RULE CHAPTER 69L-34 FLORIDA ADMINISTRATIVE CODE (F.A.C.) CARRIER REPORT OF HEALTH CARE PROVIDER VIOLATIONS WEB TRAINING
|
|
- Oliver Cain
- 8 years ago
- Views:
Transcription
1 RULE CHAPTER 69L-34 FLORIDA ADMINISTRATIVE CODE (F.A.C.) CARRIER REPORT OF HEALTH CARE PROVIDER VIOLATIONS WEB TRAINING Office of Medical Services Bureau of Monitoring and Audit Division of Workers Compensation Department of Financial Services
2 Rule Chapter 69L-34, F.A.C. Carrier Report of Health Care Provider Violation (HCP Violation Rule) Web Training Objectives To discuss the scope of the HCP Violation Rule and the process by which industry partners may report HCP violations of Chapter 440, Florida Statutes (F.S.), to the Division To establish the Division may use paid medical claims data and HCP violation reports to initiate a Division investigation, pursuant to s (11), F.S. 22
3 Rule Chapter 69L-34, F.A.C. - HCP Violation Rule Purpose & Effect To clarify that carriers satisfy the mandatory overutilization reporting requirements in s (8), F.S., when in compliance with reporting requirements of Rule 69L-7.602(5)and (6), F.A.C., Florida Workers Compensation Medical Services Billing, Filing and Reporting Rule (Billing Rule) 33
4 HCP Violation Rule - Purpose & Effect continued To introduce an elective/discretionary process to report HCP violations of Chapter 440, F.S., and applicable administrative rules To incorporate Health Care Provider Violation Referral Form, DFS-F6-DWC-2000 (Referral Form), effective September 6, 2011, for reporting health care provider violations 44
5 Rule 69L Definitions Health Care Provider (Provider) Physician or recognized practitioner as defined in s (1)(h), F.S., who is certified by the Division to receive reimbursement under Chapter 440, F.S., for services rendered to injured employees Providers who, pursuant to s (3)(f), F.S., consent to the jurisdiction of the Division by accepting payment under Chapter 440, F.S. 55
6 Rule Definitions continued Instance of Overutilization A specific inappropriate service or level of service provided to an injured employee NOTE: Overutilization is related to treatment rendered; therefore, a recommendation for treatment that would constitute overutilization is not a violation. 6
7 Rule Definitions continued Supportive Documentation All documents and records that reasonably support an allegation of a violation of this Rule Chapter Verifiable Delivery Process The ability to document a common carrier s pick-up and delivery date or a US Postal Service postmark date 7
8 Rule Definitions continued HCP Violation A health care provider s non-compliance with Chapter 440, F.S. and Division rules such as: Failing to refund an overpayment of reimbursement pursuant to s (11)(a), F.S. Failing to submit medical records and reports pursuant to s (4)(a) and (c), F.S., or 69L-7.602(4), F.A.C. 8
9 HCP Violation cont d. Rule Definitions continued Collecting or receiving payment from an injured employee in violation of s (14)(a), F.S. Failing to follow Standards of Care, pursuant to s (16), F.S., including overutilization of services Failing to properly bill medical services, pursuant to the Billing Rule 9
10 Rule Definitions continued Improper Billing and Billing Errors Non-compliance with the Billing Rule and applicable reimbursement manual(s); Improper form completion Filing of incorrect medical claim form Use of invalid or incorrect billing codes, modifiers, REV codes, etc 10
11 Rule 69L Mandatory Carrier Reporting of Overutilization of Services Carrier satisfies requirement to report all instances of overutilization of treatment rendered or recommended pursuant to s (8), F.S., when carrier complies with the: Explanation of Bill Review (EOBR) requirements in the Billing Rule or Notice of Denial requirements in Rule 69L-3.012, F.A.C. 11
12 Mandatory Carrier Reporting continued Rule 69L-7.602(5)(o), F.A.C., requires Carriers to file medical data elements to include EOBR codes documenting the carrier s bill review process for: Disallowing and adjusting reimbursement for overutilization of services Explaining the reimbursement of each billed line item adjudicated 1212
13 Mandatory Carrier Reporting continued Rule 69L-3.012, F.A.C., requires Carriers to issue a DFS-F2-DWC-12, Notice of Denial form to the Provider and injured employee to deny authorization of recommended treatment that otherwise constitutes overutilization of services NOTICE OF DENIAL DFS-F2-DWC-12 FORM 13
14 Rule 69L Elective Referral of Alleged HCP Violation Filing a Referral to report a HCP violation is DISCRETIONARY and SHALL: Be on a Health Care Provider Violation Referral Form, DFS-F6-DWC 2000 Form ( Referral form) Be accompanied by supportive documents (e.g. DWC- 25 forms, peer review reports, medical bills, collection letters, etc ) Identify one (1) violation per referral form 14
15 Elective Referral of Alleged HCP Violation continued Be filed with the DWC Office of Medical Services in Tallahassee, FL NOTE: The elective reporting of an overutilization violation neither satisfies nor negates the carrier s obligation for reporting instances of overutilization pursuant to s (8), F.S. 1515
