The Centers for Medicare and Medicaid Services has chosen Performant Financial Corp. as its Commercial Repayment Center contractor to replace CGI Federal.
The announcement of a new CRC contractor comes after CMS said in an August report that the CRC had recovered $106 million in fiscal year 2016 out of $244 million in payments identified as owed to Medicare. The amount was a decrease from $150 million recovered in fiscal year 2015 despite the expanded pool of payers for CRC to pursue.
Daniel Anders, chief compliance officer for Tower MSA Partners, compared the non-group recovery amount to the billions of dollars spent each year on workers’ comp medical benefits.
“When you consider that the CRC’s authority to recover on behalf of Medicare encompasses all non-group health plans who have accepted responsibility for injury-related medicals, $6 million seems fairly small,” Anders said on Tuesday.
The full article may be found here.
NAMSAP’s MSP Policy Palooza 2017 takes place September 27-29 in Baltimore.
Tower MSA Partners’ CEO Rita Wilson and Chief Compliance Officer Daniel Anders, MSCC will participate in two sessions at the National Alliance of Medicare Set Asides Professionals (NAMSAP) Annual Conference this month.
New rules, new contractors, new risks, and the ever-changing healthcare landscape keep the Medicare Secondary Payer industry in constant flux. Where is it heading and how can MSP companies guide clients through changes? Wilson will join Gary Patureau, of the Louisiana Association of Self Insured Employers (LASIE), Optum’s Lavonya Chapman, and Sedgwick’s Michael Merlino to examine trends and prognosticate about the future. “MSP Predictions” will start at 10:45 a.m. on September 29.
“With a new Workers’ Compensation Review Contractor (WCRC), a new WCMSA re-review announcement and the potential for changes with Liability MSAs, payers need MSP guidance now more than ever,” Wilson said. “Presented from the payers’ perspective, this session will focus on the challenges of the current environment, future predictions and a ‘call to action’ for the MSP industry to drive future behaviors.”
Anders and Contact Claims Services’ Jeff Knipper will present the “Alignment of MSP Processes” on September 27 at 4:30 p.m. This session explores the connection among Section 111 reporting, conditional payments and MSAs.
“Traditionally the industry has viewed these as separate activities and kept them in silos,” Anders said. “But each impacts the other and you need a continuous, cohesive process to accurately manage every aspect.”
NAMSAP’s MSP Policy Palooza2017 will be held at the Renaissance Baltimore Harborplace Hotel September 27-29. For more information, please see http://www.namsap.org/page/2017AnnualConference.
The full article may be found here.
Tower MSA Partners will host a free webinar on Medicare Advantage and Part D Plan Recovery Rights on October 4 at 12:00 PM EDT. Tower MSA Partners is pleased to have Brian Bargender, of Humana, as the guest presenter for the Webinar. Humana is the second largest Medicare Advantage Plan and Part D plan in the country and has been the leading advocate for seeking reimbursement under the MSP Act from primary payers and Medicare beneficiaries for payments made through these plans.
Areas covered in the presentation are:
- Intro to Medicare Advantage and Part D Plans
- MSP guidance provided by CMS to MA and Part D Plans
- MA and Part D MSP enforcement rights
- Obstacles to enforcing MSP
- Tips for addressing MSP with MA and Part D plans
To register for the Tower MSA Premier Webinar, click here.
To read more about the Webinar, click here to read article posted on WorkersCompCentral about the Webinar.
Tower MSA Partners Chief Compliance Officer, Dan Anders, spoke with WCI-TV’s Ed Heiland about Tower MSA’s theme this year at WCI 2017 Conference. Tower MSA’s theme this year is a discussion on opioids that delves on intervention strategies, claim techniques, PBM tools, MSA impact, and public policy. Dan’s interview with Ed Heiland may be found here.
During WCI 2017 Conference, Dan Anders also spoke to Michael Calendrillo, from WCI-TV, about the latest in Medicare Secondary Payer compliance topic in Day 2 of the conference. Dan’s interview with Michael Calendrillo may be found here.
Other notable WCI-TV interviews during the WCI 2017 Conference include:
- Mark Pew, Senior VP, Prium, speaking to Kimberly Bottom, from WCI-TV, about the importance and the process of using Physician Peer Review for reducing the use of Opioids. Video of the interview can be found here.
- Phil Walls, RPh, Chief Clinical and Compliance Officer, myMatrixx, speaking to Kimberly Bottom about the role of a Pharmacy Benefit Management (PBM) in addressing Opioid abuse. Video of the interview can be found here.
- Melvin Phol, MD, FASAM, Chief Medical Officer, Las Vegas Recovery Center speaking to Kimberly Bottom about Opioid addiction. Video of the interview can be found here.
