On February 27, 2026, The Centers for Medicare & Medicaid Services (CMS) imposed a 6-month nationwide moratorium on the Medicare enrollment of New Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) medical supply companies. A copy of the moratorium can be found here.

The goal of the temporary moratorium is to fight fraud and safeguard taxpayer dollars, while ensuring patient access to care. Authority to impose such moratoria was included in the Affordable Care Act, and the Agency for Health Care Administration (Agency), with the approval from CMS, is exercising that authority at this time.

Effective March 20, 2026, the Agency has imposed a temporary Medicaid moratorium on enrollment of new Durable Medical Equipment DME providers (Provider Type 90) in all Florida counties.

Exclusively for purposes of the moratorium's applicability, a medical supply company is considered a business whose principal function is to furnish durable medical equipment and medical supplies (regardless of supply type) directly to another party, such as, but not limited to: (1) recipients with a medical order (for example, via mail order); (2) medical providers and suppliers; or (3) both. A pharmacy, hospital, or other medical provider that also provide DME as a secondary function are not part of this moratorium.

The statewide moratorium will remain in place for an initial 6-month period. Under the moratorium, the Agency will not accept any new applications for DME providers for Florida Medicaid enrollment that are received after March 20, 2026. The Agency will continue processing DME provider applications submitted on or before March 20, 2026.

No Medicaid recipients will go without the services they need. If any recipient is having difficulty accessing services, please encourage them to contact the Florida Medicaid Helpline at (877) 254-1055.

All existing DME providers can continue to deliver and bill for authorized services.

The American Medical Association (AMA) has long called for Congress to enact legislation that would: (1) permanently allow Medicare patients in every geographic area, not just patients in rural areas, to receive telehealth services by waiving the geographic restrictions in current law; and (2) permanently allow Medicare patients to receive telehealth services in their homes instead of having to go to a medical facility to receive telehealth from a distant site. To date, however, Congress has passed legislation that only temporarily waives these requirements. Most recently, in March 2025 Congress extended these telehealth flexibilities for a six-month period that ends Sept. 30, 2025.

Physicians who provide telehealth services to Medicare patients should be aware that if Congress is not able to pass legislation before Oct. 1, 2025, that extends government funding, then the current Medicare telehealth flexibilities will lapse. This means that telehealth services would be limited to rural areas as they were before the COVID public health emergency and that patients would not be able to receive telehealth services in their homes. In addition, the ability to provide audio-only services to Medicare patients would lapse, as would the Acute Hospital Care at Home program.

In past government shutdowns, whenever Congress passed legislation to reopen the government, it made the funding and policies retroactive to the effective date of the shutdown. Physician practices may want to consider adjusting their patient schedules for telehealth services, however, as neither the likelihood nor the duration of a shutdown are known.

Download Members-Only White Paper 
(member login required)

A copy of the complete fee schedule can be downloaded here.    The FOS has been heavily involved in the two major legislative efforts in 2003 and 2024, to try to elevate reimbursement to the average of all other states. We have invested significant resources to make this happen and are thankful for the improved access to care this should provide our patients.   The FOS will be monitoring insurance carrier compliance with this new fee schedule.  We are also providing a White Paper for members (member login required) that discusses how physician reimbursement in Workers Compensation is regulated in Florida and how physicians can protect their interests to make sure they are reimbursed at this higher level right away.    As an organization we are pleased to provide some much-needed support for our members. This historic achievement would not have been possible without our volunteer leaders and the support we receive from membership dues and PAC donations. If any of your partners are not members of the FL Orthopaedic Society, please take a moment to encourage them to join. Together we can continue to advocate for orthopaedics in Florida.    To join the FOS, click here. To make a PAC donation, click here.

May 29 - June 1, 2025 | JW Marriott Tampa Water Street

Orthopaedic Residents, Surgical Fellows, and FOS members are invited to submit research abstracts for presentation at the 2025 FOS Annual Scientific Meeting in Tampa, Florida. Both poster and podium presentations will be considered.

We encourage you to take advantage of this platform to share your findings, receive valuable feedback, and engage with seasoned specialists in a collegial and interactive setting.

The deadline for abstract submissions is January 17, 2025, at 11:59 pm ET. Click here to learn more & get started.

June 14, 2024, will be remembered as the date that the Florida Orthopaedic Society finally ended decades of underfunding treatment of injured workers in the State of Florida.

What Does this Mean for You?

