To fulfill its statutory responsibility for ensuring the FL WC health care delivery system is self-executing and facilitates the provision of cost efficient medical care and treatment to injured employees in accordance with Chapter 440. F.S., the Division has developed and adopted the following administrative rules. The referenced rules govern how health care providers render, report and bill medical treatment and services to injured employees, as well as how workers’ compensation carriers reimburse health care providers for such services:
- Rule Chapter 69L-7.602, F.A.C., The Medical Billing Rule addresses the proper completion and submission of medical bills, medical forms, and reports related to medical services rendered and the injured employee’s medical status.
- Rule Chapters, 69L-7.020, 69L-7.501, 69L-7.100, F.A.C., FL WC provider reimbursement manuals address the applicable reimbursement policies and methodologies for covered services.
The Division also has regulatory oversight of HCPs participation in the FL WC health care delivery system and may initiate a HCP Investigation, pursuant to s. 440.13(11),F.S., and, Rule Chapter 69L-34, F.A.C. - Carrier Report of Health care Provider Violation Rule (HCP Violation Rule), to determine if a HCP is in compliance with applicable policies previously discussed. A division investigation may be initiated upon receipt of a report of a HCP violation or from the review of paid medical claims data maintained by the Division. The paid medical claims data is submitted pursuant to the mandatory reporting requirements of The Medical Billing Rule and s.440.13 (6) and (8), F.S. to include the reporting of overutilization of services by health care providers.
HCP Violation Rule, which addresses the Division HCP
investigation process, defines HCP violations and the process by
which a carrier or any industry partner may elect to report a
violation of s. 440.13, F.S and applicable rules. Moreover, the
HCP Violation Rule incorporates the Health Care Provider
Violation Referral form (static/interactive)
that must be used when reporting a health care violation to the
|HCP Violation Rule||Static Referral Form||Interactive Referral Form|