December 15, 2017

TDI-DWC Finalizes Medical Quality Review CY 2016 Annual Audit Plan

Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) recently solicited and received input from workers’ compensation system participants regarding the categories for the CY 2016 Medical Quality Review Annual Audit Plan (Annual Plan).

DWC noted that it appreciates the input provided by system participants. All comments were carefully considered and discussed. Several of the comments were categories included in previous annual plans. Other comments for categories not previously audited will be considered by DWC as categories on future annual plans.

The Commissioner of Workers’ Compensation, Ryan Brannan, approved the Annual Plan on February 23, 2016.

The Annual Plan sets the priorities for what types of audits the Medical Quality Review Panel will focus on the next year as laid out in Section IV of the Annual Plan. At a future date, DWC will obtain stakeholder input on the development of each individual plan-based audit proposal for categories within the Annual Plan.

At that time DWC will post a plan-based audit that includes:

  • inclusion and exclusion criteria,
  • service time frame to be audited,
  • same size, and
  • subject and case file selection.

All medical quality reviews initiated on or after January 1, 2016, will be performed in accordance with the approved medical quality review process (Process). The Process and Annual Plan, including any changes, are posted on the TDI website.

Source: TDI-DWC

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