The Florida Division of Workers’ Compensation will hold hearings on Aug. 30 to discuss changes to some medical reimbursement levels and procedures, the latest step in a sometimes contentious process that has lasted more than two years.
Tuesday’s hearings probably won’t be the end of the debate, stakeholders say. After legal challenges, hearings and several revisions, the DWC has landed on some significant changes that are sure to please workers’ comp insurers on hospital outpatient and ambulatory surgical center costs. But hospital inpatient charges as described in one proposed reimbursement manual are still much higher than what most surrounding states allow, said Jerry Fogel, a consultant with Imagine Clinical who represents a coalition of insurance carriers.
Most Southeast states allow inpatient reimbursement of $4,000 to $6,000 per day, but the latest plan would set Florida’s rates as high as $13,000, he said.
The good news, Fogel said, is that the manuals for outpatient services and ASCs now include maximum reimbursement amounts for many more procedures. For years, medical centers and insurers have argued over the appropriate payment for procedures that weren’t listed in the manuals. The proposed manuals also would set per-diem rates for ASCs and hospital outpatient services, bringing some certainty to the payment and bill review process.
The DWC has made other changes to the text of the manuals. The ASC manual, for example, stresses the insurer’s responsibility: “Carriers must inform ASCs of the specific reporting, billing, and submission requirements of Rule Chapter 69L-7, F.A.C., and any terms of settlement or apportionment, when known, and provide the specific address for submitting the ASC bill.”
The surgical centers also have responsibilities: “An ASC is required to meet their obligations under this Manual, regardless of any business arrangement with any entity under which medical bills are prepared, processed, or submitted to the carrier.”
The reimbursement manuals are referred to as the 2020 editions because that’s when the process began. The manuals do not raise costs enough to trigger a legislative review. Florida law requires that when overall rate changes raise costs significantly for most Florida businesses, the Legislature must ratify. Lawmakers have declined to approve most changes in the last decade, leaving some providers stuck at reimbursement levels that are several years behind other states.
The hearing on the reimbursement manual for hospitals will begin at 10 a.m. Eastern time and will be held online-only, with no in-person meeting. The link is https://meet.goto.com/935046997. Stakeholders may also participate by phone by calling 866 899 4679. The access code is 935-046-997. The manual can be seen here.
The hearing on ambulatory surgical centers reimbursement starts at 2 p.m. Eastern time. The link for the virtual meeting is https://meet.goto.com/445433517. The call-in number is 877 309 2073 and the access code is 445-433-517. The ASC manual can be seen here.
Next month, the division will hold workshops on equally contentious subjects, including physician dispensing of medications, insurer authorization and medical billing review. Those meetings will be Sept. 29, at 9:30 a.m. and 2 p.m. Eastern time. Online meeting links have not yet been posted.
Topics Florida
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