16 Rule 69L Timeliness of a Referral Properly completed Referrals and supportive documentation related to a Provider s billing practice SHALL be filed within 180 days after: Issuance of an EOBR identifying the reported violation, such as: A Billing error Overutilization of services The Failure to submit medical records reports required for the adjudication of a medical bill 16
17 Timeliness of a Referral continued Referrals related to a Provider billing an injured employee or failing to provide requested medical records and reports shall be filed within 180 days of: The date of written notice to Provider identifying violation The carrier s received date of a copy of a bill collection notice to injured employee for payment of covered treatment 17
18 Rule 69L Referral Investigation The Division MAY initiate an investigation of an alleged Provider violation based on: An audit of paid medical claim data filed with the Division and/or Receipt of a completed Referral form and all supportive documentation 1818
19 Referral Investigation continued The Division MAY request additional documentation from Carrier and Provider to support its investigation A Provider or Carrier must submit, to the Division, within 45 days of receipt of a written request: The requested documentation or A written explanation why the documentation is not available 19
20 Referral Investigation continued The Carrier s or Provider s failure to submit documentation within 45 days of receipt of request SHALL result in: Issuance of Division finding(s) based on documentation filed with referral or received subsequent to document request deadline or Termination of Division s investigation 20
21 Referral Investigation continued A finding of a provider violation SHALL result in one or more of the following administrative sanctions pursuant to s (8),(11) and (13), F.S.: Removal from the DWC provider database Barring future payment under Chapter 440 Administrative fine not to exceed $5,000 per instance of overutilization Referral to licensing authority for further review 21
22 Rule 69L Invalid Referrals Complaints related to the following issues are not subject to agency action under this rule and shall be dismissed: Reimbursement dispute issues pending a Determination, pursuant to s (7), F.S.; or Medical benefit dispute issues pending a Judge of Compensation Claims order 22
23 HCP Violation Rule Summary Rule effective September 6, 2011 Carrier satisfies mandatory reporting of Instances of Overutilization requirements of s (8), F.S., by: Filing medical claims data as required in Billing Rule or Denying authorization of a recommended medical benefit, pursuant to Rule 69L-3.012, F.A.C. 23
24 HCP Violation Rule Summary continued Filing an HCP Referral: Is OPTIONAL Is not A SUBSTITUTE for mandatory reporting requirements of statute and rule Must be filed within 180 days of notification of violation Must be filed on a Health Care Provider Violation Referral Form, DFS-F6-DWC
25 HCP Violation Rule Summary continued Alleged violation must be related to rendered services that are: Not properly billed Not properly reported Not appropriate for compensable condition Reimbursed in error due to HCP billing error or overutilization of services 25
26 HCP Violation Rule Summary continued The following types of referrals will be dismissed in accordance with the Rule: Reimbursement dispute issues addressed in petitions filed with Division Medical benefit issues addressed in Petition for Benefits filed with JCC s office Untimely filed referrals will also be dismissed 26
27 Questions and Policy Clarification Inquiries regarding the HCP Violation Rule may be directed to: The HCP Violation Rule and Referral Form are available on the Division s website at: 27
EDI Business Rules for Revision E EOBR Code List Based on Line Item Paid ASC only on the DWC-90 (Updated 05/26/2011)
EDI Business Rules for Revision E EOBR Code List Based on Line Item Paid ASC only on the DWC-90 (Updated 05/26/2011) 06 Payment disallowed: location of service(s) is not consistent with the level of service(s)
More informationEDI Business Rules for Revision E EOBR Code List Inpatient Hospital [DWC-90: codes 11x, 12x, 18x in Field Locator 10(bill type)] Updated 05/26/2011
EDI Business Rules for Revision E EOBR Code List Inpatient Hospital [DWC-90: codes 11x, 12x, 18x in Field Locator 10(bill type)] Updated 05/26/2011 06 - Payment disallowed: location of service(s) is not
More informationFLORIDA WORKERS' COMPENSATION REIMBURSEMENT MANUAL FOR HOSPITALS
FLORIDA WORKERS' COMPENSATION REIMBURSEMENT MANUAL FOR HOSPITALS 2006 Edition Florida Department of Financial Services Division of Workers Compensation for incorporation by reference into Rule 69L-7.501,
More informationCHAPTER 59A-23 WORKERS COMPENSATION MANAGED CARE ARRANGEMENTS 59A-23.001 Scope. 59A-23.002 Definitions. 59A-23.003 Authorization Procedures.
CHAPTER 59A-23 WORKERS COMPENSATION MANAGED CARE ARRANGEMENTS 59A-23.001 Scope. 59A-23.002 Definitions. 59A-23.003 Authorization Procedures. 59A-23.004 Quality Assurance. 59A-23.005 Medical Records and
More informationFlorida Workers Compensation
Florida Workers Compensation Reimbursement Manual for Ambulatory Surgical Centers Rule 69L-7.100, F.A.C. 2011 Edition THIS PAGE LEFT INTENTIONALLY BLANK TABLE OF CONTENTS CHAPTER 1 INTRODUCTION AND OVERVIEW...
