December 17, 2017

TDI-DWC Seeks Input for CY 2017 Annual Plan-Based Audit Considerations

Austin, TX – The Division of Workers’ Compensation (DWC) seeks informal input from workers’ compensation system participants concerning potential categories for the CY 2017 Medical Quality Review Annual Audit Plan (Annual Plan). As a reminder, the Annual Plan sets the priorities for audits the Medical Quality Review Panel (MQRP) will initiate during the upcoming year per Section IV of Annual Plan. This includes the scope, methodology, selection criteria, and program area responsibilities described in the medical quality review process (Process). Information about the Process and Annual Plans are posted on the TDI website.

For CY 2017, several option categories have been considered, and your recommendations for the top two category preferences from the list provided below are solicited. DWC has recently finalized the proposed IRO Plan-Based Audit, and therefore, only two new audit plans for CY 2017 can be accommodated based on staff and resources availability. Once your input has been received and reviewed, the DWC will again solicit input from system participants regarding the final recommended categories for the CY 2017 Annual Plan. Also, at a future date, the DWC will obtain stakeholder input on the development of each individual plan-based audit proposal for categories within the Annual Plan. At that time the DWC will post a plan-based audit that includes:

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

Input can be given by reviewing the options listed below and submitting your top two preferences with a brief explanation as to the value and outcome benefit these preferences provide to the Workers’ Compensation system by email to OMA@tdi.texas.gov by 5 p.m. Central time on Monday, January 2, 2017.

CY 2017 Annual Plan Category Considerations

  • Quality of designated doctor reports and the appropriateness and medical necessity of additional testing ordered by designated doctors.
  • Appropriateness of a doctor’s decision and recordkeeping supporting the ordering of Magnetic Resonance Image (MRI) prior to 21 days from the date of injury.
  • Appropriateness of decisions and recordkeeping by physician assistants and/or nurse practitioners and/or chiropractors for prescribing drugs/medications.
  • Appropriateness of decisions and recordkeeping for physical therapy services when provided either as one-on-one care or delivered via group therapy.
  • Appropriateness of preauthorization decisions issued by utilization review agents and the appropriateness of the professional certification of the peer reviewer.
  • Appropriateness of a doctor’s decision and recordkeeping for repeat knee arthroscopies.

Source: TDI-DWC

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