4123-6-20 Obligation for submitting medical documentation and reports.

 

 

 

4123-6-20                    Obligation for submitting reports.

 

 

 

(A)    As provided in rules 4123-6-02.8 and 4123-6-71 of the Administrative Code, a provider who undertakes treatment in an industrial case assumes the obligation to notify the bureau, MCO, QHP, or self-insuring employer of the injury within twenty-four hours of the initial treatment or initial visit.

 

(B)  Interim medical reports and medical documentation.

 

Compensation for temporary total disability is payable upon submission of current supporting medical documentation. Interim reports must be filed, on forms provided by the bureau, at least every thirty days while the claimant remains on temporary total disability. Interim reports must include at least:

 

(1)  The date of the report;

 

(2)   The date of the last examination;

 

(3)      The current "International Classification of Disease" diagnosis code(s), including a primary diagnosis code, with a narrative description identifying the condition and specific areas of the body being treated;

 

(4)   Any reason(s) why recovery has been delayed;

 

(5)   The date temporary total disability began;

 

(6)   The current physical capabilities of the claimant;

 

(7)   An estimated or actual return to work date;

 

(8)   An indication of need for vocational rehabilitation;

 

(9)   Objective findings; and

 

(10)   Clinical findings supporting the above information.

 

(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 claimant 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 projected or anticipated 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 which 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.

(4)   Supplemental reports from the attending physician and other providers may be requested by the bureau, industrial commission, employer, MCO, QHP, or by the claimant or representative. These reports shall be used to determine the appropriateness of a benefit or bill payment.

(D)      In  accepting  a  workers'  compensation  case,  a  medical  provider  assumes  the obligation to provide to the bureau, claimant, employer, or their representatives,

MCO, QHP, or self-insuring employer, upon written request or facsimile thereof and within five business days, all medical, psychological, or psychiatric 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 claimant to obtain medical services, benefits or compensation. A medical provider may not assess a fee or charge the bureau, claimant, employer, or their representatives, or industrial commission, MCO, or QHP, for the costs of completing any bureau form or documentation required under this rule which is necessary for the claimant to obtain medical services, benefits, or compensation.

Effective:                                01/01/2003

R.C. 119.032 review dates:    10/15/2002 and 03/01/2005

CERTIFIED ELECTRONICALLY

Certification

12/20/2002

Date

Promulgated Under:   119.03

Statutory Authority:   4121.12, 4121.30, 4121.31,

4123.05

Rule Amplifies:           4121.121, 4121.44, 4121.441,

4123.66

Prior Effective Dates: 1/27.97, 1/15/99, 1/1/01