More informationDivision of Workers Compensation
Department of Financial Services Division of Workers Compensation Wednesday, August 26, 2015 Regulatory and Legislative Update Andrew Sabolic Assistant Director Hospital Reimbursement Manual All compensable
More informationAGENCY FOR HEALTH CARE ADMINISTRATION HEALTH QUALITY ASSURANCE BUREAU OF MANAGED HEALTH CARE 2727 Mahan Drive Tallahassee Florida 32308
AGENCY FOR HEALTH CARE ADMINISTRATION HEALTH QUALITY ASSURANCE BUREAU OF MANAGED HEALTH CARE 2727 Mahan Drive Tallahassee Florida 32308 WORKERS COMPENSATION MANAGED CARE ARRANGEMENT SURVEY REPORT NAME
More informationFlorida Workers Compensation
Florida Workers Compensation Reimbursement Manual for Hospitals Rule 69L-7.501, F.A.C. 2014 Edition THIS PAGE INTENTIONALLY LEFT BLANK Page 2 TABLE OF CONTENTS Chapter 1 Introduction and Overview... 5
More informationFlorida Managed Care Arrangement. Employer s Handbook
Florida Managed Care Arrangement Employer s Handbook Contents Introduction... 1 Employer Guidelines... 2 Identification Form... 5 Employee Information... 6 Coventry s & HDi s Responsibilities... 8 Frequently
More informationFLORIDA WORKERS' COMPENSATION REIMBURSEMENT MANUAL FOR HOSPITALS 2004 EDITION. Rule 69L-7.501, Florida Administrative Code
FLORIDA WORKERS' COMPENSATION REIMBURSEMENT MANUAL FOR HOSPITALS 2004 EDITION Rule 69L-7.501, Florida Administrative Code Effective January 1, 2004 1 TABLE OF CONTENTS Title Page Section 1: Managed Care
More informationNOTICE OF PROPOSED RULE DEVELOPMENT. PURPOSE AND EFFECT: The proposed rule is amended to conform to applicable provisions of Chapter 440, F.S.
DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION NOTICE OF PROPOSED RULE DEVELOPMENT RULE NO: 69L-6.012, F.A.C. RULE TITLE: Notice of Election to Be Exempt. PURPOSE AND EFFECT: The proposed
More informationSUBCHAPTER A. General Rules for Medical Billing and Processing 133.1-133.3. SUBCHAPTER B. Health Care Provider Billing Procedures 133.10 and 133.
Page 1 of 79 Pages DWC-06-0024 SUBCHAPTER A. General Rules for Medical Billing and Processing 133.1-133.3 SUBCHAPTER B. Health Care Provider Billing Procedures 133.10 and 133.20 SUBCHAPTER C. Medical Bill
More informationFLORIDA PROVIDER MANUAL
H ERIT A GE S UMMIT H EAL T H C ARE HERITAGE SUMMIT HEALTHCARE LLC FLORIDA PROVIDER MANUAL 1 SCM0284 REV 03/14 PROVIDER GRIEVANCES DISPUTE RESOLUTION & GRIEVANCE PROCEDURES Initial requests for reimbursement
More informationRE: Department of Financial Services 2014-2015 Regulatory Plan Pursuant to Section 120.74(3), Florida Statutes
C'l-llEF FINANCIAL OFFICER JEFF ATWATER STATE OF FLORIDA June 27, 2014 The Honorable Dan Gaetz President The Florida Senate 409, The Capitol 404 South Monroe Street Tallahassee, Florida 32399-1 l 00 The
More informationNC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS
NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS CURRENT AS OF APRIL 1, 2010 I. INFORMATION SOURCES Where is information available for medical providers treating patients with injuries/conditions
More information28 Texas Administrative Code
28 Texas Administrative Code Chapter 127 - Designated Doctor Procedures and Requirements Link to the Secretary of State for 28 TAC Chapter 127 (HTML): http://info.sos.state.tx.us/pls/pub/readtac$ext.viewtac?tac_view=4&ti=28&pt=2&ch=127.
More information(2) compliance with the treatment guidelines established by the Division;
133.301. Retrospective Review of Medical Bills. (a) The insurance carrier shall retrospectively review all complete medical bills and pay for or deny payment for medical benefits in accordance with the
More informationBylaws of the Lawyer-Client Fee Dispute Resolution Committee of the Cleveland Metropolitan Bar Association. Enacted November 18, 2015
Bylaws of the Lawyer-Client Fee Dispute Resolution Committee of the Cleveland Metropolitan Bar Association Enacted November 18, 2015 Preamble and Purpose 1.) Background. Under Rule V, Section 5 of the
More informationOFFICIAL RECORDS OF OUR CONDOMINIUM ASSOCIATION
OFFICIAL RECORDS OF OUR CONDOMINIUM ASSOCIATION DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Division of Florida Condominiums, Timeshares, and Mobile Homes 1940 North Monroe Street Tallahassee, Florida
More informationHOUSTON LAWYER REFERRAL SERVICE, INC. RULES OF MEMBERSHIP
HOUSTON LAWYER REFERRAL SERVICE, INC. RULES OF MEMBERSHIP The Houston Lawyer Referral Service, Inc. (HLRS) is a non-profit corporation sponsored by the Houston Bar Association, Houston Young Lawyers Association,
More informationDivision of Medical Quality Assurance
APPLICATION FOR CANDIDATES REQUESTING SPECIAL TESTING ACCOMMODATIONS IN ACCORDANCE WITH THE AMERICANS WITH DISABILITIES ACT Prepared by Division of Medical Quality Assurance Rule 64B-1.005, F.A.C. 1 PART
More informationHow To Change A Doctor In Arkansas
RULE 099.33 MANAGED CARE #099.33 TABLE OF CONTENTS I. DEFINITIONS II. INITIAL CHOICE OF PHYSICIAN III. REFERRALS IV. CHANGE OF PHYSICIAN V. MULTIPLE MCOs VI. RULES, TERMS, AND CONDITIONS OF MCO/IMCS VII.
More informationSTATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS OFFICE OF THE JUDGES OF COMPENSATION CLAIMS DAYTONA BEACH DISTRICT OFFICE COMPENSATION ORDER
STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS OFFICE OF THE JUDGES OF COMPENSATION CLAIMS DAYTONA BEACH DISTRICT OFFICE Richard Higgs, Employee/Claimant, vs. WFF Facility Services - Bethune Cookman
More informationNOTICE OF PROPOSED RULE DEVELOPMENT
DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION NOTICE OF PROPOSED RULE DEVELOPMENT RULE CHAPTER: 69L-3, F.A.C. RULE CHAPTER TITLE: Workers Compensation Claims RULE NO: 69L-3.002 69L-3.003
More informationFLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY
FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY APPLICATION FOR TEACHING PERMIT Chapter 466.002, Florida Statutes Rule 64B5-7.005, Florida Administrative Code Applications will be accepted only if completed
More information11B-21.002 Criminal Justice Training Schools Request for Certification,
Certification of Criminal Justice Training Schools 11B-21 32-37 RULE TITLES: RULE NOS.: Local Advisement and Definitions. 11B-21.001 32 Criminal Justice Training Schools Request for Certification, 11B-21.002
More informationFlorida House of Representatives - 1997 HB 1799 By Representative Cosgrove
By Representative Cosgrove 1 A bill to be entitled 2 An act relating to workers' compensation; 3 amending s. 440.13, F.S.; providing for 4 alternative medical care under certain 5 circumstances; requiring
More informationFlorida Division of Workers Compensation. 2010 Annual Report
Florida Division of Workers Compensation 2010 Annual Report REPRESENTING ALEX SINK CHIEF FINANCIAL OFFICER STATE OF FLORIDA Division of Workers Compensation 2010 Annual Report Table of Contents THE MISSION
More informationRULE. Office of the Governor Real Estate Appraisers Board. Appraisal Management Companies (LAC 46:LXVII.Chapters 301-309)
RULE Office of the Governor Real Estate Appraisers Board Appraisal Management Companies (LAC 46:LXVII.Chapters 301-309) Under the authority of the newly enacted Appraisal Management Company Licensing and
More informationIN THE COMMONWEALTH COURT OF PENNSYLVANIA
IN THE COMMONWEALTH COURT OF PENNSYLVANIA Selective Insurance : Company of America, : Petitioner : : v. : No. 613 C.D. 2013 : Submitted: October 4, 2013 Bureau of Workers' Compensation : Fee Review Hearing
More informationTHE DOCTOR S GUIDE TO PENNSYLVANIA WORKERS COMPENSATION BILLING
THE DOCTOR S GUIDE TO PENNSYLVANIA WORKERS COMPENSATION BILLING THE DOCTOR S GUIDE TO PENNSYLVANIA WORKERS COMPENSATION BILLING 1515 Market Street Suite 1520 Philadelphia PA 19102 Phone: (215) 557-5540
More informationFREQUESTLY ASKED QUESTIONS
FREQUESTLY ASKED QUESTIONS Q.- I live in a condominium, which is the statute that applies to my situation? A.- If you live in a condominium, Chapter 718 of the Florida Statues applies to your association,
More informationZurich Handbook. Managed Care Arrangement program summary
Zurich Handbook Managed Care Arrangement program summary A Managed Care Arrangement (MCA) is being used to ensure that employees receive timely and proper medical treatment with respect to work-related
More information69L-7 Workers Compensation Medical Reimbursement and Utilization Review. Forms Incorporated by Reference for Medical Billing, Filing and Reporting
DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION NOTICE OF PROPOSED RULE DEVELOPMENT RULE CH. NO.: RULE CHAPTER TITLE: 69L-7 Workers Compensation Medical Reimbursement and Utilization
More informationFLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY
DENTAL RADIOGRAPHY CERTIFICATION APPLICATION Chapter 466.004 and 466.017(5), Florida Statutes Rule 64B5-9.011, Florida Administrative Code SPECIAL TES AND INSTRUCTIONS: 1. A N-REFUNDABLE fee of $35.00
More informationHOUSTON LAWYER REFERRAL SERVICE, INC. APPLICATION FOR MEMBERSHIP
HOUSTON LAWYER REFERRAL SERVICE, INC. APPLICATION FOR MEMBERSHIP The Houston Lawyer Referral Service, Inc. (HLRS) is a non-profit corporation sponsored by the Houston Bar Association, Houston Young Lawyers
More informationAdministrative Code. Title 23: Medicaid Part 306 Third Party Recovery
Administrative Code Title 23: Medicaid Part 306 Third Party Recovery Table of Contents Title 23: Division of Medicaid... 1 Part 306: Third Party Recovery... 1 Part 306 Chapter 1: Third Party Recovery...
More informationINSTRUCTIONS FOR FILING A CONDOMINIUM / COOPERATIVE COMPLAINT
INSTRUCTIONS FOR FILING A CONDOMINIUM / COOPERATIVE COMPLAINT Submitting your complaint on a Condominium / Cooperative Complaint form legibly printed or typed all of the information you supply on the form
More informationMolina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
More informationWorkers Compensation Provider Billing Guidelines
Billing transactions are covered under Chapter 127 (127.201 through 127.211) of the Workers Compensation Act (the Act) for the State of Pennsylvania: Workers Compensation Medical Cost Containment rules
More informationNY PIP Rule Revisions
NY PIP Rule Revisions Effective February 1, 2009 Arbitration Forums, Inc. (AF) has worked in collaboration with the New York State Insurance Department and the Loss Transfer Committee to incorporate revisions
More informationDivision of Workers' Compensation
1 of 5 10/14/2010 11:32 AM Division of Workers' Compensation Frequently Asked Questions Employer FAQs Who needs Workers' Compensation coverage? How does an employer obtain workers' compensation insurance?
