january 31, 2007 quarterly report october, november, … · 2007. 4. 24. · january 31, 2007...

January 31, 2007

QUARTERLY REPORT October, November, December 2006

The following, as required by Act 1179 of 1999, is a report of activity by the ArkansasWorkers' Compensation Commission' s Health and Safety Division and the Medical CostContainment Division.

HEALTH AND SAFETY DIVISION

Ark. Code Ann. §11-9-409, as amended by Act 796 of 1993, established the Workers’Compensation Commission’s Health and Safety Division to launch educational programs;collect injury data; identify hazardous employers; monitor their progress with follow-upinspections; and monitor accident prevention programs of insurance carriers.

MEDICAL COST CONTAINMENT DIVISION

The Medical Cost Containment Division (MCCD) was established pursuant to Ark. Code Ann.§11-9-517 (1987) and is responsible for the implementation, revision, and compliance ofCommission Rules 30, 33, and 34. Rule 30 consists of an inpatient and outpatient medical feeschedule. Rule 33 is our managed care rule, and Rule 34 refers to the Impairment RatingGuide.

Quarterly Report

January 31, 2007

MEDICAL COST CONTAINMENT DIVISION

In the last quarter the following activities occurred regarding these rules:

Rule 30

Rule 30 was revised effective May 15, 2000. The AWCC adopted the Medicare RBRVSMedical Fee Schedule with Arkansas specific reimbursement multipliers. The new MedicalFee Schedule is available electronically from the AWCC Home Page. Since the Medical FeeSchedule is available electronically, we are no longer printing a medical fee schedule.Effective April 1, 2006, the Medical Fee Schedule reimbursement for anesthesia serviceswill be increased 11 percent, and an additional 11 percent April 1, 2007.

Administrative Review

Rule 30 contains an Administrative Review Process. This process allows providers orcarriers to request assistance from the Medical Cost Containment Division regarding disputes. Each administrative review requested consists of an investigation, desk audit by departmentstaff, and the issuance of an order, which determines the disputed issue. During this quarterthere were 32 review requests processed, 18 review requests granted, and 12 orders issued. The ongoing issues in dispute consist of nonpayment, untimely payment, penalty request, andreimbursement disputes.

Balance Billing

Rule 30 also contains a prohibition against balance billing by providers. The balance billingprocess involves: receipt of an allegation of balance billing by a claimant, carrier, employer,self-insured, etc.; notice being sent to all involved parties; an investigation; an audit; and adetermination order being issued. During this quarter, the MCCD received “zero” balancebilling allegations.

Investigations

There were 65 investigations completed in October, 50 in November, and 39 in December.

Quarterly Report

January 31, 2007

Rule 33

We have 12 certified Managed Care Organizations. We continue to receive inquiries fromself-insured employers regarding Internal Managed Care System certification, but we still havenot received any applications at this time.

Medical Reports

Medical Reports: As a result of a meeting held between the Chief Legal Advisor, the MedicalCost Containment Administrator, and the Chief Administrative Law Judge, the MCCD isobtaining medical records from the provider for carriers or employers that have been unable todo so. In the past the legal advisors would write to the provider requesting medical records. If the provider did not respond, then the Chief Administrative Law Judge would issue asubpoena in order to obtain the records. We thought perhaps there was another approach,especially since the MCCD staff has numerous medical contacts. We have thus far been ableto call the provider and obtain the records without any problems.

This quarter we received six (6) cases involving disputes about obtaining the medical records.

