Solutions to the American Prescription Drug Abuse Epidemic Part III

 
Stuart Colburn, Esq., has done it again with his third installation on prescription drug abuse in America for the LexisNexis Communities on Workers Compensation. Part One explained “the problem”. Part Two identified stakeholders and his final blog offers solutions. You may read his complete blog here or take a look at this brief summary.
 
1. Government Regulation
“Prescription drug abuse and diversion is a problem requiring close interaction between public and private sectors. Stakeholders must work together using tools at their disposal in a coordinated effort to fight supply and demand,” Colburn wrote. He suggests a prescription drug monitoring program (PDMP) that would include:
 
– Scheduled and other highly abusive substances.
– Real time data transmission between stakeholders.
 -A requirement for doctors to check the PDMP database before writing a prescription.
– A requirement for pharmacies to check the PDMP database before dispensing narcotics.
Integration with neighboring states.
 
 
2. Physicians
“The public has an unreasonable view of the knowledge base of healthcare providers. Although every doctor graduated from medical school, knowledge itself comes from specialized training,” he wrote, “Scheduled narcotics should only be prescribed by doctors with the requisite training and experience. Those doctors granted the additional license to prescribe scheduled narcotics would be subject to additional regulation.”
 
 
3. Pharmacies
“Pharmacies should be required to participate in a prescription drug monitoring program for scheduled narcotics before dispensing scheduled narcotics,” Colburn suggested.
 
 
4. Pharmaceutical Companies
Drug companies should design drugs to deter abuse. Drug companies can employ manufacturing techniques, making it more difficult or impossible for drugs to be ground up into a powder,” he added.
 
 
5. Consumers
“Public education about prescription drug abuse should be paramount on billboards and in our school systems. Every day, 7,000 young people abuse prescription narcotics for the first time. Patients who receive a prescription or scheduled narcotics should also undergo approved education and information,” Colburn wrote.
 
 
6. Payers
“Payers should implement strategies designed to identify addicts, diverts and outliers. Payers should urge policy makers to adopt PDMP and common sense laws giving regulators the information and power necessary to fight PDA,” he wrote. “Payers have ever more increasingly sophisticated software able to perform advanced predictive modeling and performance analytics that can identify outlier doctors and possible addicts.”
 
 
© Copyright 2011 Stuart Colburn, Esq. Reprinted with permission.
For more information about LexisNexis products and solutions connect with them and become part of the conversation at Workers Compensation Law Community

This information was provided by attorney Stuart Colburn, a Shareholder at Downs Stanford in Austin, Texas. Colburn has extensive experience in all phases of dispute resolution before the Texas Department of Insurance, Division of Workers Compensation and in district courts across the state. Stuart represents clients regarding workers compensation, non-subscription, subrogation, and bad faith litigation. He is the founder and the first chairman of the State Bar of Texas (SBOT) Workers Compensation Section; course coordinator for the SBOT the Advanced Workers Compensation Seminar; and course coordinator for the Texas Workers Compensation Forum. He can be reached at:  scolburn@downsstanford.com

 
 
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

Texas Division of Workers Compensation Approves 14 for Self Insurance

 

pic10The Texas Department of Insurance, Division of Workers Compensation (TDI-DWC) approved one initial application and 13 renewals of certificates of authority, to self-insure for workers compensation claims for a one-year period under the TDI-DWC Self Insurance Program to 14 companies employing approximately 188,000 employees in Texas.

 

 

Under Texas law, certain large, private companies can self-insure for workers compensation claims, while retaining the protection of the Texas Workers Compensation Act for the company and for its employees. To qualify, a company must have a minimum workers compensation insurance unmodified manual premium of $500,000 and meet other requirements subject to annual review.(WCxKit)

 

 

According to the Texas Department of Insurance, certified self-insurance is a program that allows private employers in Texas to self-insure for their workers compensation losses – it is allowed because workers compensation coverage is not mandatory in Texas. Employers wanting to self-insure apply to the TDI-DWC and, if approved, pays its own workers compensation losses.

