Wednesday, June 15, 2016

Service provided in out of state ASC facility

Out-of-State Facility

ASC services provided by an out-of-state facility require prior authorization by the insurer.
An ASC outside the state of Florida shall be reimbursed the amount mutually agreed upon in a contract between the ASC and the insurer during the authorization process.

If reimbursement is not agreed upon prior to rendering the service, reimbursement shall be the greater of:

• The reimbursement amount allowed by the Florida schedule; or

• The reimbursement amount of the state in which the service(s) are rendered.

The insurer shall disallow or adjust reimbursement for any charges that are:

• Not documented in the patient’s medical record; or

• Not consistent with the ASC’s Charge Master; or

• For services, treatment or supplies that are not medically necessary for treatment of the patient’s compensable injury or condition; or

• For services unrelated to the treatment or care of a compensable injury.

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