Change of Physicians

Change of Physician: To expedite Change of Physician (COP) requests and to comply withrecent legislative changes, new procedures and policies have been implemented. COPrequests are sent to the Clerk of the Commission, who then forwards them to the MCCD forprocessing. If an AWCC file has been established, the MCCD calls the carrier/self-insuredemployer to determine if a Managed Care contract exists. This call is followed with a letterwhich is faxed and mailed to all parties. When a response is received and a contract exists,the contract is reviewed to determine if it complies with Rule 33 and if appropriate internalpolicies were followed. MCCD will review the claimant’s medical records and determine anappropriate provider. An appropriate provider will be chosen on a case-by-case basis. If therequest is to the claimant’s treating physician, MCCD must determine if the provider meets thestatutory requirements for the regular treating physician. Once an appropriate provider ischosen, MCCD will determine that the provider is a member of either the carrier/employer’sMCO , if a contract exists, or a certified MCO if no contract exists. MCCD will contact theprovider and set up an appointment for the claimant. MCCD will issue an order stating this isthe claimant’s one-time-only change of physician. This order will contain the provider’s nameand appointment date. All parties will be copied. If either party objects to the MCCD order,it can appeal to an Administrative Law Judge.

This quarter the MCCD received 199 COP requests. MCCD issued 151 orders, and 53requests were either returned to open general files, withdrawn, controverted, resolved, orreturned to the Clerk of the Commission’s office for other action.

Quarterly Report

January 31, 2007

Audits

Requests are received from the ALJ Division as well as outside entities (i.e. , caseworkers,attorneys, etc.) for medical bill audits.

This quarter the MCCD received seven (7 ) audits.

Rule 34

Rule 34: There have been no changes at this time in Rule 34. Legislation was written toextend the legislative mandate regarding an impairment rating guide.

Speaking Engagements

Speaking Engagements: During this quarter no engagements/activities were attended.

Arkansas Workers’ Compensation CommissionHealth and Safety Division

Workplace Fatalities Reported to AWCC2nd Quarter, FY 2007

During the 2nd Quarter, FY 2007, 16 fatalities were reported to the Arkansas Workers’ Compensation Commission, and all 16 occurred in Arkansas...

