Payments/Fees

(1) The following timeframes shall exclude legal holidays. A physician performing evaluations under these Rules shall be prepaid by the employer a total evaluation fee for each evaluation performed, under a MIR Registry physician estimated timetable as outlined below (a) Completed reports that do not require a psychiatric evaluation: 1. Completed reports received and accepted by the Program Coordinator within thirty (30) calendar days of completing the examination: $1,500.00. 2. Completed reports received and accepted by the Program Coordinator between thirty-one (31) and forty-five (45) calendar days of the completing the examination: $1,250.00. 3. Completed reports received and accepted by the Program Coordinator between forty-six (46) and sixty (60) calendar days of the completing the examination: $750.00 . 4. Completed reports received and accepted by the Program Coordinator later than sixty (60) calendar days of completing the examination: No fee paid. (b) Completed reports that do require a psychiatric evaluation: 1. Completed reports requiring a psychiatric evaluation and received and accepted by the Program Coordinator within thirty (30) calendar days of completing the examination: $2,000.00. 2. Completed reports requiring a psychiatric evaluation and received and accepted by the Program Coordinator between thirty-one (31) and forty-five (45) calendar days of the completing the examination: $1,500.00. 3. Completed reports requiring a psychiatric evaluation received and accepted by the Program Coordinator between forty-six (46) and sixty (60) calendar days of the completing the examination: $1,000.00. MEDICAL IMPAIRMENT RATING REGISTRY PROGRAM CHAPTER 0800-02-20 4. Completed reports requiring a psychiatric evaluation received and accepted by the Program Coordinator later than sixty (60) calendar days of completing the examination: No fee paid. (2) The evaluation fee includes normal record review, the evaluation, and production of a standard “MIR Report.” (a) At the Program Coordinator’s discretion, the evaluation fee may be increased up to an additional $750.00 if the MIR Report appropriates diagnoses from two or more chapters of the AMA Guides™ or if the time required for the record review, evaluation, or production of the MIR Report is extraordinary, or if the production of the report requires consultation with other providers. (b) All non-routine test(s) for an impairment rating essential under the applicable edition of the AMA Guides™ to the Evaluation of Permanent Impairment shall have been performed prior to the evaluation. Routine tests necessary for a complete evaluation, such as range of motion tests, should be performed by the MIR Registry physician as part of the evaluation at no additional cost. (c) Visual acuity and field vision tests, lung and heart function tests, and any other non- routine tests, if not reasonably current, valid, and available as determined by the Program Coordinator in consultation with the MIR Physician, may be ordered at a testing facility reasonably near the worker’s residence, with the employer/insurer financially responsible for the testing. (d) Any additional x-rays that the MIR Physician deems necessary to render the MIR Report must be approved in writing by the Program Coordinator and are subject to the Medical Fee Schedule. (3) Cancellations. To be considered timely, notice of a party’s desire to cancel or reschedule an evaluation appointment shall be given to the Program Coordinator at least seven (7) business days prior to the date of the evaluation. An evaluation may be canceled or rescheduled only after obtaining the consent of the Program Coordinator. (a) If the request is made three (3) business days from the date of the evaluation or less, the MIR Physician shall be entitled to collect/retain a $500.00 untimely cancellation fee. If the evaluation is rescheduled, the MIR Registry physician is entitled to the untimely cancellation fee in addition to the entire MIR fee. (b) If, after the MIR Physician is in receipt of the medical records, the cancellation request is made less than seven (7) business days from the date of the evaluation, but more than three (3), and the evaluation is not rescheduled, then the MIR Physician shall be entitled to collect/retain a $300 cancellation fee. (4) Payment of Cancelation Fees: (a) If the employee cancels untimely with good cause or fails to appear for the evaluation with good cause, as determined by the Program Coordinator, the Program Coordinator may reschedule the evaluation, and the employer shall pay any cancellation fee. (b) If the employee untimely cancels an appointment with the MIR Physician without good cause or fails to appear without good cause, as determined by the Program Coordinator, the employer shall pay any cancellation fee(s) and may seek to recover said fee(s) upon proper application to the Court of Workers’ Compensation Claims at any subsequent hearing, upon written motion, before the Court, including a settlement approval. MEDICAL IMPAIRMENT RATING REGISTRY PROGRAM CHAPTER 0800-02-20 (5) If the employee untimely cancels without good cause or fails to appear without good cause more than once, the Program Coordinator may authorize the MIR Physician to produce an MIR Report in compliance with these Rules; provided, however, the MIR Physician shall not conduct a physical evaluation.