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Member, Beacon International Group, Ltd.
Florida saw a nearly fourfold increase in medical reimbursement disputes for workers compensation cases in its most recent fiscal year, driven largely by reimbursement petitions for physician-dispensed prescription medications, according to the Florida Department of Financial Services Division of Workers’ Compensation.
That finding was discussed this month in a biennial report on the state of Florida's workers comp system, issued by a three-member panel of the state workers comp division. The Florida workers comp division includes an Office of Medical Services that resolves medical reimbursement disputes between insurers and health practitioners.
The division's report shows that there were 15,000 medical reimbursement petitions submitted by health care providers to the state workers comp division in fiscal 2011-12. That's compared with 3,777 petitions filed in fiscal 2010-11.
Reimbursement dispute petitions from practitioners increased to 12,718 last year, up from 1,308 in fiscal 2010-11. The panel report said that most of those petitions included disputes over physician-dispensed or "repackaged" medications.
In its report, the workers comp panel said Florida lawmakers could help reduce reimbursement disputes by passing legislation to limit price differences between repackaged drugs and non-repackaged prescriptions.
The panel also recommended increasing time limits for insurers to respond to medical reimbursement dispute petitions, partly to allow time for insurers and health care providers to negotiate reimbursement outside of the dispute resolution process.