BooneBenton Carroll

Marion

Baxter FultonRandolph

Clay

GreeneLawrence

Izard Sharp

Craighead Mississippi

Poinsett

Cross

Crittenden

St. Francis

Lee

Washington Madison

Newton Searcy

Stone

Jackson

Independence

CleburneVan Buren

Pope

JohnsonFranklin

Crawford

Sebastian Logan

ScottYell

Conway

Perry

Faulkner Woodruff

White

Prairie

Miller

Phillips

Monroe

LonokePulaski

Saline

GarlandMontgomeryPolk

Sevier

HowardPike

HempsteadLittle River

Lafayette

Clark

Nevada

Columbia

Grant

Dallas

Ouachita

Calhoun

Union

Jefferson

Cleveland Lincoln

Bradley

Drew

Ashley Chicot

Desha

ArkansasHot Spring

1

1

1

1

3

1

2

1

23

AWCC Workplace Fatalities, FY Totals

0

20

40

60

80

100

FY 2003 FY 2004 FY 2005 FY 2006 FY 2007

Workplace Fatalities by Quarter

0

5

10

15

20

25

30

FY 2003 FY 2004 FY 2005 FY 2006 FY 2007

1st Q

2nd Q

3rd Q

4th Q


Workplace Fatalities Reported to AWCC2nd Quarter, FY 2007

Reported

to AWCC Employer

Employer

City

Injury

Date

Death

Date

Length of

Service

(yrs.) Industry

Type

Injury

8/31/2006 Domtar, Inc. Ashdown 8/18/2006 8/18/2006 1.0 Pulp and Paper

Caught

between

10/3/2006

Wal-Mart

Associates Alma 9/22/2006 9/22/2006 0.3 Retail Struck by

10/3/2006

Strimbu

Transport W. Memphis 9/22/2006 9/22/2006 0.01 Trucking not given

10/5/2006 USA Truck Inc. Van Buren 10/4/2006 10/4/2006 0.1 Trucking MVA

10/18/2006

Tyson Sales &

Distribution,

Inc. Springdale 10/16/2006 10/16/2006 1.1 Warehousing Fall

10/19/2006

Stutzman &

Sons Oark 10/17/2006 10/17/2006 0.1 Trucking MVA

11/7/2006

Rogers Lumber

Co. Camden 7/10/2006 7/10/2006 NG Retail NG

11/7/2006

Arkansas

Aluminum

Alloys, Inc. Hot Springs 10/31/2006 10/31/2006 0.4 Manufacturing Struck by

11/7/2006

Arkansas

Aluminum

Alloys, Inc. Hot Springs 10/31/2006 10/31/2006 0.1 Manufacturing Struck by

11/8/2006 Matthews, Inc. Dumas 11/7/2006 11/7/2006 NG Construction MVA

11/13/2006 USA Truck Inc. Van Buren 11/6/2006 11/6/2006 0.3 Trucking MVA

11/14/2006

Rogers Lumber

Co. Camden 7/10/2006 7/10/2006 NG Retail Heart Attack

11/17/2006

J.A. Riggs

Tractor Co. Little Rock 11/15/2006 11/15/2006 0.3

Construction

equipment Electrocuted

12/27/2006

Austin

Transportation Crossett 12/20/2006 12/20/2006 0.9 Trucking MVA

12/26/2006

Metropolitan

National Bank Little Rock 12/23/2006 12/23/2006 1.0 Banking

Workplace

Violence

12/29/2006

Presbyterian

Village Little Rock 12/29/2006 not given NG Real Estate Fall


Employers Placed in the Rule 32 Program2nd Quarter, FY 2007

During the 2nd Quarter, FY 2007, 59 places of employment were placed in the Rule 32 Program. Employers are identified for the Rule 32 Program if they have a higher-than expected number of compensable claims for their industry group. Employers placed in this program are encouraged to work with their workers’ compensation insurance carrier, in-house staff, or other professional safety sources to develop management tools which will help them run safer workplaces and minimize workers’ compensation costs through the use of such tools as return-to-work programs, drug-free workplace programs, claims management, etc.

BooneBenton Carroll

Marion


Clay

GreeneLawrence

Izard Sharp


Poinsett

Cross

Crittenden

St. Francis

Lee

Washington Madison

Newton Searcy

Stone

Jackson

Independence

CleburneVan Buren

Pope

JohnsonFranklin

Crawford

Sebastian Logan

ScottYell

Conway

Perry

Faulkner Woodruff

White

Prairie

Miller

Phillips

Monroe

LonokePulaski

Saline


Sevier

HowardPike


Lafayette

Clark

Nevada

Columbia

Grant

Dallas

Ouachita

Calhoun

Union

Jefferson

Cleveland Lincoln

Bradley

Drew

Ashley Chicot

Desha

ArkansasHot Spring

6

4

1

2

2

3

2

1

9

1

5

1

2

2

3

5

22

2

22


Employers Completing the Rule 32 Program2nd Quarter, FY 2007

During the 2nd Quarter, FY 2007, 84 employers successfully completed the Rule 32 Program.

Boone

Miller

Benton Carroll

Marion


Clay

GreeneLawrence


Poinsett

Cross

Crittenden

St. Francis

Lee

Phillips

Washington Madison

Newton Searcy

Stone

Izard Sharp

Jackson

Independence

CleburneVan Buren

Pope

JohnsonFranklin

Crawford

Sebastian Logan

ScottYell

Conway

Perry

Faulkner Woodruff

White

Monroe

LonokePulaski

Saline


Sevier

HowardPike


Lafayette

Clark

Nevada

Columbia

Grant

Dallas

Ouachita

Calhoun

Union

Jefferson

Cleveland Lincoln

Bradley

Drew

Ashley Chicot

Desha

Arkansas

Prairie

Hot Spring

1

1

1

5

1

1

6

1

1

1

6

1

1

3

4

10

2

211

11

1

1

1

12

7

2

2

11

1

3

1


Rule 31: Accident Prevention Services ProgramArkansas Workers’ Compensation Insurance Companies

2nd Quarter, FY 2007

The Accident Prevention Services (APS) group conducts audits of all insurance companies writingworkers’ compensation insurance policies in Arkansas. During the 1st Quarter, FY 2007, the APS group inspected the following companies:

Company Account Premiums No. of PolicyholdersPMA Group - Manufacturers Alliance Insurance

Co., Pennsylvania Manufacturers' Assoc. Ins.