More informationSTATE OF FLORIDA BOARD OF MASSAGE THERAPY MASSAGE ESTABLISHMENT CHANGE OF LOCATION/ NAME APPLICATION WITH INSTRUCTIONS
STATE OF FLORIDA BOARD OF MASSAGE THERAPY MASSAGE ESTABLISHMENT CHANGE OF LOCATION/ NAME APPLICATION WITH INSTRUCTIONS Board of Massage Therapy 4052 Bald Cypress Way, #C-06 Tallahassee, FL 32399-3256 (850)
More informationONLINE INTEREST-BASED ADVERTISING ACCOUNTABILITY PROGRAM PROCEDURES. Policy Oversight By: The National Advertising Review Council (NARC)
ONLINE INTEREST-BASED ADVERTISING ACCOUNTABILITY PROGRAM PROCEDURES Policy Oversight By: The National Advertising Review Council (NARC) Administered By: The Council of Better Business Bureaus, Inc. (CBBB)
More informationCHAPTER 2011-233. Committee Substitute for Committee Substitute for Committee Substitute for Committee Substitute for House Bill No.
CHAPTER 2011-233 Committee Substitute for Committee Substitute for Committee Substitute for Committee Substitute for House Bill No. 479 An act relating to medical malpractice; creating ss. 458.3175, 459.0066,
More informationAmbulance. Provider Participation Agreement
Ambulance Provider Participation Agreement BLUE CROSS AND BLUE SHIELD OF MICHIGAN AMBULANCE PROVIDER PARTICIPATION AGREEMENT THIS AGREEMENT is made by and between Blue Cross and Shield of Michigan (BCBSM)
More informationSUBCHAPTER B. Health Care Provider Billing Procedures 28 TAC 133.20 Medical Bill Submission By Health Care Provider
Page 1 of 12 Pages SUBCHAPTER B. Health Care Provider Billing Procedures 28 TAC 133.20 Medical Bill Submission By Health Care Provider 1. INTRODUCTION. The Commissioner of Workers Compensation (Commissioner),
More informationMedicare Claims Processing Manual Chapter 34 - Reopening and Revision of Claim Determinations and Decisions
Medicare Claims Processing Manual Chapter 34 - Reopening and Revision of Claim Determinations and Decisions Transmittals for Chapter 34 (Rev. 2241, 06-17-11) Table of Contents 10 - Reopenings and Revisions
More informationRuling No. 98-1 Date: December 1998
HCFA Rulings Department of Health and Human Services Health Care Financing Administration Ruling No. 98-1 Date: December 1998 Health Care Financing Administration (HCFA) Rulings are decisions of the Administrator
More informationDAVIS SMITH ACCOUNTING ASSOCIATES, P.A.
DAVIS SMITH ACCOUNTING ASSOCIATES, P.A. 5582 Milford-Harrington Hwy. Harrington, DE 19952 (302) 398-4020 (302) 398-3665 fax Email: info@davis-smithaccounting.com Web site: www.davis-smithaccounting.com
More informationProvider Appeals and Billing Disputes
Provider Appeals and Billing Disputes UniCare Billing Dispute Internal Review Process A claim appeal is a formal written request from a physician or provider for reconsideration of a claim already processed
More informationThe Federal Circuit Affirms a Court of Federal Claims Decision Dismissing Foreign Tax Credit Refund Claims as Untimely
Tax Controversy Services IRS Insights In this issue: The Federal Circuit Affirms a Court of Federal Claims Decision Dismissing Foreign Tax Credit Refund Claims as Untimely... 1 The Court of Federal Claims
More informationSTATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES REQUEST FOR INFORMATION DFS RM RFI 12/13-04
STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES REQUEST FOR INFORMATION DFS RM RFI 12/13-04 MEDICAL SERVICES BILL REVIEW AND REPRICING, UTILIZATION REVIEW, AND HOSPITAL INPATIENT PRE-ADMISSION CERTIFICATION
More informationDepartment of Health and Human Services DEPARTMENTAL APPEALS BOARD. Civil Remedies Division
Department of Health and Human Services DEPARTMENTAL APPEALS BOARD Civil Remedies Division Carlos G. Sanchez, M.D. (NPI: 1225069776), Petitioner, v. Centers for Medicare & Medicaid Services. Docket No.
More information11.4.4.5 EFFECTIVE DATE: October 1, 2014, unless a later date is cited at the end of a section. [11.4.4.5 NMAC - Rp, 11.4.4.
