Current through Reg. 50, No. 187; September 24, 2024
(1) Website. Each center shall make available
to patients and prospective patients price transparency and patient billing
information on its website regarding the availability of estimates of costs
that may be incurred by the patient, financial assistance, billing practices,
and a hyperlink to the Agency's service bundle pricing website. The content on
the center's website shall be reviewed at least every 90 days and updated as
needed to maintain timely and accurate information. For the purpose of this
rule, service bundles means the reasonably expected center services and care
provided to a patient for a specific treatment, procedure, or diagnosis as
posted on the Agency's website. In accordance with Section
395.301, F.S., the center's
website must include:
(a) A hyperlink to the
Agency's pricing website upon implementation of the same that provides
information on payments made to the facilities for defined service bundles and
procedures. The Agency's pricing website is located at:
http://pricing.floridahealthfinder.gov;
(b) A statement informing patients and
prospective patients that the service bundle information is a non-personalized
estimate of costs that may be incurred by the patient for anticipated services
and that actual costs will be based on services actually provided to the
patient;
(c) A statement informing
patients and prospective patients of their right to request a personalized
estimate from the center;
(d) A
statement informing patients of the center's financial assistance policy,
charity care policy, and collection procedure;
(e) A list of names and contact information
of health care practitioners and medical practice groups contracted to provide
services within the center, grouped by specialty or service; and,
(f) A statement informing patients to contact
the health care practitioners anticipated to provide services to the patient
while in the center regarding a personalized estimate, billing practices and
participation with the patient's insurance provider or health maintenance
organization (HMO) as the practitioners may not participate with the same
health insurers or HMO as the center.
(2) Estimate. The center shall provide an
estimate upon request of the patient, prospective patient, or legal guardian
for nonemergency medical services.
(a) An
estimate or an update to a previous estimate shall be provided within 7
business days from receipt of the request. Unless the patient requests a more
personalized estimate, the estimate may be based upon the average payment
received for the anticipated service bundle. Every estimate shall include:
1. A statement informing the requestor to
contact their health insurer or HMO for anticipated cost sharing
responsibilities,
2. A statement
advising the requestor that the actual cost may exceed the estimate,
3. The web address to financial assistance
policies, charity care policy, and collection procedure,
4. A description and purpose of any facility
fees, if applicable,
5. A statement
that services may be provided by other health care providers who may bill
separately,
6. A statement,
including a web address if different from above, that contact information for
health care practitioners and medical practice groups that are expected to bill
separately is available on the center's website; and,
7. A statement advising the requestor that
the patient may pay less for the procedure or service at another facility or in
another health care setting.
(b) If the center provides a non-personalized
estimate, the estimate shall include a statement that a personalized estimate
is available upon request.
(c) A
personalized estimate must include the charges specific to the patient's
anticipated services.
(3)
Itemized statement or bill. The center shall provide an itemized statement or
bill upon request of the patient or the patient's survivor or legal guardian.
The itemized statement or bill shall be provided within 7 business days after
the patient's discharge or release, or 7 business days after the request,
whichever is later. The itemized statement or bill must include:
(a) A description of the individual charges
from each department or service area by date, as prescribed in subsection
395.301(1)(d),
F.S.;
(b) Contact information for
health care practitioners or medical practice groups that are expected to bill
separately based on services provided; and,
(c) The center's contact information for
billing questions and disputes.
Rulemaking Authority 395.301 FS. Law Implemented 395.301
FS.
New 2-19-18.
