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The following survey is being conducted to assess the demographics of the current provider population treating Michigan's injured workers. Your input and suggestions will assist the Health Care Services Division in determining if changes need to occur to assist you in your care of Michigan's injured worker population.
    Bold = required fields
1. Do you currently treat Michigan workers' compensation patients?
Yes
No (What reason or reasons influence your decision not to treat. Check all that apply)
  Required documentation and reports
  Disputes
  Billing and payments
  Other: Please specify

2. What services do you provide?
Occupational Medicine Clinic
  Free-standing
  Hospital owned
Facility Services
  Hospital
  Ambulatory Surgery Center
  Skilled Nursing Home
  Other: Please specify
Family Practice
Chiropractic
Surgery
  General Surgeon
  Hand Surgery
  Neurosurgeon
  Orthopedic Surgeon
  Ophthalmology
  Thoracic Surgeon
Physical Medicine and Rehabilitation
Mental Health
Ophthalmologist/Optometrist
Pain Specialist/Anesthesiologist
Other
  Ambulance
  Dental
  DME
  Orthotics/Prosthetics
  Podiatry
  Hearing/Speech
  Home Health
  Pharmacy

3. What percentage of your services are provided for workers' compensation?
Less than 10%
10-20%
20-30%
30-50%
50-70%
70-100%

4. What is your geographic location?
Greater Detroit Area
Grand Rapids, Muskegon & Kalamazoo
Tri-County Area (Flint, Midland, Saginaw & Bay City)
Lansing -Jackson
Southwestern Lower Michigan
Upper Lower Michigan
Upper Peninsula

5. How satisfied are you with the process set forth in the Health Care Services Rules when treating Michigan's injured workers?
Always satisfied
Usually satisfied
Satisfied
Somewhat dissatisfied
Always dissatisfied

6. If you are not satisfied with the process, what obstacles or problems does your office encounter?
Employer does not report the claim to the workers' compensation carrier.
Carrier does not determine compensability of the claim in a timely manner.
Carrier will not authorize treatment.
Carrier requests duplicate information (claims and medical documentation).
Incorrect payments-unresolved reconsiderations
Late payments
Mediation process
Other: Please specify

7. Comparing reimbursements received from workers' compensation to those of other payer sources, would you say that payments received for treating Michigan's injured workers generally:
Frequently exceeds other reimbursements
Usually exceeds
Equals
Sometimes is less than other reimbursements
Always less than other reimbursements?

8. What suggestions do you have for changing the process?


9. What is your hourly charge for depositions for workers' compensation cases?

10. Do you have any suggestions for education programs or materials for workers' compensation?

11. Would you like your email address included in our electronic distribution list for sending out rule change notices? If so, please provide your email address below.
Yes
No

FIRST NAME:
LAST NAME:
ORGANIZATION:

ADDRESS:

CITY, STATE, ZIP:
TELEPHONE NO.:

E-MAIL ADDRESS:


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