Definitions, Qualifications for Expert Medical Advisor Certification, Application for Expert Medical Advisor Certification, Selection of Expert Medical Advisors, Temporary Expert Medical Advisors, Expert Medical Advisor Responsibilities, Billing and ...
DEPARTMENT OF FINANCIAL SERVICES
Division of Worker’s Compensation
RULE NOS.:RULE TITLES:
69L-30.002Definitions
69L-30.003Qualifications for Expert Medical Advisor Certification
69L-30.004Application for Expert Medical Advisor Certification
69L-30.005Selection of Expert Medical Advisors
69L-30.006Temporary Expert Medical Advisors
69L-30.007Expert Medical Advisor Responsibilities
69L-30.008Billing and Reimbursement for Expert Medical Advisor
NOTICE OF CORRECTION
Notice is hereby given that the following correction has been made to the proposed rule in Vol. 41 No. 57, March 24, 2015 issue of the Florida Administrative Register.
69L-30.002 Definitions.
For purposes of this rule chapter the following definitions apply:
(1) No change.
(2) “Board eligible” or “board eligibility” means the physician has been determined eligible to take the board certification examination recognized by one or more of the applicable national-specialty boards recognized by the State of Florida Department of Health board as eligible to take the board certification examination.
(3) No change.
(4) “Expert Medical Advisor” (hereinafter “EMA”) is a physician certified by the Department to render peer review or expert medical consultation, opinions and testimony, within the advisor’s specialty area, to assist Judges of Compensation Claims (“JCC”) and the Department in resolving issues related to reimbursement, differing opinions of health care providers, and physician and health care services rendered under the Florida Workers’ Compensation health care delivery system.
(5) through (6) No change.
(7) “EMA Tutorial” means the Florida Department of Financial Services, Division of Workers’ Compensation (“DWC”), Expert Medical Advisor Certification Tutorial, which is accessible online at the DWC website at www.myfloridacfo.com/division/wc/provider.html. The EMA Tutorial is the means by which a physician demonstrates knowledge of Section 440.13, F.S., and applicable Administrative Rules adopted by the Department.
(8) through (9) No change.
(10) “Temporary EMA” is a physician identified by a JCC or the Department for temporary certification by the Department, who is board certified in a specialty area in which no Certified EMA is available to render the services necessary for the JCC or the Department to fulfill their statutory responsibilities under Chapter 440, F.S.
69L-30.003 Qualifications for Expert Medical Advisor Certification and Re-Certification.
(1) No change.
(2) A physician who has performed services as a Temporary EMA for either a JCC or the Department within the two-year period immediately preceding the date of application for certification shall not be required to meet the requirements of subparagraphs (1) (d) and (e) of this rule.
(3) No change.
(4) A physician who has been disciplined for a standard of care or a billing error violation, pursuant to Section 440.13, F.S., shall not be certified as an EMA.
69L-30.004 Application Process for Expert Medical Advisor Certification.
(1) A physician shall apply for Expert Medical Advisor certification by satisfactorily completing the on-line tutorial and certification process that are accessible through the DWC website at www.myfloridacfo.com/division/wc/provider.html submitting a signed, legible and accurately completed Expert Medical Advisor Certification Application, DFS Form 3160-0021, to the following address: Division of Workers’ Compensation, Office of Medical Services, c/o Department of Financial Services, 200 E. Gaines Street, Tallahassee, FL 32399-4232. The Expert Medical Advisor Certification Application, DFS Form 3160-0021, revised May 2006, is incorporated by reference into Chapter 69L-30, F.A.C., and may be obtained from the Office of Medical Services, c/o Department of Financial Services, Division of Workers’ Compensation’s website: www.myfloridacfo.com/wc/forms.html#7.
(2) As part of the EMA Expert Medical Advisor certification application process, the physician shall agree to provide consultation or services in accordance with the timetables set forth in Chapter 440, F.S., and abide by rules adopted by the Department, may appoint a physician including, but not limited to, rules pertaining to procedures for review of the services rendered by health care providers and preparation of reports and testimony or recommendations for submission to the Department or JCC judge of compensation claims.