 

 

The companies affected by the most recent self-insurance certificates are:

  1. AAA Cooper Transportation, Dothan, AL
  2. American Electric Power Company Inc., Heath, OH
  3. Archer-Daniels-Midland Company, Decatur, IL
  4. Baker Concrete Construction Inc., Monroe, OH (new to program)
  5. FedEx Ground Package System, Inc., Pittsburgh, PA
  6. Hyatt Corporation, Chicago, IL
  7. Limited Brands Inc., Columbus, OH
  8. Lockheed Martin Corporation, Fort Worth
  9. Parker-Hannifin Corporation, Cleveland, OH
  10. Poly-America L.P., Grand Prairie
  11. Sam Kane Beef Processors Inc., Corpus Christi
  12. Union Tank Car Company, Chicago, IL
  13. VF Corporation, Greensboro, NC
  14. Wal-Mart Associates Inc., Bentonville, AR

 

 

Among the qualifications for self-insurance in Texas are the following:

  1. A private employer with operations in Texas.
  2. An estimated unmodified manual insurance premium of at least $500,000 in Texas, or at least $10,000,000 nationwide.
  3. Presentation of audited financial statements.
  4. Qualifying Credit/Debt ratings.
  5. A qualifying Tangible Net Worth to Long Term Debt ratio of 1.5 to 1, with Minimum Tangible Net Worth of $5 million.
  6. Posting of a minimum security deposit of $300,000.
  7. Posting of excess insurance in the amount of $5 million per occurrence.
  8. Submission of an “Application for Certificate of Authority” to SIR; and
  9. Payment of a non-refundable $1,000 application fee.

 

In other news, the TDI-DWC will be hosting some educational sessions on pharamacy closed formulary. The sessions are open to are for all Texas workers compensation participants, including health care providers, pharmacists, insurance carriers, claim adjusters, case managers, and attorneys. The free sessions provide information on the new TDI-DWC pharmacy closed formulary rules, adopted in December 2010 for both certified workers compensation network (network) and non-network claims with dates of injury on or after Sept. 1, 2011. The sessions will provide information on the definition and application of both the open and closed formularies.(WCxKit)

For more details, visit the TDI-DWC Events and Training Calendar on the TDI website at www.tdi.texas.gov/wc/events/index.html.

  1.  Abilene  Nov. 10, 2011
  2.  Amarillo Oct. 25, 2011
  3.  Austin  Oct. 20, 2011
  4.  Beaumont Nov. 17, 2011
  5.  Bryan  Nov. 30, 2011
  6.  Corpus Christi Nov. 3, 2011
  7.  Dallas*  Nov. 8, 2011
  8.  El Paso  Oct. 18, 2011
  9.  Houston** Nov. 15, 2011
  10.  Laredo  Nov. 3, 2011
  11.  Lubbock Oct. 25, 2011
  12.  Lufkin  Nov. 17, 2011
  13.  Midland Nov. 10, 2011
  14.  San Angelo Nov. 10, 2011
  15.  San Antonio Oct. 27, 2011
  16.  Tyler  Nove. 30, 2011
  17.  Waco  Nov. 30, 2011
  18.  Weslaco Oct. 25, 2011
  19.  Wichita Falls Nov. 30, 2011

 

This information was provided by attorney Stuart Colburn, a Shareholder at Downs Stanford in Austin, Texas. Colburn has extensive experience in all phases of dispute resolution before the Texas Department of Insurance, Division of Workers Compensation and in district courts across the state. Stuart represents clients regarding workers compensation, non-subscription, subrogation, and bad faith litigation. He is the founder and the first chairman of the State Bar of Texas (SBOT) Workers Compensation Section; course coordinator for the SBOT the Advanced Workers Compensation Seminar; and course coordinator for the Texas Workers Compensation Forum. He can be reached at:  scolburn@downsstanford.com

 

Our WORKERS COMP BOOK:  www.WCManual.com

 

WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

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WC GROUP:   www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE:  Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

 

Division of Workers Compensation System Data Report Available Online

 

pic2The Texas Department of Insurance, Division of Workers Compensation (TDI-DWC), is now offering workers compensation system data online.

 

 

Interactive tools allow users to create customized graphics and download the charts and data from the on-line site.

 

On the site, users can find:

  1. Workers compensation claims data.
  2. Income and death benefit information.
  3. Dispute resolution.
  4. Medical fee disputes.
  5. Designated doctor appointments.
  6. Medical benefits.

 

 

Rod Bordelon, commissioner of workers compensation said, “We are pleased to provide information in an interactive format that allows system participants to more easily access aggregate claims information.”

 

 

The report contains information from 2006 through 2010 and eliminates the need for workers comp system participants to submit open records requests for the information.(WCxKit)

 

It is available for free here.

