Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (DWC) seeks input for the proposed Medical Quality Review Calendar Year 2023 Annual Audit Plan (Annual Plan).
Specifically, we are looking for input on the proposal for the review categories in the Annual Plan. The proposed plan is to evaluate the appropriateness of a health care provider’s decision making and recordkeeping for prescribing gabapentin with opioids.
The medical advisor is responsible for developing the Annual Plan, which is adopted by the commissioner of workers’ compensation. The medical advisor evaluates Annual Plan suggestions from system participants using this criteria:
- Does the suggested audit relate to a statutory responsibility of the medical advisor or the Medical Quality Review Panel (MQRP) under Texas Labor Code Sections 413.0511 and 413.0512? Examples would be, 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 used to select system participants for the audit available to DWC, or easily obtained and reasonable to complete the audit?
- Does DWC have enough resources to complete the audit within the calendar year?
The Annual Plan sets the priorities for the MQRP audits during the upcoming year. This includes the scope, methodology, selection criteria, and program area responsibilities described in the Medical Quality Review Process. Information about the process and the proposed Annual Plan is on the TDI website.
Email your suggestions for this proposed Annual Plan to OMA@tdi.texas.gov by 5 p.m., Central time, on November 16, 2022.
If you have any questions, contact Mary Landrum at 512-804-4814 or Mary.Landrum@tdi.texas.gov.
Source: TDI-DWC