(3) The certification application process shall be considered properly completed when the physician passes the EMA Tutorial and provides accompanied by the following documentation to establish that the qualifications for Expert Medical Advisor certification set forth in Rule 69L-30.003, F.A.C., have been met.: Failure to properly complete the application process shall result in the application being rejected. Subject to the limitations in this rule chapter, a rejected applicant can immediately re-apply.
(4) through (8) No change.
69L-30.005 Selection of Expert Medical Advisors.
(1) All individuals on the Certification List are eligible contracted to provide EMA services for through certification as an Expert Medical Advisor will be placed on an Department list of certified Expert Medical Advisors eligible for selection as an Expert Medical Advisor by the Department or a JCC judge of compensation claims.
(2) No change.
(3) When Expert Medical Advisor services are needed in a proceeding before a JCC judge of compensation claims, the JCC judge of compensation claims shall:
(a) and (b) No change.
(4) Upon receiving notice of selection by the Department or JCC judge of compensation claims as an Expert Medical Advisor, the EMA physician shall disclose any conflict of interest related to the case for which the physician was selected and shall decline selection if a conflict of interest exists as an Expert Medical Advisor.
(5) No change.
69L-30.006 Temporary Expert Medical Advisors.
(1) When a JCC judge of compensation claims cannot identify an appropriate EMA needs Expert Medical Advisor services and there is no Expert Medical Advisor from the physicians on the Certification List Department’s list of certified Expert Medical Advisor who meets the needs of the judge of compensation claims and is available to provide the Expert Medical Advisor services needed, the JCC judge of compensation claims may propose a specific physician for temporary Expert Medical Advisor certification by the Department.
(2) The Department will certify the specific physician proposed by the JCC judge of compensation claims as a Temporary EMA for a specific case, Expert Medical Advisor if one of the following is met:
(a) All parties in a proceeding before the JCC judge of compensation claims stipulate to the qualifications of the medical specialty board certified or board eligible physician to provide Expert Medical Advisor services in the JCC judge of compensation claims proceeding; or
(b) The physician has a clear valid and active license to practice medicine, has medical specialty board certification or is board eligible and the JCC judge of compensation claims has established that the physician has training or experience applicable to the specific medical issue before the JCC judge of compensation claims.
(3)(4) No change.
(4)(5) Upon receiving notice of selection by the JCC judge of compensation claims as a Temporary EMA Expert Medical Advisor, the physician shall disclose any conflict of interest related to the case for which the physician was selected and shall decline selection as a Temporary EMA if a conflict of interest exists pursuant to Rule 69L-30.007, F.A.C. Expert Medical Advisor.
(5) through (7) No change.
69L-30.007 Expert Medical Advisor Responsibilities.
(1) through (2) No change.
(3)(2) When the JCC judge of compensation claims selects an EMA or Temporary EMA Expert Medical Advisor, the EMA or Temporary EMA Expert Medical Advisor shall complete and submit a written report to the JCC judge of compensation claims within 15-calendar days following receipt of all medical records and, when appropriate, examination of the injured employee. The medical records to which may be submitted to an Expert Medical Advisor shall be within the discretion of the JCC judge of compensation claims.
(4)(3) through (5)(4) No change.
69L-30.008 Billing and Reimbursement for Expert Medical Advisor Services.
(1) Within 30 calendar days following completion of the written report, the EMA physician must submit billing for Expert Medical Advisor services on the Department approved or JCC judge of compensation claims approved invoice, as applicable, documenting total number of hours and total dollar charges for the contracted services.
(2) In a judge of compensation claims proceeding, If additional diagnostic testing is required for the EMA Expert Medical Advisor to render a medical opinion, charges for diagnostic testing shall:
(a) Require prior authorization from the JCC judge of compensation claims or of the Department; and
(b) through (c) No change.
(3) through (4) No change.
(5)(a) Except as provided in paragraph (b), For an Expert Medical Advisor selected by the Department pursuant to subsection 69L-30.005(2), F.A.C., reimbursement for shall not exceed $300.00 $200.00 per hour, for no more than 8 hours per case, not including reasonable expenses associated with travel, when applicable, which will be reimbursed in accordance with section Section 112.0681, F.S. The review shall not exceed 8 hours per case unless specifically approved in writing by the Department or JCC, as applicable.
(b) through (d) No change.
The remainder reads as previously published.
