7891161, 69L-7.501 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 7891161

Notice of Proposed Rule

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Workers' Compensation

Chapter:

WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW

Overview

RULE:

69L-7.501

Florida Workers' Compensation Reimbursement Manual for Hospitals

PURPOSE:

The purpose and effect of the proposed rule development is to amend the rule to adopt by reference the 2009 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals, replacing the 2006 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals in the existing rule. The 2009 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals will incorporate Medicare’s Hospital Outpatient Prospective Payment System payment methodology for reimbursing hospitals for outpatient bills, with payment adjustment factors of 1.74 times the Medicare allowed amount for scheduled surgeries and 3.95 times the Medicare allowed amount for other specified compensable charges, as approved by the Three Member Panel at its November 20, 2008 meeting. The 2009 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals also incorporates a definition for the Medicare Hospital Outpatient Prospective Payment System, recognizes the Integrated Outpatient Code Editor and the National Correct Coding Initiative (NCCI) edits and their updates from the Centers for Medicare and Medicaid Services (CMS) in the Medicare Hospital Outpatient Prospective Payment System, and makes technical changes to include a new manual format, an expanded table of contents and a listing of chapters by topic.

SUMMARY:

Rule amendment to change the Florida Workers’ Compensation Manual for Hospitals to incorporate Medicare’s Hospital Outpatient Prospective Payment System for reimbursing hospitals for outpatient bills, with payment adjustment factors of 1.74 times the Medicare allowed amount for scheduled surgeries and 3.95 times the Medicare amount for other specified compensable charges. Additional changes to the manual include recognition of the Integrated Outpatient Code Editor and the National Correct Coding Initiative edits and their updates from the Centers for Medicare and Medicaid Services in the Medicare Hospital Outpatient Prospective Payment System, and technical formatting changes to the manual.

RULEMAKING AUTHORITY:

440.13(12),(14), 440.591 FS.

LAW:

440.13(7), (12), (14) FS.

PRINT PUBLISH DATE:

11/6/2009 Vol. 35/44

COMMENTS:

From 11/6/2009 To 11/27/2009 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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