DWC Finalizes FCE Plan-Based Audit
The Division of Workers’ Compensation has finalized an audit of health care providers who referred injured workers for functional capacity evaluations under the Texas Workers’ Compensation Act. The audit will be conducted by the Medical Quality Review Panel under the direction of the Medical Advisor. Details of the plan-based audit can be found here.
The Division will select no more than 10 healthcare providers who have referred injured employees for FCEs that had the highest number of FCE bills per the selection criteria. The Division will review up to seven files per provider. The audit is designed to ensure that health care providers adhere to the Official Disability Guides and medically accepted standards of care for referring injured employees for FCEs; and to determine the appropriateness of medical decision making as a result of the FCE outcome.
Texas Labor Code §413.018(c) mandates that the Division implement a program to encourage employers and treating doctors to discuss the availability of modified duty to encourage the safe and more timely return to work of injured employees. This section furthers states that the Division may require a treating or examining doctor, on the request of the employer, insurance carrier, or division, to provide an FCE of an injured employee and to determine the employee’s ability to engage in physical activities found in the workplace or in activities that are required in a modified duty setting. Rule 134.204(g) lists the required elements when conducting an FCE.
The Office of Medical Advisor staff is responsible for coordinating with TDI Enforcement to monitor the status of each enforcement case that results from a medical quality review. The Medical Advisor will provide the Experts and Arbiters with status on the number and types of final dispositions of enforcement cases originating from medical quality reviews.
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