Maximum allowable reimbursement

Definition

The state's own price list for treating an injured worker, which a clinic may not bill around.

Why It Matters

It turns the occupational medicine premium into arithmetic. Florida pays 175 percent of Medicare for a physician visit, which is genuinely better than the walk-in book's worst payers and genuinely not yours to improve, because a three-member panel moves the number and the department republishes the schedule. Underwrite it as a regulated price carrying legislative risk. The second half is quieter: carrier authorization is a condition of payment except in emergencies, and the clinic may not then bill the patient for what was unauthorized. So the book carries a write-off line the practice management system will produce and the seller's profit and loss will not.