The folks at ExamWorks reached out to me a while back about their MSP business, and specifically about a pending acquisition, namely Optum’s Settlement Solutions.

[Note there is no press release for this transaction; Optum requested ExamWorks not do a release.]

That has closed – today – so I can now publish my interview with Exam’s Christie Britt, President of ExamWorks Compliance Solutions… edited for clarity and brevity.

MCM – Why is Examworks focusing on the MSP space?

Britt – ECS has an established long history with MSP compliance, founded as Gould & Lamb in 2004 and merged with MedAllocators, and subsequently acquired by Examworks in 2014.  Medicare compliance has become increasingly complicated over the last fifteen years as the volume of liens has exploded and as CMS has taken steps to connect the dots to coordinate benefits.  MSP is very specialized, requiring expertise in claims systems, medical expertise, and Medicare compliance.  Payers are concerned about being compliant to avoid penalties and the risks must be addressed by specialists.

Our desire to be the leader in MSP compliance drives us to focus on this space.

MCM – How will this help ECS compete going forward?

Britt – ECS will bring to market the largest Section 111 Reporting program with the most file specifications to share data, the largest data aggregation engine, most configurable interfaces to accommodate the smallest to largest reporting clients and the most robust rules engine.

We will also have the largest team of MSP experts in the industry with the most tenured knowledge and experience to service the MSP industry.

MCM – Does ECS offer the full range of MSA/MSP services?

Britt – Yes, ECS will continue to offer the full suite of MSA / MSP Services for all customers.  Our core business is and will remain offering a fully integrated Section 111, MSA and conditional payment resolutions solution and tailored to our client’s risk appetite that fit seamlessly into any claim handling program.

MCM – The reporting issue is just one of the components of MSA/MSP services…how does this acquisition impact those other components?

Britt – Section 111 Reporting ties all aspects of MSP compliance together and can no longer be viewed as separate components. We are seeing CMS connect the last remaining “dots” by requiring Mandatory MSA reporting effective April 2025 (See more detail below). This changes the voluntary process of submitting an MSA to the WCRC for review and approval to a required reporting element that may generate a Civil Money Penalty if not handled appropriately.

This acquisition will impact the other areas of MSP compliance by providing a large portion of the industry with a solution that ties all aspects of MSP compliance together from the onset of the claim to its closure, designed to proactively identify claims that needs attention before they become a compliance issue and driving up the cost of the claim.

MCM – CMS continues to waffle around MSP and MSA requirements leading to confusion and uncertainty – and some strong disagreement among payers on core issues. What is ECS’ view on the importance/significance/utility of the MSA/MSP process?

Britt – Medicare has recently announced changes to Section 111 that will require payers to report an MSA amount on all reported workers’ comp settlements beginning with claims (including $0.00 settlements) that settle on or after April 4, 2025.

CMS promises to use this data to deny treatment at the point of sale, communicate with beneficiaries, and (if ignored) enforcement against the claims payer.

In addition, CMS has made a number of technical changes to tie section 111 data with the common working file to better coordinate benefits and pursue recovery for past Medicare payments.  Section 111 reporting is an important obligation required under federal law, and because CMS continues to build enforcement activities around it, MSP issues have more claims impacts today than really at any point in the past.  Take, for example, Medicare conditional payments (aka liens).  CMS continues to misapply Section 111 reporting data and attempt to recover from workers’ comp claims payers for dormant / closed claims and – even if the claim is open and active – for unrelated medical care.  For this reason, and many more, conditional payments are a major area of compliance that requires payers to be cognizant of the claims impact of Section 111 reporting.

What does this mean for you?

ExamWorks continues to grow.

Next – what’s up with Optum?

Physical medicine management firm MedRisk will acquire Conduent’s Casualty Claims Solutions business.

So…what and why and how?

What will MedRisk do now?

Improve Conduent’s performance is Job One.  
Conduent has – to be kind – struggled to deliver customer service, to respond to client needs, to keep systems, regulations, and fee schedules updated, to keep its customers much less win new ones, to actually perform. MedRisk has a wealth of experience and expertise in turning around an entity with those problems, has the staff and internal knowledge to help fix Conduent’s major issues, and has the leadership to actually get it done.

Stabilizing the current business is the first, and by any measure the most important task.

I’d note that MedRisk is the most successful physical management company in the space because it listens to its customers; partners – in the truest sense of the word – with them and works very hard to make payers’ front-line staff’s jobs easier, less stressful and less complicated. (I know, MedRisk is not perfect, no organization is…)

That corporate culture will be hugely helpful for Conduent’s bill review clients.

Why did MedRisk do this deal?

Data.

It’s all about the data.  I CANNOT emphasize this enough.

MedRisk’s analytics folks are quite adept at assessing provider performance  – “performance” being based on what its customers value. Payers want more control over physical medicine (which is one of the fastest growing costs in workers’ comp). Now, with access to terabytes of data on provider billing, treatment practices, related services e.g. surgeries, medications, facility visits, treatment documentation, claim demographics, duration of care and lots of other hugely valuable data points, MedRisk will be able to help customers better:

• assess and identify high- and low- performing providers
• get instant notice of changes in billing patterns (e.g. new Revenue Cycle Management tricks designed to hoover dollars out of payers’ pocketbooks)
• reduce leakage from provider networks
• evaluate treatment plans to identify effective and less effective approaches to specific types of claims, diagnoses, and cases
• and a host of other things we haven’t yet thought of.

How?

Is MedRisk – a rehab management company (!!!) – becoming the major provider of bill review services which are generally recognized as the most important and impactful of workers’ comp services?

Simply put, because it is very well run, has a really impressive growth record of late, and is worth a ton of money. That corporate equity gives it a relatively low cost of capital and access to even more investment.

Finally…

I’ve worked with MedRisk for more than 2 decades. In no way am I responsible for or attempting to take credit for what Shelley Boyce, Mike Ryan, Sri Sridharan, Michelle Buckman, Ed McBurnie, Vic Pytleski, Rommy Blum, Jamie Davis, Tom Weir, Mary O’Donoghue and many others from the most senior to the least senior workers have accomplished.

The company’s leaders – starting with Shelley and continuing to today – have focused on doing right by customers and pushed that ethos throughout the organization. Yes, MedRisk had its stumbles along the way…but it recovered and became more successful by learning from those mistakes and returning to its core principles.

What does this mean for you?

Success is all about delivering your customers what they want how they want it.