ExamWorks Clinical Solutions

ExamWorks Clinical Solutions Insurance Review

ExamWorks Clinical Solutions is a prominent player in the field of Medicare compliance and Mandatory Insurer Reporting (MIR). They offer a suite of services designed to help navigate the complexities of Medicare Secondary Payer (MSP) regulations. This comprehensive review delves into their services, pricing, customer support, and overall reputation, providing a clear understanding of what ExamWorks offers and whether it aligns with your needs.

Overview of ExamWorks Clinical Solutions

Year of Establishment and Background Story

Established in 2001, ExamWorks Clinical Solutions has solidified its position as a leader in independent medical examinations (IMEs), peer reviews, bill reviews, and, most notably, Medicare compliance. Their early focus on MSP compliance propelled their growth, leading to a comprehensive service portfolio that addresses various aspects of healthcare claims management. The company's expertise extends beyond the US, with operations in Canada, the United Kingdom, and Australia.

Key Milestones in the Company’s History and Growth

• 2001: Founded, establishing a strong foothold in the nascent MSP compliance market.
• URAC Accreditation: Achieved accreditation by URAC under their IME Standards, a testament to their commitment to quality and fairness.
• International Expansion: Expanded operations globally, demonstrating scalability and adaptability in diverse healthcare systems.

Regulatory Compliance and Licenses

ExamWorks' commitment to regulatory compliance is paramount. Their core services are deeply intertwined with federal and state regulations. This commitment is reflected in their key certifications and adherence to guidelines:

• URAC Accreditation: Holding URAC accreditation for IME services demonstrates adherence to industry best practices and a focus on quality assurance. This accreditation provides a level of assurance to clients regarding the integrity and fairness of their processes.
• CMS Compliance: The company diligently follows Centers for Medicare & Medicaid Services (CMS) guidelines, ensuring their services are compliant with evolving Medicare regulations. This proactive approach minimizes the risk of penalties and ensures accurate reporting.

Insurance Products and Services

Main Insurance Products

Types of Insurance Offered

It’s crucial to understand that ExamWorks Clinical Solutions doesn't offer traditional insurance products like life, health, auto, or homeowner's insurance. Their focus is exclusively on Medicare compliance and MSP-related services. Their key offerings include:

• Medicare Set-Asides (MSAs): These are crucial for resolving potential conflicts between workers' compensation or liability settlements and Medicare's coverage of future medical needs. ExamWorks prepares detailed reports estimating the costs of future Medicare-covered treatment, ensuring proper allocation of funds and compliance with regulations.
• Conditional Payment Services: ExamWorks assists in resolving conditional Medicare payments, helping clients navigate complex reimbursement processes and avoid potential liabilities stemming from disputes and appeals. This expertise simplifies the often cumbersome process of resolving Medicare's involvement in settlements.
• Section 111 Mandatory Insurer Reporting (MIR): ExamWorks provides comprehensive reporting solutions to meet the stringent requirements of the MMSEA Section 111, helping clients avoid costly penalties associated with non-compliance. Their expertise ensures accurate and timely reporting, minimizing risk.

Coverage Options and Policy Details

• MSA Reports: Prepared by certified allocators using detailed medical evidence, ensuring accuracy and compliance.
• Life Care Plans (LCPs): ExamWorks provides objective reviews of existing Life Care Plans, verifying the accuracy and reasonableness of projected future medical needs and costs. This ensures that settlements are fair and reflect the actual needs of the injured party.

Additional Services

Beyond their core Medicare compliance services, ExamWorks also offers a range of supporting services that enhance their overall value proposition:

• Independent Medical Examinations (IMEs): Provided by a network of credentialed physicians and allied medical professionals, ensuring objective and reliable assessments.
• Peer Reviews: Comprehensive reviews of claims, verifying their validity and ensuring accurate reimbursement.
• Record Retrieval and Document Management: Streamlining the often-challenging process of obtaining, organizing, and securely storing medical records.

Premiums and Pricing

Pricing Structure

ExamWorks Clinical Solutions does not operate on a traditional insurance premium model. Instead, their pricing is based on a fee-for-service structure. The cost of each service is determined by the complexity and scope of work required. Specific pricing details are not publicly available and are typically negotiated based on individual client needs and the specific services required.

Discounts and Special Offers

Currently, there are no publicly advertised discounts or special offers from ExamWorks Clinical Solutions. Pricing is customized to each client’s specific situation, ensuring a tailored approach to their Medicare compliance needs.

Customer Service and Support

Contact Methods

While specific contact details aren't readily available on public platforms, it's reasonable to assume ExamWorks provides multiple avenues for customer communication. Contact information is typically accessible through their official website or by directly contacting their sales team. Potential methods include:

• Phone Number: A dedicated phone line is likely available for inquiries.
• Email: A contact email address is usually provided for non-urgent inquiries.
• Live Chat: Some companies offer live chat support on their websites for immediate assistance.

The availability of 24/7 support and multilingual assistance is not explicitly confirmed but could be available based on client needs and the urgency of certain situations.

Pros and Cons of ExamWorks Clinical Solutions Services

Pros

• Comprehensive Coverage: ExamWorks offers a wide range of services addressing virtually all aspects of Medicare compliance and MSP issues.
• Expertise: Their team possesses extensive experience in both clinical and legal aspects of Medicare compliance, ensuring accurate and defensible results.
• Customizable Solutions: They adapt their services to meet the unique needs of each client, providing tailored solutions.

Cons

• Limited Traditional Insurance Offerings: ExamWorks does not provide traditional insurance products. Their services are strictly focused on Medicare compliance.
• Complex Pricing Structure: The fee-for-service model, while flexible, may require detailed discussions to fully understand the costs involved.

Conclusion

ExamWorks Clinical Solutions provides valuable expertise in navigating the complexities of Medicare compliance. Their comprehensive suite of services, from MSAs to Section 111 reporting, makes them a strong choice for organizations needing assistance in this specialized area. However, it's crucial to understand their services are targeted toward Medicare compliance and do not encompass traditional insurance products.

Frequently Asked Questions about ExamWorks Clinical Solutions

1. What services does ExamWorks Clinical Solutions offer? ExamWorks offers a range of services including Medicare Set-Asides (MSAs), Conditional Payment Services, Section 111 Mandatory Insurer Reporting, IMEs, peer reviews, record retrieval and document management.
2. Is ExamWorks Clinical Solutions accredited? Yes, they are accredited by URAC for their IME services.
3. Where is ExamWorks Clinical Solutions located? Their headquarters is at 2397 Huntcrest Way, Lawrenceville, Georgia, 30043, United States.
4. How many employees does ExamWorks Clinical Solutions have? ExamWorks employs 201-500 people.
5. What is ExamWorks Clinical Solutions' annual revenue? Their annual revenue is estimated to be between $50 million and $100 million.

References

• [2] Placeholder URL for Company Information
• [3] Placeholder URL for URAC Accreditation
• [4] Placeholder URL for Medicare Compliance Services
• [5] Placeholder URL for About ExamWorks