Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 Happy monday, I was under the impression that PIP insurers were required to send us a letter stating that the patient will be sent for an IME examination. The date of that letter, from what I remember was the date from which that they could deny payment pending IME results. Am I incorrect about this? We have a patient who is done with treatment. Restored to 100% pre accident condition in about 4 months. We just got a bill denial for our last set of bills on the patient pending IME results. Adjuster says they still want to go forward with the IME. We never received any notification that this was going to take place. I feel that the number of these exams ordered has increased as of late. ph Medlin D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 I've noticed an increase also. Over the last 5 months, we have also seen IMEs being ordered with no written notification to our clinic. Progressive seems to be the most aggressive insurer among our small sampling of PIP clients.Jamey Dyson, DCOn Jan 30, 2012, at 9:55 AM, ph Medlin wrote: Happy monday, I was under the impression that PIP insurers were required to send us a letter stating that the patient will be sent for an IME examination. The date of that letter, from what I remember was the date from which that they could deny payment pending IME results. Am I incorrect about this? We have a patient who is done with treatment. Restored to 100% pre accident condition in about 4 months. We just got a bill denial for our last set of bills on the patient pending IME results. Adjuster says they still want to go forward with the IME. We never received any notification that this was going to take place. I feel that the number of these exams ordered has increased as of late. ph Medlin D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2012 Report Share Posted January 30, 2012 Somebody’s gotta pay for Flo and her wardrobe! Larry L. Oliver, DC408 NW 7thCorvallis, OR541-757-9933fax 541-757-7713www.heresco.com dro@... The information contained in this electronic message may contain protected health information which is confidential under applicable law and is intended only for the use of the individual or entity named above. If the recipient of the message is not the intended recipient, you are hereby notified that any dissemination, copying or disclosure of this communication is strictly prohibited. If you have received the communication in error, please notify Heresco Chiropractic & Associates, 408 NW 7th St, Corvallis, OR 97330, 541-757-9933 and purge the communication immediately without making any copy or distribution. From: [mailto: ] On Behalf Of Jamey DysonSent: Monday, January 30, 2012 11:47 AMph MedlinCc: Subject: Re: IME written notification? I've noticed an increase also. Over the last 5 months, we have also seen IMEs being ordered with no written notification to our clinic. Progressive seems to be the most aggressive insurer among our small sampling of PIP clients. Jamey Dyson, DC On Jan 30, 2012, at 9:55 AM, ph Medlin wrote: Happy monday, I was under the impression that PIP insurers were required to send us a letter stating that the patient will be sent for an IME examination. The date of that letter, from what I remember was the date from which that they could deny payment pending IME results.Am I incorrect about this? We have a patient who is done with treatment. Restored to 100% pre accident condition in about 4 months. We just got a bill denial for our last set of bills on the patient pending IME results. Adjuster says they still want to go forward with the IME. We never received any notification that this was going to take place. I feel that the number of these exams ordered has increased as of late. ph Medlin D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 Per the original question, the insurance companies do not have to notify the treating doctor of an IME; their contract is with the insured. They often do make notification, especially if the patient is still treating. The notice to the doctor may ask for additional records to be submitted or it may request imaging studies be forwarded for the exam. The mere notice of a pending IME sometimes has the treating doctor complete treatment and discharge the patient before the exam. Granted, the patient may have improved and the discharge coincides with the request; however, I have seen a number of cases where the patient was still treating several times a week with rather high reported levels of pain, but the doctor discharged the patient as resolved once advised of the IME. How did the patient go from a pain level of 7 out of 10 with marked muscle spasms on Monday to 0 out of 10 on Friday with no complaints or positive examination findings in a matter of days? One reason a post-treatment IME may be requested is the insurance company wants to protect their claim on subrogation. The PIP carrier will seek reimbursement from the “at fault†insurance company, and will use the IME to help support treatment as reasonable and appropriate. Patients and doctors rarely complain about exams that support treatment. Generally speaking, we as a profession have poor charting skills. What may make perfect sense to you in your own shorthand does not necessarily mean that another doctor, let alone a claims representative or attorney can make sense from your scribbles. Many of the software programs do little more than repeat the same findings from visit to visit and do not provide a clear picture of the course of