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DWC to Examine 30 Lumbar Fusions in Audit of Utilization Reviewers

Tuesday, December 1, 2020 | 312 | 0 | 86 min read

The Texas Division of Workers' Compensation has adopted a plan to audit utilization review agents based in part on the number of lumbar fusion surgeries they've allowed. The DWC is required by statute to monitor medical quality review agents regularly to ensure that they and insurers adhere to the Official Disability Guidelines by MCG Health, the agency explained in a bulletin. After receiving comments on ways to do that, the DWC last week approved an audit plan in which a medical quality review panel will randomly select 30 bills for lumbar fusion surgery done in 2018, 2019 and the ...

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