- Kimberly George, SVP of Corporate Development, M & A and Healthcare, Sedgwick and Mark Walls, VP, Communications & Strategic Analysis, Safety National speaking with Ed Heiland, from WCI-TV, about hosting Centers for Excellence that brings cutting edge topics related to Workers Compensation and Women’s Alliance. Video of the interview can be found here.
- Kimberly George and Mark Walls’ speaking with Ed Heiland about the Centers for Excellence’s Risk Management track related to private equity investing in workers compensation and the National Workers Compensation Review in part 2 of the interview. Video of the interview can be found here.
- Carrie Struzynski, RN, LHRM, CHRM, MSN, PhD, speaking with Kimberly Bottom about how Randstad addresses opioids on worker’s compensations claims. Video of the interview can be found here.
Tower MSA Partners is sponsoring WCI-TV, the televised coverage of Workers’ Compensation Institute’s Workers’ Compensation Education Conference, and is dedicating its TV segments to examining opioids.
“Tower is pleased to partner with WCI to sponsor WCI-TV for the 3rd consecutive year and participate in the interview process throughout the conference. With opioid use in the forefront of issues facing workers’ compensation payers, we will explore prescribing habits, addiction and interventions from different disciplines within the system,” said Rita Wilson, CEO of Tower MSA Partners.
Some of the perspectives and industry leaders featured in Tower’s interviews are:
- Claims Management – Carrie Struzynski, RN, LHRM, CHRM, MSN, PhDc, Quarterback/Senior Manager, Risk Management, Safety & Insurance, Randstad North America, Inc.
- MSP Compliance – Dan Anders, Chief Compliance Officer, Tower MSA Partners
- Peer Review – Mark Pew, Senior Vice President, PRIUM
- Physician – Mel Pohl, MD, FASAM, Chief Medical Officer, Las Vegas Recovery Center
- Pharmacy Benefit Management – Phil Walls, RPh, Chief Clinical & Compliance Officer, myMatrixx
- Public Policy – Mark Walls, Safety National’s Vice President of Communications, and Kimberly George, Senior Healthcare Advisor, Sedgwick Claims Management Services
From its studios near the exhibit hall, WCI-TV’s programming will be aired throughout the conference area, in conference hotels’ guest rooms, on shuttles, WCI’s website, e-blasts, and on You Tube. It is produced by CNTV, a Winter Park, Florida-based company that delivers a news approach to the convention television business.
The 2017 WCI WCEC will be held August 6-9 at the Orlando World Center Marriott.
The full article may be found here.
Patricia Smith, RN, BSN, MSCC, CDMS, CLCP has joined Tower MSA Partners as executive vice president of Clinical Operations. In this role, Smith reviews and monitors clinical trends related to Medicare coverage criteria within the confines of Medicare Secondary Payer compliance, develops clinical strategies to support company’s pre- and post-Medicare Set-Aside intervention workflow and manages all clinical and pharmaceutical oversight teams.
Most recently Smith served as senior vice president of Clinical Solutions Services for Examworks Clinical Solutions. In previous positions with MedAllocators, Concentra Integrated Services, Coventry Workers Compensation, and NuQuest Resources, she produced Medicare Set-Asides, Medical Cost Projections, and Life Care Plans.
“Pat has been involved with MSP compliance and MSAs in work comp for more than 14 years,” said Tower CEO Rita Wilson. “Her clinical expertise, track record of innovation and results-driven management philosophy make her a perfect fit to lead Tower’s clinically driven model to optimize the MSA and settlement.”
A graduate of the University of Maine with a bachelor’s of science degree in nursing, Smith holds several professional credentials. She is a Medicare Set Aside Consultant Certified (MSCC), a Certified Disability Management Specialist (CDMS), a Certified Life Care Planner (CLCP), and a legal nurse consultant. She is also a member of the National Alliance of Medicare Set Aside Professionals and International Association of Rehabilitation Professionals.
Tower MSA Partners CEO, Rita Wilson, who is a board member of the National Alliance of Medicare Set-Aside Professionals (NAMSAP), has been elected Treasurer of the organization. Full details on her election as well as the election of other board members to leadership positions is detailed in the following NAMSAP new release:
ELMHURST, Ill.–(February 2, 2017)–The board of directors of the National Alliance for Medicare Set-Aside Professionals has elected the following officers for 2017:
- President: Shawn Deane, JD, MEd, MSCC, CMSP – assistant vice president of Product Development of ISO Claims Partners
- Vice President: Greg Gitter, CMSP – president of Legacy Claims Solutions, Inc. (a Gitter Company)
- Treasurer: Rita M. Wilson – CEO of Tower MSA Partners
- Secretary: Christine Melancon, RN, CCM, MSCC, CNLCP, CMSP – vice president of Operations for EZ-MSA Services
“I am honored to be selected to represent NAMSAP as president,” said Deane. “We will build upon initiatives launched by last year’s outstanding President, Gary Patureau, and forge new opportunities to improve Medicare Secondary Payer services.”
