Independent Medical Examinations (IMEs)
Independent medical examinations are performed by credentialed physicians, instead of the treating provider, to establish an informed expert opinion on the validity and nature of a diagnosis. In preparation, all medical records are collected and questions prepared for the physician examiner to ensure all the relevant issues are addressed. Final reports are quality assured, tailored to meet state-specific and turn around time requirements, and available on ExamWorks' or respective client portal. In the event of arbitration or litigation, expert testimony, a specialty among our credentialed physicians, provides an informed evidence-based opinion about the questions in the case.
Peer Reviews are paper-based evaluations prepared by credentialed physicians to provide an informed expert opinion about the appropriateness of care, medical necessity and related issues. The review type, prospective, current, retrospective, medical-legal, or appeal, is specified by the client, including whether physician peer or nurse to physician discussions are required. All medical records are collected, and questions prepared for the physician reviewer. Final reports are quality assured, tailored to meet state-specific content and turn around time requirements and available on ExamWorks' or respective client portal.
Bill Review service offerings examine the specific medical care rendered and how its relevance and cost conform to industry accepted standards of care. The services are evidence-based, defensible and durable. Bill Reviews are prepared in accordance with industry guidelines and consistent with most jury instructions. Straightforward in their simplicity and understated in their power as an effective negotiation tool, Bill Reviews are used to facilitate the adjudication, settlement or resolution of a medical bill or claim, providing a standard for compensability relative to reasonable and necessary medical expenses.
Third-Party Bill Review:
Auto and Liability
ExamWorks is the best resource to help formulate demand packages which require an accurate and reasonable measure of what is owed on past and future medicals. Certified Professional Coders or Nurse Certified Professional Coders conduct the audit. Coders can present as expert witnesses to defend all report findings.
Upon request for review ExamWorks will:
- Ensure bills are coded properly
- Determine accurate UCR, Fee Schedule or Medicare values
- Identify inappropriate billing e.g., upcoding, unbundling and balance billing, and
- Provide values to assist settlements.
ExamWorks provides clients with detailed data analytics, fact-based narrative for each deduction analyzed, and profile in a comprehensive report. There are three tiers of service depending on the need.