Technology

Mandatory Reporting

 

What is Section 111 of the Medicare/Medicaid SCHIP Extension Act?

Mandatory Insurer Reporting requires Non-Group Health Plan (Workers’ Compensation, Liability and No-Fault) Responsible Reporting Entities (RREs) to report qualifying claims to Medicare in a specific format and time frame.  The Act serves four purposes for Medicare:

  •          Discover billions in unresolved Medicare liens or conditional payments and seek immediate recovery.
  •          Cease making ongoing conditional payments in the future.
  •          Ensure that all settlements adequately consider and allocate Medicare’s interests as required by law.
  •          Potential $1,000 per day per claim fine for non-compliance.

Section 111 Mandatory Insurer Reporting enforces the Medicare Secondary Payer Act, and non-compliance may result in severe monetary penalty.

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The ExamWorks Clinical Solutions Difference

ExamWorks Clinical Solutions has the largest and most experienced team of MMSEA Compliance Managers.  From mundane Annual RRE Recertifications to complex analysis of claims for reporting to Medicare, the MMSEA Compliance Managers assist every step of the way.

Our proprietary MMSEA platform is a sophisticated platform. From manual data entry via the web portal to fully integrated data file exchanges, the ExamWorks Clinical Solutions platform ensures that all types of client systems can integrate successfully and easily.  Features include:

  •          Simple, intuitive web portal to provide claims data
  •          Secure file exchanges via SFTP / HTTPS
  •          Data scrubbing features that result in unmatched CMS acceptance rates
  •          Dedicated technical and compliance support

Business Intelligence

ExamWorks Clinical Solutions’ business intelligence portal delivers reports that measure clients' compliance rates and assist in client stewardship activities.

TPAs manage claims for countless carriers and self-insured entities or Responsible Reporting Entities (RREs).  Analysis of a TPA’s MMSEA performance will make certain the TPA is providing the best possible service to its clients.  The ExamWorks Clinical Solutions business intelligence suite  provides TPAs with RRE-level insights to determine metrics related to data cleanliness and potential gaps in business processes. Likewise, carriers and self-insured entities have full visibility into each TPA’s performance, analyzing cleanliness of data, timeliness of correcting errors and acceptance rates at Medicare.

ExamWorks Clinical Solutions continues to search for opportunities to utilize data to enhance clients’ compliance programs and outcomes.