Texas Workers’ Comp Division Releases Health Care Provider Oversight Results for 2019

January 3, 2020

In late December, the Texas Department of Insurance, Division of Workers’ Compensation (DWC) released the 2019 Health Care Provider Performance Based Oversight (PBO) assessment.

For 2019, health care providers were assessed on their performance in one of three categories:

  • timely filing of the DWC Form-069, Report of Medical Evaluation;
  • completeness of the DWC Form-073, Work Status Report; or
  • documentation supporting why the injured employee was prevented from returning to work as reported on the DWC Form-073, Work Status Report.

DWC reviewed 97 health care providers for the timeliness of filing the DWC Form-069, Report of Medical Evaluation with the following results: 73 had scores placing them in the high performer tier, 18 were in the average performer tier, and six had scores placing them in the poor performer tier.

DWC reviewed 113 health care providers for the completeness of the DWC Form-073, Work Status Report with the following results: 49 had scores placing them in the high performer tier, 28 were in the average performer tier, and 36 had scores placing them in the poor performer tier.

DWC reviewed 113 health care providers for documentation supporting why the injured employee was prevented from returning to work, as reported on the DWC Form-073, Work Status Report with the following results: 55 had scores placing them in the high performer tier, 39 were in the average performer tier, and 19 had scores placing them in the poor performer tier.

The 2019 PBO assessment results and a list of the health care providers that were reviewed are posted on the TDI website: https://www.tdi.texas.gov/wc/pbo/hcppbo.html.

If a health care provider is not listed, they were not assessed in 2019; however, no health care provider in the Texas workers’ compensation system is exempt from compliance with the Texas Labor Code and DWC rules.

More information on PBO and the 2019 assessment are available on the TDI website.

DWC will assess insurance carriers separately in 2020.

Source: TDI-DWC

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