Based upon issues identified prior to or during the completion of the MSA by a Doctor of Pharmacy, we propose alternatives to high cost Medicare-covered medications, and clarify the drug regimen to produce a medically sound and supported MSA. The goal of the program is to impact medication therapy and mitigate MSA drug costs through sending the treating provider(s) a letter with proposals and clinical rationale.
RxAnalysis is a comprehensive review by a Doctor of Pharmacy (PharmD) of the medications prescribed for the injured worker. Our PharmDs identify safe, therapeutically appropriate alternatives that may be less costly than the current medications being prescribed. Through our additional Physician Outreach Service, the PharmD can collaborate with the treating provider(s) regarding the RxAnalysis results.
ExamWorks Clinical Solutions’ RxAnalysis utilizes medical records and payment histories to identify pharmaceutical areas of potential concern. Our RxAnalysis team is composed of PharmD professionals who are passionate about reducing medication costs, in addition to improving patient functionality through outreach to the treating provider.
Physician Outreach service is performed in conjunction with our RxAnalysis services. Clients receive recommendations from an ExamWorks Clinical Solutions PharmD after contact is made with the physician or provider to discuss recommendations. The PharmD provides documentation outlining:
- Recommended pharmacy changes,
- Results of the conversation with the treating provider, and
- Savings when the physician agrees to recommended changes.
Signed confirmation of the conversation is requested from the provider. Additional services can be provided to monitor the file and ensure the agreed-upon changes have been implemented.
ExamWorks Clinical Solutions’ Claims Resolution is a comprehensive solution designed to bring our client’s cases to a successful conclusion. Our multidisciplinary team of experts address client needs from obtaining missing documentation to mitigating areas of exposure throughout the life of a claim.
- Follow-up for and review of medical records to confirm treatment and medication changes have been implemented and sustained.
- Obtain documentation necessary to ensure an accurate and reliable MSA from the start.
- Obtain clarification of any pending items required by CMS for successful submission, reducing risk of development requests.
- Secure documentation necessary to decrease or eliminate the amount of identified exposure prior to CMS Submission.
- Specialists can work directly with any entity to gather documentation on the adjuster’s behalf for any reason, such as Conditional Payment services.