December 15, 2017

TDI-DWC Seeking Input on Development of Medical Quality Review CY 2018 Annual Audit Plan

Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation recently announced that it is seeking informal input from workers’ compensation system participants concerning potential categories for the 2018 Medical Quality Review Annual Audit Plan.

The Annual Plan sets the priorities for audits the Medical Quality Review Panel (MQRP) will initiate during the upcoming year per Section IV of the 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 available on the TDI website.

The Medical Advisor is responsible for developing the Audit Plan, which is adopted by the Commissioner of Workers’ Compensation. The Medical Advisor evaluates Audit Plan suggestions from system participants using the following criteria:

  • Does the suggested audit relate to a statutory responsibility of the Medical Advisor or the Medical Quality Review Panel pursuant to Sections 413.0511 and 413.0512 of the Texas Labor Code? (e.g., the quality of health care provided by doctors or other health care providers treating injured employees; or the quality and timeliness of decisions made by utilization review agents, insurance carriers, designated doctors or independent review organizations)
  • Is the administrative data to select system participants for the audit available to TDI-DWC, or is it easily obtained and reasonable to complete the audit?
  • Does TDI-DWC have adequate resources to complete the audit within the next year?

Workers’ compensation system participants can submit suggestions for this Plan-Based Audit by email to OMA@tdi.texas.gov by 5:00pm Central time on Monday, December 4, 2017.

Source: TDI-DWC

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