october 31, 2006 quarterly report july, august, september ... · 1st quarter, fy 2007 during the...
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October 31, 2006
QUARTERLY REPORT July, August, September 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
October 31, 2006
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 33 review requests processed, 18 review requests granted, and 10 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 45 investigations completed in July, 67 in August, and 32 in September.
Quarterly Report
October 31, 2006
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 seven (7) cases involving disputes about obtaining the medicalrecords.
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.
Quarterly Report
October 31, 2006
This quarter the MCCD received 208 COP requests. MCCD issued 178 orders, and 50requests were either returned to open general files, withdrawn, controverted, resolved, orreturned to the Clerk of the Commission’s office for other action.
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 two (2 ) 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 the following engagement was attended:
/ IAIABC Annual Conference
Arkansas Workers’ Compensation CommissionHealth and Safety Division
Workplace Fatalities Reported to AWCC1st Quarter, FY 2007
During the 1st Quarter, FY 2007, 25 fatalities were reported to the Arkansas Workers’ Compensation Commission, 23 occurred in Arkansas, 2 out of the state and the exact location of the accident was not reported in 4 cases.
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
Workplace Fatilities by Quarter
05
1015202530
FY
2003
FY
2004
FY
2005
FY
2006
FY
2007
1st Q
2nd Q
3rd Q
4th Q
AWCC Workplace Fatilitie s, FY
Totals
0
2040
6080
100
FY 2003 FY 2004 FY 2005 FY 2006 FY 2007
1
2
1
1
1
1
3
1
1
2
1
2
4
1
2
2
Out of State
Arkansas Workers’ Compensation CommissionHealth and Safety Division
Workplace Fatalities Reported to AWCC1st Quarter, FY 2007
Reported to
AWCC Employer
Employer
Co. Injury Date Death Date
Length of
Service
(yrs.) Job Title NAICS Code Type Injury
9/15/2006
Bierbaum Timber
& Contracting Ashley 9/12/2006 9/12/2006 0.5 Truck driver 113310 Struck by
8/10/2006 George's Inc. Benton 8/1/2006 8/1/2006 9.2 Driver 551114 MVA
9/18/2006
Gilbert Central
Corp. Benton 9/8/2006 9/8/2006 2.1
Construction
worker 237310 Fall
8/2/2006 L & P Logging, Inc. Bradley 8/2/2006 8/2/2006 16.6 Foreman 113310 not given
7/13/2006 Summit Bancorp Clark 7/7/2006 7/7/2006 1.9
Equipment
operator 522110 MVA
4/7/2006
Arco Towers and
Contracting, Inc. Craighead 4/6/2006 4/6/2006 not given Technician 238322 Fall
7/26/2006 USA Truck Inc. Crawford 7/24/2006 7/24/2006 0.6 Truck driver 484121 MVA
8/7/2006 USA Truck Inc. Crawford 8/7/2006 8/7/2006 1.0 Driver 484121 MVA
8/14/2006
Peacock
Enterprises, Inc. Crawford 7/15/2006 7/15/2006 0.1 Driver 484121 not given
8/4/2006
Randstad North
America Crittenden 7/27/2006 7/27/2006 0.7
Materials
handler 561320 not given
9/28/2006 Adair Construction Dallas 4/4/2006 4/4/2006 not given Roofer not given Fall
7/12/2006
Arkansas Boll
Weevil Eradication Desha 10/1/2005 2/9/2006 not given not given 115112 not given
7/25/2006
Asc Property
Management Desha 7/12/2006 7/12/2006 0.4 Manager 722110 Homicide
8/16/2006
Klassmeyer
Construction Co. Faulkner 5/3/2006 5/3/2006 not given not given not given Struck by
7/14/2006
McGeorge
Contracting Co.,
