Current through all regulations passed and filed through September 16, 2024
(A) A provider is
responsible for the accuracy and legibility of all reports, information,
and documentation submitted by the
provider, the provider's employees, or the provider's agents to the bureau,
industrial commission, injured worker, employer, or their representatives,
MCO, QHP, or self-insuring employer in connection with a workers' compensation
claim. The provider, the provider's employees, and the provider's agents shall
not submit or cause or allow to be submitted to the bureau, industrial
commission, injured worker, employer, or their representatives,
MCO, QHP, or self-insuring employer any report, information, and documentation containing false, fraudulent,
deceptive, or misleading information.
(B) Physician's medical reports of work
ability.
(1)
Physicians
treating
injured workers shall complete, sign, and submit to
the MCO a physician's report of work ability on form MEDCO-14 or equivalent
upon every
injured worker encounter, unless:
(a) The
injured
worker has been awarded compensation for permanent total
disability;
(b) The
injured worker returns to work without
restrictions within seven days of the injury; or
(c) The
injured
worker is seeing the treating physician after the treating physician has
submitted a MEDCO-14 or equivalent releasing the
injured
worker to return to the former position of employment without
restrictions.
(2) The physician's
report of work ability must include at a minimum the following:
(a) The date of the
report;
(b) The date of the last examination;
(c)
The "International Classification of Disease" diagnosis code(s) recognized in
the claim for all conditions and all parts of the body being treated that are
affecting the length of disability, including a primary diagnosis code, with a
narrative description identifying the condition(s) and specific area(s) of the
body being treated;
(d) Any reason(s) why recovery has been delayed;
(e) The date temporary total disability began;
(f) The current physical capabilities of the
injured
worker;
(g) An estimated or actual return to work date;
(h) An indication of need for vocational
rehabilitation;
(i) Objective findings; and
(j) Clinical findings
supporting the information in this rule.
(C)
Treatment plan.
(1) Upon allowance of a claim
by the bureau, industrial commission, or self-insuring employer, the physician
of record and other providers treating the injured worker shall provide and
continue to update a treatment plan to the MCO, QHP, or self-insuring employer
according to the format or information requirements designated by the bureau. A
treatment plan should include at least the following:
(a) Details of the frequency, duration, and
expected outcomes of medical interventions, treatments, and
procedures;
(b) The estimated
return to work date; and
(c)
Factors that are unrelated to the work-related condition, but are impacting
recovery.
(2)
Modifications should be made to the initial treatment plan as treatment is
extended, changed, completed, added, deleted or canceled. The modification
should describe the current prognosis for the injured worker, progress to date,
and expected treatment outcomes.
(3) Treatment plans should be updated when
significant changes occur in the claim that impact claims management. Changes
include:
(a) Additional allowance;
(b) Re-activation;
(c) Authorization of expenditures from the
surplus fund;
(d) Return to
modified or alternative work;
(e)
Maximum medical improvement;
(f)
Rehabilitation;
(g) A new injury
while receiving treatment in the claim.
(D)
Supplemental reports or other bureau forms from
the attending physician and other providers may be requested by the bureau,
industrial commission, employer, MCO, QHP, or by the
injured
worker or representative. These reports shall be used to determine the
appropriateness of a benefit,
bill payment, or
allowance.
(E) In accepting a
workers' compensation case, a provider assumes the obligation to provide to the
bureau, injured worker, employer, or their representatives,
MCO, QHP, or self-insuring employer, upon written request or facsimile thereof
and within five business days, all medical, psychological, psychiatric, or
vocational documentation relating causally or historically to physical or
mental injuries relevant to the claim required by the bureau, MCO, QHP, or
self-insuring employer, and necessary for the
injured
worker to obtain medical services, benefits or compensation.
(F) Independent medical examinations.
(1) A provider performing an independent
medical examination of a
injured worker shall create, maintain, and retain
sufficient records, papers, books, and documents in such form to fully
substantiate the accuracy of the resulting report submitted to the bureau,
industrial commission, injured worker, employer, or their representatives,
MCO, QHP, or self-insuring employer in connection with a workers' compensation
claim. The provider, the provider's employees, and the provider's agents shall
keep such records in accordance with rule
4123-6-45.1 of the
Administrative Code, and such records shall be subject to audit pursuant to
rule 4123-6-45 of the Administrative
Code.
(2) A provider performing an
independent medical examination of a
injured
worker shall keep confidential all information obtained in the
performance of the independent medical examination, including but not limited
to knowledge of the contents of confidential records of the bureau, industrial
commission, injured worker, employer, or their representatives,
MCO, QHP, or self-insuring employer. The provider, the provider's employees,
and the provider's agents shall maintain the confidentiality of such records in
accordance with all applicable state and federal statutes and rules, including
but not limited to rules
4123-6-15 and
4123-6-72 of the Administrative
Code.
