Senate Bill sb2482c1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 CS for SB 2482
By the Committee on Banking and Insurance; and Senator
Alexander
311-2240-04
1 A bill to be entitled
2 An act relating to motor vehicle personal
3 injury protection insurance benefits; amending
4 s. 627.736, F.S.; deleting the period of time
5 relating to adjustments in the Medical Care
6 Item of the Consumer Price Index which applies
7 to allowable amounts that may be charged to a
8 personal injury protection insurance insurer
9 and insured for magnetic resonance imaging
10 services; exempting services rendered by an
11 ambulatory surgical center from certain
12 disclosure requirements; providing an effective
13 date.
14
15 Be It Enacted by the Legislature of the State of Florida:
16
17 Section 1. Paragraphs (b) and (e) of subsection (5) of
18 section 627.736, Florida Statutes, are amended to read:
19 627.736 Required personal injury protection benefits;
20 exclusions; priority; claims.--
21 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
22 (b)1. An insurer or insured is not required to pay a
23 claim or charges:
24 a. Made by a broker or by a person making a claim on
25 behalf of a broker;
26 b. For any service or treatment that was not lawful at
27 the time rendered;
28 c. To any person who knowingly submits a false or
29 misleading statement relating to the claim or charges;
30
31
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 CS for SB 2482
311-2240-04
1 d. With respect to a bill or statement that does not
2 substantially meet the applicable requirements of paragraph
3 (d);
4 e. For any treatment or service that is upcoded, or
5 that is unbundled when such treatment or services should be
6 bundled, in accordance with paragraph (d). To facilitate
7 prompt payment of lawful services, an insurer may change codes
8 that it determines to have been improperly or incorrectly
9 upcoded or unbundled, and may make payment based on the
10 changed codes, without affecting the right of the provider to
11 dispute the change by the insurer, provided that before doing
12 so, the insurer must contact the health care provider and
13 discuss the reasons for the insurer's change and the health
14 care provider's reason for the coding, or make a reasonable
15 good faith effort to do so, as documented in the insurer's
16 file; and
17 f. For medical services or treatment billed by a
18 physician and not provided in a hospital unless such services
19 are rendered by the physician or are incident to his or her
20 professional services and are included on the physician's
21 bill, including documentation verifying that the physician is
22 responsible for the medical services that were rendered and
23 billed.
24 2. Charges for medically necessary cephalic
25 thermograms, peripheral thermograms, spinal ultrasounds,
26 extremity ultrasounds, video fluoroscopy, and surface
27 electromyography shall not exceed the maximum reimbursement
28 allowance for such procedures as set forth in the applicable
29 fee schedule or other payment methodology established pursuant
30 to s. 440.13.
31
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 CS for SB 2482
311-2240-04
1 3. Allowable amounts that may be charged to a personal
2 injury protection insurance insurer and insured for medically
3 necessary nerve conduction testing when done in conjunction
4 with a needle electromyography procedure and both are
5 performed and billed solely by a physician licensed under
6 chapter 458, chapter 459, chapter 460, or chapter 461 who is
7 also certified by the American Board of Electrodiagnostic
8 Medicine or by a board recognized by the American Board of
9 Medical Specialties or the American Osteopathic Association or
10 who holds diplomate status with the American Chiropractic
11 Neurology Board or its predecessors shall not exceed 200
12 percent of the allowable amount under the participating
13 physician fee schedule of Medicare Part B for year 2001, for
14 the area in which the treatment was rendered, adjusted
15 annually on August 1 to reflect the prior calendar year's
16 changes in the annual Medical Care Item of the Consumer Price
17 Index for All Urban Consumers in the South Region as
18 determined by the Bureau of Labor Statistics of the United
19 States Department of Labor.
20 4. Allowable amounts that may be charged to a personal
21 injury protection insurance insurer and insured for medically
22 necessary nerve conduction testing that does not meet the
23 requirements of subparagraph 3. shall not exceed the
24 applicable fee schedule or other payment methodology
25 established pursuant to s. 440.13.
26 5. Effective upon this act becoming a law and before
27 November 1, 2001, allowable amounts that may be charged to a
28 personal injury protection insurance insurer and insured for
29 magnetic resonance imaging services shall not exceed 200
30 percent of the allowable amount under Medicare Part B for year
31 2001, for the area in which the treatment was rendered.
3
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 CS for SB 2482
311-2240-04
1 Beginning November 1, 2001, allowable amounts that may be
2 charged to a personal injury protection insurance insurer and
3 insured for magnetic resonance imaging services shall not
4 exceed 175 percent of the allowable amount under the
5 participating physician fee schedule of Medicare Part B for
6 year 2001, for the area in which the treatment was rendered,
7 adjusted annually on August 1 to reflect the prior calendar
8 year's changes in the annual Medical Care Item of the Consumer
9 Price Index for All Urban Consumers in the South Region as
10 determined by the Bureau of Labor Statistics of the United
11 States Department of Labor for the 12-month period ending June
12 30 of that year, except that allowable amounts that may be
13 charged to a personal injury protection insurance insurer and
14 insured for magnetic resonance imaging services provided in
15 facilities accredited by the Accreditation Association for
16 Ambulatory Health Care, the American College of Radiology, or
17 the Joint Commission on Accreditation of Healthcare
18 Organizations shall not exceed 200 percent of the allowable
19 amount under the participating physician fee schedule of
20 Medicare Part B for year 2001, for the area in which the
21 treatment was rendered, adjusted annually on August 1 to
22 reflect the prior calendar year's changes in the annual
23 Medical Care Item of the Consumer Price Index for All Urban
24 Consumers in the South Region as determined by the Bureau of
25 Labor Statistics of the United States Department of Labor for
26 the 12-month period ending June 30 of that year. This
27 paragraph does not apply to charges for magnetic resonance
28 imaging services and nerve conduction testing for inpatients
29 and emergency services and care as defined in chapter 395
30 rendered by facilities licensed under chapter 395.
