Amendments improve billing and reimbursement for certain workers' comp specific services, including Designated doctor (DD) exams, Required medical exams (RMEs).
In addition to work status reports, Maximum medical improvement (MMI) evaluations and Impairment rating (IR) examinations by treating and referring doctors.
Adjusted fees once by applying Medicare economic index (MEI) % adjustment factor for the period 2009-2024; adjusted fees annually on Jan. 1, after initial adjustment.
By applying the MEI percentage adjustment factor in TX INS 28-2-134.203(c)(2).
Rounded fees to whole dollars; set $100 missed appointment fee, $300 specialist fee.
Additionally, provisions eliminated tiering so that for DDs and RME doctors, all issues addressed within one exam will be paid at the established fee and not reduced.
Required assignment number in the prior authorization field of medical billing forms to identify DD-associated billing; clarified start of 95-day period for submission of DD bill.
Consultation
Comments on the proposal due by Jan. 29, 2024; hearing scheduled for Jan. 23, 2024.
Dec. 29, 2023 TX INS Proposal Publication
On Dec. 29, 2023, TX INS published the workers' comp proposals in the State register.
Document dated Dec. 29, 2023, was received on Jan. 5, 2024, due to a fixed feed.
Mar. 2024 TX INS Adopted Rules
On Mar. 8, 2024, TX INS issued notice of adoption of rules on workers' comp billing.
