DWC Seeks Comments on Designated Doctor Billing and Reimbursement Rules
DWC informally proposes amendments to 28 Texas Administrative Code (TAC) Chapter 133, General Medical Provisions and 28 TAC Chapter 134, Benefits–Guidelines for Medical Services,
Charges, and Payments to improve the designated doctor (DD) program. Also posted with these amendments is a fee table showing the rates for DD exams, required medical exams, and maximum medical improvement and impairment rating exams for treating doctors and referral doctors.
Proposed amendments can be found at https://www.tdi.texas.gov/wc/rules/2023rules.html.
To implement these improvements, DWC must adopt rules. DWC held stakeholder presentations in March, September, and December 2022 to discuss specific possible changes to the billing methodology for DD exams and possible changes to DD exam reimbursement rates. They posted informal working drafts in August and November 2022. They considered comments on those drafts, as well as stakeholder comments on House Bill 2702. While the bill did not pass, DWC has indicated that because it directly addressed DD billing and reimbursement, the “information gathered as the bill moved through the process was relevant.”
This third informal working draft:
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- Adjusts the fees once by applying the Medicare Economic Index (MEI) percentage adjustment factor for the period 2009-2024.
- Adjusts the fees annually on January 1 (after that initial adjustment) by applying the MEI percentage adjustment factor in Section 134.203(c)(2).
- Rounds the fees to whole dollars.
- Creates a $100 missed appointment fee.
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Because the 2024 MEI percentage adjustment factor is not yet final, the fee amounts in this informal working draft are estimates based on the current projection for the 2024 factor.
DWC is requesting comments on the rule text. Email your comments to RuleComments@tdi.texas.gov. Include “Chapters 133 and 134 Informal Posting” in the subject line.
You may also mail or deliver your comments to:
Legal Services, MC-LS
Texas Department of Insurance, Division of Workers’ Compensation
PO Box 12050
Austin, Texas 78711.
DWC must receive your written comments by 5 p.m., Central time, on Wednesday, July 26, 2023.
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