Everything You Need to Know about IME Transcription

Medical transcription services are highly flexible in that they can address different needs and priorities for healthcare professionals. One of the options with third-party transcription for this purpose is what’s known as independent medical examination, or IME, transcription. Here’s what you need to know about this option with medical transcription services and how it can be beneficial.

Defining IME Transcription

Independent medical examination transcription refers to documentation of a patient’s condition and status performed by a doctor who has not previously evaluated the same patient. It’s typically done for legal and/or insurance purposes that might include:

• Evaluating a patient’s eligibility for workers’ compensation
• Assessing a patient’s condition to determine the ability to return to work
• Determining the extent of disability benefits for an injury

What’s Included and Covered

This type of transcription covers a full review of a patient’s condition and related treatments and results. An IME report is what ultimately needs to be prepared by a transcriptionist that presents all the related patient information. These reports are used by attorneys, insurance professionals, or anyone else that needs an easily digestible patient summary. Such reports typically must include:

• Introduction: The introduction typically includes basic patient facts and relevant information such as the nature of the injury and the date it occurred.
• Symptom history and current complaints: These details are usually presented within what’s usually a fairly large section with appropriate subheads to allow for easier reading and reference.
• Physical findings: While an IME report is generally meant to be a review of records, there may also be a new physical examination. Results must be relevant to the reason for the IME report request, but may include additional details.
• Diagnostic results: Any image tests or other diagnostic results are also included in the report. Such information may be included within another section if it’s appropriate to do so.
• Medical records review: Finally, the report includes a listing of all medical documents and records the examiner reviewed. This information is sometimes included in the intro of the report.

Benefits for Everyone Involved

One of the reasons to have an experienced transcriptionist prepare IME reports is because such reports have a specific and unique structure, as outlined above. If anything is missing or not properly documented, patients may have decisions about benefits or claims delayed or denied. The medical professional who regularly performs medical evaluations for workers’ comp and similar purposes also benefits from transcription services. For one thing, they won’t have to take time away from other patient-related tasks to prepare detailed and very specific IME reports. Transcription services also boost IME report preparation efficiency and accuracy.

Learn What a Medical Transcription Company Can Do for You

Whether you need independent medical evaluation transcription or another approach to documenting patient information, a medical transcription company can help. It’s worth the effort to explore available services to determine how what’s offered could benefit your practice and patients.