Practical Aspects of IME Appointments: Scheduling, Agreements, Etc.

Abstract

Independent medical evaluations are different than usual physician appointments where a doctor-patient relationship exists and parameters regarding appointments, billing, and correspondence are straightforward. IMEs require considerations of dealing with a requesting party who is often unaffiliated with the examinee. Thus, multiple avenues of communication need to occur for IME appointments to be successfully scheduled and attended. Since these evaluations are conducted within a medicolegal context, the IME physician should develop policies that address billing, no-shows, cancellations, and follow-up work.

Since individuals who are being evaluated may not necessarily be pleased that they are attending an IME appointment, exceptional care should be taken regarding informed consents and protections to ensure the integrity of the IME process.

Appendices

Appendix 1: Example Confirmation Letter for Requesting Party

September 24, 2017

XYZ Insurance Company

Mr. George Zazzy

420 Roller Street

Hightown, CO 88878

RE: Independent Medical Examination of Constance C Chronicus

Dear Mr. Zazzy:

Thank you for your telephone call from this morning wherein we have tentatively scheduled the above individual for an Independent Medical Examination that will be conducted by Douglas W Martin MD on Friday October 9, 2017 at 3:00 p.m.

With your signature below, you have acknowledged the fee schedule and parameters surrounding the IME set forth in the accompanying documents.

If you have any questions, please contact us.

Sincerely,

Kara Benny

Office Manager

Acknowledged and agreed:

_________________________________    ______________________

Mr. Goerge Zazzy               Date

Please fax back to 712-444-4000

Appendix 2: Example Confirmation Letter to Examinee

September 24, 2017

Ms. Constance C Chronicus

8675309 Jenny Avenue

Tutone, CO 87958

RE: Your Upcoming Independent Medical Examination of October 9, 2017

Dear Ms. Chronicus:

You have been scheduled for an independent medical examination (IME) to be conducted by Douglas W Martin MD on Friday October 9, 2017 at our office.

We ask that you arrive at 2:30 p.m.

Please note that this examination will last approximately 90 minutes.

Please contact us at least 48 hours in advance if you will be unable to make your appointment and an attempt will be made to reschedule. Arriving late for your appointment unfortunately cannot be accommodated.

We ask that you plan ahead regarding travel and that you bring only one friend or family member with you if you so choose. Our office is unable to accommodate child care or supervision.

If you have any questions, please contact us as soon as possible. We look forward to seeing you on October 9.

Sincerely,

Kara Benny

Office Manager

Appendix 3: Example List of IME and Other Rules to Be Sent with Requesting Party Letter

Protocols and Policies: Medicolegal Clinic Services

Independent Medical Examinations

• 1. All examinations shall be scheduled for one hour, unless the complexity of the case demands a longer appointment time.

• 2. All pertinent medical records shall arrive at least 48 hours prior to the scheduled appointment.

• 3. All pertinent x-rays shall arrive at least 48 hours prior to the scheduled appointment.

• 4. The collection, assimilation, and distribution of the medical records and x-rays are the responsibility of the party requesting the exam.

• 5. A cover letter detailing any special requests or questions to be answered is recommended.

• 6. The basic clinical charge for the exam, record review, and report generation is not set by Dr. XXX but is set by administration. The basic charge includes one hour for the examination and one hour for record review and report generation. Any additional time needed will be charged at an additional rate, set by administration for each additional 30 minute increment.

• 7. Any cancellation less than 48 hours prior to the appointment will necessitate a “no-show” fee set by administration.

• 8. If an examinee does not show for the appointment or is greater than 20 (twenty) minutes late for the examination, this will incur the no-show fee. Please understand that it is typical for most IME examinations to take one hour and that being late can significantly impact the day-to-day operations of the clinic.

Impairment Rating Examinations/Finalization Examinations

• 1. All examinations shall be scheduled for one hour, unless the complexity of the case demands a longer appointment time.

• 2. These examinations are defined as impairment evaluations and finalization appointments on patients that Dr. XXX has cared for that need impairment ratings and/or permanent return to work prescriptions (restrictions) that go above and beyond the normal follow-up examination.

• 3. A cover letter is recommended from the requesting party to insure that all issues are addressed by Dr. XXX.

• 4. Due to the increasing frequency of no-shows for these appointments, a no-show policy will be implemented.

