WORKERS' COMPENSATION UPDATE
January 2022
With Valentine's Day right around the proverbial corner, we wanted to share a few items that keep us loving what we do.
DWC Shows HCPs Some Love and a Friendly Reminder
In January, the DWC announced new training opportunities for health care providers and their medical staff who participate in the workers’ compensation system. The Division’s on-demand training topics for HCPs include reimbursement policies and methodologies and billing and reimbursement for DDs, RMEs and other MMI/IR providers. The DWC also announced upcoming HCP Lunchtime Webinars. February topics include Medical Fee Dispute Resolution and The Preauthorization Process: Utilization Review and Medical Necessity.
You can take a look at the on-demand training topics here
Fun Fact: No where in any of the DWC materials is there a provision for a designated doctor to seek reimbursement for a no-show appointment. If you are seeing bills for claimant’s failing to attend a DD examination – you should not be!
The Division reminded HCPs that they need to disclose their financial interests (and those of their immediately family members) in imaging centers, physical therapy and work hardening clinics and other facilities if they refer patients to those facilities. The reason for such disclosure – reducing the likelihood of HCPs making unnecessary referrals in order to pad their own wallets.
Who Doesn't LOVE Safety?
The Division recently announced its 2022 Safety Pro Seminars. New safety professionals and coordinators can enjoy free online courses in Safety and Health Program Development and Recordkeeping beginning in February.
More information is available here.
A Time for Love and A Time for Audit
Carriers: It’s that time again. Every two years, the DWC audits insurance carriers through PBO. The majority of the audit focuses on timely payment of TIBs and processing of initial medical bills. Other measures include timely processing of requests for reconsideration of medical bills and timely submission of EDI data for initial payments and medical bill processing. The relevant time frame for the audit: 1/1/22 through 6/30/22. You can get more information here.
HCPs: The DWC announced its approval of the 2022 Medical Quality Review audit this month. This year, the audit will focus on the reasonableness of return-to-work decisions and recordkeeping and the use and effectiveness of spinal cord stimulators.
We gave you a sneak peak of the proposed Shoulder Surgery Plan-Based Audit in our November newsletter. On 1/13/22, the DWC announced that audit plan was approved. It will be interesting to see if the audit results in a curtailing of distal clavicle resections in routine shoulder surgery as those procedures can, without careful monitoring and/or litigation, result in significantly higher impairment ratings for shoulder injuries.
Copyright 2022, Stone Loughlin & Swanson, LLP
Lonely Hearts' Club
Blame it on supply chain issues, COVID or Zoom BRCs, but we recently ran into one of the saddest things we have seen lately. The winner of the Lonely Hearts’ Award February 2022 is this lonely vending machine in the corridor of the Lubbock Field Office of the DWC.
No Love for this Fraudster
Earlier this month, DWC announced the arrest and indictment of a Houston area businessman who ran a $1.1 million insurance fraud scheme over a period of seven years. Kunal “Sonny” Puri had been charged with hiding employees and their payroll information under different companies in order to lower workers’ compensation insurance premiums payable to Texas Mutual, Service Lloyds and Travelers. If convicted, Puri faces up to 99 years in prison.
Do We Love This Change?
The Division recently solicited comments on proposed changes to EDI Rules. According to our good friend Steve Nichols of Sentinel Governmental Affairs, the biggest issue is the short window of time provided for testing of the submission of claims EDI data. In comments to the rule, Steve proposed additional time for testing so that insurance companies, EDI trading partners and the DWC could ensure successful claims data reporting. Steve cautioned the DWC and stakeholders to avoid a repeat of the NPI EDI data element change that resulted in enforcement actions, that could have been eliminated with adequate testing. We await the DWC rule changes and hope that adequate consideration is given to these concerns.
Exclusive Love
On 1/25/22, in Reyes v. Lubrizol Corp., the Texas 14th Court of Appeals upheld an exclusive remedy defense asserted by a property owner in a lawsuit filed by a welder who alleged he suffered injuries as a result of the negligence of two employees. The court addressed “the nuanced but not uncommon situation where a non-employer secures - by written agreement - workers’ compensation employer’s status over the employees of others.” The court held that it was proper for the trial court to grant summary judgment dismissing the complaint made by the welder asserting the exclusive remedy. This was a classic scenario where a general contractor entered into a written agreement to provide workers’ compensation insurance coverage to the subcontractor and its employee. That agreement made the general contractor the employer for purposes of workers’ compensation law and, by extension, covered the actions of the subcontractor’s employees under the exclusive remedy provision of the Workers’ Compensation Act. See the entire opinion here.
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