A Time for Love and A Time for Audit
Carriers: It’s that time again. Every two years, the DWC audits insurance carriers through PBO. The majority of the audit focuses on timely payment of TIBs and processing of initial medical bills. Other measures include timely processing of requests for reconsideration of medical bills and timely submission of EDI data for initial payments and medical bill processing. The relevant time frame for the audit: 1/1/22 through 6/30/22. You can get more information
here.
HCPs: The DWC announced its approval of the 2022 Medical Quality Review audit this month. This year, the audit will focus on the reasonableness of return-to-work decisions and recordkeeping and the use and effectiveness of spinal cord stimulators.
We gave you a sneak peak of the proposed Shoulder Surgery Plan-Based Audit in our November newsletter. On 1/13/22, the DWC announced that audit plan was approved. It will be interesting to see if the audit results in a curtailing of distal clavicle resections in routine shoulder surgery as those procedures can, without careful monitoring and/or litigation, result in significantly higher impairment ratings for shoulder injuries.
