Today’s issue of WorkCompRecap features the release of a new report from CWCI that examined the independent medical review (IMR) medical dispute resolution process in California, and found that review volume rose, while high uphold rates continue.
The study found that in the first half of 2018, 89,843 IMR decision letters were issued, representing an increase of 4.4% from the first half of 2017, with the average number of primary treatment decisions in the letters unchanged at 1.8 decisions. While volume was up in the first half of 2018, outcomes remained relatively unchanged, with 90.7% of all utilization review (UR) physicians’ modifications or denials of treatment that were reviewed by an IMR physician upheld, falling in line with the 91.2% uphold rate in 2017. As with past analyses, prescription drug requests represented nearly half of this year’s IMR decisions, led by opioids.
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