| (5) If an impairment rating is assigned in violation
of subsection (c)(4), the rating is invalid and the evaluation and
report are not reimbursable. A provider that is paid for an evaluation
and/or report that is invalid under this subsection shall refund the
payment to the insurance carrier.
(d) Reporting.
(1) Certification of MMI, determination of permanent
impairment, and assignment of an impairment rating (if permanent impairment
exists) for the current compensable injury requires completion, signing,
and submission of the Report of Medical Evaluation and a narrative
report.
(A) The Report of Medical Evaluation must be signed
by the certifying doctor. The certifying doctor may use a rubber stamp
signature or an electronic facsimile signature of the certifying doctor's
personal signature.
(B) The Report of Medical Evaluation includes an attached
narrative report. The narrative report must include the following:
(i) date of the certifying examination;
(ii) date of MMI;
(iii) findings of the certifying examination, including
both normal and abnormal findings related to the compensable injury
and an explanation of the analysis performed to find whether MMI was
reached;
(iv) narrative history of the medical condition that
outlines the course of the injury and correlates the injury to the
medical treatment;
(v) current clinical status;
(vi) diagnosis and clinical findings of permanent impairment
as stated in subsection (c)(3);
(vii) the edition of the AMA Guides that was used in
assigning the impairment rating (if the injured employee has permanent
impairment); and
(viii) a copy of the authorization if, after September
1, 2003, the doctor received authorization to assign an impairment
rating and certify MMI by exception granted from the division.
(2) A Report of Medical Evaluation under this rule
shall be filed with the division, injured employee, injured employee's
representative, and the insurance carrier no later than the seventh
working day after the later of:
(A) date of the certifying examination; or
(B) the receipt of all of the medical information required
by this section.
(3) The report required to be filed under this section
shall be filed as follows:
(A) The Report of Medical Evaluation shall be filed
with the insurance carrier by facsimile or electronic transmission;
and
(B) The Report of Medical Evaluation shall be filed
with the division, the injured employee and the injured employee's
representative by facsimile or electronic transmission if the doctor
has been provided the recipient's facsimile number or email address;
otherwise, the report shall be filed by other verifiable means.
(e) Documentation. The certifying doctor shall maintain
the original copy of the Report of Medical Evaluation and narrative
as well as documentation of:
(1) the date of the examination;
(2) the date any medical records necessary to make
the certification of MMI were received, and from whom the medical
records were received; and
(3) the date, addressees, and means of delivery that
reports required under this section were transmitted or mailed by
the certifying doctor.
|
| Source Note: The provisions of this §130.1 adopted to be effective June 7, 2000, 25 TexReg 5352; amended to be effective January 2, 2002, 26 TexReg 10910; amended to be effective March 14, 2004, 29 TexReg 2328; amended to be effective August 25, 2013, 38 TexReg 5263 |
