ATHENS eBULLETIN | December 23, 2019
Earlier this year the Department of Industrial Relations (DIR) and it’s Division of Workers Compensation (DWC) discussed the progress they’ve seen on the Department’s Independent Medical Review (IMR) program. An IMR is the dispute resolution process put together by the state’s workers’ compensation system. It is a panel of medical professionals who review decisions made by the insurance program.
As the use of Independent Medical Reviews continues to increase, we are seeing a steady decrease in the turnaround time. Overall, the industry is seeing Maximus Federal Services, Inc., (the IMR organization administering the program) overturn denial decisions at 10.33%. Contrary to industry standards, Athens Managed Care (AMC) has seen an overturn rate of only 1.14% and has found that the IMR program has not had a negative effect on the Utilization Review process confirming that Athens Managed Care is making appropriate, evidence based decisions that stand up to dispute challenges.
- Decisions Overturned – 1.14%
- Decisions Partially Overturned – 0.80%
- Decisions Upheld – 7.26%