Regulatory News

Revised Rule 69L-7.100, Florida Administrative Code, (Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)), became effective as of September 28, 2015; however, the reimbursement manual does not go into effect until January 1, 2016 (as provided in the rule text). https://www.flrules.org/gateway/RuleNo.asp?title=WORKERS''%20COMPENSATION%20MEDICAL%20REIMBURSEMENT%20AND%20UTILIZATION%20REVIEW&ID=69L-7.100 If you have any questions regarding this message, please contact Pam Macon, Chief, Bureau of Monitoring and Audit, Division of Workers' Compensation at (850) 413-1708 or Pamela.Macon@myfloridacfo.com . 

The following is directly from a Division of Workers' Compensation notification and is all quoted verbatim.  On October 1, 2015 the Centers for Medicare & Medicaid Services (CMS) will be transitioning to ICD-10 (diagnosis coding).  In line with the CMS policy, the Division of Workers' Compensation will require ICD-10 codes for medical bills and medical EDI transactions containing dates of service on or after 10/1/15.  The Division will require ICD-9 codes on medical bills and medical EDI transactions with dates of service prior to 10/1/15. In an effort to promote the self-executing nature of the workers' compensation system, the Division urges all interested parties to consider Rule 69L-7.710(5)(j)1.a., F.A.C. in securing correct diagnosis codes.  The rule states, in part, the insurer, service company/TPA, or entity acting on behalf of the insurer can: "Secure and/or correct the information on the medical bill and proceed to make a reimbursement decision to pay, ...

https://www.flrules.org/gateway/ruleNo.asp?id=69L-30.002 Notice of Change/Withdrawal DEPARTMENT OF FINANCIAL SERVICES Division of Worker's Compensation RULE NOS.:        RULE TITLES: 69L-30.002           Definitions 69L-30.003           Qualifications for Expert Medical Advisor Certification 69L-30.004           Application for Expert Medical Advisor Certification 69L-30.005           Selection of Expert Medical Advisors 69L-30.006           Temporary Expert Medical Advisors 69L-30.007           Expert Medical Advisor Responsibilities 69L-30.008           Billing and Reimbursement for Expert Medical Advisor 69L-30.010     ...