TITLE 11 CHAPTER 4 PART 4 LABOR AND WORKERS COMPENSATION WORKERS COMPENSATION CLAIMS RESOLUTION 11.4.4.1 ISSUING AGENCY: Workers Compensation Administration. [11.4.4.1 NMAC - Rp, 11.4.4.1 NMAC, 10/1/2014]
More informationMODIFICATION, TERMINATION OR SUSPENSION OF TEMPORARY DISABILITY BENEFITS
RULE IX MODIFICATION, TERMINATION OR SUSPENSION OF TEMPORARY DISABILITY BENEFITS A. TERMINATION OF TEMPORARY DISABILITY BENEFITS BY AN ADMISSION OF LIABILITY IN CLAIMS ARISING PRIOR TO JULY 2, 1987, AT
More informationRULES OF TENNESSEE DEPARTMENT OF LABOR DIVISION OF WORKER S COMPENSATION CHAPTER 0800-02-01 GENERAL RULES OF THE WORKERS COMPENSATION PROGRAM
RULES OF TENNESSEE DEPARTMENT OF LABOR DIVISION OF WORKER S COMPENSATION CHAPTER 0800-02-01 GENERAL RULES OF THE WORKERS COMPENSATION PROGRAM TABLE OF CONTENTS 0800-02-01-.01 Purpose and Scope 0800-02-01-.15
More informationFLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY NON-PROFIT CORPORATION PERMIT APPLICATION
FLORIDA DEPARTMENT OF HEALTH BOARD OF DENTISTRY N-PROFIT CORPORATION PERMIT APPLICATION Applications will be accepted only if completed by an officer of the non-profit organization. Any questions not applicable
More informationSTATE OF FLORIDA VOLUNTARY PREKINDERGARTEN EDUCATION PROGRAM SPECIALIZED INSTRUCTIONAL SERVICES PROVIDER AGREEMENT
STATE OF FLORIDA VOLUNTARY PREKINDERGARTEN EDUCATION PROGRAM SPECIALIZED INSTRUCTIONAL SERVICES PROVIDER AGREEMENT, Rule 6M-8.500, F.A.C. Call the Office Early Learning at 1-866-357-3239 for assistance
More informationCOUNTY OF ORANGE DEPARTMENT OF HEALTH. Corporate Compliance Plan
COUNTY OF ORANGE DEPARTMENT OF HEALTH Corporate Compliance Plan COUNTY OF ORANGE DEPARTMENT OF HEALTH CORPORATE COMPLIANCE PLAN I. Corporate Compliance Plan It is the policy of the Orange County Department
More informationWorkers Compensation System Guide
Workers Compensation System Guide INTRODUCTION THE WORKERS COMPENSATION SYSTEM GUIDE IS INTENDED TO GIVE ALL PARTIES A GENERAL OVERVIEW AND SUMMARY OF THE WORKERS COMPENSATION SYSTEM. IT IS NOT INTENDED
More informationBoard of Speech-Language Pathology and Audiology
Board of Speech-Language Pathology and Audiology Application for Speech-Language Pathology or Audiology Provisional Licensure With Instructions Attached Board of Speech-Language Pathology and Audiology
More informationColorado Department of Labor and Employment Division of Workers Compensation. Claims Compliance Audit Guide
Colorado Department of Labor and Employment Division of Workers Compensation Claims Compliance Audit Guide Division of Workers Compensation Carrier Practices Unit 633 17 th Street Suite 400 Denver, CO
More informationAPPLICATION FOR SUPPLEMENTAL INCOME BENEFITS (DWC Form-052)
Texas Department Of Insurance Division of Workers Compensation 7551 Metro Center Dr. Ste.100 MS-603 Austin, TX 78744-1609 (800) 252-7031 (512) 804-4378 fax www.tdi.texas.gov Please complete, if known:
More informationTITLE 810. OKLAHOMA WORKERS COMPENSATION COMMISSION PROPOSED ADMINISTRATIVE RULES. Public Comment Draft
TITLE. OKLAHOMA WORKERS COMPENSATION COMMISSION PROPOSED ADMINISTRATIVE RULES Page of 0 0 0 TITLE. OKLAHOMA WORKERS COMPENSATION COMMISSION PROPOSED ADMINISTRATIVE RULES CHAPTER - General Information Section
More information(d) Concurrent review means utilization review conducted during an inpatient stay.
9792.6. Utilization Review Standards Definitions For Utilization Review Decisions Issued Prior to July 1, 2013 for Injuries Occurring Prior to January 1, 2013. As used in this Article: The following definitions
More informationTexas Workers Compensation
Texas Workers Compensation Tips for Successful Medical Billing and Reimbursement Practices Presented by: Regina Schwartz Health Care Specialist Texas Dept of Insurance - Division of Workers Compensation
More informationNAME (First, Middle, Last) Social Security Number Date of Accident (Month-Day-Year) Time of Accident
FIRST REPORT OF INJURY OR ILLNESS RECEIVED BY CLAIMS-HANDLING ENTITY SENT TO DIVISION DATE DIVISION RECEIVED DATE FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION For assistance
More informationAB1455 Claims Processing Complete Definitions
Complete s Automatically Automatically means the payment of the interest due to the provider within five (5) working days of the payment of the claim without the need for any reminder or : (a) (1) request
More informationState of Oregon - Board of Licensed Social Workers 3218 Pringle Rd. SE, Ste. 240, Salem, OR 97302 (503) 378-5735 Oregon.BLSW@state.or.
