Input Needed for Development of the Medical Quality Review CY 2015 Annual Audit Plan
Tuesday, October 14, 2014 11:14 AM

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) invites public comments on an informal draft of CY 2015 Medical Quality Review Annual Audit Plan (Audit Plan).  

The Audit Plan sets the priorities for the types of audits the Medical Quality Review Panel will focus on for the next calendar year.  Stakeholder input will be solicited for each individual plan-based audit within the Audit Plan at a future date.  A copy of the 2014 and 2015 Audit Plan may be viewed HERE or on the TDI website at http://www.tdi.texas.gov/wc/hcprovider/medadvisor.html.

The DWC Medical Advisor is responsible for developing the Audit Plan, which will be adopted by the Commissioner of Workers’ Compensation.  The Medical Advisor will evaluate Audit Plan suggestions from system participants using the following criteria:

  • Does the suggested audit relate to a statutory responsibility of the Medical Advisor or the Medical Quality Review Panel pursuant to Labor Code Sections 413.0511 and 413.0512 (e.g., the quality of health care provided by doctors or other health care providers treating injured employees; or the quality and timeliness of decisions made by utilization review agents, insurance carriers, designated doctors or Independent Review Organizations)
  • Is the administrative data to select system participants for the audit available to the DWC, or can the necessary data be obtained easily and economically to complete the audit?  
  • Does the DWC have adequate resources to complete the audit within the next year?

Public comments on the CY 2015 Audit Plan may be submitted via e-mail to OMA@tdi.texas.gov by 5 p.m. Central Standard Time on Wednesday, October 15th, 2014.  

For questions regarding this memo, please contact Mary Landrum of DWC Health Care Quality Review at 512-804-4814 or Mary.Landrum@tdi.texas.gov.