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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”…
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