State of Oregon - Board of Licensed Social Workers 3218 Pringle Rd. SE, Ste. 240, Salem, OR 97302 (503) 378-5735 Oregon.BLSW@state.or.us LCSW License Renewal Application License Number: Renewal Date (end
More informationEarly Intervention Central Billing Office. Provider Insurance Billing Procedures
Early Intervention Central Billing Office Provider Insurance Billing Procedures May 2013 Provider Insurance Billing Procedures Provider Registration Each provider choosing to opt out of billing for one,
More informationTHE ALMOST HASSLE-FREE WAY TO COLLECT PA WORKERS COMPENSATION MEDICAL BILLS
www.workinjuryinpa.com THE ALMOST HASSLE-FREE WAY TO COLLECT PA WORKERS COMPENSATION MEDICAL BILLS This book has the forms and guidance to get your workers compensation medical bills paid. THE ALMOST HASSLE-FREE
More informationDepartment of Health and Human Services DEPARTMENTAL APPEALS BOARD. Civil Remedies Division
Department of Health and Human Services DEPARTMENTAL APPEALS BOARD Civil Remedies Division M. Dwight Evans, Petitioner, v. Social Security Administration. Docket No. C-14-552 Decision No. CR3143 Date:
More information"HAWAII ADMINISTRATIVE RULES TITLE 11 DEPARTMENT OF HEALTH CHAPTER 160 MEDICAL USE OF MARIJUANA. Debilitating Medical Conditions
"HAWAII ADMINISTRATIVE RULES TITLE 11 DEPARTMENT OF HEALTH CHAPTER 160 MEDICAL USE OF MARIJUANA Subchapter 1 General Provisions 11-160-1 Purpose 11-160-2 Definitions 11-160-3 Severability 11-160-4 Disclaimer
More informationc) Provider Identification Number(s) associated with claims,
Title 23: Division of Medicaid Part 305: Program Integrity Part 305 Chapter 1: Program Integrity Rule 1.1: Fraud and Abuse A. Title XIX of the Social Security Act, the implementing federal regulations
More informationSAN FRANCISCO AMENDS BUSINESS TAX ORDINANCE BOARD OF REVIEW ELIMINATED, STATUTE OF LIMITATIONS FOR REFUNDS INCREASED AND MUCH MORE. Tax March 26, 2004
SAN FRANCISCO AMENDS BUSINESS TAX ORDINANCE BOARD OF REVIEW ELIMINATED, STATUTE OF LIMITATIONS FOR REFUNDS INCREASED AND MUCH MORE Tax On February 19, 2004, San Francisco Mayor Gavin Newsom approved recent
More informationOFFICE OF INSURANCE REGULATION Property and Casualty Product Review
OFFICE OF INSURANCE REGULATION Property and Casualty Product Review NOTIFICATION OF PERSONAL INJURY PROTECTION BENEFITS YOUR PERSONAL INJURY PROTECTION RIGHTS AND BENEFITS UNDER THE FLORIDA MOTOR VEHICLE
More informationSTATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF FLORIDA LAND SALES, CONDOMINIUMS, AND MOBILE HOMES
STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF FLORIDA LAND SALES, CONDOMINIUMS, AND MOBILE HOMES IN RE: PETITION FOR ARBITRATION BERMUDA CLUB MANAGEMENT COUNSEL, INC.,
More informationSTATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF FLORIDA LAND SALES, CONDOMINIUMS, AND MOBILE HOMES
STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF FLORIDA LAND SALES, CONDOMINIUMS, AND MOBILE HOMES IN RE: PETITION FOR ARBITRATION Joel D. Ronan and Jana L. Ronan, Petitioners,
More informationorientation for injured workers Workers Compensation Program for Employees and Volunteers of State of Florida Agencies and Universities
Workers Compensation Program for Employees and Volunteers of State of Florida Agencies and Universities Florida Department of Financial Services Division of Risk Management 1-800-262-4402 orientation for
More informationSUBCHAPTER 57D APPRAISAL MANAGEMENT COMPANIES SECTION.0100 APPLICATION FOR APPRAISAL MANAGEMENT REGISTRATION
SUBCHAPTER 57D APPRAISAL MANAGEMENT COMPANIES SECTION.0100 APPLICATION FOR APPRAISAL MANAGEMENT REGISTRATION 21 NCAC 57D.0101 FORM An appraisal management company that wishes to file an application for
More informationKey Provisions of Tennessee Senate Bill 200 Effective July 1, 2014, through July 1, 2016
2014 Construction of Statute Definition of Injury (Causation) Revises Section 50-6-116, Construction of Chapter, to indicate that for dates of injury on or after July 1, 2014, the chapter should no longer
More informationBOARD OF RESPIRATORY CARE
BOARD OF RESPIRATORY CARE APPLICATION MATERIALS FOR REGISTERED RESPIRATORY THERAPIST & CERTIFIED RESPIRATORY THERAPIST LICENSURE July 2012 Edition Mission: To protect, promote & improve the health of all
More informationREFERENCE ACTION ANALYST STAFF DIRECTOR or BUDGET/POLICY CHIEF. 1) Insurance & Banking Subcommittee 11 Y, 0 N Reilly Cooper.
