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Comments to Proposed URA Plan Based Audit

September 12, 2012                                         Bulletin 2012 - No. 5



John D. Pringle has commented by letter on the Texas Department of Insurance, Division of Workers’ Compensation’s (DWC) Medical Director’s Insurance Carrier/Utilization Review Agent Plan-Based Audit which comments were solicited by Dr. Donald Patrick on September 4, 2012. 


A portion of the comments from page 3 of the letter are set out below:


The present Section IV of the Plan-Based Audit sets out two time frames to select data for purposes of the audit.  The second time frame is for office visits that occurred during January 9, 2011 through December 31, 2011.  The Plan-Based Audit should be prospective and not retrospective.  Auditing insurance carriers and URAs for conduct occurring prior to the adoption of the Plan-Based Audit with its criteria is certainly unfair and may be unconstitutional.


To see the entire letter click here. 





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