• 5. The typical charge for this examination is not set by Dr. XXX but is set by administration and is a flat fee, unless there are circumstances where additional time is needed for the examination or record procurement above the normal one-hour time allotment.

• 6. Any cancellation less than 48 hours prior to the appointment will necessitate a “no-show” fee also set by administration.

• 7. If an examinee does not show for the appointment or is greater than 20 (twenty) minutes late for the examination, this will incur the no-show fee. Please understand that it is typical for most of these examinations to take one hour and that being late can significantly impact the day-to-day operations of the clinic.

Second Opinion Examinations

• 1. Please understand that there are two basic types of second opinion examinations, those where opinion alone is desired and those where there is an assumption of treatment. It is absolutely imperative that the type of exam be explicitly communicated to the clinic in advance of the appointment.

• 2. Second opinion examinations are intended for those injured employees who have already sought treatment from other providers for their workers compensation claim. Typically, second opinion examinations cover treatment recommendations alone, and do not rise to the level of determining impairment or disability as in an independent medical examination.

• 3. All examinations shall be scheduled for one hour, unless the complexity of the case demands a longer appointment time.

• 4. All pertinent medical records shall arrive at least 48 hours prior to the scheduled appointment.

• 5. All pertinent x-rays shall arrive at least 48 hours prior to the scheduled appointment.

• 6. The collection, assimilation, and distribution of the medical records and x-rays are the responsibility of the party requesting the exam.

• 7. A cover letter detailing any special requests or questions to be answered is recommended.

• 8. The charge for these examinations will follow the CPT codes and applicable fees for the complexity of the case.

• 9. Due to the increasing frequency of no-shows for these appointments, a no-show policy will be implemented.

• 10. Any cancellation less than 48 hours prior to the appointment will necessitate a “no-show” fee that is not set by Dr. Martin, but is set by administration.

• 11. If an examinee does not show for the appointment or is greater than 20 (twenty) minutes late for the examination, this will incur the no-show fee. Please understand that it is typical for most of these examinations to take one hour and that being late can significantly impact the day-to-day operations of the clinic.

Depositions

• 1. All depositions shall be scheduled at least two weeks prior. A minimum of two hours will be scheduled for all depositions.

• 2. All deposition will occur at Dr. XXX’s office @ Anyplace, USA unless other arrangements are made. A conference room that includes a speaker phone is available to accommodate.

• 3. All depositions cancelled less than 5 working days prior to their occurrence will be subject to charge at the regular deposition fee rate. The rate is not set by Dr. XXX, but is set by administration.

• 4. Charges for depositions shall originate from the originally scheduled time for the beginning of the deposition. Late appearances of attorneys or recorders are not the responsibility of the physician.

Testimony

• 1. In-person testimony is available for workers compensation, personal injury, and professional liability cases.

• 2. Scheduling of such testimony shall occur at least two weeks in advance, sooner if possible.

• 3. Usually, testimony is scheduled for one-half day blocks, but may be scheduled for a shorter period or longer period of time depending upon the complexity of the case.

• 4. The charge for live testimony is not set by Dr. XXX but is set by administration. There is a base rate for the first hour and then an additional rate at 30 minute increments following.

• 5. The hourly amount will be calculated from the time of departure from the clinic to include travel time to the destination of testimony and include return travel time. The billed time will include only the time that is part of normally scheduled clinic time.

• 6. Any travel expenses above and beyond driving expenses will be the responsibility of the requesting party.

• 7. All testimony cancelled less than 5 working days prior to its occurrence will be subject to charge at the regular deposition fee rate.

Appendix 4: Example CPT Codes Used

IME

99456—Work related or medical disability examination by other than the treating physician that includes:

• Completion of a medical history commensurate with the patient’s condition

• Performance of an examination commensurate with the patient’s condition

• Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment

• Development of future medical treatment plan

• Completion of necessary documentation/certificates and report

Impairment or Disability Evaluation—Current Patient

99455—Same as above—difference is only that this applies to a current patient where a doctor-patient relationship has already been established

99499—Unlisted Evaluation and Management Service

• Some systems use 99499 for a variety of items that cannot be categorized elsewhere

  99075—Medical Testimony

Independent File Reviews

99080—Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form

• Some systems use 99080 for a variety of items that are not well categorized by other CPT codes such as narrative responses to letters from insurance carriers, HR managers, etc. and other correspondence generated by the physician