If you don’t have a copy of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual 2006 edition, and don’t have the inclination to get one any time soon, don’t worry. That’s why you lean on me. I can give you the low down on the Florida Workers’ Compensation Health Care Provider Reimbursement Manual until you have the inclination, time, or need for it. Or, if you may never get the Florida Workers’ Compensation Health Care Provider Reimbursement Manual—still, stick with me, kid.
Some of the most important info you can find in the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, updated 2006 version, are the updated basic program requirements for medical providers who you are allowed to lean on for your workers’ comp medical services. First of all, not every medical provider in the state of Florida can give care to a workers’ cimp patient. In fact, the list changes every year, as medical providers must have certain certification and meet certain requirements to be able to provide the services, and receive money from you, the employer, for them. You can demand this info from your medical providers every year, fact check yourself with the Agency for Health Care Administration in Florida.
Most of all, medical providers who you will in particular allow your employees to visit when they’re injured must be authorized by your workers’ comp insurance company. Or if you are self insured for workers’ comp, you provide that authorization (so check with yourself!). They must have this authorization before they give medical services to any of your employees.
On the other hand, the rule hasn’t changed in Florida workers’ comp system regarding emergency medical care. Injured workers are allowed to get emergency medical care without worrying about whether or not it was authorized with the insurance company. There are certain exemptions to this rule, but for the most part, workers injured on the job are entitled to emergency medical care as soon as possible.
If you are a Florida employer with serious questions about how workers’ comp works in your state, I am here for you, buddy. Of course, I offer you my complete repertoire of blog entries, on everything and anything about Florida employment and labor law and federal law for that matter. But for what you can’t find here—and I’d like to think that that was not very much—let me point you in another direction: the Florida Workers’ Compensation Health Care Provider Reimbursement Manual.
The 2006 edition just came out recently, and you should expect the 2007 version any time now. Keep an eye out at the Web site of the Florida Department of Workforce Development, but in the meantime, use the 2006 version to its full extent. The Florida Workers’ Compensation Health Care Provider Reimbursement Manual contains a wealth of info on how employers and their workers’ comp insurers are meant to reimburse their medical providers when it comes to medical bills for workers’ comp injury and illness treatment.
The Florida Workers’ Compensation Health Care Provider Reimbursement Manual also delves into all of the codes that employers ought to know when it comes to reporting injuries, reimbursing medical providers for their services to heal them, and for keeping hold of all of the claims that come through your workers’ comp system. The Florida Workers’ Compensation Health Care Provider Reimbursement Manual also details the maximum reimbursement allowances for physicians and other health care providers licensed in the state of Florida who are offering services to workers injured on the job.
When it comes to medical equipment and supplies, as well as pharmaceuticals and other medications, for workers’ injuries, the Florida Workers’ Compensation Health Care Provider Reimbursement Manual also provides info on all of the procedures and codes for them, as well as the reimbursement procedures and maximum allowances.
Employers in Florida could possibly face other rules changes coming soon. The Florida Department of Financial Services Division of Workers’ Comp has recently posted on their site a notice of proposed rulemaking for a new possible law called the “Florida Workers’ Comp Medical Services Billing, Filing and Reporting Rule.”
The whole purpose of this proposed workers’ comp rule will be to adopt new versions of the uniform billing forms that have come out in 2007 and have national approval. These forms would be for medical providers that work with the Florida workers’ comp system, in order for them to ask for medical bill reimbursements. Remember, reimbursements is the process by which these providers get their money for medical services given to injured workers.
The particular forms in question would also include a form for pharmacy billing, so that would include costs for any pain killers or other pharmaceuticals that workers may need during the course of their disability or treatment. The new law would also be for changing all of the data reporting requirements when it comes to medical bill review, so that it will be easier to resolve any sort of medical bill squabble between the medical providers, the employers, and the workers’ comp insurers in the state.
The law doesn’t stop there. It would also set about revising the Florida Workers’ Comp Medical EDI Implementation Guide as well as other reference material for employers and other stakeholders in the state’s workers’ comp system. An EDI system is a way for the electronic exchange of data between all of the people involved in the workers’ comp experience, but especially the state system, the workers’ comp insurers, and employers. We must all wait and see if this new proposed law passes through and becomes a real live law soon for 2007.
Speaking of the issue of going before a hearing and the time limits that workers have to declare a claim and or declare that they have an issue with the settlement for compensation, in Florida, there is a big important issue on these topics when it comes to many small business owners and employers. These small business owners are wondering how they can still get sued by their employees even tough they have given these employees all the care and different training and work necessary to compensate for a workplace injury or illness.
But in the state of Florida, this issue can arise because workers have up to two years under the state statutes, Chapter 440, to file a petition with the state workers’ comp board to get benefits through a hearing with the Division of Administrative Hearings. Of course, this issue shouldn’t arise if a small employer is providing their workers with the proper compensation, light work duties, and other training options, all with the purpose of getting those employees back to work and making money.
But what happens in those two years is that employees may feel that you are not doing all you can to get them back to a happy work situation. They may feel, using the state of Florida’s term, that you are not doing all the “necessary care” to compensate their work site injury and or illness.
In that case, the employee has to take you to the arbitrator so that the judge can decide exactly what necessary care is defined as. That judge then reviews what compensation you are paying these employees, and what sort of light work duty or other retraining you have offered them, and whether or not is proper and enough. Employers may feel like this is like having a guillotine over their heads for two years, but it is the law in Florida.
I know what you have been thinking, loyal readers. You have heard me say how every state’s workers’ comp program, rules and regulations are different, and how it’s important to cover each one because of it. Yet, where are all of these differences? Well, have I got a good state for you now—Florida.
As I mentioned in the last blog entry, roughly speaking, states determine which employers have to have workers; comp coverage for their workers by the number of workers that they employ. For instance, if the employer has one employee, or five employees. With Florida, though, the workers’ comp law takes into account the number of employees as well, but bases it on the particular industry that the company is in.
For example, for employers in any industry besides construction, they are required to have workers’ comp coverage if they have four or more employees, part time and or full time. Exempted corporate officers do not count to this total. If you are a Florida employer but are in construction, then you have to have workers’ comp coverage if you have one employee or more, and that includes yourself.
On the other hand, if you are a state, city, or other local government, you must have workers’ comp coverage no matter what.
The equation for farmers in Florida is even more complicated. If a farmer has more than five regular employees and or 12 or more seasonal workers, who work for the farmer for 30 or more days, then the farmer has to have workers’ comp coverage for all of these employees.
Now you can see how different some state workers’ comp systems are from one another, despite the fact that workers’ comp basically covers the same thing no matter what—a worker injured on the job.