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The Division, faced with a rapidly dwindling list of available designated
doctors (current numbers show 60 MDs, 9 DOs and 169 DCs for a total of 238 designated
doctors), has again changed things up in efforts to make more doctors available
to field the number of requests they receive each year.
The new rules change the qualification criteria to require less for certain
kinds of examinations and add to the list of board-certified doctors qualified
to evaluate traumatic brain injuries with the justification that those doctors
are to send out for testing anyway and they can then incorporate that testing
into their reports. These qualification changes are effective 6/5/23.
This is not the first rule change impacting the designated doctor suite of
rules, and it likely won’t be the last, but here are the high points:
• For DD
examinations involving traumatic brain injuries, the Division added doctors who
are or have been board certified in orthopaedic surgery, occupational medicine,
dermatology, plastic surgery, surgery, anesthesiology with a subspeciality in
pain medicine, emergency medicine, thoracic and cardiac surgery and family
medicine.
• For DD examinations involving injuries with multiple fractures, a
single spinal fracture or rib fractures where there is no vascular injury,
chiropractors are now qualified, in addition to MDs and DOs.
• DD examinations involving spinal cord injuries including spinal
fractures with documented neurological injury or vascular injury, more than one
spinal fracture or cauda equina syndrome are assigned to board certified
doctors in neurosurgery, neurology, PM&R or orthopedic surgery.*
• DD examinations involving multiple fractures accompanied by vascular
injury are assigned to board certified doctors in emergency medicine,
orthopedic surgery, plastic surgery, PM&R or occupational medicine.*
• Multiple certifications will no longer be ordered unless the Division
orders them as the result of a Presiding Officer Directive.
*These examinations are handled by the same specialties, but carve out the more complex fracture injuries for board certification while allowing chiropractors to evaluate multiple fractures, single spine fractures and rib fractures that don’t involve vascular injury.
• Doctors
who passed DWC certification on or after 5/13/13 don’t have to test again for
certifications that expire on or after 4/30/23.**
• Doctors still have to take required training and reapply every 2
years.
• The certification and re-certification rules have been streamlined.
• None of the
rule changes address billing and reimbursement for designated doctor
examinations. (Specifically, there is no mention of increasing
the reimbursement rate for designated doctor examinations. In 2022, the
Division posted and took comment on Rules 133 and 134 and the relevant sections
relating to billing and reimbursement for designated doctor examinations. The
second informal posting of those rules provided increased reimbursement for
examinations and even provided a $150.00 missed appointment fee. The
comment deadline for those rules was 12/16/22. There is no word yet on
the status of this rule project).
**The rule allows the
Division to require a doctor to take the test again on a case-by-case basis as
part of a performance review.
Copyright 2023, Stone Loughlin & Swanson, LLP