ProviderPulse

Non-Division Independent Medical Exams

Billing/Administration

August 2011
During the course of a claim, there is sometimes a need to clarify the medical/legal status of an injured worker through the use of an independent medical examination (IME). There are two types of IMEs. One is administered through the Division of Workers’ Compensation (DOWC) and is called a Division IME. The other is not administered through the DOWC and is called a non-Division IME. A non-Division IME is an examination performed independently of the DOWC’s IME procedures. These examinations are often used to help settle causality or other medical and/or legal issues. Typically, the payer requests this type of IME and has chosen the examiner. The findings of non-Division IMEs are not binding, and reimbursement for non-Division IMEs is made at the appropriate statutory rate.


DOWC Rule 18 (Medical Fee Schedule) provides clear guidance for IMEs. Please make note of the following:


Providers who establish and/or require a standard number of hours for non-Division IMEs, regardless of the size or complexity of the file, have created a process that falls outside of the rules of procedure for Rule 18.
Additionally, providers occasionally submit erroneous charges related to their non-Division IMEs. Examples of erroneous IME billings include charges for Battery for Health Improvement (BHI) — billed with the psychological testing code of 96101 — and charges for travel expenses listed under codes 99082 and Z755.

There is no provision under Rule 18 for travel to a non-Division IME, and psychological testing is something for which you should obtain approval before providing service.

Finally, agreements/contracts that require a signature cannot be signed by claims staff. It is appropriate for providers to send notices regarding the agreement; however a signature should not be required.

If you have any questions about non-Division IMEs, please contact your provider relations specialist.