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Austin, TX (CompNewsNetwork) - The Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) today announced the results of the second Performance Based Oversight (PBO) assessment.
Of the 138 insurance carriers reviewed in the 2009 PBO assessment process, 30 had scores placing them in the high performer tier, 100 were in the average performer tier, and 8 were in the poor performer tier.
Insurance carriers assessed for the 2009 PBO process were assessed on their performance with timeliness of medical bill processing; timeliness of payment of the initial Temporary Income Benefit checks; timeliness of reporting medical billing data; and timeliness of reporting the initial payment of Temporary Income Benefits to TDI-DWC.
Of the 274 health care providers reviewed in the 2009 PBO assessment process, 4 had scores placing them in the high performer tier, 51 were in the average performer tier, and 219 had scores placing them in the poor performer tier.
Health care providers assessed for the 2009 PBO process were assessed on their performance with timely filing the Report of Medical Evaluation Form, DWC Form-069; timely filing of the Work Status Report, DWC Form-073; and completeness of the DWC Form-073. Health care providers were not assessed on the quality of medical care they provided.
As a state regulatory authority, TDI-DWC is required to monitor system participants' compliance with the Texas Workers' Compensation Act and rules and to take actions to correct noncompliant behavior. Performance Based Oversight, data monitoring, complaint handling, audits, and enforcement actions and referrals to law enforcement (when appropriate) are tools the agency is authorized to use to achieve compliance objectives.
The results of the PBO assessment include scoring and tiering those assessed entities into high, average, and poor performance tiers. The TDI-DWC will focus its regulatory oversight on the poor performers while offering incentives for high performers in order to promote improved performance and greater overall compliance with the Workers' Compensation Act and rules.
The results of the 2009 PBO assessment and a list of the insurance carriers and health care providers assessed are posted on TDI website. Insurance carriers and health care providers not listed were not assessed, but this does not imply that any insurance carrier or health care provider participating in the Texas workers' compensation system is exempt from the requirement to comply with the Workers' Compensation Act and rules.
Further information regarding PBO and the 2009 assessments may be found on the PBO webpage at http://www.tdi.state.tx.us/wc/pbo/pbo.html.
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