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The Texas Dep’t of Insurance Dep’t of Workers Compensation has recently released the results of its 2009 Performance-Based Oversight Assessment. The results of the assessment could impact your practice.

Assessments were conducted on the performance of two key players in the worker’s compensation arena:  insurance carriers and healthcare providers.

Insurance carrier report card

Insurers were evaluated based on performance in 4 measures. While the overall performance in all 4 measures was average, the report indicates that insurance carriers scored in the high tier when it comes to timeliness of medical bill processing.

Healthcare provider report card

Healthcare providers were evaluated based on performance in 3 measures. All 3 measures were related to the filing of DWC forms 69 and 73 in a timely and complete manner and were not related in any way to quality of care.  Providers scored in the poor tier on both the overall performance and especially the timeliness of filing the required DWC forms.

How does this affect your practice?

If you currently are not accepting worker’s compensation patients, it may now be the time to consider doing so.  I have observed a marked improvement in workers compensation claims processing and reimbursement in Texas since the Texas Dep’t of Insurance took over as the governing body in 2005. These  latest PBO results indicate that insurance carriers are, by and large, processing medical bills in a timely manner.

If you are currently treating worker’s compensation patients, how did your practice stack up in the latest assessment?  Healthcare providers have been notified of their performance via letter and those who scored in the poor tier were put on notice that improvement is needed, audits will be conducted in 2010, and there is a possibility of penalties being assessed.  If your practice has received one of these letters, please take steps now towards compliance.

The complete report with pie charts and sample letters sent to both carriers and providers may be found on the TDI website:

http://www.tdi.state.tx.us/wc/pbo/pboresults.html#icsrslt

CRT has extensive experience with Texas workers compensation claims. If we may be of assistance, please do not hesitate to contact us!

TDI Insurance report cardTDI Provider report card