Florida Medicaid Provider Bond: A Comprehensive Guide

January 3, 2022

Florida Medicaid Provider Bond

This guide provides information for insurance agents to help their customers obtain a Florida Medicaid Provider bond

At a Glance:

  • Average Cost: Between $500 to $3,750 per year based on the applicant’s credit
  • Bond Amount: $50,000
  • Who Needs it: Florida Medicaid providers reimbursed on a fee-for-service basis or fee schedule basis that is not cost-based
  • Purpose: To ensure the public will receive compensation for any damages should the Medicaid provider submit false reimbursement requests
  • Who Regulates Medicaid Providers in Florida: The Florida Agency for Health Care Administration

Background

Florida statute 409.907 requires all Medicaid providers operating in the state to enroll with the Agency for Health Care Administration. The Florida legislature enacted the enrollment requirement to ensure that Medicaid providers engage in ethical business practices. To provide financial security for the enforcement of the enrollment requirements, Medicaid providers who are reimbursed on a fee-for-service basis or fee schedule basis that is not cost-based must purchase and maintain a $50,000 surety bond to be eligible for a provider agreement.

What is the Purpose of the Florida Medicaid Provider Bond?

Florida requires Medicaid providers who are reimbursed on a fee-for-service basis or fee schedule basis that is not cost-based to purchase a surety bond as part of the application process to obtain a provider agreement. The bond ensures that the public will receive compensation for financial harm if the Medicaid provider fails to comply with the regulations set forth in Florida statutes 409.907. Specifically, the bond protects the public if the Medicaid provider submits false reimbursement requests. In short, the bond is a type of insurance that protects the public if the Medicaid provider does not use Medicaid reimbursement funds for their intended purposes.

Florida Medicaid Provider Bond Form

Florida Medicaid Provider Bond Form

How Can an Insurance Agent Obtain a Florida Medicaid Provider Surety Bond?

BondExchange makes obtaining a Florida Medicaid Provider surety bond easy. Simply log in to your account and use our keyword search to find the “Medicaid” bond in our database. Don’t have a login? Enroll now and let us help you satisfy your customers’ needs. Our friendly underwriting staff is available by phone at (800) 438-1162, email, or chat from 7:30 AM to 7:00 PM EST to assist you.

At BondExchange, our 40 years of experience, leading technology, and access to markets ensures that we have the knowledge and resources to provide your clients with fast and friendly service whether obtaining quotes or issuing bonds.

How is the Bond Amount Determined?

Florida statute 409.907 dictates that the bond amount may not exceed $50,000 or the total amount billed to the Medicaid program in a calendar year. Essentially, Medicaid providers will need to, at a minimum, purchase a $50,000 bond as well as an additional bond to cover the leftover funds if they billed or are expected to bill the Medicaid program more than $50,000 in a single calendar year.

Is a Credit Check Required for the Florida Medicaid Provider Bond?

Surety companies will run a credit check on the owners of the Medicaid provider to determine eligibility and pricing for the Florida Medicaid Provider bond. Owners with excellent credit and work experience can expect to receive the best rates. Owners with poor credit may be declined by some surety companies or pay higher rates. The credit check is a “soft hit”, meaning that the credit check will not affect the owner’s credit.

How Much Does the Florida Medicaid Provider Bond Cost?

The Florida Medicaid Provider Bond can cost anywhere between $500 to $3,750 per year. Insurance companies determine the rate based on a number of factors including your customer’s credit score and experience. The chart below offers a quick reference for the bond cost on the $50,000 bond requirement.

$50,000 Medicaid Provider Bond Cost

Credit Score Bond Cost (1 year)
680+ $500
625 – 679 $750
575 – 624 $1,875
550 – 574 $2,500
500 – 549 $3,750

*The credit score ranges do not include other factors that may result in a change to the annual premium offered to your customers, including but not limited to, years of experience and underlying credit factors contained within the business owner’s credit report.

Who is Required to Purchase a Bond?

Florida statute 409.907 grants the Agency for Health Care Administration the authority to require Medicaid providers reimbursed on a fee-for-service basis or fee schedule basis that is not cost-based to purchase a surety bond.

Florida defines a Medicaid provider as any individual or business entity that provides services covered by Medicaid and is reimbursed for these services by the state’s Medicaid agency.

How Do Florida Medicaid Providers Apply for a Provider Agreement?

Medicaid providers in Florida must navigate several steps to obtain a provider agreement. Below are the general guidelines, but applicants should refer to the application guide for details on the process.

Agreement Period – All Florida Medicaid Provider Agreements are valid for 5 years and must be renewed before the expiration date

Step 1 – Determine the Enrollment Type

Florida requires Medicaid providers to obtain specific types of enrollments based on the way the providers’ businesses operate. Below are the different enrollment types for Florida Medicaid providers:

    • Fully Enrolled: Allows providers to bill for services and receive payments directly from Medicaid as well as participate in the network of a Medicaid health plan
    • Limited Enrolled: Providers may only participate in the network of a Medicaid health plan
    • Ordering or Referring: Providers may solely participate as a physician for the purposes of ordering, certifying, or prescribing items or services for Medicaid participants

Step 2 – Purchase a Surety Bond

Medicaid providers reimbursed on a fee-for-service basis or fee schedule basis that is not cost-based must purchase and maintain a $50,000 surety bond

Step 3 – Complete the Application

All Florida Medicaid Provider enrollment applications can be completed online here. Providers must submit separate applications depending on whether they are institutional (hospitals) or non-institutional (not a hospital) providers. All relevant application forms for both institutional and non-institutional providers can be found here. Providers should utilize the interactive enrollment checklist for assistance navigating through the application process.

How Do Florida Medicaid Providers Renew Their Provider Agreements?

Prior to their agreement’s expiration date, Florida Medicaid providers will be mailed instructions on how to renew their provider agreement. All Florida Medicaid Provider Agreements are valid for 5 years and must be renewed before the expiration date.

How Do Florida Medicaid Providers File Their Bond?

Medicaid providers should submit their completed bond form, including the power of attorney, electronically here. The surety bond requires signatures from both the surety company that issues the bond and from a representative of the Medicaid provider. The surety company should include the following information on the bond form:

  • Legal name and address of entity/individual(s) buying the bond
  • Surety company’s name and address
  • Premium rate
  • Date the bond goes is signed

What Can Florida Medicaid Providers Do to Avoid Claims Against Their Bonds?

To avoid claims on their bond, Medicaid providers in Florida must ensure that they do not submit false reimbursement requests.

What Other Insurance Products Can Agents Offer Medicaid Providers in Florida?

Most reputable Medicaid providers in Florida will seek to obtain liability insurance. Bonds are our only business at BondExchange, so we do not issue any other types of insurance, but our agents often utilize brokers for this specific line of business. A list of brokers in this space can be found here.

How Can Insurance Agents Prospect for Florida Medicaid Provider Customers?

Florida conveniently provides a public database to search for active Medicaid providers in the state. The database can be accessed here. Contact BondExchange for additional marketing resources. Agents can also leverage our print-mail relationships for discounted mailing services.

2022-03-09T17:29:59-05:00