Medical Evaluation and Second Opinion Policy
To ensure maximum efficiency and the highest level of care and quality, we ask that all Employers, Insurance Companies, Attorneys, and Case Managers be aware of the following policies.
Independent Medical Examinations (IMEs)
1. IMEs will address questions regarding diagnosis, treatment, return to work, pre-existing conditions, and claim causality.
2. To schedule an IME with The Center for Musculoskeletal Evaluations (CME), please contact the IME & Deposition Scheduling Coordinator, Lisa Abbondanza, at (412) 369-4000 ext. 308 or our IME Services Manager, Jacqueline Herman, at ext. 347,or toll-free at 1-866-900-IMES(4637), or request an appointment via our website at www.theIMEcenter.com. IMEs will be scheduled at the request of employers, attorneys, insurance companies, case managers and rehabilitation consultants.
3. The physicians will not perform an IME on an examinee previously treated by any CME physician without advance approval by the CME manager and physician.
4. Physicians will not assume care or treatment of IME examinees.
5. If the CME physician recommends additional diagnostic tests, the physician may write a script for the test/study, which will be included with the IME report. However, the CME physician and staff will not schedule/coordinate the recommended test.
6. CME must receive all pertinent medical records at our North Hills office one (1) week (i.e. 7 calendar days) prior to the scheduled IME appointment. There may be an additional charge for records received less than one (1) week prior to the appointment.
7. Regardless of the physician or office location for the IME appointment, all medical records and correspondence must be directed to our IME Corporate Office in the North Hills. Furthermore, if you have to cancel or reschedule an IME appointment for all offices/physicians, you must call our Corporate Office at 412-369-4000 ext. 308 or ext. 347 or toll-free at 1-866-900-IMES(4637).
8. As a courtesy, CME physicians will meet with rehabilitation personnel at the time of the IME visit for no additional charge.
9. Physicians will complete job analysis/descriptions and physical capability forms if received no later than the day of the exam. These forms will be included with the initial IME report at no additional cost. There is a charge for reviews or completion of forms for job analysis/descriptions and physical capability forms that are received or requested after the exam. These fees must be paid prior to completion of the forms.
10. The final report(s) for IME related services will only be sent to the individual/company that scheduled the IME appointment.
11. Please adhere to the following policies regarding multiple body parts and/or multiple dates of injury:
· Extended appointment times are required for evaluation of multiple body parts. Injuries to parts of the same limb are generally considered one body part, (i.e. wrist and elbow). Questions regarding multiple body parts must be addressed before the appointment is scheduled (prior to IME).
· Only one appointment slot will be necessary to address one body part with multiple dates of injury.
12. Payment in full is required within 30 days for all IME-related services. (Late fees may be applied for outstanding balances over thirty days.) Pre-payment for some IME services may be required. In addition, payment for all IME services must be paid in full before we can schedule a deposition.
13. There is a fee for addendum requests, as well as the review of additional records received after the IME appointment. (Payment for all IME services must be paid in full before we will process requests for addendums.)
14. CME charges a “No Show Fee” when the examinee does not arrive for the initial/first IME appointment or if the appointment is cancelled or rescheduled with notice of two (2) weeks or less (i.e. 14 calendar days or less). Additionally, if the examinee does not attend a rescheduled/second appointment or if we receive notice of two (2) weeks or less to cancel or reschedule this appointment, the full IME fee is due. The full fee will be due thereafter for all subsequent visits. (The same “No Show” fee and policy will apply if the examinee is more than fifteen (15) minutes late for the scheduled IME appointment.)
Mandated Second Opinions (These IMEs are scheduled by CME)
Mandated Second Opinions are scheduled the same as an IME. Please follow above policies for IME services.
Examinee-Requested Second Opinions (Scheduled by our office staff at all locations.)
1. “Examinee-Requested Second Opinions” are scheduled directly by the practice staff of Tri-State Orthopaedics & Sports Medicine at (412) 369-4000 (select “Option #2”) if:
· The examination is requested by the examinee and not mandated by rehabilitation personnel (rehab nurse, case manager, etc.), insurance companies, attorneys, etc..
· The only issues to be addressed are diagnosis and treatment recommendations, (not causality, return to work, etc.).
2. When there has been prior surgery on the injured body part, the examinees must obtain their medical records and forward them to the North Hills office for the physician to review. The examination will be scheduled at the physician’s discretion.
3. For these examinee-requested appointments (scheduled by the examinee), if rehabilitation personnel accompany the examinee and the examinee agrees, the physician will meet with the rehab nurse/case manager after the exam. However, no physical capabilities or claim causality issues will be addressed if the physician does not assume care.
4. Fees for Second Opinions requested by the examinee are billed by the practice as a second opinion visit (not an IME).
Please direct any questions or concerns regarding the above policies to:
The Center for Musculoskeletal Evaluations