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Workers' Compensation Advocacy

Latest News | Advocacy In Action | Sample Letters | FAQs Regarding HB7 and Workers' Compensation Reform | Resources  

Dr. Patrick Joins Workers' Comp

Former Texas Medical Board (TMB) Executive Director Donald Patrick, MD, JD, is the new medical advisor at the Texas Department of Insurance Division of Workers' Compensation.

Workers' Comp Grades Physicians

If you treat workers' compensation patients, you may soon get a letter telling you that you have been selected for the workers' compensation system's Performance-Based Oversight Regulatory System. Physicians reviewed by the program will be designated as high, average, or poor performers. The ratings will be made public on the Texas Department of Insurance Division of Workers' Compensation (TDI-DWC) website. (Action, July 1, 2010)

Workers' Compensation Fee Schedule By Region

Do you know what you are supposed to be paid for non-network workers’ compensation services according to the updated 2010  Workers’ Compensation Medical Fee Guideline?

Workers’ Compensation Division Adopts New Medical Fee Guideline

TMA has consistently asked legislators and regulators to reform the broken worker’ compensation system for injured workers and employers. The Texas Department of Insurance’s Division of Workers’ Compensation has adopted a new medical fee guideline that addresses some of TMA’s concerns. The new fee schedule which increases reimbursements for physicians who treat injured workers was an important step in the right direction.

Current Information

TMA's Workers' Compensation Advocacy in Action

•  
• Workers’ Compensation: Medical Fee Guideline Update  (February 2008)
• Before You Sign, Read Your Workers' Comp Contract Carefully (Jan. 17, 2008)
• Frequently Asked Questions  (TDI)
• Workers' Compensation Fee Schedule By Region (March 11, 2008)
• Workers' Comp Worth It? State Hopes Higher Fees Will Bring Doctors Back - Texas Medicine (February 2008) 
• Reforms Continue for Physicians Who Remain in the Texas Workers' Compensation System
• TMA Urges TDI to Consider Comments Relating to the Proposed Rules for the Texas Workers' Compensation Medical Fee Guideline (PDF, Nov. 2, 2007)
• Administrative Burden Complaint List
• Frequently Asked Questions About the Workers’ Compensation Reform House Bill 7
• Disability Management for Injured Texas Workers (PDF)
• Carrier Phone Numbers for Determining Network Status of Injured Employees (PDF )
• Billing and Payment Problems
• Cookbook Comp? Physicians Skeptical About Workers' Comp Guidelines   (Texas Medicine - May 2007)
• History of the Workers' Compensation System in Texas
• A New Concept in Workers' Compensation: Managed Care Contract Negotiations (March 2006)
• Workers' Compensation Managed Care in Texas will Include Rental Networks: An AMA whitpaper Explaining the Tangled Web - (PDF)  (November 2005)
• Workers' Compensation Managed Care Networks Certified by the Texas Department of Insurance
• Workers' Compensation: Frequently Asked Questions About Reform by Providers (September 2005) 
• Workers' Compensation Commissioner Bulletins
• Workers' Compensation Special Report - 2004 Survey of Texas Physicians   (PDF) (December 2004)
• Texas Workers' Compensation Presentation: Understanding the Workers' Compensation Public Policy Crisis (PDF) (December 2004)
• Termination of the Physician-Patient Relationship

Designated Doctor Services

• Billing and Reimbursement for Designated Doctor Services (FastFacts, TDI: Division of Workers' Compensation)

FAQs: Recent Workers' Compensation Reform From Texas Department of Insurance (TDI): Division of Workers' Compensation

• FAQs Regarding Recent Workers' Compensation Reforms: Employees
• FAQs Regarding Recent Workers' Compensation Reforms: Employers
• FAQs Regarding Recent Workers' Compensation Reforms: Providers

Sample Letters to Carriers

• Reply to Carrier Request for More Information on an Incomplete Claim or More Documentation for a Retrospective Review
  View HTML version or download MS Word 6.0 version
• Claims in Process Over 45 Days
  View HTML version or download MS Word 6.0 version
• Request for Reconsideration
  View HTML version or download MS Word 6.0 version

Additional Articles

• Division Introduces Comp Connection for Health Care Providers 
• Changes to Conversion Factors for Workers' Compensation Medical Fee Guidelines 
• TMA Working to Improve Workers' Compensation ( PDF, Feb. 16, 2009)
• Disputes and Complaints In the Workers' Compensation System (PDF) (FAST FACTS, TDI)
• FAST FACTS (TDI)
• New Workers' Compensation Codes Adopted by Accredited Standards Committee (PDF) - March 2008 CompMinute TDI - Workers' Compensation
• Improper Denials Based on Lack of Documentation (PDF)
• E-billing Required for Workers’ Compensation
• Electronic Medical Bill Data Exchange (eBilling) Implementation
• eBilling Frequently Asked Questions (PDF).
• Health Care Provider's Treatment Decisions in a Disability Management Context
• Preauthorization for Common Treatments/Services
• How to Respond to Denials of Reimbursement for Emergency Medical Care (PDF)
• Review of Requests for Reimbursement for Emergency or Immediate Post-Injury Medical Care (PDF)
• Division Assists Health Care Providers With Disputes Involving Nonmedical Issues (PDF)

Last Published: 7/15/2010