RxD

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

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. (see service details below) 

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

Our 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
  • Savings when the physician agrees to recommended changes

Signed confirmation of the conversation is requested from the provider following the Outreach. Additional services can be provided to monitor the file and ensure the agreed-upon changes have been implemented.

Claims Resolution

ExamWorks Clinical Solutions’ Claims Resolution is a comprehensive performance solution designed to bring our client’s cases to a successful conclusion. Our multidisciplinary team of experts can address client needs from obtaining missing documentation to mitigating areas of exposure throughout the life of a claim.

Outcome Management:

  • Continuous follow-up for and review of medical records to confirm treatment and medication changes have been implemented and sustained.
    • This service is a great addition to the above noted Physician Outreach.  

Pre-MSA Resolution:

  • Obtain documentation necessary to ensure an accurate and reliable MSA from the very start

Post-MSA Resolution:

  • 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

Records Acquisition:

  • Specialists can work directly with any entity to gather documentation on the adjuster’s behalf for any reason, such as Conditional Payment services.

MSA Resolution Services

ExamWorks Clinical Solutions' MSA Resolution Services analyze MSAs and accompanying Addendums for issues which could prevent a case settlement.  Our Resolution Services team focuses on obtaining documentation, correspondence and records which could present challenges during the Centers for Medicare & Medicaid Services' (CMS) submission process, if not obtained and clarified prior to the submission process.  The service produces a reliable MSA allocation, accurately identifying cases not suitable for filing with CMS, thereby reducing the overall cost to carrier clients and the time associated with the CMS submission process. ExamWorks Clinical Solutions' MSA Resolution Services can resolve Development Letters upon issuance from CMS after submission to obtain the requested items.