Partnering in the Provision of Health Care to Injured Employees

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Division: HCP Compliance Monitoring

The Division is statutorily responsible for administering Chapter 440, F.S., in a manner to facilitate the self-execution of the system and the process of ensuring the prompt and cost-effective delivery of benefits. To fulfill this responsibility, the Division has developed and adopted administrative rules to ensure injured employees receive medically necessary treatment and services in a timely manner and providers receive proper reimbursement for authorized services rendered to injured employees. These policies, which are incorporated in the Florida Administrative Code, are related to:

• The proper completion and submission of medical bills, medical forms, and reports related to medical services rendered and the injured employee’s medical  status, The Billing Rule, Rule Chapter 69L-7.602, F.A.C.
• The reimbursement policies and the reimbursement methodology for covered Services, reimbursement manuals

The Division is also responsible for determining if providers are in compliance with established policies related to standards of care and proper billing and reporting of services. The Division may initiate a HCP Investigations to evaluate compliance with these policies upon receipt of a HCP violation referral from a carrier or other Division associated or upon the routine review of HCP performance indicator reports based on medical claims data submitted to wc insurers for reimbursement purposes.

The division may impose administrative penalties and fines for violations of established statutory or applicable rule requirements for a finding of non-compliance.

 

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