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Independent
Medical Examination (“IME”)
We
strongly believe that an initial IME should be performed as
quickly as possible and in any event, within 4-6 weeks of
the accident. This provides the carrier with a timely initial
diagnosis and treatment recommendation from the second opinion
doctor and strong support for the carrier’s determination
of necessity for diagnostic testing (MRI, EMG, etc.)
and amount and frequency of treatment. The longer the IME
is delayed, the greater the possibility that unnecessary testing and/or
treatment may occur and the blurrier the causal link between
the accident and the patient’s condition.
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Peer
Review
Peer Review is a strong deterrent
and a very effective method to eliminate/reduce wasteful diagnostic
claims. We find Peer Reviews handled by the doctor that performed
the initial IME on the same patient to be particularly effective.
Following a timely IME, that doctor has the best likelihood
of assessing medical necessity for additional treatment and
diagnostic testing.
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Radiological
Review
We
handle the process from start to finish, beginning with obtaining
authorization from plaintiff’s attorney where necessary.
Once the film is obtained, we send the film by messenger to
one of the many board certified radiologists on our panel.
We also have doctors on our panel who will go to the courthouse
to review film. When the review is completed, we promptly
provide a comprehensive report and store the film. Of course,
all of our panel doctors understand that they must be available
to testify.
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Review
and Settlement of Durable Medical Equipment (“DME”)
Billing
The influx of "interdisciplinary centers" has created a blizzard
of billing that has overwhelmed many of our carrier clients. We
have had great success, on an outsource basis, negotiating and
settling charges for durable medical equipment. Our experience
enables us to evaluate both medical necessity
and whether DME has been reasonably priced. We have found many equipment
providers more than willing to discount their bills to avoid
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Medical
Record Retrieval
We have an authorization-processing
unit dedicated to medical record retrieval for pending litigation.
Our diligent efforts have been greatly appreciated by otherwise
overwhelmed claims representatives. We store all records for
seven years in scanned format for easy retrieval and production,
if necessary.
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Examination
Under Oath (“EUO”)
The EUO is a cutting-edge tool with a variety
of benefits. The EUO gives the insurer
a unique opportunity to gather material information, under
oath, that will
be useful throughout the processing of the claim. For the legitimate claimant, coupled with an Independent Medical
Exam and/or Peer Review, the EUO provides the insured with a
helpful tool to ensure that treatment is necessary and proper
and not duplicative and/or excessive. And the information
learned during the EUO will establish an irrefutable record
that will discourage many fraudulent claimants and their
advisors from continuing with the charade.
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Medical Education Seminars
Metro
Medical Services is pleased to provide medical education/training
seminars to our clients, potential clients and organizations
in the industry. Recent topics have included: a simulated IME;
acupuncture and electrodiagnostic testing; medical terminology;
and MRI interpretation.
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