Florida Regulations 69L-34.001

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§ 69L-34.001 Definitions

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.

(4) �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.

(6) �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 subsection 69L-7.602(4), 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 69L-7.602, F.A.C. Recommending treatment that would constitute overutilization, in and of itself, is not an instance of overutilization.

(7) �Improper billing and billing errors� means the failure of a Provider to comply with the Division's billing and reporting requirements pursuant to Rule 69L-7.602, F.A.C., and the applicable reimbursement manual(s).

Rulemaking Authority 440.13(4)(c), (7)(e), 440.591 FS. Law Implemented 440.13, 440.13(1)(k) FS. History-New 9-6-11.