FOLIO

DWC Proposes DD and RME Billing and Reimbursement Rule Changes

Jan 2, 2024 | by FOL

DWC proposes amendments to Chapter 133 (General Medical Provisions) and Chapter 134 (Benefits–Guidelines for Medical Services, Charges, and Payments) relevant to billing and reimbursement for certain workers’ compensation-specific services, including:

• • • Designated doctor (DD) examinations.
    • Required medical examinations (RMEs).
    • Work status reports.
    • Maximum medical improvement (MMI) evaluations and impairment rating (IR) examinations by treating and referred doctors.

DWC General Counsel Kara Mace explains in her December 18, 2023 memo to all system participants that “[t]he proposed rules are necessary to attract and retain DDs, RME doctors, and doctors that perform MMI evaluations and IR examinations by addressing billing and reimbursement issues, reducing disputes, and decreasing the administrative burdens of participating in the programs.”

General Counsel Mace goes on to explain that the proposals:

• • • Adjust the fees once by applying the Medicare Economic Index (MEI) percentage adjustment factor for the period 2009-2024.
    • Adjust the fees annually on January 1 (after that initial adjustment) by applying the MEI percentage adjustment factor in Section 134.203(c)(2).
    • Round the fees to whole dollars.
    • Create a $100 missed appointment fee.
    • Create a $300 specialist fee.
    • Eliminate tiering so that for DDs and RME doctors, all issues addressed within one exam will be paid at the established fee and not reduced.
    • Require an assignment number in the prior authorization field of medical billing forms to identify DD-associated billing.
    • Clarify the start of the 95-day period for timely submission of a DD exam bill.
    • Contain editorial and formatting changes throughout to improve clarity.

The proposed rules were published in the December 29, 2023, issue of the Texas Register and are available at www.sos.state.tx.us/texreg/index.shtml. DWC also posted a copy on the TDI website at www.tdi.texas.gov/wc/rules/2023rules.html.

DWC will hold a public hearing on the proposed rules at 11 a.m., Central time, on January 23, 2024.

You may submit written comments or requests for a hearing on the proposed rules to RuleComments@tdi.texas.gov, or mail or deliver your comments to:

Legal Services, MC-LS
Texas Department of Insurance, Division of Workers’ Compensation
PO Box 12050
Austin, Texas 78711-2050

The deadline to submit comments is 5 p.m., Central time, on January 29, 2024