCPCS 2010 2009”, American Medical Association, Twenty-first Edition, Copyright 2009 2008, Ingenix Publishing Group, are adopted by reference as part of this rule. When a health care provider performs a procedure or service which is not listed in the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2010 2008 Edition incorporated above, the provider must use a code contained in the CPT^®-2010 2009, CDT-2009/2010 2007/2008 or HCPCS-2010 2009 as specified in this section.

(3) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2010 2008 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.myfloridacfo.com/wc/provider/reimbursement-manuals.html.

Rulemaking Specific Authority 440.13(14)(b), 440.591 FS. Law Implemented 440.13(7), (12), (14)(c) FS. History–New 10-1-82, Amended 3-16-83, 11-6-83, 5-21-85, Formerly 38F-7.20, Amended 4-1-88, 7-20-88, 6-1-91, 4-29-92, 2-18-96, 9-1-97, 12-15-97, 9-17-98, 9-30-01, 7-7-02, Formerly 38F-7.020, 4L-7.020, Amended 12-4-03, 1-1-04, 7-4-04, 5-9-05, 9-4-05, 11-16-06, 10-18-07,_________.

 

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

(1) The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2010 2006 Edition, (ASC Reimbursement Manual) is incorporated by reference as part of this rule. The ASC Reimbursement Manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to Section 440.13(12), F.S., and establishes reimbursement policies, guidelines, codes and maximum reimbursement allowances (MRAs) for services provided to an injured worker in connection with a surgical procedure performed in an Ambulatory Surgical Center.

(2) The ASC Reimbursement Manual refers to a number of procedure codes and modifiers that are consistent with the 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^®), 2010 2007 Copyright 2009 2006, American Medical Association, which is hereby incorporated by reference as part of this rule. In addition, the rule incorporates the 2010 ICD-9-CM Professional for Hospitals, Volumes 1, 2 and 3, International Classification of Diseases, 10th Revision, Clinical Modification, Copyright 2009, Ingenix, Inc. (American Medical Association); the Physician ICD-9-CM 2010, Volumes 1 & 2, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2009, Ingenix, Inc. (American Medical Association).

(3) The Current Dental Terminology (CDT-2009/2010 2007/2008), Copyright 2008 2006, American Dental Association, and the Healthcare Common Procedure Coding System, Medicare’s National Level II Codes, HCPCS 2010 2007, Twenty-second Nineteenth Edition, Copyright 2009 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.

(4) The ASC Reimbursement Manual 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.myfloridacfo.com/wc/provider/reimbursement-manuals.html.

Rulemaking 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: Tanner Hollomon, Director, Division of Workers’ Compensation, Department of Financial Services
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Jeff Atwater, Chief Financial Officer, Department of Financial Services
DATE PROPOSED RULE APPROVED BY AGENCY HEAD:
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: August 20, 2010