On January 2, 2018, Medical Advisor Patrick M. Palmer, M.D., sent out a notice advising system participants that the Medical Quality Review Panel (MQRP) had finalized its CY 2018 Medical Quality Review Annual Audit Plan (Annual Plan). The Annual Plan sets priorities for the types of audits the MQRP will initiate during the year.
According to the Annual Plan as approved by Commissioner Brannan, the two categories of focus will be: (1) the appropriateness of a health care provider’s decision and recordkeeping for prescribing opioids; and (2) the appropriateness and necessity of health care providers (excludes designated doctors) referring for testing. Notably, the following specific services were specifically mentioned as being subject to review: muscle testing, range of motion (ROM) testing, needle electromyography (EMG), and nerve conduction tests.
The Division had solicited input from workers’ compensation participants on November 20, 2017 regarding the two potential categories for the Annual Plan, but received no input. Therefore, Commissioner Brannan approved the plan as proposed on December 27, 2017.
The Division plans to obtain stakeholder input on the development of each individual plan-based audit proposal for categories within the Annual Plan, and will then post a plan-based audit that, according to the Medical Advisor, includes: inclusion and exclusion criteria; service time frame to be audited; sample size; and subject and case file selection. All medical quality reviews initiated on or after January 1, 2018 will be performed in accordance with this approved medical quality review process.
~ This blog submission was prepared by Erin Shanley, an attorney with Stone Loughlin & Swanson, LLC, a law firm dedicated to representing self-insured employers, insurance carriers, and third party administrators in all matters related to workers’ compensation. Stone Loughlin & Swanson is a member of the National Workers’ Compensation Defense Network (NWCDN). If you have any questions about this submission or Texas workers’ compensation in general, please contact Erin by e-mailing her at firstname.lastname@example.org or by calling her directly at (512) 343-1300.
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