Texas Department of Insurance, Division of Workers Compensation Approves Lumbar Spine MRI Plan-Based Audit

On January 23, 2018 officials with the Texas Department of Insurance, Division of Workers Compensation approved a plan to randomly select doctors in the workers compensation system to evaluate the appropriateness of a doctor’s decision to order lumber spine MRI’s prior to one month of conservative therapy. These audits will be based of the Official Disability Guidelines. This will exclude MRI’s performed in emergency rooms and for injured workers who have a previous history of back surgery.
The audit will select 10 doctors in the workers compensation system who order the most MRI’s, then will select at random, 10 injured workers treating under that doctor. The purpose of the audit is to “monitor healthcare providers, insurance carriers, independent review organizations, and workers compensation claimants who receive medical services to ensure the compliance of those persons with rules adopted by the Commissioner relating to health care, including medical policies and fee guidelines.”
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