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 Company.
- IME Detailed Reports available within ten (10) business days.
- PPI Ratings Reports available within ten (10) business days.
- MOR will invoice customer for pre-pay at time of scheduling and payment must be received within 14 days of appointment date. X-ray and DME charges incurred at time of IME and/or excess records reviewed will be invoiced separately after delivery of service.
- MOR will advise IME patients to bring a photo ID.
III. COMPANY RESPONSIBILITIES
A. Company 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.
B. Company will require IME patient to bring a photo ID.
C. Company will pay for services in the time-frames stipulated in this agreement.
D. Company 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 $1300;
- Pre-pay $1200;
- A standard IME is an IME for a single body part.
- The IME's medical record is one (1) inch in thickness or less.
B. Additional records review and addendums after the patient is seen are billed at $1,250/hr. in 15 minute increments.
C. Permanent Partial Impairment (PPI) Rating:
- Retail charge $1300;
- Pre-pay $1200; a standard PPI is a PPI for a single body part.
D. Other Terms:
- Prepaid Services must be paid at least 14 days in advance of the scheduled service date.
- Retail Services must be paid no later than 30 days after invoice receipt.
- 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).
- Cancellation fee of 100% applies if appointment is cancelled less than 2 business days prior to scheduled time.
V. APPOINTMENT SCHEDULING
IME / Workers' Compensation Appointment Scheduling Department
Hours of operation: Monday - Thursday: 7:00 a.m. - 7:00 p.m. Friday: 7:00 a.m. - 5:00 p.m.
To schedule an IME or Workers' Compensation appointment call 708.236.2783 or email SchedulingTeam4@rushortho.com.
VI. REMITTANCE ADDRESS
Midwest Orthopaedics at Rush LLC
One Westbrook Corporate Center Suite #240
Westchester, IL 60154
Attn: Janice Ewing