In January 2025, starting with the implementation of the new physician fee schedule for Workers' Compensation, physicians will receive an increase in reimbursement from 110% of Medicare to 175% of Medicare for non-surgical codes, and an increase from 140% of Medicare to 210% of Medicare for surgical codes. That represents an unprecedented increase in physician reimbursement of 59% for non-surgical codes and 50% for surgical care. In addition, starting in January, your expert witness fees in Workers' Compensation will increase 50%, from $200 to $300.

Florida has endured the lowest reimbursement for physicians treating Workers' Compensation in the country for over 25 years. While reform passed in 2003 provided an increase in reimbursement, Orthopaedic Surgeons in Florida still trailed their colleagues in other states significantly as documented by the Workers' Compensation Research Institute. All of that changed last Friday, after years of engagement and steadfast determination, the Governor has signed a bill to take effect on January 1, 2025, that will significantly increase reimbursement for physicians in the Workers' Compensation program.

The Florida Orthopaedic Society led this initiative with support in the final stages by the Florida Medical Association. Through the commitment of our physician leaders and talented lobbying team and staff, we have delivered for all orthopaedic surgeons and injured workers in this state. This is clear example of the power of organized orthopaedics in Florida and what is possible when we rally support and allocate the necessary resources to achieve our goals.

Will You Help Us Recognize this Historic Achievement?

The FOS leadership wants to recognize this achievement by reinvesting a small fraction of our success into building a stronger organization to tackle our ongoing and future challenges. We are asking all members of the Florida Orthopaedic Society to make a donation to the Florida Orthopaedic Political Action Committee to make sure we can continue to advance orthopaedics in this state.

View a message from the FOS President. 

• Provider failed to timely report a change in address
• Supplier didn't respond to a revalidation request
• Independent diagnostic testing facility failed to comply with a supplier standard
• A supplier failed to timely report a change in address of an organizational owner
• A supplier failed to report the deletion of a managing employee

Note: If a stay of enrollment has been placed on your enrollment record, you will be notified by hard-copy mail, email, and fax, if applicable. To have the stay of enrollment removed, you must fix the non-compliance with Medicare by submitting the applicable Medicare application. Remember, if you need help, Acevedo Consulting has the expertise to assist with Medicare enrollment.

For example: Your clinic group practice recently changed practice locations and did not notify Medicare. Your MAC implemented a stay of enrollment because you did not report a change in practice location. To have the stay of enrollment removed and be able to continue billing Medicare, you will have to submit a change of information enrollment application to update your practice address.

If you believe you meet all provider enrollment requirements and the stay of enrollment should not have been imposed, you can submit a provider enrollment rebuttal. Refer to your stay of enrollment letter for instructions on how and where to submit the rebuttal. For more information, please click here.

Provider Type(s): ALL
7.3% Pediatric Rate Increases for Physicians Serving Children (Ages 0-20)

The Agency for Health Care Administration (Agency) has adjusted the Practitioner payment methodology to include a Pediatric Rate Increase of 7.3% to the Practitioner Fee Schedule for Physicians PT25 (M.D.) and PT26 (D.O), serving recipients ages 0-20 years.

The Agency has included the 7.3% Pediatric Rate Increase as directed in the 2023-24 General Appropriations Act. This increase was implemented December 8, 2023, and the rates are effective October 1, 2023.

To receive the higher rates for fee-for-service (FFS) claims or encounter transactions with Dates of Service on or after October 1, 2023, and submitted prior to December 8, 2023, you will need to adjust the transaction. If the Billed Amount is less than the new max fee, the Billed Amount(s) must be updated. Florida Medicaid pays the lesser of the amount billed or the allowed amount (max fee). Detailed instructions are below for FFS claim and encounter adjustments.

The Practitioner Fee Schedule can be accessed on the Agency’s website at the following link:

Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes (myflorida.com)

Below are the instructions for submitting FFS claim and encounter transaction adjustments:

➢ Submit Adjustment (FFS or encounter) via X12 837 transaction:

• Adjusted claims must contain a frequency code of “7” and the 13-digit ICN of the paid claim being adjusted in the REF02 segment of the X12 837 transaction.
• For additional information on the successful processing of adjustments, please refer to the EDI companion guides on the public Web Portal.

➢ Submit FFS Adjustment via secure Web Portal:

• Open the claim and make any necessary changes (including billed amount(s)), then click the Adjust button. If there are no changes then just click the Adjust button.
• For additional information on submitting claims via the secure Web Portal, please refer to the Direct Data Entry (DDE) Claim Form Presentations on the public Web Portal.