Addressing the opioid epidemic remains a top priority, and NAMSAP will continue its efforts to persuade the Centers for Medicare and Medicaid Services (CMS) to follow its own Part D guidelines when reviewing and approving Workers’ Compensation Medicare Set-Asides (WCMSAs). NAMSAP will also monitor CMS’ selection of a new Workers’ Compensation Review Contractor and the evolution of the Commercial Recovery Center.
“Promoting payer participation in NAMSAP is another high priority,” Deane added. “We are delighted to add Beth Hostetler with Albertsons and Safeway to our board of directors and look forward to better representing the MSP goals for both payers and submitters.”
Other new board members are Amy Bilton with Nyhan Bambrick Kinzie & Lowry and Monica Williams, MWC Associates.
The National Alliance of Medicare Set-Aside Professionals (NAMSAP) is the only non-profit association exclusively addressing the issues and challenges of the Medicare Secondary Payer Statute and its impact on workers’ compensation and liability settlements. Through the voluntary efforts of our members, NAMSAP is a forum for the exchange of ideas and is a leading resource for information and news in this constantly evolving area of practice. The collective knowledge of our members and NAMSAP’s resources will provide attorneys, nurses, settlement planners, claims professionals, and others with the ingredients essential to their success.
Tower MSA Partners CEO, Rita Wilson, is the subject of a recent Workcompcentral article, Focus on Tech Has Guided MSP Compliance Co. CEOs Career, highlighting how Rita’s career in building better pharmaceutical and worker’s compensation technology systems led her to develop a Medicare Secondary Payer (MSP) technology platform which electronically integrates medical and cost-containment information.
In discussing why the MSP compliance technology platform is a difference maker for Tower MSA, Workcompcentral’s Emily Brill quotes Rita:
Tower MSA has differentiated itself by building out a software system that monitors and shares claim information from beginning to end, integrating medical and cost containment information for “continuity” and to avoid “reinventing the wheel” by scrambling to get information from separate sources.
The article further quotes Rita in explaining how the platform assists Tower MSA in providing MSP compliance services to its clients:
Our technology platform is able to track claim information all the way through, through the conditional payment research process, through the intervention process, through the MSA process. What we did was integrate this information and track it with one software application that allows us to measure the progress each month, and determine when the right time to finalize the MSA.
In understanding the benefits of Rita’s focus on technology in MSP compliance, Ms. Brill spoke to Ann Schnure, the former Vice-President of Risk Management for Macy’s, and also a strong proponent of the use of technology in claims handling, who said of Rita:
Wilson’s focus on technology has always given the CEO an edge.
To learn more about how Tower MSA Partners’ technology platform can give you an “edge” in MSP Compliance please contact Rita Wilson at email@example.com or 888.331.4941.
In a widely acclaimed presentation at the recent 2016 National Workers Compensation and Disability Conference, Jennifer Saddy, Workers’ Compensation Director for American Airlines and Mark Pew, Senior Vice President of PRIUM, detailed the successful cooperation among American, PRIUM and Tower MSA to reduce pharmacy costs, litigation referrals and Medicare Set Aside costs ultimately leading to significant claim settlements. Tower MSA is grateful to Jennifer and Mark for highlighting how Tower MSA’s Identification, Intervention and Involvement services were a key contribution to the success of this legacy claim reduction program.
For more information on American’s program please read the Risk & Insurance article Make a Decision and Move the Needle: American Airlines needed to take aggressive action to resolve 6,000 lingering workers’ compensation claims.
For more information on Tower MSA’s legacy claim reduction services please contact us at 888.331.4941 or firstname.lastname@example.org.
Please take a moment to read Michael Stack’s article outlining qualities needed in an MSP compliance partner. MSP compliance is complicated and penalties can be high. There are a lot of components – Section 111 reporting, Conditional Payments, medical and pharmaceutical interventions, legal interventions, and MSA preparation.
Typically these various activities are handled in silos, and time lags and errors can occur during the transfer to the next step. It’s easy to miss a data field or deadline.
Tower recognizes that Section 111, Conditional Payments, pre-MSA Triage, all interventions, and MSA preparation through CMS acceptance should occur in a continuous, unbroken process. That’s why we developed an all-inclusive MSP Automation Suite around compliance best practices. Our MSP Automation Suite drives the entire compliance process, automatically updates clients of each activity on the file, escalates medical and pharmacy issues, prompts for interventions and much more.
Claims close faster, quality and accuracy are assured and our clients enjoy smooth settlements. Click here for details or contact us at info@TowerMSA.com or 888-331-4941.