Independent Medical Examinations: 10 Common Myths!

5 Provider Misconceptions: 

1. If the PIP insurer utilizes an IME doctor, I should stop billing PIP and bill the patient’s health insurance.

This is incorrect for the following reasons:

• If you do not continue billing PIP your bills will not be reimbursable by the PIP insurer.
• The PIP statute requires all bills be sent in within 35 days of the last date of service, unless you send in a Notice of Initiation of Treatment, or unless you are a Hospital or Emergency Service Provider
• Continue billing the PIP insurer to ensure reimbursement down the road. As long as your bills are submitted in a timely fashion you stand to receive some PIP money.
  

2. IME doctors are given immunity, in that they do not sit for Depositions nor do they have to appear in court. I do not want to waste my time with these claims.

NO, NO, NO! We request the IME Doctors Deposition immediately after filing suit. If the PIP insurers’ attorney refuses to give us dates, we subpoena the doctor for deposition. We will pick apart the IME report clearly prepared at the PIP insurer’s request.

TIP: Did you know most IME doctors do not review your patient’s records prior to the examination!

3. My patient will never attend an IME for two reasons: 1)He/she will not pay for the mileage and 2) He/she will not pay for the costs of the examination.

Transportation costs are reimbursable! Your patient need only submit a mileage sheet to the insurer for the travel time to and from the IME. Neither you nor your patient pay anything. The actual examination is paid for by the PIP insurer. Moreover, the IME costs DO NOT count against your patient’s policy of insurance.

4. I should not continue treating my patient after an IME Cut-off, he does not have health insurance and the treatment will not be paid by PIP.

This is one of the WORST strategies to employ.

Continue treating your patient! Insurers utilize IME’s all of the time to harass and encourage your practice to stop treating patients. We can defeat the insurer’s IME Cut-off. However, to ensure your patient’s full recovery, continue treating the patient, even in the absence of a secondary insurance source.  We have an extremely high success rate collecting reimbursement for IME Cut-offs.

As you know, most patients become repeat clients. Secure your future and continue billing PIP!!!!

5. I was told not to coach or tell my patients anything about the IME process because insurers frown on this.

NO!!! Do not fall into the insurers trap. You should absolutely educate your patients about the IME process.

Fill them in on what they should expect:

1. 20-30 Minute examination performed by an independent medical examiner
2. The IME doctor will ask questions about:Accident history
   • Current complaints
   • The current course of treatment
   • Treatment in the past for same/similar injuries
   • Effectiveness of the treatment
3. The examination should consist of:
   • Palpitation, range of motion, etc.
   • Review of medical records
4. Give a detailed history of the accident/injury:
   • It is essential to explain all details of the accident. The more open the client is regarding the accident/injury, the better the chance of a favorable IME report.

5 Patient Misconceptions:

1. I refuse to appear for an IME without my attorney.  I know he/she is not allowed to attend so I will not attend.

INCORRECT!

Your attorney can absolutely appear at an IME.  Moreover, any representative from your attorney’s law firm can attend the IME. Simply notify the PIP Insurer and the IME provider’s office of your attorney’s intention to attend the IME.

2.  I heard any IME doctor can deny my treating physician’s medical services.

Good news, this is NOT true! The IME statute specifically states the IME doctor who cuts off treatment/benefits must be from the same licensing chapter as your doctor.

For Example: If you receive treatment from a chiropractor then the PIP insurer must hire a chiropractor as their IME doctor.  If they hired a Physical Therapist then their IME Cut-off WOULD NOT BE VALID.

3.  I heard that if I re-schedule multiple IME’s my doctor won’t be paid.

This is not necessarily true if you have valid reasons for rescheduling the date of the IMEs, your benefits should not be cut off. However, if you simply skip multiple IMEs, then yes, you will not receive reimbursement from the PIP carrier if you do not have a reasonable excuse for the no-shows.

4.  I refuse to travel to another city for my IME. A friend of mine told me I may have to travel up to 100 miles.

This is untrue. The examination must be conducted in the same municipality as you live, or a reasonably accessible location no more than 10 miles from your house.

5. This entire thing is a waste of time.

The IME process is crucial; WHY? If you attend you will most likely get your bills paid by the insurer down the road. You will also ensure your doctors have a fighting chance to getting their claims paid by the PIP insurer.

Top 3 Things To Remember When it Comes to IME’s:

1. Contact our office immediately if your treatment has been cut off due to an IME or a Peer review determination
   • I have personally handled thousands of IME cut-off PIP cases. We have an innovative approach to litigating these suits which maximizes reimbursement.
   • We have multiple years of experience litigating PIP claims.
   • Our team is ready, willing, and able to assist you with all things PIP/insurance collections-related!
2. Document, Document, Document Make sure your records clearly specify the reason for treatment.
3. Explain the importance of attending an IME to your patients and help them understand the process!