Managed Care Plan providers should contact the plan directly for billing questions and instructions.

Details:
When: December 13th at 8:00 PM ET
Where: Zoom

Workers' Compensation Physician Fees in Florida are the lowest in the nation impacting access to care for Florida’s injured workers.

Learn how the Florida Orthopaedic Society is taking action to increase physician fees and deliver higher quality care for Florida’s work force.

The following bills seeking to increase physician payment for workers’ compensation services have been filed for the 2024 legislative session: House Bill 161 and Senate Bill 362.

Support from the orthopaedic community is vital if we are to secure an increase in physician fees.

Information on how to register has been sent to active BSOF and FOS members.

AAOS has created a member resource center to help you meet this requirement. Click here to view.

• Why do you want to be part of the FOS Resident Council?
• What leadership or advocacy experience do you have?
• What are two objectives you hope to accomplish while serving on the board?

Florida Orthopaedic Residents can submit their application and personal statement here.

Applications are due May 1, 2023. Applications will be reviewed by members of the current FOS Resident Council and FOS leadership for selection at the Annual Meeting.

Please note a maximum of two members will be selected from each residency program.

To help regulated entities better comply with the requirements of the HIPAA Privacy, Security, and Breach Notification Rules, the HHS Office for Civil Rights (OCR) is sharing two Reports to Congress for 2021, on HIPAA Privacy, Security, and Breach Notification Rule Compliance and Breaches of Unsecured Protected Health Information. These reports, delivered to Congress, may benefit regulated entities to assist in their HIPAA compliance efforts. Click here to continue reading and view the reports.

Please keep providing services:

• The Agency will waive all prior authorization requirements for critical Medicaid services beginning September 27, 2022, until further notice.

• Early prescription refill edits have been lifted for all maintenance medications (this does not apply to controlled substances).

• If a recipient requires critical Medicaid services beyond limits stated in policy in order to maintain safety and health, providers can furnish the service.

• All Preadmission Screening and Resident Review (PASRR) processes are postponed until further notice by the Agency.

• Retroactively performed screenings or resident reviews must document the reason for delay in the completion of PASRR requirements.

• The PASRR process is waived for recipients who are evacuated due to an evacuation order or power outage and are admitted and discharged during the storm.

Additional information for providers is located on the Agency website: Click the Hurricane banner at the top of the page for more information.

Governor Ron DeSantis’ emergency executive orders, including impacted counties, is located online at: https://www.flgov.com/2022-executive-orders

QUESTIONS? FLMedicaidManagedCare@ahca.myflorida.com

The Florida Division of Workers' Compensation submitted a Notice of Rule Development for 69L-7.730, F.A.C. – Health Care Provider Medical Billing and Reporting Responsibilities. The Workshop will be held on Thursday, September 29, 2022 at 9:30 a.m. Eastern Time, 1579 Summit Lake, Room 155, Tallahassee, Florida 32317.

SUBJECT AREA TO BE ADDRESSED: The medical reimbursement and utilization review requirements regarding physician dispensed medication.

The Notice of Rule Development was published in Volume 48, Number 134 of the Florida Administrative Weekly, on 7/12/2022. A Notice of Correction was published in Volume 48, Number 135 of the Florida Administrative Weekly, on 7/13/2022, because preliminary text of the proposed rule development is not available. If you have questions about the contents of this notice, please contact Brittany O’Neil, Assistant Director,  Division of Workers' Compensation at Brittany.Oneil@myfloridacfo.com

The Florida Division of Workers' Compensation submitted a Notice of Rule Development for 69L-7.740, F.A.C. – Insurer Authorization and Medical Bill Review Responsibilities. The Workshop will be held on Thursday, September 29, 2022 at 2:00 p.m. Eastern Time, 1579 Summit Lake, Room 155, Tallahassee, Florida 32317.

SUBJECT AREA TO BE ADDRESSED: The medical reimbursement and utilization review requirements regarding physician dispensed medication.

The following message is from the Centers for Medicare & Medicaid Services (CMS):

Reminder: MIPS 2021 Data Submission is Open through March 31

The data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2021 performance year of the Quality Payment Program (QPP) is open. Data can be submitted and updated until 8:00 p.m. ET on March 31, 2022.CMS recently added new 2021 Data Submission Demonstration Videos on its YouTube channel to support submission.

How to Submit Your 2021 MIPS Data

Clinicians will follow the steps outlined below to submit their data:

1. Go to the Quality Payment Program webpage.
2. Sign in using your QPP access credentials (see below for directions).
3. Submit your MIPS data for the 2021 performance year or review the data reported on your behalf by a third party.

