(Effective Until March 1, 2010.)
WAC 296-23-317   What qualifications must a provider meet to receive an independent medical examination (IME) provider number?  In order to ensure high quality independent medical examinations, the department shall only approve an IME provider number for persons, firms, partnerships, corporations or other legal entities that meet the following qualification requirements:

     (1) Providers who wish to bill or get paid for independent medical examinations or related services must apply for and receive an IME provider number. Issuance of an IME provider number does not guarantee IME referrals.

     (2) Providers must have and maintain a current license to practice in the state in which they conduct IMEs and meet at least one of the two following requirements:

     (a) Board certification in their medical specialty; or

     (b) A minimum of an average of eight hours per week over the past two years of direct patient care in their medical specialty (excluding IMEs).

     (3) Only providers in the following practice specialties who meet all other requirements may perform IMEs;

	Doctors licensed to practice:
Examiner is:	Medicine & surgery	Osteopathic medicine & surgery	Podiatric medicine & surgery	Chiropractic	Dentistry
In Washington	Yes	Yes	Yes	Yes	Yes
Not in Washington	Yes	Yes	Yes	No	Yes

     (4) A provider licensed to practice chiropractic in Washington must also meet all the following requirements:

     (a) Be a chiropractic consultant for the department for at least two years;

     (b) Take an impairment rating course approved by the department; and

     (c) Attend the department's chiropractic consultant and examiners' seminar during the twenty-four months prior to application.

     (5) Business requirements:

     (a) Providers must conduct independent medical examinations only in a professional office suitable for medical, dental, podiatric, chiropractic or psychiatric examinations where the primary use of the examination site is for medical services; not residential, commercial, educational or retail in nature. The site must have, at a minimum, adequate access, climate control, light, space and equipment to provide for the comfort and safety of the injured/ill worker and provide the privacy necessary for workers to discuss their medical issues.

     (b) Providers must comply with all federal and state laws, regulations and other requirements with regard to business operations, including specific requirements for business operations for the provision of medical services.

     (c) Providers must have a private disrobing area and adequate provision of examination gowns.

     (d) Providers must have telephone answering capability during regular business hours, Monday through Friday, in order to facilitate scheduling of independent medical 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.

     (e) In order to be assigned an IME provider number, an IME firm, partnership, corporation or other legal entity must have a medical director. The medical director must be a licensed provider and be responsible to provide oversight on the quality of independent medical examinations, impairment ratings and reports.



[Statutory Authority: RCW 51.32.055, 51.32.112, 51.32.114, 51.36.060, and 51.36.070. 04-04-029, § 296-23-317, filed 1/27/04, effective 3/1/04.]






(Effective March 1, 2010.)
WAC 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?  In order to ensure that independent medical examinations are of the highest quality and propriety, examiners, firms, partnerships, corporations, or other legal entities must apply and meet the following requirements for department approval:

     (1) For all examiner applicants:

     (a) Have a current, unrestricted, and active professional license to practice in this state or in any other jurisdiction where the applicant would conduct an examination.

     (i) Unrestricted is defined as not currently having a temporary or permanent probation, suspension, revocation or any other limitation of any kind placed on a professional license or privilege to practice by any court, board, or administrative agency in any jurisdiction.

     (ii) If any restriction once existed against the applicant's license, 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.

     (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.

     (iv) 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.

     (b) Have no final action by the department to suspend or revoke a previously assigned provider number as a treating or independent medical provider.

     (i) 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.

     (ii) 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) If an applicant has any pending action in any jurisdiction, the department will not process the application until the matter has been resolved.

     (d) Applicants must attest that all information submitted on the application is true and accurate and must sign under penalty of perjury.

     (e) Other requirements:

     (i) Providers must comply with all federal and state laws, regulations, and other requirements with regard to business operations, including specific requirements for the provision of medical services.

     (ii) Providers must 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:

     • Provider application agreement;

     • Medical Aid Rules and Fee Schedules (MARFS);

     • Payment policies;

     • Medical Examiners' Handbook.

     (iii) Providers must review and sign the IME report and attest to its accuracy.

     (iv) Providers must achieve a passing score on the Medical Examiners' Handbook test prior to initial application and every three years thereafter.

     (v) Providers must meet one of the following two criteria:

     (A) Providers must document a minimum of three hundred eighty-four hours of patient related services (excluding independent medical examinations) per calendar year; or

     (B) Providers may complete a minimum of twelve continuing medical education (CME) units of department-approved education and training per year or a total of thirty-six CMEs in three years. This training would focus on improving the provider's skills in completing IMEs or staying current in the provider's specialty. Topics include but are not limited to:

     • Report writing;

     • Providing testimony;

     • Standards of practice;

     • Medical ethics;

     • Patient care;

     • Impairment rating.

