Fw: W/C Question

[Guest guest]

Follow-up to Dr. s question,

Was over at the Dept. of Business & Consumer Services dropping off the professionally bound Chiropractic Assoc. of Oregon's Workers' Comp survey results for the MLAC member....I will testify to the results during the April 14th meeting.....and met with Savage MCO (= Managed Care Organization) "In-Office Audit and Certification Unit, Compliance Section. She is your answer woman for MCO W/C questions....

To....answer the doc's question if the MD is on panel he must following the MCO guidelines all of which mandate he refer to panel providers.....which the Dr. s is not.

Key to the equation is if the worker has been enrolled into an MCO? Docs need to ask the worker if they have received notification that they have been enrolled...if so the provider and the worker must be "simultaneously" notified.

The worker is subject to MCO enrollment 3 days following written notice however, OAR 436-010-0275 (7) refers to "continuity of care" and OAR 436-015-0035 4 e (A) allows 7 days after notification of none qualified (not on panel) providers to allow for care of the enrolled worker.....

Clear as mud?

Vern Saboe

W/C Question

Ok, at the risk of sounding like someone who's never treated a WC claim before, here goes...

Special Ed. teacher wants to come in for a WC injury (student jumped on her). We blew her off as long as we could (my opinion is...heck with them...if they want to get Chiropractic treatment for work related injuries...THEY can go get the law changed).

So, anyway, she goes to her MD who will now give her a referral to come see me... My question is, do I have her fill-out "change of attending physician," see her a couple times, have WC STOP the care, and force her to go the one-and-only managed care Chiro in our area...OR...just treat her under a "referral" from the MD (like PT) and let the MD remain the attending physician so that WC can't yank her out of mine and her MD's care?

What would be the best "strategy" here...?

M. s, D.C.