How to Sign In to the Quality Payment Program Data Submission System

To sign in and submit data, clinicians will need to register in the HCQIS Authorization Roles and Profile (HARP) system. For clinicians who need help enrolling with HARP, please refer to the Quality Payment Program Access User Guide.

How to Confirm Eligibility

Clinicians who are not sure if they are eligible to participate in the Quality Payment Program can check their final eligibility status using the QPP Participation Status Tool. Clinicians and groups that are opt-in eligible will need to make an election before they can submit data. (No election is required for those who don’t want to participate in MIPS.)

2021 Extreme and Uncontrollable Circumstances (EUC) Application Period Reopened

CMS also reopened the MIPS EUC application for groups, virtual groups, and Alternative Payment Model (APM) Entities that need to cite COVID-19 as the triggering event through March 31, 2022, at 8 p.m. ET. Note: Because of the automatic EUC policy, individual clinicians don’t need to submit an application.

For More Information

To learn more about how to submit data, please review the following resources available on the QPP Resource Library:

• 2021 Data Submission User Guide
• 2021 APP Data Submission User Guide
• 2021 MIPS Opt-In and Voluntary Reporting Election Guide
• 2021 Data Submission FAQs
• NEW! 2021 Data Submission Demonstration Videos Playlist:
  1. Reporting as a Group Under the APM Performance Pathway (APP)
  2. Reporting as a Medicare Shared Savings Program ACO Under the APM Performance Pathway (APP)
  3. Manual Attestation for Promoting Interoperability Performance Category of MIPS
  4. Connecting to an Organization as a Practice for MIPS
  5. Connecting to an Organization APM Entity

You can contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8 a.m. - 8 p.m. ET or by e-mail at:QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours— before 10 a.m. and after 2 p.m. ET.

• Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.
  
  

Reminder: CMS Recently Reopened the MIPS Extreme and Uncontrollable Circumstances Application for the 2021 MIPS Performance Year in Response to COVID-19

CMS continues to offer flexibilities to provide relief to clinicians responding to the 2019 Coronavirus (COVID-19) public health emergency (PHE). We applied the Merit-based Incentive Payment System (MIPS) automatic extreme and uncontrollable circumstances (EUC) policy to all individual MIPS eligible clinicians for the 2021 performance period.

Recently, we’ve also reopened the MIPS EUC application for groups, virtual groups, and Alternative Payment Model (APM) Entities through March 31, 2022, at 8 p.m. ET. (Because of the automatic EUC policy, you don’t need to submit an application for individual clinicians.)Please note that applications received between now and March 31, 2022, won’t override previously submitted data for groups and virtual groups.

MIPS EUC applications citing COVID-19 as the triggering event can be submitted until Thursday, March 31, 2022, at 8 p.m. ET.

This listserv will review what the MIPS EUC application extension means for:

• Groups and virtual groups that haven’t submitted data.
• Groups and virtual groups that have submitted data.
• APM Entities.

Groups and virtual groups that haven’t submitted data:

• Groups: You don’t need to take any further action if you’re unable to submit data for the 2021 performance period. Group participation is optional, and your individual MIPS eligible clinicians qualify for the MIPS automatic EUC policy. They’ll have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless 1) they submit data in 2 or more performance categories as individuals, or 2) the practice reports as a group, by submitting data for one or more performance category.
• Virtual Groups: If you’re unable to submit data for the 2021 performance period, you must submit a MIPS EUC application for all 4 performance categories by the March 31, 2022, deadline.

Groups and virtual groups that have submitted data.

• Groups and virtual groups that have submitted data for a single performance category:
  • If you’re unable to complete data submission for other performance categories, you can submit a MIPS EUC application to request reweighting in the remaining 3 performance categories.
  • This includes small practices that were automatically scored as a group on Medicare Part B claims measures submitted throughout the 2021 performance period.
  • If you don’t submit a MIPS EUC application, your group will be scored in all performance categories unless you’re eligible for reweighting in one or more performance categories.
  • If your application is approved and no additional data is submitted at the group level (or available for scoring, such as the automatic improvement activities credit awarded to groups with clinicians participating in an APM), your MIPS eligible clinicians will receive a neutral payment adjustment for the 2023 MIPS payment year.
• Groups and virtual groups that have submitted data for 2 or 3 performance categories:
  • Your MIPS eligible clinicians will receive a MIPS final score and MIPS payment adjustment for the 2023 MIPS payment year.
  • You can’t submit an application to override previously submitted data but you can submit an application to request reweighting of performance categories for which you haven’t submitted data.

