Florida Regulations 69L-30.008: Billing and Reimbursement for Expert Medical Advisor Services
Current as of: 2024 | Check for updates
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(1) Within 30 calendar days following submittal of the written report, the EMA must submit billing, per the contract with the Department or JCC, for services, documenting total number of hours and total dollar charges for the contracted services.
(2) If additional diagnostic testing is required for the EMA to render a medical opinion, charges for diagnostic testing shall:
(a) Require prior authorization from the JCC or the Department; and,
(b) Be billed in accordance with Fl. Admin. Code R. 69L-7.730; and,
(c) Be reimbursed in accordance with the appropriate Florida Workers’ Compensation reimbursement manual in effect on the date services were completed.
(3) Within 45 calendar days from receipt of both the written report and invoice, reimbursement shall be rendered to the EMA pursuant to paragraph 440.13(9)(f), F.S.
(4) Hourly reimbursement for EMA services shall be for all services rendered except specialty-diagnostic testing.
(5) Reimbursement, pursuant to an EMA Contract, in accordance with subsections 69L-30.005(2) and (3), F.A.C., shall be as follows:
(a) Except as provided in paragraph (b), reimbursement shall not exceed $300.00 per hour, per case, not including reasonable expenses associated with travel, when applicable, which will be reimbursed in accordance with Florida Statutes § 112.061 The review shall not exceed 8 hours per case unless specifically approved in writing by the Department or JCC, as applicable.
(b) When an examination of an injured employee is required for the EMA to render a medical opinion, charges for an examination shall:
1. Require prior authorization from the requesting party;
2. Be billed in accordance with Fl. Admin. Code R. 69L-7.730; and,
3. Be reimbursed in accordance with the appropriate Florida Division of Workers’ Compensation reimbursement manual in effect on the date services were rendered.
(c) An EMA shall be reimbursed for travel and other administrative expenses consistent with the terms of the contract between the EMA and the Department.
(d) Fees for EMA deposition testimony are limited to $200 per hour, pursuant to subFlorida Statutes § 440.13(10)
Rulemaking Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History-New 1-23-95, Formerly 38F-54.008, Amended 10-11-06, Formerly 59A-30.008, Amended 3-1-16.
Terms Used In Florida Regulations 69L-30.008
- Contract: A legal written agreement that becomes binding when signed.
- Deposition: An oral statement made before an officer authorized by law to administer oaths. Such statements are often taken to examine potential witnesses, to obtain discovery, or to be used later in trial.
- Testimony: Evidence presented orally by witnesses during trials or before grand juries.
(a) Require prior authorization from the JCC or the Department; and,
(b) Be billed in accordance with Fl. Admin. Code R. 69L-7.730; and,
(c) Be reimbursed in accordance with the appropriate Florida Workers’ Compensation reimbursement manual in effect on the date services were completed.
(3) Within 45 calendar days from receipt of both the written report and invoice, reimbursement shall be rendered to the EMA pursuant to paragraph 440.13(9)(f), F.S.
(4) Hourly reimbursement for EMA services shall be for all services rendered except specialty-diagnostic testing.
(5) Reimbursement, pursuant to an EMA Contract, in accordance with subsections 69L-30.005(2) and (3), F.A.C., shall be as follows:
(a) Except as provided in paragraph (b), reimbursement shall not exceed $300.00 per hour, per case, not including reasonable expenses associated with travel, when applicable, which will be reimbursed in accordance with Florida Statutes § 112.061 The review shall not exceed 8 hours per case unless specifically approved in writing by the Department or JCC, as applicable.
(b) When an examination of an injured employee is required for the EMA to render a medical opinion, charges for an examination shall:
1. Require prior authorization from the requesting party;
2. Be billed in accordance with Fl. Admin. Code R. 69L-7.730; and,
3. Be reimbursed in accordance with the appropriate Florida Division of Workers’ Compensation reimbursement manual in effect on the date services were rendered.
(c) An EMA shall be reimbursed for travel and other administrative expenses consistent with the terms of the contract between the EMA and the Department.
(d) Fees for EMA deposition testimony are limited to $200 per hour, pursuant to subFlorida Statutes § 440.13(10)
Rulemaking Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History-New 1-23-95, Formerly 38F-54.008, Amended 10-11-06, Formerly 59A-30.008, Amended 3-1-16.