Search
296-23-312  <<  296-23-317 >>   296-23-322

WAC 296-23-317

Agency filings affecting this section

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

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.
(2) Requirements for specific examiner specialties:
(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 become board certified within five years of completing the residency.
(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) Podiatric physician (DPM) applicants must: Have a current board certification in their specialty or have completed a residency and become board certified within five years of completing the residency.
(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.
(c) Chiropractic physician (DC) applicants must be a chiropractic consultant for the department for at least two years and attend the department's chiropractic IME seminar in the twenty-four months before initial application.
(d) Dentist (doctor of dental science/doctor of dental medicine) (DDS/DMD) applicants must have at least two years of clinical experience after licensure, and:
(i) Hold current certification in their specialty; or
(ii) Have one year of postdoctoral training in a program approved by the American Dental Association Commission on Dental Accreditation (CODA); or
(iii) Be a general dentist.
(3) All examiners must meet the continuing education (CE) requirement for their respective state licensure. Washington state CE requirements are shown in the table below.
 
Doctors licensed to practice:
 
Medicine
& surgery
Osteopathic
medicine
& surgery
Podiatric
medicine
& surgery
Chiropractic
Dentistry
Required continuing education hours:
50 hours per year or 200 hours in 4 years
50 hours per year or 150 hours in 3 years
25 hours per year or 50 hours every 2 years
25 hours per year
21 hours per year
Applicants must submit documentation of CE hours with their initial application and when renewal is due or required. This training must focus on subject areas relevant to the provider's specialty or skills required to complete IMEs.
Exception: The requirement to submit CE documentation will be waived for applicants who provide documentation of a minimum of seven hundred sixty-eight hours of patient related services (excluding independent medical examinations) per calendar year.
Only examiners 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
(4) IME firms (partnerships, corporations or other legal entities) that derive income from independent medical examinations must:
(a) Have a medical director. The medical director must be a licensed medical physician and surgeon (MD) or osteopathic physician and surgeon (DO), 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.
(i) IME firms conducting exams in Washington state must have a medical director who has a Washington state medical license.
(ii) The medical director must be an approved independent medical examiner.
(b) Have no previous business or audit action by the department to suspend or revoke an assigned provider number.
(c) Have no previous action taken by any federal or state agency for any business previously owned or operated.
(d) 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.
(e) Attest that all information submitted on the application is true and accurate and must sign under penalty of perjury.
(f) Comply with all federal, state, and local laws, regulations, and other requirements with regard to business operations including specific requirements for any business operations for the provision of medical services.
(g) 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.
(h) Ensure that examinations are conducted 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.
(i) 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 an exam site is open on Saturday, telephone access must be available.
(j) Agree that either the firm or the department may inactivate their IME provider number or numbers. If an IME provider number has been inactivated and the firm wishes to resume related services, they must reapply and meet current requirements.
(k) 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.
(l) 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 IME firms must reapply.
(ii) Firms will be notified by mail sixty days prior to their renewal application due date.
(m) Have their medical director and a representative from their quality assurance (QA) staff achieve a passing score on the Medical Examiners' Handbook test prior to initial application and when renewal is due or required.
[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.112, 51.32.114, 51.32.055, 51.36.060, 51.36.070. WSR 13-03-129, § 296-23-317, filed 1/22/13, effective 2/25/13; WSR 11-01-069, § 296-23-317, filed 12/10/10, effective 1/10/11. Statutory Authority: RCW 51.32.055, 51,32,112 [51.32.112], 51.32.114, 51.36.060, and 51.36.070. WSR 09-24-085, § 296-23-317, filed 11/30/09, effective 3/1/10; WSR 04-04-029, § 296-23-317, filed 1/27/04, effective 3/1/04.]