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Compensation Review System (CRS)

The Compensation Review System (CRS) is the final component of the 1991 Reform Act. The CRS will allow the DIA to examine and analyze the utilization of medical treatment for work-related injuries and compare that utilization to the Treatment Guidelines that are promulgated by the Health Care Services Board (HCSB). More importantly, the DIA is seeking to secure the best medical care for the injured worker at the lowest possible cost.

I look forward to working with the medical providers and the insurers in this endeavor and I thank you in advance for your cooperation.

I. Overview

In accordance with 452 CMR 6.00 et seq. for the monitoring of health care services related to worker's compensation, the Department of Industrial Accidents, Office of Health Policy (OHP) is implementing the Compensation Review System (CRS). This data system will allow the Department to monitor billing data on services delivered to injured/ill workers, and to compare the data to the Health Care Services Boards' endorsed treatment guidelines.

The implementation date for the CRS program was January 1, 2003. The CRS data will be collected quarterly from all insurers on the CRS Self-Insured list in accordance with the following schedule:

QUARTER	DATE DATA IS DUE	DATES OF DATA FOR QUARTER
1st	April 30th	January 1 - March 31
2nd	July 31st	April 1 - June 30
3rd	October 31st	July 1 - September 30
4th	January 31st	October 1 - December 31

Claims data should include all office visits, physical therapy treatments, occupational therapy treatments, chiropractic visits, and x-rays relating to back injuries. The information should be based on date of payment for treatment approved by the insurer. For example, if the insurer-approved payment on January 1, 2003 for a procedure completed in December of the previous year it should be included in the 2003 data.

II. Legislative Authority

As a concept, the CRS system is a component of the utilization review system (reviewing the health care provided by those who render medical services to injured workers.)
The legislative authority for the Department to collect this data is found in the following sections of 452 CMR et seq.: 6:05: Utilization Reporting:
Beginning January 1, 1994, providers must use, and insurers must accept standardized forms prescribed by the DIA, based on the most recent Universal Billing (UB) form and the Health Care Financing Administration (HCFA) 1500 billing form.
6:07: Quality Assessment and Enforcement
The Department of Industrial Accidents will gather data on compliance with the treatment guidelines through reports from insurers and utilization review agents.

III. The Goals of The Compensation Review System Are to

Provide standardized, comparable data for the improvement of programs, policies, and services relative to injured worker health care in Massachusetts.
Review compliance with Health Care Services Board (HCSB) Treatment Guidelines.
Review patterns of care.
Review utilization of medical services and trends in medical care.

IV. What Are We Measuring?

Quality of Medical Care
Necessity of Medical Care
Effectiveness of Medical Care
Best Practices

VI. Frequently Asked Questions

Why is the DIA implementing a monitoring system?|

A statutory requirement exists.
Will all insurers have to report data?

Yes.

NOTE: It is the responsibility of the insurer and/or data submitter to inform the Department if there is a change in the Federal Identification Number (FEIN) regarding these entities.
Will all injuries have to be reported?

All injuries having one of the following ICD9 codes have to be reported
.
How many data elements must be submitted to the DIA?

Eleven.
How must the data be submitted?|

By e-mail or CD-ROM
.
How often must data be submitted?

Quarterly.
Will the insurers need special equipment or software to comply?

No, special equipment will be needed.
Will additional personnel be needed to comply?

No! Your existing labor pool is sufficient.

View CRS - Basic Information View Listing - ICD9 Codes reported to OHP for the CRS All CPT codes associated with ICD9 codes (see above) must be reported.

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