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 296-23-317 - What qualifications must a provider meet to become an approved independent medical examination (IME) provider and be assigned an IME provider number?

Current through Register Vol. 24-14, July 15, 2024
To ensure that independent medical examinations are of the
				  highest quality and propriety, examiners and firms (partnerships, corporations,
				  or other legal entities) that derive income from independent medical exams must
				  apply and meet the following requirements for department approval:
(1) Examiners must:
(a) Submit an accurate and complete IME
				provider application, including any required supporting documentation and sign
				without modification, an IME provider agreement with the department.
(b) Be currently licensed, certified,
				accredited or registered according to Washington state laws and rules or in any
				other jurisdiction where the applicant would conduct an examination.
(i) The license, registration or
				certification must be free of any restrictions, limitations, or conditions
				relating to the provider's acts, omissions, or conduct.
(ii) The applicant must not have surrendered,
				voluntarily or involuntarily his or her professional state license or Drug
				Enforcement Administration (DEA) registration in any state while under
				investigation or due to findings resulting from the provider's acts, omissions,
				or conduct. The department may grant an exception for any restriction,
				limitation, or condition deemed by the department to be minor or clerical in
				nature or for a case where the restriction, limitation, or condition has been
				removed.
(iii) If any restriction
				once existed against the applicant's license, registration, or certification,
				the department must automatically deny the application if the applicant's
				record has not been clear for at least five years. If after five years the
				record has been cleared, then the department exclusively reserves the right to
				grant or deny the application based on the nature of the prior
				restriction.
(iv) Exception to the
				five-year limit may be granted for any restriction or offense deemed by the
				department to be of a minor or clerical nature.
(c) Not have had clinical admitting and
				management privileges denied, limited, or terminated for quality of care
				issues.
(i) If an applicant has any pending
				action on their privilege to practice by any court, board, or administrative
				agency, or by any health care institution such as a hospital in any
				jurisdiction, the department exclusively reserves the right to grant or deny
				the application based upon the nature of the action.
(ii) If the applicant has any criminal
				history, history of a violation of statutes or rules by any administrative
				agency, court or board in any jurisdiction, the department must automatically
				deny the application if such history exists within five years of the
				application. If such history exists but is older than five years, then the
				department exclusively reserves the right to grant or deny the application
				based upon the nature of the history.
(iii) Exception to the five-year limit may be
				granted for any restriction or offense deemed by the department to be of a
				minor or clerical nature.
(d) Have no final action by the department to
				suspend or revoke a previously assigned provider number as a treating provider
				or independent medical examiner.
(e) Have no pending civil or administrative
				action in any jurisdiction that affects the ability or fitness to practice
				medicine. The department will not process the application until the matter has
				been resolved.
(f) Have not been
				excluded, expelled, terminated, or suspended from any federally or state funded
				health care programs including, but not limited to, medicare or medicaid
				programs based on cause or quality of care issues.
(g) Have no significant malpractice claims or
				professional liability claims (based on severity, recency, frequency, or
				repetition).
(h) Have not been
				denied approval, or removed, from the provider network as defined in WAC
				296-20-01010.
(i) Attest that all information submitted on
				the application or credentialing materials is true and accurate and must sign
				under penalty of perjury.
(j)
				Comply with all federal, state, and local laws, regulations, and other
				requirements with regard to business operations, including specific
				requirements for the provision of medical services.
(k) Adhere to the independent medical
				examination standards of conduct, and all other laws, rules, and policies.
				These include but are not limited to the following:
. IME provider application agreement;
.
Medical Aid Rules and Fee Schedules
(MARFS);
. Payment policies;
.
Medical Examiners'
				  Handbook
.
(l)
				Review and sign the IME report and attest to its accuracy.
(m) Conduct examinations in a facility
				primarily designated as a professional office for medical, dental, podiatric,
				chiropractic or psychiatric examinations where the primary use of the facility
				is for medical services. The facility must not be residential, commercial,
				educational or retail in nature. The facility must be clean, sanitary and
				provide adequate access, climate control, light, space, and equipment. The
				facility must provide for the comfort and safety of the worker and for the
				privacy necessary to conduct examinations and discuss medical issues. Providers
				must have a private disrobing area and adequate provision of examination gowns
				if disrobing is required.
(n) Have
				telephone answering capability during regular business hours, Monday through
				Friday, in order to facilitate scheduling of independent examinations and means
				for workers to contact the provider regarding their scheduled examination. If
				the office is open on Saturday, telephone access must be available.
(o) Agree that either they or the department
				may inactivate their IME provider number or numbers. If an IME provider number
				has been inactivated and the examiner wishes to resume performing IMEs, they
				must reapply and meet current requirements.
(p) Agree to keep the department informed and
				updated with any new information regarding changes or actions that may affect
				their status as an IME examiner.
(q) Reapply every three years in order to
				maintain an active IME provider number.
(i)
				In the first year of the new rule, effective March 1, 2013, all current
				examiners must reapply.
(ii)
				Examiners may have until March 1, 2014, to comply with the new continuing
				education (CE) documentation requirement.
(iii) Examiners will be notified by mail
				sixty days prior to their renewal application due date.
(r) Achieve a passing score on the
Medical Examiners' Handbook
test prior to initial application
				and when renewal is due or required.