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Percentage of IMR Decisions Favoring Employers Falls to 65%
07/12/2013
condition as stated in the utilization denialmodification.
The reviewing doctors adds that because the original medical records of the requesting physician were not submitted the medical necessity of physical therapy is not demonstrated.
In IMR Decision 13-114 the only documents reviewed were the
Category: News
Revised WCAB Rules Prohibit Interpreter Petitions for Costs
07/10/2013
medical treatment and related expenses.
Proposed Section 10451.2 says independent medical review shall be used to determine medical necessity and that independent bill review will determine the appropriateness of payment for medical treatment. All other treatment issues are not subject to IMR or IBR the
Category: News
Attorneys See Potential Pitfalls with Independent Medical Review
07/02/2013
to IMR Vargas said Labor Code Section 4610.5 and DWC Regulation 9792.10.5 require the claims administrator to provide the applicant's medical records to Maximus within 15 days.
She emphasized that both the code and regulation direct that the claims administrator "shall" provide these documents
Category: News
Nearly 3/4 of Early IMR Decisions Favor Employer
05/22/2013
treatment for cervical pain and associated radiculopathy. The injured workers medical history and records support the diagnosis and treatment plan the decision says.
At the same time long-term use of Soma a muscle relaxant Lyrica a Schedule V non-opioid painkiller and Norco a combination of
Category: News
Maximus Seeing Increase in IMR , IBR Requests
05/08/2013
By Greg Jones Western Bureau Chief
OAKLAND Calif. The doctor who is developing the independent medical and bill-review processes for Maximus Federal Services said the number of requests to resolve treatment and billing disputes has been increasing but he cant yet estimate how many reviews
Category: News
Stakeholders Seek Clarity, Consistency to Make IMR Rules Work
04/05/2013
claims administrator to send medical records from the last six months to independent medical review because those records may not contain enough information to make a decision. He said utilization review requests are often denied because diagnostic images performed months earlier arent included among
Category: News
SIU Head Says Focus on Outcomes a Step to Control Opioids
03/06/2013
paperwork they have less time to review medical records and can be less likely to consider alternatives to opioids such as authorizing additional physical therapy treatments beyond the 24-visit cap created by SB 899. Adjusters can also fail to identify red flag indicators that a patient is diverting or
Category: News
Too Soon to Cry Chicken Little on IMR Rates, Observers Say
02/13/2013
utilization review what Maximus is offering to pay appears appropriate.
A doctor performing utilization review adheres to a pretty straightforward exercise of evaluating the pertinent medical records and the evidence-based guidelines to determine whether a treatment is medically necessary he said. IMR
Category: News
Vendor's Low Pay to Doctors Raises Questions about Quality
02/07/2013
Services.
Senate Bill 863 created independent medical review in the California workers' comp system as a way to move disputes over treatment decisions from workers' compensation judges to medical professionals. The provisions in the bill say an IMR decision to approve or deny a recommended treatment can
Category: News
Stakeholders Worried about IMR Doctors' Conflicts of Interest
12/10/2012
pointed out that IMR Regulation 9792.10.5.a1F2 and 3 require the claims administrator to send all the medical records that were submitted to IMR to the applicant as well. Don suggested that the regulation should also require service to the applicant's attorney.
"If the applicant's attorney
Category: News
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