Inc. Jefferson 7/10/2006 7/10/2006 0.2 Truck driver 212319 MVA
8/28/2006
Wheeling Machine
Products Jefferson 4/20/2006 4/20/2006 0.1
Maintenance
Mechanic 332996 not given
7/11/2006 C.C. Jones, Inc. Pulaski 7/7/2006 7/7/2006 3.1 Driver 484121 MVA
7/20/2006
McCormick
Industrail
Abatement Pulaski 7/18/2006 7/18/2006 3.2 Foreman 562910 not given
8/17/2006 KATV Pulaski 7/31/2006 7/31/2006 27.9 Sports Director 515120 MVA
9/25/2006 Kohls Dept. Store Pulaski 9/6/2006 9/6/2006 2.7
District loss
prevention 452112 MVA
7/17/2006
Rheem
Manufacturing Co. Sebastian 3/10/2005 3/10/2005 1.0 Laborer 333415
Chemical
exposure
7/27/2006
Kilgore
Construction Washington 7/24/2006 7/24/2006 not given not given not given Fall
8/16/2006
Charley
Transporation, Inc. Washington 8/13/2006 8/13/2006 0.4 Driver 484121 Struck by
8/3/2006
Constructor
Services, Inc. out of state 10/6/2005 not given not given not given not given Fall
8/14/2006 Arkansas Gas out of state 9/25/2005 9/25/2005 27.5 Service tech not given MVA
Arkansas Workers’ Compensation CommissionHealth and Safety Division
Employers Placed in the Rule 32 Program1st Quarter, FY 2007
During the 1st Quarter, FY 2007, 46 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
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 Spring1
1
1
41
1
11
1
3
2
1
1
1
1
1
1
1
1
1
2
1
1
8
1
5
1
1
Arkansas Workers’ Compensation CommissionHealth and Safety Division
Employers Completing the Rule 32 Program1st Quarter, FY 2007
During the 4th quarter, FY 2002, 72 employers successfully completed the Rule 32 Program.
Boone
Miller
Benton Carroll
Marion
Baxter FultonRandolph
Clay
GreeneLawrence
Craighead Mississippi
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
GarlandMontgomeryPolk
Sevier
HowardPike
HempsteadLittle River
Lafayette
Clark
Nevada
Columbia
Grant
Dallas
Ouachita
Calhoun
Union
Jefferson
Cleveland Lincoln
Bradley
Drew
Ashley Chicot
Desha
Arkansas
Prairie
Hot Spring
11
1
1
116
6
1
1
1
6
1
1
3
4
4
1
2
2
1
1
1
1
1
11
2
722
1
1
Arkansas Workers’ Compensation CommissionHealth and Safety Division
Rule 31: Accident Prevention Services ProgramArkansas Workers’ Compensation Insurance Companies
1st 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 AR Account Premiums No.of AR PolicyholdersWausau Insurance $19,525,676.00 215Federated Mutual - Federated Service Insurance
Co. $3,825,009.00 408Argonaut Great $363,003.00 105
Zurich American Ins.- American Guarantee &
Liability Insurance Co., American Zurich
Insurance Co., Assurance Co. of America,
Colonial American Casualty & Surety, Fidel ity &
Deposit Insurance Co., Maine Bonding & Casualty
Insurance Co., Maryland Casualty Insurance Co.,
National Standard Insurance Co., Northern
Insurance Co., Valiant Insurance Co., Zurich-
American Insurance Co., Zurich Am erican
Insurance Co. Of Illinois. $11,489,314.00 1,874Triangle Insurance $20,136.00 1
Safeco Insurance - Safeco Insurance Co. of
America, First National Insurance Co. of America,
General Insurance Co. of America, American
States Insurance Co.,American Economy
Insurance Co., $2,003,790.00 352Sompo Japan Insurance $456,612.00 11Guarantee Insurance $3,863,322.00 200Transguard Ins. Co $214,644.00 37Hanover - Hanover American, Massachusetts
Bay Ins. $502,889.00 132Union Standard $2,926,334.00 142
Meadowbrook - Star Insurance Co, William sburg
National Insurance Co., Star Insurance Company $508,556.00 222Vanliner Ins. Co. $238,252.00 6
Arkansas Workers’ Compensation CommissionHealth and Safety Division
