All IME Partners are Created Equal, Right?  Not so Fast!

Working with a Quality IME Service Provider

Although the basic functions of the IME have remained the same, the nature of the industry has changed tremendously to meet demands for a greater level of service and clinical excellence. In fact, many Workers' Compensation payers have moved from using many smaller shops to establishing a preferred list of best-in-class IME companies that have an extensive geographic reach, a team of medical experts, clinical coordination, quality assurance processes, provider credentialing, efficient workflow, and an advanced technology platform.

As leading IME service providers—like Emperion—have emerged, they strive to structure their enterprises to facilitate a quality IME process. Criteria for enabling a quality process and defensible report include the following:

• Objectivity. When requesting an IME, objectivity is crucial. When employers or insurers request an IME directly from a physician, there’s a perception that the doctor is being recruited or paid to provide a specific medical opinion. Whereas, with a third-party IME vendor, impartiality is built into the process. The IME company identifies an expert qualified to evaluate the case, and since they have no “skin in the game,” there is no bias in the outcome. It simply recruits the most qualified expert to provide an independent, impartial opinion, and pays them for their work regardless of the findings.

In addition, adjusters should be careful about requesting directly from medical providers, based solely on their knowledge of the physician community. If a claim is litigated, it’s vital that a credible expert performs the IME. Many times, claims staff may not have all the information necessary to select the right doctor. For example, do they know if certain physicians have sanctions against them, or if they’re board certified? If a vital component is left out in the provider selection process, the resulting IME could lose credibility.

• Quality Providers. A quality IME company has fostered relationships with a broad pool of medical experts. It evaluates physicians to make sure they are skilled at performing IMEs, don’t have sanctions filed against them and have active treating practices. The IME company is familiar with these physicians’ areas of specialty, board certifications and expertise on body parts, such as orthopedic surgeons who specialize in hands vs. knees. IME companies also work with physicians to help them become more skilled in the IME process.
• Past Clinical Coordination. When an IME is ordered, trained clinical coordinators help to organize medical records, highlight critical pieces of the file, and identify items physicians should specifically review and consider in relation to the IME objective. For example, if the purpose is to assess causality, the coordinator will ensure all diagnostic test results are included and available for the physician to review.
• Quality Assurance. The final IME report is carefully vetted through a clinically focused process to ensure a quality end result. Obviously, the medical opinion is solely that of the examining physician. However, the IME company will review the report to ensure a clear medical opinion is supported by evidence-based medicine and all the questions posed are addressed.
• Jurisdictional Expertise. The IME company has in-depth knowledge of various jurisdiction requirements, such as when, why, and how often IMEs can be requested. Each jurisdiction may use different evaluation guidelines, language, and notifications. If state rules are not followed (for example, if the claimant is not given sufficient notice), an IME may be disallowed.
• Efficiencies. A sophisticated IME company has set up consistent, efficient processes across a national marketplace. It streamlines workflows around scheduling, intake, coordination, quality assurance and report delivery—all of which minimize delays and improve communication throughout the process. The vendor has fostered strong relationships with these providers, so it can promptly schedule an exam and obtain a quick response.
• Accreditation. As the bar for the best service continues to rise, sophisticated IME companies have obtained external accreditation. Through organizations such as URAC, an IME company can validate its use of best practices regarding data security, quality business processes, and HIPAA standards. For insurers looking to create a short list of IME partners, URAC accreditation offers a stamp of approval that the IME company meets high-quality standards. Currently, a select few IME companies are URAC accredited.
• Digitization of the IME Process. A sophisticated IME company has made strategic investments in infrastructure. It has built systems and processes to work more efficiently with claims and provider communities. Digital portals have been established to securely and electronically transfer medical records between claims staff and IME physicians. These portals significantly streamline workflow, as the process of copying and shipping medical records is eliminated.
  
  

What’s next On Point: In case you missed it! Recap of our last four blogs. These four are only the beginning—what comes next refines the process further.

If you are ready to explore further, download the entire IME eBook here: Emperion eBook.

If now is the time to request an exam, visit our online referral form.