Company, Pennsylvania Manufacturers

Indemnity Co. $1,542,147.00 93Arch Group $72,072.00 20Church Mutual $410,226.00 363

American Interstate - Silver Oak Casualty, Inc. $10,485,572.00 461Companion Property & Casualty- Companion

Commercial Ins. Co. $6,265,145.00 1806Midwest Employer Casualty $261,126.00 10Florists Mutual $25,723.00 10ACIG Insurance Co.

Everest Reinsurance $141,991.00 31Lumbermens Underwriting $262,504.00 7Mitsui Sumitomo Group - Mitsui Sumitomo

Insurance USA, Inc., Mitsui Sumitomo

Insurance Co. of America $381,911.00 25Penn Millers Insurance $73,325.00 1Harleysville Ins. - Harlesyville Mutual Ins..

Harleysville Preferred Insurance Co., Mid-

America Ins Co., $1,076,961.00 177Safety National Casualty $978,952.00 20


Presentations and Speaking Engagements2nd Quarter, FY 2007

The AWCC Health and Safety staff receive frequent requests to speak on a variety of topics related to loss control, drug-free workplace programs, and related topics. If your constituents would like to host a program by the Health and Safety staff on these or other subjects, please contact Patricia Burge at 501-682-2063 or [email protected].

BooneBenton Carroll

Marion


Clay

GreeneLawrence

Izard Sharp


Poinsett

Cross

Crittenden

St. Francis

Lee

Washington Madison

Newton Searcy

Stone

Jackson

Independence

CleburneVan Buren

Pope

JohnsonFranklin

Crawford

Sebastian Logan

ScottYell

Conway

Perry

Faulkner Woodruff

White

Prairie

Miller

Phillips

Monroe

LonokePulaski

Saline


Sevier

HowardPike


Lafayette

Clark

Nevada

Columbia

Grant

Dallas

Ouachita

Calhoun

Union

Jefferson

Cleveland Lincoln

Bradley

Drew

Ashley Chicot

Desha

ArkansasHot Spring

12

1

2 1

1

2

1

2

2

Out of State1


Voluntary Drug Free Workplace ProgramNew Approvals and Renewals


During the 2nd Quarter, FY 2007, the following Arkansas companies received approval of their Voluntary Drug Free Workplace Programs:

BooneBenton Carroll

Marion


Clay

GreeneLawrence

Izard Sharp


Poinsett

Cross

Crittenden

St. Francis

Lee

Washington Madison

Newton Searcy

Stone

Jackson

Independence

CleburneVan Buren

Pope

JohnsonFranklin

Crawford

Sebastian Logan

ScottYell

Conway

Perry

Faulkner Woodruff

White

Prairie

Miller

Phillips

Monroe

LonokePulaski

Saline


Sevier

HowardPike


Lafayette

Clark

Nevada

Columbia

Grant

Dallas

Ouachita

Calhoun

Union

Jefferson

Cleveland Lincoln

Bradley

Drew

Ashley Chicot

Desha

ArkansasHot Spring

3

8

1

1

21

1

17

1

10

4

2

1

3

1

11

1

1

1

4

2

2

1

1

8 1

2




COMPANY CITY COUNTYHarness Roofing, Inc. Harrison BOONEFirst Community Bank Corning CLAY

Deltic Timber Corporation Waldo COLUMBIAGrady Jones Co. Jonesboro CRAIGHEAD

Lone Star Co., Inc. Jonesboro CRAIGHEADHall & Hunt Enterprises, LLC Jonesboro CRAIGHEAD

