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Regulators Mulling Electronic Submission of Medical Records to Speed Up IMR

  • State: California
  • Topic: Top
  • - Popular with: Legal
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OAKLAND, Calif. – The Commission on Health and Safety and Workers’ Compensation on Thurs…

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Anonymous Nov 21, 2016 a 10:49 am PST

The problem I see with mandatory electronic records in that many injured workers will not have access to or the capability to send records electronically. I hope they will still allow injured workers to mail or fax their records.

The few times I have had an IMR, my claims adjuster set records, but not relevant records. As an injured worker, I would like to send my own records due to this.

I do not think all records in a claims adjusters possession will be reviewed by these IMR reviewers. For older claims it could take two days for a reviewer to read all of their records. That is what AME and QME's previously did, was review the patients entire file. Then they would make a decision based on the entire information AND the exam with the patient. IMR reviewers do not get paid enough to review the entire file (if the injured workers has been in the system for a number of years). They should read the entire file, especially if they are making important decisions such as cutting off all of the patients medications. I just do not see this occurring for what they are paying these ghost reviewers. If they paid IMR reviewers more to review larger files, that would be more realistic. Then their IMR reviews would not be two pages long, and more like a QME or AME supplemental report. (JMO)

Charles Cleveland Nov 3, 2016 a 7:58 am PDT

I don't see what difference it will make whether they get the records via snail mail or email. I suspect for the pittance that they pay these anonymous faceless doctors they don't read them anyway. They deny care and uphold utilization review denials 84 to 91% of the time depending on whose study look at.

Anonymous Nov 21, 2016 a 10:49 am PST

True. Anyone can read the past IMR determinations to see the IMR reviewers use the same rational as UR did (most of the time). They may be denying just because it is easier than having to read records and come up with different rational than the UR doctor did to deny it. If we had the names of these doctors we could see if any of them are ....I don't know denying all requests.

Gary Nelson Nov 3, 2016 a 7:58 am PDT

Since the outcome is essentially predetermined, might as well screw them faster and more efficiently.

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