 

 

This information was provided by attorney Stuart Colburn, a Shareholder at Downs Stanford in Austin, Texas. Colburn has extensive experience in all phases of dispute resolution before the Texas Department of Insurance, Division of Workers Compensation and in district courts across the state. Stuart represents clients regarding workers compensation, non-subscription, subrogation, and bad faith litigation. He is the founder and the first chairman of the State Bar of Texas (SBOT) Workers Compensation Section; course coordinator for the SBOT the Advanced Workers Compensation Seminar; and course coordinator for the Texas Workers Compensation Forum. He can be reached at:  scolburn@downsstanford.com
Our WC Book:  http://www.wcmanual.com

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

 

Texas Department of Insurance Issues Disciplinary Orders

pic4The Texas Department of Insurance, Division of Workers Compensation (TDI-DWC), recently issued disciplinary orders under the Commissioner of Workers Compensation Rod Bordelon. The actions are related to violations of the Texas labor code.

 

Among the many disciplinary orders posted for 2011 are the following:(WCxKit)

 

 

Ace American Insurance Co. of Philadelphia, Penn., was fined $40,000 for failing to timely pay a medical bill and failure to pay for preauthorized medical services.

 

 

For failing to accurately report medical bill and payment data to the TDI-DWC America First Lloyds Insurance Company of Richardson was fined $9,000.

 

 

A fine of $2,500 was levied against the Connecticut Indemnity Company of Addison, Texas, for failing to pay an order awarding benefits; and failing to comply with an order of the Commissioner or TDI-DWC.

 

 

 EBI, LLC of Parisippany, NJ, was fined $2,500 for improperly billing injured employee for provided workers compensation medical services provided.

 

 

FedEx Freight, Inc., of Memphis, Tenn., was fined $7,500, for failing to accurately report medical bill and payment data to the TDI-DWC.

 

 

A fine of $2,500 was levied against Netherlands Insurance Company of Boston, Mass., for failing to accurately submit pay income benefits to injured employee.

 

 

And Valdez, Anthony Francis M.D. of El Paso was ordered to cease and desist from participating in the workers compensation system because he provided health care and received remuneration for services to injured employees after being denied admission to approved doctors list.

 

 

Alpha Dental Programs, Inc., of Flower Mound was fined $25,000 for failing to pay clean claims in a timely manner.(WCxKit)

 

 

To read more violations, check the TFI-DWC website here.

 

 

This information was provided by attorney Stuart Colburn, a Shareholder at Downs Stanford in Austin, Texas. Colburn has extensive experience in all phases of dispute resolution before the Texas Department of Insurance, Division of Workers Compensation and in district courts across the state. Stuart represents clients regarding workers compensation, non-subscription, subrogation, and bad faith litigation. He is the founder and the first chairman of the State Bar of Texas (SBOT) Workers Compensation Section; course coordinator for the SBOT the Advanced Workers Compensation Seminar; and course coordinator for the Texas Workers Compensation Forum. He can be reached at:  scolburn@downsstanford.com

 
Our Workers Compensation Book:  http://www.wcmanual.com

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

 

Big Changes this Fall in Texas Insurance

 

pic5The Texas Department of Insurance announced four new initiatives, which we have summarized. The details of all can be found here:

 

  1. Case management certification.
  2. Establishment of procedures for insurance carriers to recoup overpayment.
  3. Paper and electronic billing requirements for workers compensation.
  4. Pharmacy closed formulary adoption.

 

  1. Case Manager Certification

The first new rule establishes certification requirements for case managers working with insurance carriers on non-network workers compensation claims. Beginning Sept. 1, all managers must be certified in one of six ways. Other details as follows:

 

 

New managers must work under supervision of a certified manager an have 24 months to accrue necessary experience to sit certification exams.

Claims adjusters may no be used as case managers.

Insurance carriers must verify, document, and submit proof of certification.

 

 

  1. Over and Underpayment Regulations

The second announcement regards the establishment of how insurance carriers get overpayment or how they should make an underpayment. Details of this new bill will be discussed in a series of meetings beginning Sept. 1 and also available via live audio stream. More information can be found on the Texas Department of Insurance website, here.

 

 

  1. Paper and Electronic Billing Requirements

The third announcement regards the way billing is performed – regulations began August 1. Among the changes are:

  1. All health care workers are subject to the rules.
  2. Bills must be submitted electronically unless you are exempt.
  3. If your office treated fewer than 32 injured workers or have fewer than 10 employees, you can file that electronic billing will cause undue financial hardship.
  4. A workers compensation claim number and National Provider Identifier (NPI) must be on all bills.
  5. State license numbers are required on all paper professional, institutional, and dental medical bills. They are not required on pharmacy bills or electronic bills after Jan. 1.

 

 

  1. Pharmacy Closed Formulary

Finally, the last announcement regards the Texas workers compensation system adopting a pharmacy closed formulary in order to bring more drug prescribing consistency certified workers compensation health-care network and non-network claims. The outpatient open formulary (all FDA-approved prescription and non-prescription drugs) is still in effect until Sept. 1. Details on this transition, legacy claims and non-network requirements can be found here.

