قالب وردپرس درنا توس
Home / Insurance / Insurance companies question proposed payment rules for inpatient hospital care

Insurance companies question proposed payment rules for inpatient hospital care



A group of insurance companies is asking the Florida Division of Administrative Hearings to analyze the validity of proposed hospital reimbursement rules and determine whether the methods used by the Division of Workers’ Compensation to set maximum reimbursements were “arbitrary and capricious.”

Normandy Insurance Co., Zenith Insurance Co., Bridgefield Employers Insurance Co., Bridgefield Casualty Insurance Co., BusinessFirst Insurance Co. and RetailFirst Insurance Co. asks the Administrative Hearings Division to review certain provisions of the proposed 2020 edition of the Florida Workers’ Compensation Manual for Hospitals, which have not become effective.

The challenge specifically addresses the recently proposed maximum inpatient reimbursements and the definitions and criteria for their application. The insurers also challenge a provision dealing with emergency services and care as too vague.

The proposed fee schedule would pay $7,000 per day for hospital stays not involving surgery or intensive care, $1

1,000 per day for each day of a stay where surgery was performed, and $13,000 per day for intensive care.

The hospital’s current reimbursement manual allows payments from $2,283.40 per day to $3,850.33 per day. It also includes a “stop loss” provision that requires the insurer to pay 75% of the billed fee if a hospital charges more than a certain threshold amount.

The three-member panel approved the new method in December 2020.

Insurers say they generally agree with the proposed reimbursement model, but not the proposed daily payments.

WorkCompCentral is a sister magazine to Business Insurance. More stories here.


Source link