HB 0355 2004
1	A bill to be entitled
2	An act relating to motor vehicle insurance costs; amending
3	s. 627.732, F.S.; defining the terms "biometrics" and
4	"biometric time date technology"; amending s. 627.736,
5	F.S.; providing presumptions and revising procedures with
6	respect to billing and payment for treatment of injured
7	persons under personal injury protection benefits;
8	providing an effective date.
9
10	Be It Enacted by the Legislature of the State of Florida:
11
12	Section 1. Subsections (16) and (17) are added to section
13	627.732, Florida Statutes, to read:
14	627.732 Definitions.--As used in ss. 627.730-627.7405, the
15	term:
16	(16) "Biometrics" means a computer-based biological
17	imprint.
18	(17) "Biometric time date technology" means technology
19	that uses biometric imprints to document the exact date and time
20	a biological imprint was made or recognized.
21	Section 2. Paragraphs (a), (b), and (e) of subsection (5)
22	of section 627.736, Florida Statutes, are amended to read:
23	627.736 Required personal injury protection benefits;
24	exclusions; priority; claims.--
25	(5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
26	(a) Any physician, hospital, clinic, or other person or
27	institution lawfully rendering treatment to an injured person
28	for a bodily injury covered by personal injury protection
29	insurance may charge the insurer and injured party only a
30	reasonable amount pursuant to this section for the services and
31	supplies rendered, and the insurer providing such coverage may
32	pay for such charges directly to such person or institution
33	lawfully rendering such treatment, if the insured receiving such
34	treatment or his or her guardian has countersigned the properly
35	completed invoice, bill, or claim form approved by the office
36	upon which such charges are to be paid for as having actually
37	been rendered, to the best knowledge of the insured or his or
38	her guardian. In no event, however, may such a charge be in
39	excess of the amount the person or institution customarily
40	charges for like services or supplies. With respect to a
41	determination of whether a charge for a particular service,
42	treatment, or otherwise is reasonable, consideration may be
43	given to evidence of usual and customary charges and payments
44	accepted by the provider involved in the dispute, and
45	reimbursement levels in the community and various federal and
46	state medical fee schedules applicable to automobile and other
47	insurance coverages, and other information relevant to the
48	reasonableness of the reimbursement for the service, treatment,
49	or supply. It shall be presumed that the insured received the
50	treatment or services specified in the bill for services if the
51	provider uses biometric time date technology that verifies that
52	the insured was present in the provider's office for the time
53	the billed services were rendered.
54	(b)1. An insurer or insured is not required to pay a claim
55	or charges:
56	a. Made by a broker or by a person making a claim on
57	behalf of a broker;
58	b. For any service or treatment that was not lawful at the
59	time rendered;
60	c. To any person who knowingly submits a false or
61	misleading statement relating to the claim or charges;
62	d. With respect to a bill or statement that does not
63	substantially meet the applicable requirements of paragraph (d);
64	e. For any treatment or service that is upcoded, or that
65	is unbundled when such treatment or services should be bundled,
66	in accordance with paragraph (d). To facilitate prompt payment
67	of lawful services, an insurer may change codes that it
68	determines to have been improperly or incorrectly upcoded or
69	unbundled, and may make payment based on the changed codes,
70	without affecting the right of the provider to dispute the
71	change by the insurer, provided that before doing so, the
72	insurer must contact the health care provider and discuss the
73	reasons for the insurer's change and the health care provider's
74	reason for the coding, or make a reasonable good faith effort to
75	do so, as documented in the insurer's file. It shall be presumed
76	that the insured received the treatment or services specified in
77	the bill for services if the provider uses biometric time date
78	technology that verifies that the insured was present in the
79	provider's office for the time the billed services were
80	rendered; and
81	f. For medical services or treatment billed by a physician
82	and not provided in a hospital unless such services are rendered
83	by the physician or are incident to his or her professional
84	services and are included on the physician's bill, including
85	documentation verifying that the physician is responsible for
86	the medical services that were rendered and billed.
