Senate Bill sb2482
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Florida Senate - 2004 SB 2482
By Senator Alexander
17-1760-04
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; providing an effective date.
11
12 Be It Enacted by the Legislature of the State of Florida:
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14 Section 1. Paragraph (b) of subsection (5) of section
15 627.736, Florida Statutes, is amended to read:
16 627.736 Required personal injury protection benefits;
17 exclusions; priority; claims.--
18 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
19 (b)1. An insurer or insured is not required to pay a
20 claim or charges:
21 a. Made by a broker or by a person making a claim on
22 behalf of a broker;
23 b. For any service or treatment that was not lawful at
24 the time rendered;
25 c. To any person who knowingly submits a false or
26 misleading statement relating to the claim or charges;
27 d. With respect to a bill or statement that does not
28 substantially meet the applicable requirements of paragraph
29 (d);
30 e. For any treatment or service that is upcoded, or
31 that is unbundled when such treatment or services should be
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Florida Senate - 2004 SB 2482
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1 bundled, in accordance with paragraph (d). To facilitate
2 prompt payment of lawful services, an insurer may change codes
3 that it determines to have been improperly or incorrectly
4 upcoded or unbundled, and may make payment based on the
5 changed codes, without affecting the right of the provider to
6 dispute the change by the insurer, provided that before doing
7 so, the insurer must contact the health care provider and
8 discuss the reasons for the insurer's change and the health
9 care provider's reason for the coding, or make a reasonable
10 good faith effort to do so, as documented in the insurer's
11 file; and
12 f. For medical services or treatment billed by a
13 physician and not provided in a hospital unless such services
14 are rendered by the physician or are incident to his or her
15 professional services and are included on the physician's
16 bill, including documentation verifying that the physician is
17 responsible for the medical services that were rendered and
18 billed.
19 2. Charges for medically necessary cephalic
20 thermograms, peripheral thermograms, spinal ultrasounds,
21 extremity ultrasounds, video fluoroscopy, and surface
22 electromyography shall not exceed the maximum reimbursement
23 allowance for such procedures as set forth in the applicable
24 fee schedule or other payment methodology established pursuant
25 to s. 440.13.
26 3. Allowable amounts that may be charged to a personal
27 injury protection insurance insurer and insured for medically
28 necessary nerve conduction testing when done in conjunction
29 with a needle electromyography procedure and both are
30 performed and billed solely by a physician licensed under
31 chapter 458, chapter 459, chapter 460, or chapter 461 who is
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Florida Senate - 2004 SB 2482
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1 also certified by the American Board of Electrodiagnostic
2 Medicine or by a board recognized by the American Board of
3 Medical Specialties or the American Osteopathic Association or
4 who holds diplomate status with the American Chiropractic
5 Neurology Board or its predecessors shall not exceed 200
6 percent of the allowable amount under the participating
7 physician fee schedule of Medicare Part B for year 2001, for
8 the area in which the treatment was rendered, adjusted
9 annually on August 1 to reflect the prior calendar year's
10 changes in the annual Medical Care Item of the Consumer Price
11 Index for All Urban Consumers in the South Region as
12 determined by the Bureau of Labor Statistics of the United
13 States Department of Labor.
14 4. Allowable amounts that may be charged to a personal
15 injury protection insurance insurer and insured for medically
16 necessary nerve conduction testing that does not meet the
17 requirements of subparagraph 3. shall not exceed the
18 applicable fee schedule or other payment methodology
19 established pursuant to s. 440.13.
20 5. Effective upon this act becoming a law and before
21 November 1, 2001, allowable amounts that may be charged to a
22 personal injury protection insurance insurer and insured for
23 magnetic resonance imaging services shall not exceed 200
24 percent of the allowable amount under Medicare Part B for year
25 2001, for the area in which the treatment was rendered.
26 Beginning November 1, 2001, allowable amounts that may be
27 charged to a personal injury protection insurance insurer and
28 insured for magnetic resonance imaging services shall not
29 exceed 175 percent of the allowable amount under the
30 participating physician fee schedule of Medicare Part B for
31 year 2001, for the area in which the treatment was rendered,
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Florida Senate - 2004 SB 2482
17-1760-04
1 adjusted annually on August 1 to reflect the prior calendar
2 year's changes in the annual Medical Care Item of the Consumer
3 Price Index for All Urban Consumers in the South Region as
4 determined by the Bureau of Labor Statistics of the United
5 States Department of Labor for the 12-month period ending June
6 30 of that year, except that allowable amounts that may be
7 charged to a personal injury protection insurance insurer and
8 insured for magnetic resonance imaging services provided in
9 facilities accredited by the Accreditation Association for
10 Ambulatory Health Care, the American College of Radiology, or
11 the Joint Commission on Accreditation of Healthcare
12 Organizations shall not exceed 200 percent of the allowable
13 amount under the participating physician fee schedule of
14 Medicare Part B for year 2001, for the area in which the
15 treatment was rendered, adjusted annually on August 1 to
16 reflect the prior calendar year's changes in the annual
17 Medical Care Item of the Consumer Price Index for All Urban
18 Consumers in the South Region as determined by the Bureau of
19 Labor Statistics of the United States Department of Labor for
20 the 12-month period ending June 30 of that year. This
21 paragraph does not apply to charges for magnetic resonance
22 imaging services and nerve conduction testing for inpatients
23 and emergency services and care as defined in chapter 395
24 rendered by facilities licensed under chapter 395.
25 6. The Department of Health, in consultation with the
26 appropriate professional licensing boards, shall adopt, by
27 rule, a list of diagnostic tests deemed not to be medically
28 necessary for use in the treatment of persons sustaining
29 bodily injury covered by personal injury protection benefits
30 under this section. The initial list shall be adopted by
31 January 1, 2004, and shall be revised from time to time as
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Florida Senate - 2004 SB 2482
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1 determined by the Department of Health, in consultation with
2 the respective professional licensing boards. Inclusion of a
3 test on the list of invalid diagnostic tests shall be based on
4 lack of demonstrated medical value and a level of general
5 acceptance by the relevant provider community and shall not be
6 dependent for results entirely upon subjective patient
7 response. Notwithstanding its inclusion on a fee schedule in
8 this subsection, an insurer or insured is not required to pay
9 any charges or reimburse claims for any invalid diagnostic
10 test as determined by the Department of Health.
11 Section 2. This act shall take effect July 1, 2004.
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14 SENATE SUMMARY
15 Revises the method of calculating changes in the Consumer
Price Index for purposes of determining the allowable
16 amount payable for magnetic resonance imaging services
under personal injury protection coverage.
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