 

This information was provided by attorney Stuart Colburn, a Shareholder at Downs Stanford in Austin, Texas. Colburn has extensive experience in all phases of dispute resolution before the Texas Department of Insurance, Division of Workers Compensation and in district courts across the state. Stuart represents clients regarding workers compensation, non-subscription, subrogation, and bad faith litigation. He is the founder and the first chairman of the State Bar of Texas (SBOT) Workers Compensation Section; course coordinator for the SBOT the Advanced Workers Compensation Seminar; and course coordinator for the Texas Workers Compensation Forum. He can be reached at:  scolburn@downsstanford.com

For complete contents of all state laws and legal research, contactwww.workcompresearch.com or rwilson@workerscompensation.com

Our WC Book:  http://www.wcmanual.com

WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:  http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

 

Seminars on Texas Pharmacy Formulary and Claims/eBill

pic6The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) will present a series of free, half-day educational seminars titled Pharmacy Closed Formulary and Clean Claims/eBill. The seminars are being offered in cooperation with Small Business Development Centers.

 

 

The Pharmacy Closed Formulary portion of the seminar will provide an overview of the pharmacy closed formulary rules adopted by the TDI-DWC in December 2010 for both certified network and non-network workers’ compensation claims with dates of injury on or after Sept. 1, 2011.

 

 

The Clean Claims/eBill portion of the seminar will provide an overview of the new TDI-DWC requirements related to submitting paper and electronic medical bills, including a discussion of the changes from the previous requirements and a brief introduction to the new electronic medical billing standards. This presentation also provides an opportunity for new and experienced medical billing employees to recognize how to complete medical bills to minimize insurance carrier returns or rejections after the Aug. 1, 2011 effective date.(WCxKit)

 

House bill 528, which becomes effective June 17, can be found here.

 

Among some the regulations in the bill include:

  1. Insurance carriers must reimburse health care providers in accordance with the TDI-DWC’s pharmacy fee guideline or at a contracted rate.
  2. Insurance carriers may also reimburse health care providers for pharmaceutical services at rates inconsistent with the TDI-DWC’s pharmacy fee guideline if the carrier has a contract with that health care provider that includes a specific fee schedule.
  3. Insurance carriers or their authorized agents may use a pharmacy informal or voluntary network to obtain these contractual agreements with health care providers. If an insurance carrier chooses to use a pharmacy informal or voluntary network, there must be: a contractual arrangement between the insurance carrier or its agent and the pharmacy informal or voluntary network authorizing the network to contract with health care providers for pharmaceuticals on the insurance carrier’s behalf; and a contract between the network and the health care providers that includes a specific fee schedule and complies with the health care provider notice requirements of Texas Labor code.
  4. The carrier must notify each health care provider, at least quarterly of any person, other than the injured employee, to which the network’s contractual fee arrangements with the health care providers are sold, leased, transferred or conveyed.
  5. Each informal or voluntary network that has contracts in effect on June 17, 2011, must report the information listed in the labor code by July 17, 2011.
  6. Failure for a pharmacy informal or voluntary network to comply with the registration requirements will result in an administrative violation.

 

Details of these new requirements will be explained at the conference.

 

Due to limited space, registration is required. For more details on the following educational seminars, visit the TDI-DWC Events and Training Calendar at www.tdi.state.tx.us/wc/events/index.html. Pharmacy Closed Formulary will be presented from 8 a.m. to 11 a.m. and Clean Claims/eBill will be presented from 11 a.m. to 12 p.m. at each venue. Texas workers’ compensation system participants may attend one or both portions of the seminar.

 

 

Training Dates

Date                       City

May 6, 2011          Dallas

May 7, 2011          Fort Worth

May 20, 2011        San Antonio

May 25, 2011        Wichita Falls

June 3, 2011        Corpus Christi

June 8, 2011        San Antonio

June 10, 2011      Houston

June 24, 2011      Edinburg

July 15, 2011        El Paso

Aug. 18, 2011       Austin

 

 

This information was provided by attorney Stuart Colburn, a Shareholder at Downs Stanford in Austin, Texas. Colburn has extensive experience in all phases of dispute resolution before the Texas Department of Insurance, Division of Workers Compensation and in district courts across the state. Stuart represents clients regarding workers compensation, non-subscription, subrogation, and bad faith litigation. He is the founder and the first chairman of the State Bar of Texas (SBOT) Workers Compensation Section; course coordinator for the SBOT the Advanced Workers Compensation Seminar; and course coordinator for the Texas Workers Compensation Forum. He can be reached at:  scolburn@downsstanford.com

 

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