Chapter 627 Section 732 - 2012 Florida Statutes (2023)

627.732Definitions.As used in p.627.730-627,7405, condition:

(1)"Provider" means any person not licensed under chapter 395, chapter 400, chapter 429, chapter 458, chapter 459, chapter 460, chapter 461, or chapter 641 who charges or receives compensation for any use of a medical device , who is not 100 percent owner or 100 percent lessee of such equipment. For purposes of this section, such owner or lessee may be an individual, corporation, partnership or any other entity and any of its subsidiaries and wholly-owned subsidiaries. In this subsection, the term "lessee" means a long-term lessee under a capital or operating lease, but does not include a part-time lessee. The term "intermediary" does not include a hospital or physician management company whose medical equipment is ancillary to a managed practice, a collection agency, or an entity contracted with an insurance company to receive a discount rate for such services. the term also does not include a management company that is contracted to provide general management services to a licensed physician or healthcare facility and whose compensation is not materially affected by the use or frequency of use of a medical device or device that is fully owned by one or more hospitals or doctors. The term "intermediary" does not include a person or entity who certifies, at the insurer's request, that:

(in)It is an authorized clinic.400.990-400.995;

(and)It concerns 100 percent ownership of medical equipment. and

(do)Owner's only partial rental of medical equipment to patients with bodily injury coverage is on a temporary basis and does not exceed 30 days in any 12-month period, and such rental is solely for the purpose of necessary repair or maintenance of 100% owned medical equipment or until arrival and installation of newly purchased or 100 percent replacement medical equipment or for patients who, due to physical size or claustrophobia, are assessed by the medical director or clinic director to be medically necessary for a test performed in open medical equipment. Leased medical equipment may not be used by patients who are not patients at a registered outpatient clinic for the performance of health services. Any person or entity who makes a false certification under this subsection commits insurance fraud as defined in subsection817.234. However, the 30-day period specified in this paragraph may be extended by an additional 60 days, applicable to magnetic resonance imaging equipment, if the owner certifies that the extension is otherwise consistent with this paragraph.

(2)"Medically necessary" refers to a medical service or supply that a prudent practitioner would provide for the purpose of preventing, diagnosing or treating an illness, injury, disease or symptom in such a way that:

(in)According to generally accepted standards of medical practice.

(and)Clinically appropriate in type, frequency, extent, location and duration. and

(do)Not primarily for the sake of the patient, doctor or other healthcare provider.

(3)"Motor vehicle" means any motor vehicle having four or more wheels of a type designed and required for use on the highways of this state and any trailer or semi-trailer designed for use with such vehicle, and includes:

(in)"Private passenger vehicle" which is any motor vehicle that is a sedan, station wagon or jeep and, if not primarily used for business, professional or business purposes, a pick-up, panel, van, station wagon or camper motor vehicle.

(and)"Commercial motor vehicle" which is any motor vehicle that is not a private passenger motor vehicle.

The term "motor vehicle" does not include a motor home or any motor vehicle used in public transportation, other than public school transportation, that is designed to carry more than five passengers, exclusive of the operator of the motor vehicle, and that is owned by a municipality, transit authority or the political unit of the state.

(4)"Named insured" means the person, usually the owner of the vehicle, identified in the policy by name as the insured under the policy.

(5)"Owner" means a person who has legal title to a motor vehicle; or, when the motor vehicle is covered by a security or sales contract with a debtor or lessee who has the right of possession, then the debtor or lessee is considered the owner in accordance with §§.627.730-627,7405.

(6)"Relative living in the same household" means a relative of any degree of blood or consanguinity who habitually resides in the same family unit, whether or not temporarily residing elsewhere.

(7)"Affirm" means to swear or affirm that it is true or that it is represented in writing.

(8)"Direct personal supervision," as it refers to the provision of medical services by non-physicians not located in a hospital, means that the person authorized to provide medical services or provide medical supplies must be present within the framework of the physical structure where the medical care is performed or where medical supplies are made available so that an authorized person can immediately respond to any emergency if necessary.

(9)"Incident", with respect to services deemed incidental to the professional performance of a physician, for a physician authorized under chapter 458, chapter 459, chapter 460, or chapter 461, if not performed in a hospital, means, that such services must be an integral part of, even and otherwise, part of a covered medical service.

(10)"Knowing" means that the person with respect to the information has actual knowledge of the information; acts in willful ignorance of the truth or falsity of the information; or acts in reckless disregard of the information, and proof of specific intent to defraud is not required.

(11)"Lawful" or "lawful" means substantial compliance with all applicable applicable criminal, civil and administrative requirements of state and federal law relating to the provision of medical services or treatment.

(12)"Hospital" means a facility that was licensed under chapter 395 at the time the services or treatment were provided.

(13)"Correctly completed" means providing truthful, substantially complete and substantially accurate responses in all material respects to any relevant media request for information or statement that may be lawfully made under this section or as otherwise agreed between the parties .

(14)"Upgrading" means an action by which a billing code is submitted that would result in a payment greater than what would be paid using a billing code that accurately describes the Services performed. The term does not include an otherwise legitimate bill from an MR entity that combines technical and professional components together if the amount of the general bill does not exceed the components if billed separately. However, payment of such invoice constitutes full payment for all elements of this service.

(15)"Split" means an action that submits a Billing Code that is properly billed with one Billing Code, but is split into two or more Billing Codes and results in a payment in excess of what would have been paid with a single Billing Code.

(16)"Medical emergency" means a medical condition manifested by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in one of the following:

(in)A serious risk to the patient's health.

(and)Severe impairment of bodily functions.

(do)Severe dysfunction of any organ or part of the body.

(17)"Wholly Owned Entity" means a proprietorship, group practice, partnership, or corporation that provides health care services provided by licensed health care professionals and where the licensed health care professional owns all aspects of the business entity, including but not limited to showing themselves as the owner of the business in their own or leasing a physical object, filing a tax return as the owner of the business, having an account in the entity's bank account, being listed as the principal on all incorporation documents required by that state, and having final authority over all personnel and compensation decisions referring to the subject matter . However, this definition does not apply to an entity wholly owned, directly or indirectly, by a hospital licensed under chapter 395.

History.little. 3, Chapters 71-252; little. 3, Chapters 76-168; little. 1, Chapter 77-457; little. 2, Chapters 78-374; pp. 2, 3, chapters 81-318; pp. 551, 563, chapters 82-243; little. 68, Chapters 82-386; little. 1, Chapters 85-320; little. 5, Chapters 86-182; little. 6, Chapters 95-202; little. 1, Chapters 97-84; little. 361, Chapters 97-102; little. 5, Chapter 2001-271; little. 18, Chapter 2003-2; pp. 7, 19, chapter 2003-411; little. 30, Chapter 2005-3; little. 98, Chapter 2006-197; little. 10, Chapter 2007-324; little. 9, chapter 2012-197.

Top Articles
Latest Posts
Article information

Author: Tyson Zemlak

Last Updated: 05/22/2023

Views: 6311

Rating: 4.2 / 5 (43 voted)

Reviews: 90% of readers found this page helpful

Author information

Name: Tyson Zemlak

Birthday: 1992-03-17

Address: Apt. 662 96191 Quigley Dam, Kubview, MA 42013

Phone: +441678032891

Job: Community-Services Orchestrator

Hobby: Coffee roasting, Calligraphy, Metalworking, Fashion, Vehicle restoration, Shopping, Photography

Introduction: My name is Tyson Zemlak, I am a excited, light, sparkling, super, open, fair, magnificent person who loves writing and wants to share my knowledge and understanding with you.