HOUSE OF REPRESENTATIVES STAFF ANALYSIS BILL #: CS/CS/HB 271 Workers' Compensation SPONSOR(S): Regulatory Affairs Committee; Government Operations Appropriations Subcommittee; Cummings and others TIED
More informationHow To Enforce The Insurance Regulation 13.1.1
State of Rhode Island and Providence Plantations DEPARTMENT OF BUSINESS REGULATION Division of Insurance 1511 Pontiac Avenue Cranston, RI 02920 INSURANCE REGULATION 13 UNFAIR LIFE, ACCIDENT AND HEALTH
More informationAETNA MEDICARE OPEN SM PLAN PROVIDER TERMS AND CONDITIONS OF PAYMENT
AETNA MEDICARE OPEN SM PLAN PROVIDER TERMS AND CONDITIONS OF PAYMENT Table of Contents 1. Introduction 2. When a provider is deemed to accept Aetna Medicare Open Plan s terms and conditions 3. Provider
More informationEXHIBIT COORDINATING PROVISIONS-STATE/FEDERAL LAW, ACCREDITATION STANDARDS AND GEOGRAPHIC EXCEPTIONS NEW JERSEY
EXHIBIT COORDINATING PROVISIONS-STATE/FEDERAL LAW, ACCREDITATION STANDARDS AND GEOGRAPHIC EXCEPTIONS NEW JERSEY I. INTRODUCTION: 1. Scope: To the extent of any conflict between the Agreement and this State
More informationSTATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF FLORIDA LAND SALES, CONDOMINIUMS, AND MOBILE HOMES
STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF FLORIDA LAND SALES, CONDOMINIUMS, AND MOBILE HOMES IN RE: PETITION FOR ARBITRATION EDWIN L. STANLEY, JR. and SANDRA D. STANLEY,
More informationPART ONE PRACTICE AND PROCEDURE (60 minutes)
PART ONE PRACTICE AND PROCEDURE (60 minutes) ANSWER THE QUESTIONS IN THIS PART OF THE EXAMINATION IN ANSWER BOOK/S SEPARATE FROM THE ANSWER BOOK/S CONTAINING ANSWERS TO OTHER PARTS OF THE EXAMINATION Question
More information211 CMR 51.00: PREFERRED PROVIDER HEALTH PLANS AND WORKERS COMPENSATION PREFERRED PROVIDER ARRANGEMENTS
211 CMR 51.00: PREFERRED PROVIDER HEALTH PLANS AND WORKERS COMPENSATION PREFERRED PROVIDER ARRANGEMENTS Section 51.01: Authority 51.02: Definitions 51.03: Applicability 51.04: Approval of Preferred Provider
More informationOur Lady of Lourdes Health Care Services, Inc. and Affiliates Administrative and General Policy POLICY NUMBER: AS0019CCP. PAGE NUMBER: 1 of 9
Administrative and General Policy PAGE NUMBER: 1 of 9 ACCOUNTABILITY: OBJECTIVES: POLICY: President and Chief Executive Officer RELATION TO MISSION: Our Lady of Lourdes, a Catholic Health System a member
More informationASSEMBLY, No. 1028 STATE OF NEW JERSEY. Introduced Pending Technical Review by Legislative Counsel PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION
ASSEMBLY, No. STATE OF NEW JERSEY Introduced Pending Technical Review by Legislative Counsel PRE-FILED FOR INTRODUCTION IN THE SESSION By Assemblymen DiGAETANO and KELLY 0 0 AN ACT concerning home improvement
More informationSITE REHABILITATION FUNDING ALLOCATION AGREEMENT FOR A PETROLEUM CONTAMINATED SITE WITH BOTH ELIGIBLE AND NON-ELIGIBLE CONTAMINATION
SITE REHABILITATION FUNDING ALLOCATION AGREEMENT FOR A PETROLEUM CONTAMINATED SITE WITH BOTH ELIGIBLE AND NON-ELIGIBLE CONTAMINATION This Site Rehabilitation Funding Allocation Agreement ( SRFAA or Agreement
More informationPart 2. Texas Department of Insurance, Division of Workers Compensation Chapter 133. Medical Billing and Processing
Page 1 of 5 Pages DWC-06-0021 SUBCHAPTER A. General Rules for Required Reports 133.1 and 133.2 SUBCHAPTER B. Required Reports 133.100, 133.104-133.106 SUBCHAPTER D. Dispute and Audit of Bills by Insurance
More informationINDEPENDENT CONTRACTOR vs. EMPLOYEE:
INDEPENDENT CONTRACTOR vs. EMPLOYEE: IMPROPERLY TREATING A D.C. OR LMT AS AN INDEPENDENT CONTRACTOR INSTEAD OF AN EMPLOYEE CAN LEAD TO AN IRS AUDIT, FINES, PENALTIES AND PAYMENT OF UNCOLLECTED TAXES By,
More informationTRANSFER OF STRUCTURED SETTLEMENT PAYMENT RIGHTS
For more information please visit Strategic Capital Corporation at www.strategiccapital.com, or contact us at Toll Free: 1-866-256-0088 or email us at info@strategiccapital.com. TRANSFER OF STRUCTURED
More informationUNITED STATES OF AMERICA BEFORE THE FEDERAL TRADE COMMISSION
UNITED STATES OF AMERICA BEFORE THE FEDERAL TRADE COMMISSION In the Matter of MACHINIMA, INC., a corporation File No. 1423090 AGREEMENT CONTAINING CONSENT ORDER The Federal Trade Commission has conducted
More informationFlorida Workers Compensation
Florida Workers Compensation Reimbursement Manual for Hospitals Rule 69L-7.501, F.A.C. 2014 Edition THIS PAGE INTENTIONALLY LEFT BLANK Page 2 TABLE OF CONTENTS Chapter 1 Introduction and Overview... 5
More informationSubchapter G. Electronic Medical Billing, Reimbursement, and Documentation 133.500 & 133.501
Page 1 of 22 pages Subchapter G. Electronic Medical Billing, Reimbursement, and Documentation 133.500 & 133.501 1. INTRODUCTION. The Commissioner of the Division of Workers' Compensation, Texas Department
More informationEMPLOYEE HANDBOOK FOR WORKERS COMPENSATION FLORIDA
EMPLOYEE HANDBOOK FOR WORKERS COMPENSATION FLORIDA District School Board of Pasco County Kurt S. Browning, Superintendent Dear Employee: The District School Board of Pasco County s (District) goal is to
More information