treatment. Poor documentation is also one of the things that might trigger an IME. There are many reasons for an IME to be requested. It is not simply a means to harass the treating providers. I would like to think that we, as a profession, can be open minded enough to at least appreciate that there are many sides to an issue. Tom Freedland, DC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 Tom Very true from my experience with IME’s Bob W. Pfeiffer, D.C., D.A.B.C.O.Lee Pfeiffer, R.N., B.S.46 N.E. Mt. Hebron Dr. (no USPS mail)P.O. Box 606 Pendleton, OR 97801drbob@...leernbs@...541-276-2550 All people smile in the same language From: [mailto: ] On Behalf Of TFreedland@...Sent: Tuesday, January 31, 2012 12:32 PM Subject: Re: IME written notification? Per the original question, the insurance companies do not have to notify the treating doctor of an IME; their contract is with the insured. They often do make notification, especially if the patient is still treating. The notice to the doctor may ask for additional records to be submitted or it may request imaging studies be forwarded for the exam. The mere notice of a pending IME sometimes has the treating doctor complete treatment and discharge the patient before the exam. Granted, the patient may have improved and the discharge coincides with the request; however, I have seen a number of cases where the patient was still treating several times a week with rather high reported levels of pain, but the doctor discharged the patient as resolved once advised of the IME. How did the patient go from a pain level of 7 out of 10 with marked muscle spasms on Monday to 0 out of 10 on Friday with no complaints or positive examination findings in a matter of days? One reason a post-treatment IME may be requested is the insurance company wants to protect their claim on subrogation. The PIP carrier will seek reimbursement from the “at fault†insurance company, and will use the IME to help support treatment as reasonable and appropriate. Patients and doctors rarely complain about exams that support treatment. Generally speaking, we as a profession have poor charting skills. What may make perfect sense to you in your own shorthand does not necessarily mean that another doctor, let alone a claims representative or attorney can make sense from your scribbles. Many of the software programs do little more than repeat the same findings from visit to visit and do not provide a clear picture of the course of treatment. Poor documentation is also one of the things that might trigger an IME. There are many reasons for an IME to be requested. It is not simply a means to harass the treating providers. I would like to think that we, as a profession, can be open minded enough to at least appreciate that there are many sides to an issue. Tom Freedland, DC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 31, 2012 Report Share Posted January 31, 2012 I would concur with your insights on IME's also Tom. Schneider DCPDXOn Tue, Jan 31, 2012 at 7:14 PM, Bob Pfeiffer <drbob@...> wrote: Tom Very true from my experience with IME’s Bob W. Pfeiffer, D.C., D.A.B.C.O. Lee Pfeiffer, R.N., B.S.46 N.E. Mt. Hebron Dr. (no USPS mail) P.O. Box 606 Pendleton, OR 97801 drbob@...leernbs@... 541-276-2550 All people smile in the same language From: [mailto: ] On Behalf Of TFreedland@... Sent: Tuesday, January 31, 2012 12:32 PM Subject: Re: IME written notification? Per the original question, the insurance companies do not have to notify the treating doctor of an IME; their contract is with the insured. They often do make notification, especially if the patient is still treating. The notice to the doctor may ask for additional records to be submitted or it may request imaging studies be forwarded for the exam. The mere notice of a pending IME sometimes has the treating doctor complete treatment and discharge the patient before the exam. Granted, the patient may have improved and the discharge coincides with the request; however, I have seen a number of cases where the patient was still treating several times a week with rather high reported levels of pain, but the doctor discharged the patient as resolved once advised of the IME. How did the patient go from a pain level of 7 out of 10 with marked muscle spasms on Monday to 0 out of 10 on Friday with no complaints or positive examination findings in a matter of days? One reason a post-treatment IME may be requested is the insurance company wants to protect their claim on subrogation. The PIP carrier will seek reimbursement from the “at fault” insurance company, and will use the IME to help support treatment as reasonable and appropriate. Patients and doctors rarely complain about exams that support treatment. Generally speaking, we as a profession have poor charting skills. What may make perfect sense to you in your own shorthand does not necessarily mean that another doctor, let alone a claims representative or attorney can make sense from your scribbles. Many of the software programs do little more than repeat the same findings from visit to visit and do not provide a clear picture of the course of treatment. Poor documentation is also one of the things that might trigger an IME. There are many reasons for an IME to be requested. It is not simply a means to harass the treating providers. I would like to think that we, as a profession, can be open minded enough to at least appreciate that there are many sides to an issue. Tom Freedland, DC -- Schneider DC PDX Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.