First Community Bank Jonesboro CRAIGHEADFirst Community Bank Jonesboro CRAIGHEADFirst Community Bank Jonesboro CRAIGHEADFirst Community Bank Jonesboro CRAIGHEADFirst Community Bank Jonesboro CRAIGHEADFirst Community Bank Jonesboro CRAIGHEADFirst Community Bank Lake City CRAIGHEAD

Seamless Systems Memphis CRITTENDENUUN, Inc. Conway FAULKNER

Hugg and Hall Equipment Conway FAULKNERNBMC, Inc. Greenbrier FAULKNER

Dayco Construction Damascus FAULKNERGigerich Electrical, Inc. Hot Springs GARLANDFirst Community Bank Paragould GREENEFirst Community Bank Paragould GREENE

First Community Bancshares Batesville INDEPENDENCEVital Link, Inc. Batesville INDEPENDENCE

First Community Bank Newport JACKSONFirst Community Bank Tuckerman JACKSONFirst Community Bank Swifton JACKSON

Building & Utility Contractors Redfield JEFFERSONFirst Community Bank Walnut Ridge LAWRENCEFirst Community Bank Hoxie LAWRENCEFirst Community Bank Imboden LAWRENCE

Master Made Tanks, Inc. Paris LOGANHugg and Hall Equipment Camden OUACHITA

First Community Bank Marked Tree POINSETTLittle Rock Christian Academy Little Rock PULASKI

P. I. Roofing North Little Rock PULASKIMcClelland Consulting Engineers Little Rock PULASKI

Energy Master Little Rock PULASKIGrady W. Jones Co. North Little Rock PULASKI

Staley, Inc. Little Rock PULASKILantrip Construction Co. North Little Rock PULASKI

Hall & Hunt Enterprises, LLC North Little Rock PULASKI




COMPANY CITY COUNTYHugg and Hall Equipment Little Rock PULASKI

Chenal Country Club Little Rock PULASKIChenal Properties Little Rock PULASKI

Arkansas Local Police & Fire Retirement Little Rock PULASKIGolden Eagle of Arkansas, Inc. Little Rock PULASKI

Lomanco, Inc. Jacksonville PULASKICoulson Oil Group North Little Rock PULASKICBM Construction North Little Rock PULASKIWright's Cabinets Jacksonville PULASKI

First Community Bank Pocahontas RANDOLPHFirst Community Bank Pocahontas RANDOLPHFirst Community Bank Pocahontas RANDOLPHFirst Community Bank Pocahontas RANDOLPHMiddleton Heat and Air Bryant SALINE

Annette's Nursing Service Bryant SALINEHarris Company Fort Smith SEBASTIAN

Grady W. Jones Co. Fort Smith SEBASTIANHall & Hunt Enterprises, LLC Fort Smith SEBASTIAN

Hugg and Hall Equipment Fort Smith SEBASTIANCrawford Construction Company Fort Smith SEBASTIAN

Fianna Hills Country Club Fort Smith SEBASTIANSteve Beam Construction Barling SEBASTIANDale Crampton Company Fort Smith SEBASTIAN

Tri-Lakes Services Gillham SEVIERFirst Community Bank Hardy SHARPFirst Community Bank Hardy SHARP

Deltic Timber Corporation El Dorado UNIONHugg and Hall Equipment El Dorado UNION

Johnson Mechanical Contractor Fayetteville WASHINGTONMountain Mechanical Contractors Fayetteville WASHINGTON

McClelland Consulting Engineers, Inc. Fayetteville WASHINGTONGrady W. Jones Springdale WASHINGTON

Hall & Hunt Enterprises, LLC Springdale WASHINGTONHugg and Hall Equipment Fayetteville WASHINGTON

Staley, Inc. Springdale WASHINGTONHugg and Hall Equipment Springdale WASHINGTONPlumbing & Maintenance Bald Knob WHITEWhite River Rural Health Augusta WOODRUFFDeltic Timber Corporation Ola YELL

january 31, 2007 quarterly report october, november, … · 2007. 4. 24. · january 31, 2007...

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