September 25, 2014

Florida Workers’ Compensation Hospital Manual Update

On Sept. 21, the Florida Division of Workers' Compensation submitted a Notice of Change regarding Rule 69L-7.501, F.A.C., Florida Workers' Compensation Reimbursement Manual for Hospitals. The new manual addresses a number of issues raised by the FHA regarding payment for outpatient implants as part of its revised payment methodology for outpatient services. It also increases the per diem and stop loss for inpatient services by 16.5 percent. Note, the manual is still proposed, but has been revised from the manual posted earlier this year.

As part of a Settlement Agreement following a rule challenge to the manual, the Division of Workers' Compensation has revised the "Base Rates" in Appendices B and C to adjust the threshold number of bills required to establish a "Base Rate" from 20 to 40. This resulted in a revised set of "Base Rates." For Appendix B, this results in 98 fewer CPT codes subject to the Maximum Reimbursement Amount; for Appendix C, there are 79 fewer codes in the revised manual. In addition, the base rates in the new version appear to be higher than in the previous version. 

The notice specified a proposed effective date for the new inpatient rates and outpatient methodology of Jan. 1, 2015. A revised version of the proposed Florida Workers' Compensation Reimbursement Manual for Hospitals, 2014 Edition, is available on the Division of Workers' Compensation Web site under "Notices, New Rules & Draft Rules."

For more information, contact Kathy Reep, vice president of financial services, at (407) 841-6230.