Division of Workers Compensation

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Division of Workers Compensation Centralized
Performance System
Robin Ippolito, Coordinator Ippolitor_at_dfs.state.fl
.us
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• Statutory reform effective 10/01/03 (Senate Bill
  50-A) heightened the emphasis on the prompt
  payment of workers compensation benefits and the
  timeliness and accuracy of data reporting to the
  Division.

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Statutory changes in Sections 440.185 and 440.20
Florida Statutes, have

• Increased monitoring of data

• Increased penalties for noncompliance

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The penalty sections responsibilities are to

• Monitor the workers compensation system
  participants performance of their duties as
  required by law and assess fines/penalties for
  failure to comply.

• Ensure data is reported to the Division as
  required by law and assess penalties for failure
  to comply.

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What is the Centralized Performance System (CPS)?
An interactive web-based system where insurers
will access their performance information and
respond to the Division through this website
portal.
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Centralized Performance System (CPS)

• Allows for real time assessment of data
  submitted.

• Data is electronically analyzed and reviewed for
  accuracy, timeliness, and compliance with rule
  and statute.

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CPS Workbench

• Insurers will be able to review information,
  analyze and download the data into spreadsheets,
  add comments and notes, and attach documents.

• The Division can also review the insurers
  response, provide notes and responses to the
  insurer.

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Performance MonitoringDevelopment
CPS Phase One
The first phase of the CPS will be the medical
bill data and reporting.
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As insurers are approved to file medical billing
data electronically through the Medical Data
System (MDS), the CPS will evaluate the data and
the insurer will be notified via email to access
the CPS website and view the performance
information.
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CPS Continued

• Until insurers are approved to submit medical
  billing information through the CPS, the insurer
  must file paper copies of the medical billing
  forms, or file an excel spreadsheet as detailed
  in Rule 69L-7.602, F.A.C. Penalties will be
  issued via written correspondence for the paper
  and excel spreadsheet submissions.

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CPS Medical Billing Data

• Medical Billing Data Forms DFS-F5-DWC-9,
  DFS-F5-DWC-10, DFS-F5-DWC-11, DFS-F5-DWC-90
• CPS monitors both the Payment of Medical Billings
  and the Filing/Reporting of Medical Data Required

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Medical PerformancePayment Requirements
Medical bills must be paid, adjusted and paid,
disallowed, or denied within 45 days of the
insurers receipt of the bill in accordance with
Section 440.20(2)(b).
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Filing Requirements

• Medical bills must be submitted to the Division
  within 45 days of the insurers disposition
  (payment, disallowance, denial) of the bill in
  accordance with Section 440.185(5)(9), and Rule
  69L-7.602.

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Medical Penalties

• In accordance with Rule 69L-7.602, F.A.C.,
• Penalties are calculated monthly by form type

DFS-F5-DWC9 Physician Bill DFS-F5-DWC10
Pharmaceutical/Medical Supplier Bill DFS-F5-DWC11
Dental Billing DFS-F5-DWC90 Hospital Billing
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Medical Performance Penalties
Payment of Medical Bills - Those paid, adjusted
and paid, denied, and disallowed in excess of 45
days after receipt will be subject to penalties
in accordance with Section 440.20(6)(b) as
follows
25.00 per bill for each bill below the 95
timely performance standard, but meeting a 90
timely performance standard.

50.00 per bill for each bill below the 90
timely performance standard.
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• Late Filing of Medical Bills

• Pursuant to Section 440.185(9), F.S., insurers
  who fail to timely submit forms required shall be
  subject to fines up to 1,000. In accordance
  with Rule 69L-7.602, F.A.C., fines are imposed
  for each untimely filed, un-filed, rejected and
  not re-submitted, or rejected and re-submitted
  untimely medical data report according to the
  following schedule
• 01-15 days late - 10.00 16-30 days late -
  20.00
• 31-45 days late - 30.00 46-60 days late -
  40.00
• 61-75 days late - 50.00 76-90 days late -
  100.00
• 91 days or greater - 500.00

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DWC-1 Notice of Injury Penalties
CPS Phase Two early 2005

• Penalties for late payment of compensation and
  late reporting of the DWC-1 will be issued on a
  monthly basis through the Centralized Performance
  System website portal rather than correspondence
  addressing individual claims.

• The insurer will be able to provide additional
  information to clarify/resolve individual items
  included in the monthly penalties.

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DWC-1 Notice of Injury

• Penalties paid to the claimant for Late
• Payment of Compensation in accordance
• with Section 440.20, Florida Statutes

• 12 Interest on the Unpaid Installment

• 20 Penalty on the Unpaid Installment

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DWC-1 Notice of InjuryPursuant to Section
440.185(9), F.S., insurers who fail to timely
submit forms required shall be subject to fines
up to 1,000.

• Current
• 100 1-7 days late
• 200 8-14 days late
• 300 15-21days late
• 400 22-28 day late
• 500 for over 28 days late

• Proposed
• 350 1-7 days late
• 500 8-14 days late
• 650 15-21days late
• 800 22-28 days late
• 1000 over 28 days late

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CPS additions following later in 2005

• DWC-13 (Claim Cost Report)
• Timely Filing

• Proof of coverage forms
• Timely filing

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Penalties and fines for the late filing of claims
forms and late payment of compensation are sent
directly to the Insurer rather than the
claims-handling entity in accordance with Section
440.20(7)(b), Florida Statutes.
If a carrier contracts with a servicing agent
to fulfill its administrative responsibilities
under this chapter, the payment practices of the
servicing agent are deemed the payment practices
of the carrier for the purpose of assessing
penalties against the carrier.
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Measures of Success

• Improvement in the Timeliness of Payment of
  Benefits to injured workers and medical providers

• Improvement in Timeliness and Quality of the Data
  Reported to the Division

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Division Websitehttp//www.fldfs.com/WC

• Rules Current and Proposed
• Forms
• Databases
• Information and Links to the Centralized
  Performance System

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Florida Division of Workers Compensation Central
ized Performance System
Robin Ippolito, Penalty Coordinator Ippolitor_at_dfs.
state.fl.us