The Texas Department of Insurance, Division of Workers’ Compensation (DWC) informally proposes amendments to 28 Texas Administrative Code (TAC) Chapter 133, General Medical Provisions and 28 TAC Chapter 134, Benefits–Guidelines for Medical Services, Charges, and Payments to improve the designated doctor (DD) program. Also posted with these amendments are billing examples that illustrate the proposed changes.
DWC staff evaluated the DD program and identified several possible areas of improvement, including:
- clarifying billing requirements;
- updating reimbursement amounts for services; and
- reducing administrative burdens
This first informal proposal details changes to billing methodology. DWC will informally propose changes to reimbursement rates in the next informal proposal.
To implement these improvements, DWC must adopt rules. DWC held a stakeholder presentation in March 2022 to discuss specific possible changes to the billing methodology for DD exams and possible changes to DD exam reimbursement rates.
The informal proposal also includes corresponding changes to billing for required medical examinations, and maximum medical improvement and impairment rating exams for treating doctor and referral doctors. DWC is also posting examples of several billing scenarios to show the current and proposed changes to the billing methodology for DD exams.
DWC will host a stakeholder presentation on the amendments to Chapters 133 and 134 on Thursday, September 8, 2022, at 1:30 p.m., Central time, to discuss updated amendments to rule language and feedback from system participants on the first informal proposal.
Topics Texas
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