Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics and nursing-Drugless therapeutics, etc › INDEPENDENT MEDICAL EXAMINATION › Section 296-23-302 - Definitions Approved independent medical examination (IME) provider

Current through Register Vol. 24-14, July 15, 2024
- A licensed doctor or firm whose credentials are approved to
				  conduct an independent medical examination, rating evaluation, or provide IME
				  associated services including but not limited to file preparation, scheduling
				  of examinations and processing billing. An approved IME provider is assigned a
				  unique provider number.
Case progress examination
- An examination
				  requested for an accepted condition because:
(a) A proper and necessary treatment plan,
				per the definition of "proper and necessary" found in WAC
				296-20-01002, is not
				in place; or
(b) The treatment plan
				has stalled or been completed without resulting in objective or functional
				improvement for physical conditions, or clinically meaningful signs of
				improvement for mental health conditions.
Department
- For the purpose of this section,
				  department means the department of labor and industries industrial insurance
				  workers' compensation state fund and self-insured programs.
Direct patient care
- For the purpose of meeting
				  the qualifications of an independent medical examination (IME) provider, direct
				  patient care means face-to-face contact with the patient for the purpose of
				  evaluation and management of care that includes, but is not limited to:
* History taking and review of systems;
* Physical examination;
* Medical decision making;
* Coordination of care with other providers and
				  agencies.
This does not include time spent in independent medical
				  examinations.
Impairment rating examination
- An examination
				  to determine whether or not the injured/ill worker has any permanent
				  impairment(s) as a result of the industrial injury or illness after the worker
				  has reached maximum medical improvement. An impairment rating may be conducted
				  by a qualified attending provider, a medical consultant, or an approved
				  examiner. An impairment rating may be a component of an IME.
Independent medical examination (IME)
- An
				  objective medical-legal examination requested (by the department or
				  self-insurer) to establish medical findings, opinions, and conclusions about a
				  worker's physical condition. These examinations may only be conducted by
				  department-approved examiners.
Independent medical examination (IME) provider
-
				  A firm, partnership, corporation, or individual licensed doctor (examiner) who
				  has been approved and given an independent medical examination (IME) provider
				  number by the department to perform IMEs.
Medical director
- A licensed doctor and
				  approved IME examiner in the firm, partnership, corporation or other legal
				  entity responsible to provide oversight on quality of independent medical
				  examinations, impairment ratings and reports.
Medical Examiners' Handbook
- A
				  handbook developed by the department containing department policy and
				  information to assist providers who perform independent medical examinations
				  and impairment rating examinations.
Patient related services
- Patient related
				  services are defined as one or more of the following professional
				  activities:
* Direct patient care;
* Locum tenens;
* Clinical consultations for treating/attending
				  doctors;
* Clinical instruction of medical, osteopathic, dental,
				  podiatry, or chiropractic students and/or residents;
* On-call emergency services;
* Volunteer clinician providing direct patient care services
				  in his or her specialty.
Provider number
- A unique number(s) assigned to
				  a provider by the department of labor and industries. The number identifies the
				  provider and is linked to a tax identification number that has been designated
				  by the provider for payment purposes. A provider may have more than one
				  provider number assigned by the department.
Suspension
- A department action during which
				  the provider is approved by the department but not available to accept
				  referrals.
Temporarily unavailable
- Provider is approved
				  by the department but is temporarily unavailable to accept referrals.
				  Temporarily unavailable applies at the provider's request for personal reasons
				  or by the department as part of an administrative action. Provider remains
				  unavailable until the issue is resolved.
Termination
- The permanent removal of a
				  provider from the list of approved IME examiners. All IME provider numbers
				  assigned to the examiner are inactivated.
Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030,
					 51.32.112,
					 51.32.114,
					 51.32.055,
					 51.36.060,
					 51.36.070. 13-03-129, §
					 296-23-302, filed 1/22/13, effective 2/25/13. Statutory Authority:
					 RCW
					  51.32.055, 51, 32, 112 [51.32.112],
					 51.32.114,51.36.060, and 51.36.070. 09-24-085, § 296-23-302, filed
					 11/30/09, effective 3/1/10; 04-04-029, § 296-23-302, filed 1/27/04,
					 effective 3/1/04.