87	2. Charges for medically necessary cephalic thermograms,
88	peripheral thermograms, spinal ultrasounds, extremity
89	ultrasounds, video fluoroscopy, and surface electromyography
90	shall not exceed the maximum reimbursement allowance for such
91	procedures as set forth in the applicable fee schedule or other
92	payment methodology established pursuant to s. 440.13.
93	3. Allowable amounts that may be charged to a personal
94	injury protection insurance insurer and insured for medically
95	necessary nerve conduction testing when done in conjunction with
96	a needle electromyography procedure and both are performed and
97	billed solely by a physician licensed under chapter 458, chapter
98	459, chapter 460, or chapter 461 who is also certified by the
99	American Board of Electrodiagnostic Medicine or by a board
100	recognized by the American Board of Medical Specialties or the
101	American Osteopathic Association or who holds diplomate status
102	with the American Chiropractic Neurology Board or its
103	predecessors shall not exceed 200 percent of the allowable
104	amount under the participating physician fee schedule of
105	Medicare Part B for year 2001, for the area in which the
106	treatment was rendered, adjusted annually on August 1 to reflect
107	the prior calendar year's changes in the annual Medical Care
108	Item of the Consumer Price Index for All Urban Consumers in the
109	South Region as determined by the Bureau of Labor Statistics of
110	the United States Department of Labor.
111	4. Allowable amounts that may be charged to a personal
112	injury protection insurance insurer and insured for medically
113	necessary nerve conduction testing that does not meet the
114	requirements of subparagraph 3. shall not exceed the applicable
115	fee schedule or other payment methodology established pursuant
116	to s. 440.13.
117	5. Effective upon this act becoming a law and before
118	November 1, 2001, allowable amounts that may be charged to a
119	personal injury protection insurance insurer and insured for
120	magnetic resonance imaging services shall not exceed 200 percent
121	of the allowable amount under Medicare Part B for year 2001, for
122	the area in which the treatment was rendered. Beginning November
123	1, 2001, allowable amounts that may be charged to a personal
124	injury protection insurance insurer and insured for magnetic
125	resonance imaging services shall not exceed 175 percent of the
126	allowable amount under the participating physician fee schedule
127	of Medicare Part B for year 2001, for the area in which the
128	treatment was rendered, adjusted annually on August 1 to reflect
129	the prior calendar year's changes in the annual Medical Care
130	Item of the Consumer Price Index for All Urban Consumers in the
131	South Region as determined by the Bureau of Labor Statistics of
132	the United States Department of Labor for the 12-month period
133	ending June 30 of that year, except that allowable amounts that
134	may be charged to a personal injury protection insurance insurer
135	and insured for magnetic resonance imaging services provided in
136	facilities accredited by the Accreditation Association for
137	Ambulatory Health Care, the American College of Radiology, or
138	the Joint Commission on Accreditation of Healthcare
139	Organizations shall not exceed 200 percent of the allowable
140	amount under the participating physician fee schedule of
141	Medicare Part B for year 2001, for the area in which the
142	treatment was rendered, adjusted annually on August 1 to reflect
143	the prior calendar year's changes in the annual Medical Care
144	Item of the Consumer Price Index for All Urban Consumers in the
145	South Region as determined by the Bureau of Labor Statistics of
146	the United States Department of Labor for the 12-month period
147	ending June 30 of that year. This paragraph does not apply to
148	charges for magnetic resonance imaging services and nerve
149	conduction testing for inpatients and emergency services and
150	care as defined in chapter 395 rendered by facilities licensed
151	under chapter 395.
