Independent Medical Review – Now More Popular with Payers

by | Published on Dec 20, 2012 | Medical Record Review

Independent medical reviews are ordered by payers that have to deal with disbursing compensation for employees with working disabilities. They are provided on the basis of a patient’s medical records. They help in a preliminary evaluation of the case and are more economical. Independent medical review (IMR) is distinct from independent medical evaluation (IME).

An IME is ordered by an insurance company when an employee has suffered a work-related injury, or has some injury that makes it difficult to perform certain types of tasks. This evaluation assists in determining the cause, extent and medical treatment of an injury that is work related. It is conducted by a medical professional who was not earlier involved in the injured person’s care so that an unbiased evaluation can be obtained. IMEs help assess whether a person has received maximum benefit from the treatment provided and whether there is some permanent disability remaining even after treatment. In case the IME concludes that the patient’s condition is not associated with an event that can be recompensed, the payer may deny the claim.

While an IME requires the patient to be present before the evaluating physician, an IMR is made on the basis of the patient’s medical records and history.  There is no need for the patient to visit the IMR company. Payers prefer independent medical reviews because of the lesser hassles and lesser delay involved. IMR specialists will accurately review the patient’s medical records that are themselves comprehensive and analyze them to arrive at the correct conclusion.

Independent medical reviews provided by a reputable medical record review company are more accurate, especially because there is no direct contact with the patient and the physician. This rules out the issue of patients pretending to be in pain at the time of evaluation. IMRs identify mistakes, frauds and improprieties if any, in the medical claims. Outsourcing to a dependable medical review company ensures that a large number of claims are appropriately settled in minimum turnaround time.

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