Issue link: https://viewer.e-digitaledition.com/i/155478
++++++++++++++++++ +++ + +++ Í LEGAL EASE+ ++++++++++++++++++ BWC Criteria to Authorize Treatment — The Miller Criteria By Lisa A. Fike, Esq. A for medical treatment in Ohio workers' compensation claims is initially determined by the employer's managed care organization or by the self-insured employer. Requests for treatment must satisfy threshold criteria in order to be authorized and paid in an Ohio workers' compensation claim. Practitioners treating work related claims should be knowledgeable of the criteria to ensure that treatment requests are promptly approved and bills for services are promptly paid. A three-part test was established by the Ohio Supreme Court in the Miller v. Industrial Commission case, to establish the criteria to authorize requests for treatment. This test is now known as the "Miller Criteria." The Miller Criteria has also been codified in the Ohio Administrative Code § 4123-6-16.2(B)(1)–(B)(3). The Miller Criteria is as follows: 1. Are the medical services reasonably related to the allowed conditions? 2. Are the medical services reasonably necessary for PPROVAL AND PAYMENT treatment of the allowed conditions? 3. Are the costs of the medical services reasonable? It is the BWC's policy to authorize and pay for treatment that meets all three of the criteria. A further consideration in the Miller case is that treatment should not be approved if it is merely "palliative" and does not improve the allowed condition. Practitioners should ensure that requests for treatment provide sufficient detail to ensure that the requested treatment clearly satisfies the Miller Criteria. By providing the required information initially, the physician and the patient may save a lot of time, effort, and expense and potentially avoid a delay in providing the requested treatment and payment for treatment. Lisa Fike is an attorney with the law firm of Krugliak, Wilkins, Griffiths & Dougherty Co. LPA in Canton. I NOTE: This general summary of the law should not be used to solve individual problems since slight changes in the fact situation may require a material variance in the applicable legal advice. We've worked with physicians for so long, we'll give you a sandwich if you have borborygmus. For more than 30 years, Weidrick Livesay & Company has been serving the business and accounting needs of physicians, from wealth management and retirement planning to prescribing corned beef on rye for those pesky stomach rumblings. 2150 N. Cleveland-Massillon Rd. • Akron, OH 44333 330.659.5985 www.wlcpa .co m SEPTEMBER- OCTOBER 2013 I MDNEWS.COM I MD NEWS Cleveland/Akron/Canton | 21