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OhioBWC - Basics: (Policy library) - File

Policy Name:

Applicability of Medical Documentation Submitted by Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants

Policy #:

MP-03-03

Code/Rule Reference:

R.C. 4123.56, 4723.42, 4723.43, 4730.08, 4730.20,

O.A.C 4123-5-18, 4123-6-20

Effective Date:

06/01/17

Approved:

Freddie L. Johnson, Chief of Medical Services

Origin:

Medical Policy

Supersedes:

All medical policies and procedures, directives and memos regarding the Certification of Periods of Disability by Nurse Practitioners, Clinical Nurse Specialists and Physician Assistants.

History:

Rev. 06/01/17; New 02/26/16

Review date:

06/01/20

 

 

I. POLICY PURPOSE

 

The purpose of this policy is to provide direction to medical providers, BWC staff and Managed Care Organizations (MCOs) on the applicability of medical documentation submitted by different provider types that is used as supporting evidence in certifying periods of temporary total disability.

 

II. APPLICABILITY

 

This policy applies to BWC staff, MCOs, and providers.

 

III. DEFINITIONS

 

Certified nurse practitioner (CNP): A registered nurse holding a license to practice as a CNP from the Ohio Board of Nursing or equivalent, authorized to practice in collaboration with one or more physicians. A CNP may provide preventative and primary care services, provide services for acute illnesses, and evaluate and promote patient wellness within the nurse’s nursing specialty, consistent with the nurse’s education and certification, and in accordance with rules adopted by the nursing board. A CNP who holds a certificate to prescribe may, in collaboration with one or more physicians, prescribe drugs and therapeutic devices.

 

Clinical nurse specialist (CNS): A registered nurse holding a license to practice as a CNS from the Ohio Board of Nursing or equivalent, authorized to practice in collaboration with one or more physicians. A CNS may provide and manage the care of individuals and groups with complex health problems and provide health care services that promote, improve, and manage health care within the nurse's nursing specialty, consistent with the nurse's education and in accordance with rules adopted by the nursing board. A CNS who holds a certificate to prescribe may, in collaboration with one or more physicians, prescribe drugs and therapeutic devices.

Physician assistant (PA): A skilled person holding a license to practice as a PA from the State Medical Board of Ohio or equivalent, qualified by academic and clinical training to provide services to patients under the supervision, control and direction of one or more physicians with whom the physician assistant has entered into a supervision agreement approved by the state medical board and who are responsible for the PA’s performance.

Physician extender (PE): For purposes of this policy, a physician extender is a certified nurse practitioner, clinical nurse specialist or physician assistant.

IV. POLICY

 

A.    It is BWC’s policy to recognize, the following as authorized to take action as outlined in section IV.B., below:

1.    Physicians, or

2.    PEs, only:

a.    During the first six weeks after the date of an injury, for no more than six weeks of disability, or

b.    With the co-signature of a physician.

 

B.    The authorized individuals as noted in section IV.A., above, may do any of the following:

1.    Examine the injured worker (IW);

2.    Submit medical documentation BWC may use to support an IW’s temporary total disability due to an allowed work-related injury or disease;

3.    Complete and submit a MEDCO-14 form or its equivalent; and

4.    Submit a detailed return to work (RTW) plan.

 

C.   BWC does not authorize PEs to:

1.    Submit medical documentation which may be utilized to support any type of compensation other than temporary total disability;

2.    Work outside the scope of their collaborative or supervisory agreement;

3.    Be granted Physician of Record (POR) status; or

4.    Be granted the status of a Disability Evaluators Panel (DEP) physician.

 

V. PROCEDURE

 

A.    Before awarding the initial period of temporary total disability, BWC shall ensure that the physician or PE has:

1.    Examined the IW;

2.    Completed, signed and submitted the MEDCO-14 or equivalent;

a.    The PE may sign and submit a MEDCO-14 or equivalent, which may be utilized to support temporary total disability without a physician signature during the first six weeks after the date of injury, and for no more than six weeks of disability;

b.    Following the period specified in V.A.2.a. above, the PE may sign and submit a MEDCO-14 or equivalent, which may be utilized to support temporary total disability only with the co-signature of a physician;

c.     At any point in the life of the claim, a MEDCO-14 or equivalent signed only by a physician may be utilized in support of temporary total disability

3.    Completed a detailed treatment and RTW plan.

 

B.    If an initial period of TT is granted based upon a MEDCO-14 or equivalent signed only by a PE, prior to the conclusion of that initial period BWC shall inform the IW that ongoing requests for TT must be supported with medical documentation signed or co-signed by a physician (not a PE only).

 

C.   If a PE renders treatment for periods of TT beyond the initial six weeks following the date of injury, BWC shall ensure that the supporting medical documentation indicates that:  

1.    The PE and/or physician has examined the IW; and

2.    A physician co-signature is on the MEDCO-14 or equivalent if such medical documentation is being used to extend an injured worker’s periods of disability.

 

D.   BWC shall ensure that medical documentation supporting an IW’s RTW is signed by:

1.    A physician; or

2.    A PE:

a.    Independently, when the RTW occurs within the initial six-week period immediately following the date of injury; or

b.    With a physician co-signature, when the RTW occurs after the initial six-week period immediately following the date of injury.

 

E.    Please refer to Temporary Total Compensation policy and procedure for further guidance on the payment of this type of compensation.

 


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