31
4
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 CS for SB 2482
311-2240-04
1 6. The Department of Health, in consultation with the
2 appropriate professional licensing boards, shall adopt, by
3 rule, a list of diagnostic tests deemed not to be medically
4 necessary for use in the treatment of persons sustaining
5 bodily injury covered by personal injury protection benefits
6 under this section. The initial list shall be adopted by
7 January 1, 2004, and shall be revised from time to time as
8 determined by the Department of Health, in consultation with
9 the respective professional licensing boards. Inclusion of a
10 test on the list of invalid diagnostic tests shall be based on
11 lack of demonstrated medical value and a level of general
12 acceptance by the relevant provider community and shall not be
13 dependent for results entirely upon subjective patient
14 response. Notwithstanding its inclusion on a fee schedule in
15 this subsection, an insurer or insured is not required to pay
16 any charges or reimburse claims for any invalid diagnostic
17 test as determined by the Department of Health.
18 (e)1. At the initial treatment or service provided,
19 each physician, other licensed professional, clinic, or other
20 medical institution providing medical services upon which a
21 claim for personal injury protection benefits is based shall
22 require an insured person, or his or her guardian, to execute
23 a disclosure and acknowledgment form, which reflects at a
24 minimum that:
25 a. The insured, or his or her guardian, must
26 countersign the form attesting to the fact that the services
27 set forth therein were actually rendered;
28 b. The insured, or his or her guardian, has both the
29 right and affirmative duty to confirm that the services were
30 actually rendered;
31
5
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 CS for SB 2482
311-2240-04
1 c. The insured, or his or her guardian, was not
2 solicited by any person to seek any services from the medical
3 provider;
4 d. That the physician, other licensed professional,
5 clinic, or other medical institution rendering services for
6 which payment is being claimed explained the services to the
7 insured or his or her guardian; and
8 e. If the insured notifies the insurer in writing of a
9 billing error, the insured may be entitled to a certain
10 percentage of a reduction in the amounts paid by the insured's
11 motor vehicle insurer.
12 2. The physician, other licensed professional, clinic,
13 or other medical institution rendering services for which
14 payment is being claimed has the affirmative duty to explain
15 the services rendered to the insured, or his or her guardian,
16 so that the insured, or his or her guardian, countersigns the
17 form with informed consent.
18 3. Countersignature by the insured, or his or her
19 guardian, is not required for the reading of diagnostic tests
20 or other services that are of such a nature that they are not
21 required to be performed in the presence of the insured.
22 4. The licensed medical professional rendering
23 treatment for which payment is being claimed must sign, by his
24 or her own hand, the form complying with this paragraph.
25 5. The original completed disclosure and
26 acknowledgment form shall be furnished to the insurer pursuant
27 to paragraph (4)(b) and may not be electronically furnished.
28 6. This disclosure and acknowledgment form is not
29 required for services billed by a provider for emergency
30 services as defined in s. 395.002, for emergency services and
31 care as defined in s. 395.002 rendered in a hospital emergency
6
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 CS for SB 2482
311-2240-04
1 department, for services rendered in an ambulatory surgical
2 center as defined in s. 395.002, or for transport and
3 treatment rendered by an ambulance provider licensed pursuant
4 to part III of chapter 401.
5 7. The Financial Services Commission shall adopt, by
6 rule, a standard disclosure and acknowledgment form that shall
7 be used to fulfill the requirements of this paragraph,
8 effective 90 days after such form is adopted and becomes
9 final. The commission shall adopt a proposed rule by October
10 1, 2003. Until the rule is final, the provider may use a form
11 of its own which otherwise complies with the requirements of
12 this paragraph.
13 8. As used in this paragraph, "countersigned" means a
14 second or verifying signature, as on a previously signed
15 document, and is not satisfied by the statement "signature on
16 file" or any similar statement.
17 9. The requirements of this paragraph apply only with
18 respect to the initial treatment or service of the insured by
19 a provider. For subsequent treatments or service, the provider
20 must maintain a patient log signed by the patient, in
21 chronological order by date of service, that is consistent
22 with the services being rendered to the patient as claimed.
23 The requirements of this subparagraph for maintaining a
24 patient log signed by the patient may be met by a hospital or
25 ambulatory surgical center that maintains medical records as
26 required by s. 395.3025 and applicable rules and makes such
27 records available to the insurer upon request.
28 Section 2. This act shall take effect July 1, 2004.
29
30
31
7
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 CS for SB 2482
311-2240-04
1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 2482
3
4 Provides that the disclosure and acknowledgment form which
health care providers and insureds must execute at the initial
5 treatment of the insured is not required for medical services
rendered in an ambulatory surgical center. Requires that the
6 ambulatory surgical center may maintain medical records and
have such records available to an insurer upon request, in
7 lieu of maintaining a patient log.
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
8
CODING: Words stricken are deletions; words underlined are additions.