152	6. The Department of Health, in consultation with the
153	appropriate professional licensing boards, shall adopt, by rule,
154	a list of diagnostic tests deemed not to be medically necessary
155	for use in the treatment of persons sustaining bodily injury
156	covered by personal injury protection benefits under this
157	section. The initial list shall be adopted by January 1, 2004,
158	and shall be revised from time to time as determined by the
159	Department of Health, in consultation with the respective
160	professional licensing boards. Inclusion of a test on the list
161	of invalid diagnostic tests shall be based on lack of
162	demonstrated medical value and a level of general acceptance by
163	the relevant provider community and shall not be dependent for
164	results entirely upon subjective patient response.
165	Notwithstanding its inclusion on a fee schedule in this
166	subsection, an insurer or insured is not required to pay any
167	charges or reimburse claims for any invalid diagnostic test as
168	determined by the Department of Health.
169	(e)1. At the initial treatment or service provided, each
170	physician, other licensed professional, clinic, or other medical
171	institution providing medical services upon which a claim for
172	personal injury protection benefits is based shall require an
173	insured person, or his or her guardian, to execute a disclosure
174	and acknowledgment form, which reflects at a minimum that:
175	a. The insured, or his or her guardian, must countersign
176	the form attesting to the fact that the services set forth
177	therein were actually rendered;
178	b. The insured, or his or her guardian, has both the right
179	and affirmative duty to confirm that the services were actually
180	rendered;
181	c. The insured, or his or her guardian, was not solicited
182	by any person to seek any services from the medical provider;
183	d. That the physician, other licensed professional,
184	clinic, or other medical institution rendering services for
185	which payment is being claimed explained the services to the
186	insured or his or her guardian; and
187	e. If the insured notifies the insurer in writing of a
188	billing error, the insured may be entitled to a certain
189	percentage of a reduction in the amounts paid by the insured's
190	motor vehicle insurer; and
191	f. Countersignatures may be done by biometric or
192	electronic means.
193	2. The physician, other licensed professional, clinic, or
194	other medical institution rendering services for which payment
195	is being claimed has the affirmative duty to explain the
196	services rendered to the insured, or his or her guardian, so
197	that the insured, or his or her guardian, countersigns the form
198	with informed consent.
199	3. Countersignature by the insured, or his or her
200	guardian, is not required for the reading of diagnostic tests or
201	other services that are of such a nature that they are not
202	required to be performed in the presence of the insured.
203	4. The licensed medical professional rendering treatment
204	for which payment is being claimed must sign, by his or her own
205	hand, the form complying with this paragraph.
206	5. The original completed disclosure and acknowledgment
207	form shall be furnished to the insurer pursuant to paragraph
208	(4)(b) and may not be electronically furnished.
209	6. This disclosure and acknowledgment form is not required
210	for services billed by a provider for emergency services as
211	defined in s. 395.002, for emergency services and care as
212	defined in s. 395.002 rendered in a hospital emergency
213	department, or for transport and treatment rendered by an
214	ambulance provider licensed pursuant to part III of chapter 401.
215	7. The Financial Services Commission shall adopt, by rule,
216	a standard disclosure and acknowledgment form that shall be used
217	to fulfill the requirements of this paragraph, effective 90 days
218	after such form is adopted and becomes final. The commission
219	shall adopt a proposed rule by October 1, 2003. Until the rule
220	is final, the provider may use a form of its own which otherwise
221	complies with the requirements of this paragraph.
222	8. As used in this paragraph, "countersigned" means a
223	second or verifying signature, as on a previously signed
224	document, and is not satisfied by the statement "signature on
225	file" or any similar statement.
226	9. The requirements of this paragraph apply only with
227	respect to the initial treatment or service of the insured by a
228	provider. For subsequent treatments or service, the provider
229	must maintain a patient log signed by the patient, in
230	chronological order by date of service, that is consistent with
231	the services being rendered to the patient as claimed. The
232	requirements of this subparagraph for maintaining a patient log
233	signed by the patient may be met by a hospital that maintains
234	medical records as required by s. 395.3025 and applicable rules
235	and makes such records available to the insurer upon request.
236	Section 3. This act shall take effect July 1, 2004.