     (vi) Providers must conduct examinations in a facility designed as a professional office suitable for medical, dental, podiatric, chiropractic or psychiatric examinations where the primary use of the site is for medical services. The site must not be residential, commercial, educational or retail in nature. The site must be clean, sanitary and provide adequate access, climate control, light, space, and equipment. The site 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.

     (vii) Providers must 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.

     (viii) Providers will 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 provider wishes to resume performing IMEs, they must reapply and meet current requirements.

     (ix) Providers must keep the department informed and updated with any new information.

     (x) In order to maintain an active IME provider number, providers must reapply every three years. For the current IME providers to be in compliance with the new rule, they must reapply in the first year. Each provider will be notified by mail sixty days prior to their application due date.

     (2) Additional examiner requirements:

     (a) Medical physician and surgeon (MD) or osteopathic physician and surgeon (DO) applicants must: Hold a current board certification in their specialty; or have completed a residency and be within five years of obtaining board certification.

     (i) Residency must be in a program approved by the American College of Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA) or equivalent approving body.

     (ii) Fellowships will not be accepted in lieu of accredited residency training though they may be used to determine examination specialty qualifications.

     (b) Chiropractic physician (DC) applicants must be a chiropractic consultant for the department for at least two years.

     (c) Podiatric physician (DPM) applicants must: Have a current board certification in his or her specialty; or have completed a residency and be within five years of obtaining board certification.

     (i) Complete a residency program approved by the American Podiatric Medical Association (APMA).

     (ii) Fellowships will not be accepted in lieu of accredited residency training though they may be used to determine examination specialty qualifications.

     (d) Dentist (doctor of dental science/doctor of dental medicine) (DDS/DMD) applicants must:

     (i) Hold current certification in their specialty; or

     (ii) Have two years of postdoctoral clinical experience, and complete at least one year of postdoctoral training in a program approved by the American Dental Association Commission on Dental Accreditation (CODA).

     Only providers in the following practice specialties who meet all other requirements may perform IMEs:

	Doctors licensed to practice:
Examiner is:	Medicine & surgery	Osteopathic medicine & surgery	Podiatric medicine & surgery	Chiropractic	Dentistry
In Washington	Yes	Yes	Yes	Yes	Yes
Outside Washington	Yes	Yes	Yes	No	Yes

     (3) All other provider applicants that derive income from independent medical examinations must:

     (a) Comply with all federal and state laws, regulations, and other requirements with regard to business operations including specific requirements for any business operations for the provision of medical services.

     (b) Attest that all information submitted on the application is true and accurate and must sign under penalty of perjury.

     (c) Have no previous action taken by any federal or state agency for any business previously owned or operated.

     (d) Have no previous business or audit action by the department to suspend or revoke an assigned provider number.

     (e) In order to be assigned an IME provider number, an IME firm, partnership, corporation or other legal entity, have a medical director. The medical director must be a licensed provider, be responsible to provide oversight on the quality of independent medical examinations, impairment ratings and reports, and be available to resolve any issue that department staff may bring to the medical director's attention.

     (f) Conduct examinations in a facility designed as a professional office suitable for medical, dental, podiatric, chiropractic or psychiatric examinations where the primary use of the site is for medical services. The site must not be residential, commercial, educational or retail in nature. The site must be clean, sanitary and provide adequate access, climate control, light, space, and equipment. The site 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.

     (g) Have telephone answering capability during regular business hours, Monday through Friday, in order to schedule independent medical examinations and communicate with workers about scheduled examinations. If the office is open on Saturday, telephone access must be available.

     (h) Facilitate scheduling of providers both for the examination and for any required follow up, including amendments to the report, subsequent reports, or for any testimony required. If the provider fails to participate in scheduling or otherwise causes an undue expense to the department, whether intentionally or not, the department may fine the provider up to five hundred dollars per violation.

     (i) Agree to keep the department informed and updated with any new information such as exam site or administrative office locations, phone numbers or contact information.

     (j) Agree that either the provider or the department may inactivate their IME provider number or numbers. If an IME provider number has been inactivated and the provider wishes to resume performing IMEs, they must reapply and meet current requirements.

     (k) In order to maintain an active IME provider number, the provider must reapply every three years.



[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, § 296-23-317, filed 11/30/09, effective 3/1/10; 04-04-029, § 296-23-317, filed 1/27/04, effective 3/1/04.]