Input Needed for Development of the Medical Quality Review 2016 Annual Audit Plan
The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) seeks suggestions regarding the categories for the 2016 Medical Quality Review Annual Audit Plan (Audit Plan).
The Audit Plan sets the priorities for the types of audits the Medical Quality Review Panel will focus on for the next calendar year. Stakeholder input will be solicited for each individual plan-based audit within the Audit Plan at a future date. A copy of the 2015 Audit Plan is available on the TDI website: http://www.tdi.texas.gov/wc/hcprovider/medadvisor.html.
The Medical Advisor is responsible for developing the Audit Plan, which is adopted by the Commissioner of Workers’ Compensation. The Medical Advisor evaluates Audit Plan suggestions from system participants using the following criteria:
•Does the suggested audit relate to a statutory responsibility of the Medical Advisor or the Medical Quality Review Panel pursuant to the Texas Labor Code Sections 413.0511 and 413.0512? (e.g., the quality of healthcare provided by doctors or other health care providers treating injured employees; or the quality and timeliness of decisions made by utilization review agents, insurance carriers, designated doctors, or independent review organizations)?
•Is the administrative data to select system participants for the audit available to TDI-DWC, or is it easilyobtained and reasonable to complete the audit?
•Does TDI-DWC have adequate resources to complete the audit within the next year?
You are invited to submit suggestions for the Audit Plan by email to OMA@tdi.texas.gov by 5 p.m. Central Standard Time on Wednesday, February 3, 2016. The Medical Advisor uses the qualified suggestions received, along with the expected available resources, to formulate the abridged 2016 Audit Plan.
For questions, please contact Mary Landrum at (512) 804-4814 or Mary.Landrum@tdi.texas.gov.
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