Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-7 - WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW › Section 69L-7.730 - Health Care Provider Medical Billing and Reporting Responsibilities

Current through Reg. 50, No. 138; July 16, 2024
(1) Bill Submission/Filing and Reporting
				Requirements.
(a) All health care providers
				are responsible for meeting their obligations, under this rule, regardless of
				any business arrangement with any entity under which claims are prepared,
				processed or submitted to the insurer.
(b) Each health care provider is responsible
				for submitting any form completion information and supporting documentation
				requested by the insurer that is in addition to the requirements of this rule
				and the applicable reimbursement manual, when it is requested, in writing, by
				the insurer at the time of authorization or upon receipt of notification of
				emergency care.
(c) Each health
				care provider shall resubmit a medical claim form or medical bill with
				insurer-requested documentation when the EOBR provides an explanation for the
				disallowed service based on the provider's failure to submit requested
				documentation with the medical bill.
(d) Insurers and health care providers shall
				utilize only the Form DFS-F5-DWC-25 for physician reporting of the injured
				employee's medical treatment/status. No other reporting forms may be used in
				lieu of or supplemental to the Form DFS-F5-DWC-25.
1. The Form DFS-F5-DWC-25 does not replace
				physician notes, medical records or Division-required medical
				reports.
2. All information
				submitted on physician notes, medical records or Division-required medical
				reports shall be consistent with information documented on the Form
				DFS-F5-DWC-25.
3. The
				DFS-F5-DWC-25, submitted to address the physical limitation(s), permanent
				impairment rating or maximum medical improvement date, shall be signed by the
				physician performing the physical examination upon which the physical
				limitation(s), permanent impairment or maximum medical improvement date is
				based.
(e) All medical
				claim form(s) or medical bill(s) related to authorized services shall be coded
				by the health care provider at the highest level of specificity for the
				reference material used and submitted to the claim administrator or any entity
				acting on behalf of the insurer, as a requirement for billing.
(f) Medical claim form(s) or medical bill(s)
				may be electronically filed or submitted via facsimile by a health care
				provider to the claim administrator or any entity acting on behalf of the
				insurer, provided the insurer agrees.
(g) When requested by the claim administrator
				or any entity acting on behalf of the insurer, a health care provider shall
				send documentation that supports the medical necessity of the specific services
				rendered and any other required documentation pursuant to subsection
				 69L-7.730(2),
				F.A.C., and the applicable reimbursement manual.
(h) Each health care provider is responsible
				for correcting and resubmitting any billing forms returned by a claim
				administrator or any entity acting on behalf of the insurer pursuant to
				paragraph  69L-7.740(11)(g),
				F.A.C.
(i) Each hospital and ASC
				shall maintain its charge master and shall produce relevant portions when
				requested for the purpose of verifying its usual charges pursuant to Section
				 440.13(12)(d),
				F.S.
(j) A health care provider
				shall bill multiple services, rendered on the same date of service, on a
				contiguous bill; provided however, nothing herein shall prevent a physician
				from selling, assigning or otherwise factoring a claim for the provision of
				pharmacy related services to a third party billing entity.