Today’s issue of WorkCompRecap features the release of a new report from CWCI that examined IMR decisions issued in 2014 and found that the new process is generally working to help make sure care is meeting evidence-based standards. Notably 94.1% of medical service requests are approved by UR, leaving only 5.9% even eligible for IMR.
The study looked at 137,781 IMR determination letters and found that independent reviewers agreed with UR doctors’ modification or denial 91% of the time. Prescription drugs including compounds and opioids were by far the most common type of treatment submitted for IMR, accounting for 45% of decisions, with UR denials or modifications upheld in 92% of drug IMRs. The analysis also found that 10% of physicians accounted for the majority (83%) of disputed services.
Find out more (including a link to the free report!) by clicking here!