Current through Reg. 47, No. 249; December 28, 2021
As used in this Rule Chapter:
(1) "Carrier" is as defined in Section
440.13(1)(c), Florida Statutes (F.S.).
(2) "Division" means The Department of
Financial Services Division of Workers' Compensation.
(3) "Health Care Provider" (hereinafter
referred to as "Provider") is as defined in Section 440.13(1)(h), F.S., and
includes those that consent to the jurisdiction of the Division pursuant to
Section 440.13(3)(f), F.S.
"Supportive Documentation" is defined as all documents and records that support
an allegation of a violation pursuant to this Rule Chapter.
(5) "Verifiable delivery process" is defined
as the ability to document a common carrier's pick-up date or a United States
Postal Services postmark date.
"Violation" is defined as a Provider's non-compliance with Chapter 440, F.S.,
and Division rules, which shall include: failing to submit medical records and
reports pursuant to Sections 440.13(4)(a) and (c), F.S., or pursuant to
F.A.C.; failing to refund an overpayment of reimbursement, pursuant to Section
440.13(11)(a), F.S.; collecting or receiving payment from an injured worker in
violation of Section 440.13(14)(a), F.S.; failing to follow standards of care,
pursuant to Section 440.13(16), F.S., including overutilization of services; or
failing to properly bill medical services, pursuant to Rule
F.A.C. Recommending treatment that would constitute overutilization, in and of
itself, is not an instance of overutilization.
"Improper billing and billing errors"
means the failure of a Provider to comply with the Division's billing and
reporting requirements pursuant to Rule
F.A.C., and the applicable reimbursement manual(s).