Presentations and Speaking Engagements1st 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
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
4
Arkansas Workers’ Compensation CommissionHealth and Safety Division
Voluntary Drug Free Workplace ProgramNew Approvals and Renewals
1st Quarter, FY 2007
During the 1st Quarter, FY 2007, the following Arkansas companies received approval of their Voluntary Drug Free Workplace Programs:
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
4
3
1
1
3
1
1
1
2
1
1
1
6
1
1
74
25
1 Out of State1
2
Arkansas Workers’ Compensation CommissionHealth and Safety Division
Voluntary Drug Free Workplace ProgramNew Approvals and Renewals
1st Quarter, FY 2007
Company City CountyThree Lakes Distributing Little Rock PulaskiThree Rivers Distributing Little Rock Pulaski
White River Beverage Little Rock PulaskiBeard-Breeding Painting Mabelvale Pulaski
Chief Seahawk Transport LLC North Little Rock PulaskiSecuritas Security Services Little Rock PulaskiLift Truck Service Center Little Rock Pulaski
Fleming Electric, Inc. Bryant SalineFleming Network Services, Inc. Bryant Saline
Grace Healthcare of Benton Benton SalineBR McGinty Mechanical Contractor Bryant Saline
Fort Smith Airport Commission Fort Smith SebastianForsgren, Inc. Fort Smith Sebastian
Howard Barnes Trucking Fayetteville WashingtonFayetteville Mechanical Contractors, Inc. Fayetteville Washington
Haynie Utility Construction, Inc. Searcy WhiteNorth Star EMS Searcy White
Delk Construction Co. Bald Knob WhiteD & H Electrical Cont. Inc. Searcy White
Collins Pipeline Construction, LLC Bald Knob WhiteThe McBurney Corporation Norcross Out of State
Arkansas Workers’ Compensation CommissionHealth and Safety Division
Voluntary Drug Free Workplace ProgramNew Approvals and Renewals
1st Quarter, FY 2007
Company City CountyKing Ready Mix, Inc. Mountain Home Baxter
Guy King & Sons Mountain Home BaxterTwin Lakes Quarrys, Inc. Mountain Home Baxter
Crawford Electric, Inc. Mountain Home BaxterCrafton, Tull & Assoc. Inc. Rogers Benton
Roll Off Service Lowell BentonBella Vista Village POA Bella Vista Benton
Mike Rogers Drilling Co., Inc. Magnolia ColumbiaHummelstein Iron & Metal, Inc. Jonesboro Craighead
McExpress, Inc. Jonesboro CraigheadDixie Contractors Inc. Jonesboro Craighead
Tankersley Food Service LLC Van Buren CrawfordLanston Companies, Inc. West Memphis Crittenden
Leer, Star/Starrett Dumas DeshaSeaArk Marine, Inc. Monticello DrewArkansas One Call Conway Faulkner
Cajun Brothers Conway FaulknerEagle Heating & Air Conditioning, Inc. Hot Springs Garland
Rock City Mechanical Nashville HowardRonnie Dowdy Batesville Independence
Smith Concrete LLC Star City LincolnInterstate Mobil #1 Osceola Mississippi
Stop N By #3 Osceola MississippiInterstate Shell #6 Blytheville MississippiShell Truckstop #8 Osceola Mississippi
Stop N By #11 Manila MississippiGibson Oil Co. Osceola Mississippi
Greenway Equipment, Inc. Weiner PoinsettW.E. Clark & Sons North Little Rock Pulaski
Security Airport Parking Little Rock PulaskiEast Harding, Inc. Little Rock Pulaski
Jason International, Inc. North Little Rock, PulaskiCummins Mid South Little Rock PulaskiOak Forest Cleaners Little Rock PulaskiOak Forest Cleaners Little Rock Pulaski
Arkansas Precast Jacksonville PulaskiRobert M Goff & Associates/Holiday Inn
Select Little Rock PulaskiRobert M. Goff & Associates/Hampton Inn
& Suites Little Rock Pulaski