Workers Compensation Medical Peer Review Data Call ：工人的赔偿医学同行评审数据呼叫.pptVIP

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Workers Compensation Medical Peer Review Data Call ：工人的赔偿医学同行评审数据呼叫.ppt

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Workers Compensation Medical Peer Review Data Call ：工人的赔偿医学同行评审数据呼叫

Workers’ Compensation Medical Peer Review Data Call: Comprehensive Results Workers’ Compensation Research and Evaluation Group June 2007 Purpose of Division of WC’s Data Call To collect objective information regarding: The frequency and cost of peer reviews requested by insurance carriers; The reasons why peer reviews are requested; The types (licensure) of doctors performing peer reviews; The opinions of peer review doctors; and The actions taken (or not) by insurance carriers as a result of the peer review. Summary of Data Call Division of Workers’ Compensation (Division) issued data call in late July 2006; This is the first time this type of information has been collected on WC peer reviews; 25 insurance carriers were asked to submit data on every peer review they received during September and October 2006; These 25 insurance carriers represented approximately 70% of the medical payments in 2003; and Data was submitted to the Division at the end of December 2006. General Data Call Results A total of 11,437 peer reviews received during Sept/Oct 2006 by the 25 insurance carriers included in the data call; These peer reviews were conducted on approximately 8,583 WC claims; Approximately 655 doctors (58% Texas licensed/42% non-Texas licensed) conducted these reviews. Frequency, Cost and Type of WC Peer Reviews Requested Percentage of Peer Reviews Conducted by Primary Reason Percentage of Peer Reviews Conducted by Cost Range Percentage of Peer Reviews Conducted by Cost Range and Primary Reason Type and Licensure of Doctors Performing Peer Reviews Percentage of Peer Reviews Conducted by Texas/Non-Texas Licensed Doctors by Primary Reason Percentage of Peer Reviews Conducted by Type of Doctor and Primary Reason Comparison of Peer Review Doctor Type with Type of Doctors Being Reviewedpreauthorization/concurrent review of medical necessity Comparison of Peer Review Doctor Type with Type of Doctors Being Reviewedretrospective review of medical necessity C