So you Need an IME – What are Your Next Steps?
April 22, 2025 - Posted on WorkCompWire Leaders Speak (Read Part One)
By Randy McKinney, SVP of IME and Peer Review Operations, Emperion
Last week we spent time discussing what IMEs are, why they are important, and the importance of medical records including diagnostic imaging results. We also addressed the need for a clear and concise list of conditions to be examined to avoid wasting time on conditions unrelated to the claims. This week we want to provide next steps and best practices when an IME is needed to bring clarity to the case.
Partner with an Expert that Specializes in IMEs
Despite their many benefits, IMEs can also present several challenges for claims professionals. Coordinating the examination process, ensuring the completeness of medical records, and navigating the potential for disputes over the findings are just a few of the hurdles that can complicate the IME process. Additionally, claims professionals must remain vigilant against any perceived biases in the examination, as the credibility of the IME can be called into question if impartiality is compromised. This is where a trusted partner comes into play.
Relying upon an “independent” partner who handles all aspects of coordinating, scheduling, selecting the IME provider, and ensuring the report addresses the requested items, impartiality is achieved. In today’s hybrid and work-from-home reality, many payers are faced with onboarding new claims professionals that may not have the opportunity to learn the intricacies of claims handling from their peers in a traditional office environment. These management realities make the selection of a reliable trusted IME partner increasingly important to support both new and seasoned claims professionals when cases warrant the use of an IME. You want a partner that follows jurisdictional requirements and spends all day, every day, thinking about ways to improve the process and the reports you rely upon to settle your claims efficiently.
Furthermore, a partner with a broad-based network of relevant specialties in the individual’s location is required. The IME partner should be responsible for selecting the right provider in the right specialty who can render an independent, unbiased opinion. If the IME partner selects the examining provider, you can definitively prove you are acting in the best interests of all involved.
Best Practices for Effective IME Management
To navigate the complexities of IMEs successfully, claims professionals can adopt several best practices. As mentioned, selecting a partner who is dedicated to recruiting, credentialing and managing a network of qualified IME providers is critical. You should vet those partners to ensure that their provider credentialing and operational processes are sound and accredited. Such accreditation, as provided by the Utilization Review Accreditation Commission (URAC), is a seal of approval that the organization has the processes and policies in place to evaluate the background and expertise of the IME physicians in their network. Accredited credentialing and operational practices will help you feel confident that the exams you request will be completed with the utmost quality while withstanding legal scrutiny.
Once you have selected the right partner, thorough preparation on each case is key. This includes compiling complete and organized medical records, ensuring that all relevant diagnostic tests are included, and clearly communicating the scope and objectives of the IME to the examining physician. By laying a solid foundation, claims professionals can facilitate a smoother and more effective examination process.
Another best practice is maintaining open communication with all parties involved in the IME. This includes the claimant, the IME physician, and any other stakeholders. Clear communication helps manage expectations, address any concerns, and ensure that the IME findings are understood and appropriately integrated into the claims decision-making process.
Quality, it matters.
As with all the steps leading up to the exam, once the report is received the heavy lifting begins for your IME partner. It is critical to have a partner that has extensive experience performing quality assurance (QA) checks on the report provided by the examiner. It is not merely that the report be free from spelling and grammatical errors. It is also important for QA to ensure that all the questions posed by the requestor were answered. If you asked 10 questions and only got 7 answers, there is likely to be a big gap in what you wanted confirmed or refuted and what you received. This puts you in a position to have to go back and ask for the missing information, and typically the clock is ticking, and you may have hearings to attend or discussions to be had.
Being your Best when it Comes to IMEs
As a claims professional, staying on top of medical and legal developments related to IMEs can prove quite helpful. Staying abreast of new and innovative topics helps claims professionals better understand the recommendations and information outlined in the reports received from the examining provider. Learning about innovative or experimental technologies and changing regulations can also be helpful when determining when it makes sense to request an IME. This is why working with your IME partner on relevant continuing education topics can be beneficial, and not just to maintain licensure. Be sure to pick topics that add to your team’s repertoire and allow you to be in the driver’s seat when it comes to the claims you and your team manage. The more knowledge you have, the better you will be prepared to handle these examinations with confidence and precision, ultimately leading to fairer and more efficient claims resolutions.
About Randy McKinney
Randy McKinney is senior vice president of IME and Peer Review Operations, where his duties include overseeing Emperion’s nationwide independent medical exam and peer review programs for workers’ compensation, auto and disability payers. He is also responsible for the organization’s Independent Review Organization (IRO) for health care payers nationally.
McKinney began his journey with Genex in 1996 and has broad industry experience earned through his increasing responsibilities. His strong competencies exhibited as area sales manager, regional account executive, and regional manager serve as an excellent foundation. Genex IME became Emperion in April 2024 allowing the company to dedicate the resources and attention necessary to deliver the highest quality services in this specific sector.
Before serving in his current position, McKinney was southeast region vice president, where he incorporated a best-practice approach to yield superior medical and financial outcomes in telephonic and field case management. McKinney holds a bachelor’s degree in finance from the University of Oklahoma.
About Emperion
Emperion is a national provider of outsourced clinical review services including Independent Medical Examination (IME), Peer Review (PR), and Independent Review Organization (IRO) solutions. The company manages a national network of approximately 25,000 providers across a broad range of medical specialties. These capabilities promote patient recovery, return to employment, and successful claim outcomes across Workers’ Compensation, Automobile, Disability, and Health benefit systems.
Disclosure:
Emperion has advertised with WorkCompWire.
This is NOT a paid placement.