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The April 2023 edition of The
Compendium outlined recent changes to the designated doctor rules,
which were presumably designed to incentivize those already on the DD list to
maintain their status while increasing the number of new applicants.
However, as we pointed out, the amendments omitted any updates to the
reimbursement rates for DD exams, perhaps the component most to blame for the
dwindling number of available designated doctors overall and certainly a reason
for the dearth of M.D.s and D.O.s currently on the list.
That oversight seems poised to change, as the DWC announced on June 26, 2023, a
new set of proposed amendments to Rules 133 (General Medical Provisions) and
134 (Guidelines for Medical Services, Charges, and Payments). Key
modifications would include adjusting fees via the Medicare Economic Index
(MEI) percentage adjustment factor for the period of 2009 through 2024, then
annually thereafter every January 1. Fees would be rounded to the nearest
whole dollar, and a $100.00 missed appointment fee would also be permitted when
injured workers neglect to attend their exams. (More on that in a
moment.) These provisions can be found in the new Rule 134.210(b)(4).
The DWC released a table of fee adjustment estimates (estimated because the MEI
percentage adjustment factor for 2024 is not yet set) for Designated Doctor
Exams, Required Medical Examinations, and treating/referral doctor impairment
rating certifications. Fees for extent of injury, disability, return to
work, return to work for SIBs, appropriateness of care (RMEs only), and “other
similar issues” jump from $500.00 to $640.00 per issue (again, estimated).
Maximum medical improvement issues would invite an increase from
$350.00 to $448.00, while the first musculoskeletal impairment rating
assessment rises from a range of between $150.00 and $300.00 to $384.00.
Fees for subsequent impairment rating areas would also increase from
$150.00 to $192.00, approximately.
New additions to some designated doctor bills will include a “Specialist Fee”
of $300.00. Specialist fees pertain to designated doctors (though not
RMEs) asked to evaluate injuries itemized in Rule 127.130(b)(9)(B-I): traumatic
brain injuries, spinal cord injuries, severe burns, complex regional pain
syndrome, multiple fractures, complicated infectious diseases, chemical
exposure, and heart/cardiovascular conditions.
Comments on the proposed changes can be sent via email to RuleComments@tdi.texas.gov.
The DWC advises that “Chapters 133 and 134 Informal Posting” should be
included in the subject line. Comments must be received in writing by
5:00 p.m. on the still-not-random-in-the-least date of July 26, 2023.
Now, about that “Missed Appointment Fee”…
Copyright 2023, Stone Loughlin & Swanson, LLP