28 Tex. Admin. Code § 180.4 - On-Site Visits
(a) As often as it
considers necessary, the division may review the operations of a system
participant to determine compliance with the Act or division rules.
(b) When reviewing the operations of a system
participant to determine compliance with the Act or division rules, the
division may conduct on-site visits to the system participant's premises.
On-site visits may be announced or unannounced.
(c) The on-site visit will occur during the
system participant's normal business hours.
(d) An on-site visit must not disturb a
health care provider's actual provision of health care to a patient.
(e) The division shall provide written notice
of each announced and unannounced on-site visit. This notice shall:
(1) be sent at least 10 days before the
on-site visit unless the on-site visit is unannounced in which case the notice
will be provided at the time of the on-site visit;
(2) specify the alleged violation(s) that is
the subject of the on-site visit;
(3) specify the types of records that must be
made available during the on-site visit;
(4) list the name and telephone number of the
division staff representative; and
(5) specify the date, time, location, and
conditions of the on-site visit.
(f) The person who is the subject of the
on-site visit shall designate a general contact person at the premises. During
the on-site visit the contact person shall:
(1) provide access to requested personnel and
information;
(2) respond to the
needs of division staff and to inquiries by division staff; and
(3) be familiar with the system participant's
procedures and recordkeeping systems that are related to the records and
information requested during the on-site visit.
(g) The person subject to an on-site visit
shall make available to the division in the format and manner specified by the
division all records specified in the written notice provided under subsection
(e) of this section. A written notice may specify for inspection any records
related to the person's participation in the workers' compensation system,
including:
(1) claim files;
(2) medical records and reports;
(3) payment records;
(4) billing records;
(5) electronic records;
(6) communications;
(7) adjustor notes;
(8) accident reports;
(9) notifications of lost time;
(10) notifications of injuries;
(11) payroll data and wage
statements;
(12) investigative
reports;
(13) filed division forms;
and
(14) contracts.
Notes
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