Florida Posts New Workers’ Comp Doctor Reimbursement, But Lawmakers Must Review

The Florida Division of Workers’ Compensation has adopted a new reimbursement manual, governing fee schedules and payments to doctors and other health care providers.

The 2020 Health Care Provider Reimbursement Manual was adopted by the division on Oct. 22 after months of input, including a hearing that was held in August. But Florida law requires legislative approval of most rule changes that would raise costs for Florida businesses.

Lawmakers have declined to review the manuals for the past few years, leaving providers stuck with the 2016 manual and reimbursement levels. The latest manual will not take effect until the Legislature approves, the DWC said.

Physician groups and national reports have said that Florida’s workers’ comp fee schedules for doctors provide some of the lowest reimbursements in the country. The new manual would not raise payments significantly but would make other changes.

The 2020 manual aims to settle questions about reimbursement when medical procedures are not listed in the fee schedule. The new language reads:

“When the health care provider bills a valid procedure code found in the CPT® or the HCPCS Level II® manual that corresponds to the date of service, and the procedure code is not listed in the fee schedule in this Manual, reimbursement is determined by:

• Comparing the billed procedure code with a clinically similar procedure code found in this Manual;
• The health care provider’s documentation and medical bills; or
• The National Physician Fee Schedule Relative Value File copyrighted by the American Medical Association.

At a minimum, reimbursement must be the Florida Workers’ Compensation MRA (maximum reimbursement allowance) for a clinically similar procedure code that is listed in this Manual or an agreed upon contract price. Carriers must have an established methodology for determining reimbursement for procedure codes that are not listed in this Manual and the methodology must be available upon request by the Division.”

Gone from the manual is language that required that procedures not listed in the fee schedule must be made according to an agreed-upon contract price.

A summary of the proposed changes can be seen here.

Topics Florida Legislation Workers' Compensation