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MCCoy & Associates |
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Consultants to Chiropractors & the Profession |
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There is no need to be alone when dealing with IME issues |
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Independent Medical Exams or IME’s pose a myriad of challenges for doctors, patients and attorneys. Certainly patients have no past experience to guide them and most often the doctor or attorney have little if any. If you are a patient and you have been instructed to undergo an IME or your records have been reviewed you need to understand the nature of the relationship between you and the doctor working for the insurance company. Similarly. doctors need to understand the ramifications of an adverse IME and how to handle them. Attorneys need help with the unique landscape of chiropractic, its politics, scope of practice and clinical spectrum. Simply applying the medical model to chiropractic could spell disaster. The list below outlines some the services and issues that come up in IME’s where we can assist. |
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IME Rebuttals: Unfavorable IME opinions should never go unchallenged if you disagree with them since they are essentially questioning the reasonableness and necessity of the care you provided to your patient. They raise very serious ethical concerns and can destroy the doctor/patient relationship. We can help you analyze the IME’s report, its recommendations/allegations and advise on an appropriate response.
IME Review of Records: We’ll need to review all of the patient records as well as the IME reports, letters and correspondence from the insurance company, billing records etc.
IME Consultations: Should you and your patient become the victims of an unfair IME we can consult with you as to the best course of action.
Second Opinion Examinations: You and/or your patient or attorney may elect to get a second opinion on the diagnosis, care plan and management being rendered. These can be completed prior to an insurance IME being done or following them. They can also be done simply to get a second opinion on difficult or complicated cases, cases slow to respond or whenever questions or uncertainty arise about patient management.
Second Opinion Review of Records: This is simply a second opinion based on a review of records. Obviously limited in its scope some decision may be made as to a course of action based on this review.
Review of Insurance Denials: As with adverse IME’s, insurance denials should never go unanswered. If the EOB states that care is unnecessary and unreasonable then this is a potential accusation of malpractice and insurance fraud since they are saying that you provided care that was not needed and you billed for it. We can help you analyze denials of benefits and determine why they are occurring, develop responses and work on long-term strategies to avoid them.
Attendance at IME Exams: Your patient should never attend an IME examination alone. You or their attorney should accompany them and/or it should be videotaped. Many state laws specifically allow for this. If you cannot attend or are unsure what to look for we may be able to attend the exam with your patient.
Drafting Responses to Insurance Denials: Similar to unfavorable IME opinions, denials from insurance companies should never go unchallenged if you disagree with them. Insurance companies are usually denying payment and raising questions about the reasonableness and/or necessity of the care you provided to your patient. This might raise ethical concerns by your patient and can destroy the doctor/patient relationship. We can help you analyze the explanation of benefits and advise on an appropriate response.
Literature Searching: This may be necessary if your case involves a controversial topic or if we simply need to search the literature for supportive literature and/or references to help defend your position. It might also be used to find literature to thwart the accusations against you in a malpractice case or state board action.
Literature Gathering and Interpretation: Once the literature is found it must be gathered. This can be a tedious and time consuming process involving going to libraries requesting copies of articles, ordering the articles, gathering articles over the internet and then ultimately reviewing those articles and determining their value to your case.
Referrals to Appropriate Experts: Your case may need additional expert witness support depending on its nuances and circumstances. Perhaps you need an expert in a specific technique, or you need an attorney who focuses on a particular area of the law. We can make recommendations for this or in any case help guide you where to look.
Depositions: We are available in instances where you or your attorney, or other party, request to depose us as your expert witness.
Expert Witness Testimony: We are available in case you or your attorney request that we appear on your behalf in court or be present and give testimony regarding your IME issue or insurance claim issue.
Deposition & Trial Preparation for the Defendant: We are available if you or your attorney would like advice or coaching for you in order to prepare you for a deposition or trial related to an IME, PI or work comp case.
Risk Management Analysis: You’ve worked too hard and too long to build your practice or put a new one together to have an adverse event tear it apart. Malpractice suits, board actions, patient complaints etc are a fact of life. We can help you analyze your practice, tell you where your potential risks are and offer solutions to help you sleep soundly. |
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McCoy & Associates 4390 Bells Ferry Road |
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To contact us: |
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IME Services |