APM Entities (Includes Shared Savings Program Accountable Care Organizations (ACOs))

Official representatives of APM Entities participating in MIPS, including Shared Savings Program ACOs, can submit a MIPS EUC application on behalf of all MIPS eligible clinicians in the APM Entity for the 2021 performance year. If approved, all of the MIPS eligible clinicians in the APM Entity will receive a neutral MIPS payment adjustment in the 2023 MIPS payment year. (Applications must be submitted by an official representative of the APM Entity, and not by a participant in the APM.)

There are some differences from our existing MIPS EUC policy for individuals, groups, and virtual groups:

• APM Entities are required to request reweighting for all performance categories.
• More than 75% of the MIPS eligible clinicians in the APM Entity must be eligible for reweighting in the Promoting Interoperability performance category.
• Unlike MIPS EUC applications for individuals, groups and virtual groups, an APM Entity’s approved application for performance category weighting will override previously submitted data.

Additional Resources

• Quality Payment Program COVID-19 Response Factsheet (PDF)
• 2021 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide
• 2021 Data Submission FAQs

For more information, please see the Quality Payment Program COVID-19 Response webpage of the QPP website. You can contact the Quality Payment program at 1-866-288-8292, Monday through Friday, 8 a.m. - 8 p.m. ET or by e-mail at: QPP@cms.hhs.gov. To receive assistance more quickly, please consider calling during non-peak hours— before 10 a.m. and after 2 p.m. ET.

• Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

The U.S. Department of Labor’s Occupational Safety and Health Administration is withdrawing the vaccination and testing emergency temporary standard issued on Nov. 5, 2021, to protect unvaccinated employees of large employers with 100 or more employees from workplace exposure to coronavirus. The withdrawal is effective January 26, 2022.

Although OSHA is withdrawing the vaccination and testing ETS as an enforceable emergency temporary standard, the agency is not withdrawing the ETS as a proposed rule. The agency is prioritizing its resources to focus on finalizing a permanent COVID-19 Healthcare Standard. OSHA strongly encourages vaccination of workers against the continuing dangers posed by COVID-19 in the workplace.

CMS Vaccination Requirement for Healthcare Workers

While the US Supreme Court struck down OSHA’s COVID-19 vaccination requirement for employers with 100+ employees, the Court ruled that the CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule may be implemented. CMS updated its FAQ document for this rule on January 20, 2022: External FAQ IFC-6 - 1.21.22 (cms.gov)

This document is thorough and should provide answers to most of your questions.

FAQ Highlights

Who must comply?

The vaccination requirement does not apply to Physician Group Practices. It does apply to Ambulatory Surgery Centers enrolled in Medicare and/or Medicaid.

The requirement does not apply to therapy services rendered within a Physician Group Practice.

The requirement does apply to all hospitals enrolled in Medicare and/or Medicaid so those facilities will require all physicians, Physician Assistants and Nurse Practitioners who render services in their facilities to comply even if they are not employed by the facility.

Deadlines

Phase 1 deadline for FL, PA, MD, DE: January 27, 2022
Phase 2 deadline for FL, PA, MD, DE: February 28, 2022

Phase 1 deadline for GA, SC, Kansas, Missouri: February 14, 2022
Phase 2 deadline for GA, SC, Kansas, Missouri: March 15, 2022

Phase 1: Staff must have received at least the first dose of a primary series or a single dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the facility and/or its patients.

Phase 2: Staff must complete the primary vaccination series (except for those who have been granted exemptions from the COVID-19 vaccine or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by CDC).

Boosters:

For the purposes of this Rule, booster doses are not currently needed for staff who have completed a COVID-19 primary vaccination series authorized or licensed by the FDA.

Documentation Plan:

Regulated facilities must implement a process or plan for documenting and tracking staff vaccinations. The Rule does not include testing requirements for unvaccinated staff.

Exemptions:

CMS requires facilities to allow for exemptions to staff with (as a reasonable accommodation for a disability or a sincerely held religious belief, observance, or practice and for medical reasons. Providers and suppliers should establish exceptions as a part of its policies and procedures and in alignment with Federal law… no exemption should be provided to any staff for whom it is not legally required or who requests an exemption solely to evade vaccination. Refer to the Updated CMS FAQ Document for more information: View document

Click here to access the first Monday Morning Rounds.