Here are five key points:
1. ASCs and health plans are currently able to file a dispute on payment with the Division of Workers’ Compensation. However, the new proposal would require the parties to resolve the issue with “independent action.”
2. The Florida Society of Ambulatory Surgical Centers and HCA affiliates say the division does not have the authority to change the dispute process based on current law. In its challenge, the Florida Society of Ambulatory Surgical Centers said current law does not allow for healthcare providers and an insurance company to resolve their disputes in an “independent application” as the fact that the parties filed a reimbursement dispute indicates the two entities could not reach an agreement without the division.
3. Specifically, the proposal’s opponents contest the provision that says the division would not need to provide findings about whether insurers improperly disallowed or need to adjust payments in situations where providers or payers claim contracts or managed care arrangements determine the reimbursement total.
4. The proposed rule would allow the division to issue the reimbursement amount based on “appropriate reimbursement schedules, practice parameters and protocols of treatment under (a chapter of state law) to assist the healthcare provider and the carrier in the independent application of the provisions of the contract or the workers’ compensation managed care arrangement to resolve the dispute,” according to News 4 Jax.
5. Case hearings are scheduled in late June with Administrative Law Judge D. R. Alexander.
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