Terms & Conditions
MIDWEST ORTHOPAEDICS AT RUSH LLC - Terms & Conditions
- Independent Medical Evaluation (IME)
- Permanent Partial Impairment Rating (PPI)
- Second Opinion, Evaluation and Re-Evaluation
MOR physicians agree to provide the following services to CLIENT:
- Independent Medical Examinations (IME)
- Second Opinions, Evaluations and Re-Evaluations
- Permanent Partial Disability Impairment Ratings (PPI)
II. MOR RESPONSIBILITIES
A. MOR will provide centralized scheduling/contact persons to assist with:
- Finding a convenient location for the IME.
- Scheduling with a Board Certified IME credentialed physician with the appropriate sub-specialty.
- Scheduling Impairment Ratings with physicians utilizing the 6th Addition AMA Guidelines.
- PPI Ratings can be scheduled independently or in conjunction with the IME with separate reporting.
- Arranging the appointment and sending notification of time, physician and location of appointment.
- Handling problems and issues promptly and efficiently through our Midwest Orthopaedics at Rush Scheduling and Customer Service teams.
B. MOR staff will schedule IME or PPI appointments within 24 hours as follows:
- 7-14 days for the first available orthopedic physician.
- Date specified or specific physician at earliest available open slot in his/her practice schedule.
- Will make every effort to accommodate specific request or make acceptable alternate suggestions.
C. MOR will facilitate timely IME / PPI Rating Reports:
- A quick report will be provided within forty-eight (48) hours if requested by Client.
- IME Detailed Reports available within ten (10) business days.
- PPI Ratings Reports available within ten (10) business days.
- MOR will send an agreement for IME pre-payment at time of scheduling and payment must be received within 14 days of appointment date.
- MOR will advise IME patients to bring a photo ID.
III. COMPANY RESPONSIBILITIES
- Client will use its best efforts to provide the IME physician with the patient's medical record at least 2 weeks before the scheduled appointment date by traceable method.
- Client will require IME patient to bring a photo ID.
- Client will pay for services in the time-frames stipulated in this agreement.
- Client will provide a professional interpreter if patient does not speak English.
IV. PAYMENT TERMS AND FEES
A. Standard IME, Re-Evaluation, Second Opinion, and Evaluation exams:
- Retail charge $1,300.
- Pre-pay $1,200.
- A standard IME is an IME for a single body part.
- The standard IME pricing includes up to 1 inch of medical records. Records over 1 inch will be subject to the additional records charges of $1,250 per inch in quarter ¼ inch increments.
B. Permanent Partial Impairment (PPI) Rating:
- Retail charge $1,300.
- Pre-pay $1,200.
- A standard PPI is a PPI for a single body part.
C. Addendums after the patient is seen are billed at $1,250 per hour in 15 minute increments.
D. Record Reviews are billed at $1,250 per inch in quarter (¼) inch increments.
E. Other Terms:
- Prepayments must be received at least 14 days in advance of the scheduled service date.
- Retail IME, Addendum, and PPI charges will be invoiced after service date.
- For each additional body part for an IME Only add an additional $300.
- For each additional body part for an IR Only add an additional $300.
- For each additional body part for an IME + IR add an additional $600 ($300 IME + $300 IR).
- Excessive record review, X-ray and DME charges incurred at time of service will be invoiced separately after service date.
- Addendums will be sent to client once payment is received (for standard IME clients).
- Invoices must be paid no later than 30 days after invoice receipt.
- All services rendered are expected to be paid.
- A cancellation or no-show fee charge of one IME body part applies if the appointment is canceled less than 2 business days prior to the scheduled time or if the patient does not show for the scheduled visit. If records exceed that which is considered to be otherwise included for purposes of the IME for a single body part, additional record review charges of $1,250 per inch in quarter-inch increments may be billed in addition to the cancellation or no-show fee.
V. APPOINTMENT SCHEDULING
IME / Workers' Compensation Appointment Scheduling Department
|Monday — Thursday||7AM — 7PM|
|Friday||7AM — 5PM|
To schedule an IME or Workers' Compensation appointment call 708-236-2783 or email SchedulingTeam4@rushortho.com.
VI. REMITTANCE ADDRESS
IME Financial Department
1 Westbrook Corporate Center #240, Westchester, IL 60154