Simple Cost Savings with a Structured MSA Premier Webinar

December 27, 2018

Kerri Poe - webinar speaker portrait and event details

Wednesday, January 23, 2018 at 2:00 PM ET

One of the simplest ways to lower the cost of settlement is through a structured Medicare Set-Aside. Not only does this reduce the employer or insurer’s cost of funding the MSA, it also provides the injured worker a consistent stream of funds for injury-related medical care over his or her life expectancy. This hour-long webinar will show how structured MSAs help all the stakeholders involved in a settlement – the injured party, Medicare and the insurance carrier or employer.

On January 23rd Tower is pleased to host Kerri Poe of Atlas Settlement Group for an informative presentation on structured MSAs as part of settlement. This webinar is intended for anyone involved in the management or handling of workers’ compensation or liability claims and for plaintiff and defense attorneys. By attending this free webinar, you can expect to come away with the ability to:

 

  • Understand how structured MSAs work and recognize the benefits they provide to the injured worker/claimant, employer/insurer and Medicare
  • Explain the methodology by which CMS calculates a structured MSA
  • Convert a CMS-approved lump sum MSA to a structured MSA
  • Define the role of a structured settlement broker pre-settlement, during settlement negotiations and post-settlement.

Case Studies will be included, and attendees will have an opportunity to ask questions.

Hope to see you on January 23rd!

Dan Anders

Chief Compliance Officer

 

 

Background on Guest Presenter, Kerri Poe, CSSC:

Kerri Poe is head of Atlas Settlement Group’s Los Angeles office. Her experience spans Workers’ Compensation, Longshore and Harbor Workers’ Compensation Act, liability, and employment litigation nationwide. Kerri brings value to both sides of the negotiation by facilitating settlement and working as an advocate to the settlement process.

As part of the settlement team, Kerri assists with case evaluation, prepares settlement proposals, attends conferences and mediations and reviews legal documents to ensure the tax benefits of the structured settlement are preserved. Her extensive experience with Medicare Set-Asides and the integration of public benefits allow her to provide needs-based financial options for the injured party.

Her specialties include assisting with case evaluation, preparing settlement proposals, and attending settlement conferences and mediations. Kerri also performs file reviews and client trainings and has been a guest speaker at several claims associations, risk management groups, and settlement annuity seminars. In addition to being a member of the National Structured Settlement Trade Association, she is the Chairwoman of its Legislative Committee.

Kerri began her structured settlement career in 1997 as a Case Manager for a national structured settlement firm in Tampa, Florida and Houston, Texas. She also has experience as a Business Analyst and Project Manager for a prominent benefits administration firm and as the Regional Operations Manager for a large fund-raising company.

Optimize your MSAs for 2019

December 17, 2018

As 2018 comes to a close, it’s a good time to evaluate the effectiveness of your MSA program and make improvements. But, where to start? Step one is to measure the current program’s performance and Michael Stack’s thoughtful recent post, 12 Questions and Metrics to Assess Work Comp MSA Cost Drivers, cites the metrics needed. Take some time to get a handle on your program, identify any unmet cost drivers and update your processes so that your MSAs comply with state and federal statutes, are adequately allocated, and that you do not pay any unnecessary costs.

Tower MSA Partners can help you define, measure and manage the metrics that yield the best balance of care, cost and compliance to continuously improve your MSA outcomes. For more on our data-driven philosophy, see Tower CEO Rita Wilson’s article, What Gets Measured Gets Managed . . . What’s Your Number?

For questions, or to learn more about Tower’s MSP compliance solutions, please email us at info@towermsa.com or call us directly at 888.331.4941.

CMS Rulemaking Notices Provide Possible Timeline for Criteria on LMSAs and Reporting Penalties

December 12, 2018

US Capitol dome

This past week the Office of Management and Budget posted two rulemaking notices from the Centers for Medicare and Medicaid Services (CMS), one with implications for the consideration of future medicals in liability settlements and the other regarding criteria for imposing penalties under the Medicare Secondary Payer Act related to the Section 111 Mandatory Insurer Reporting requirements.

 

Liability and Future Medicals

The first notice titled Miscellaneous Medicare Secondary Payer Clarifications and Updates (CMS-6047-P), states as follows:

This proposed rule would ensure that beneficiaries are making the best health care choices possible by providing them and their representatives with the opportunity to select an option for meeting future medical obligations that fits their individual circumstances, while also protecting the Medicare Trust Fund. Currently, Medicare does not provide its beneficiaries with guidance to help them make choices regarding their future medical care expenses when they receive automobile and liability insurance (including self-insurance), no fault insurance, and workers’ compensation settlements, judgments, awards, or payments, and need to satisfy their Medicare Secondary Payer (MSP) obligations.

A timetable is given which provides for a Notice of Proposed Rulemaking to be issued by September 2019.   While no-fault insurance and worker’s compensation is mentioned in the notice, it is expected that any eventual rule regarding Medicare Set-Asides will be primarily applicable to liability.

CMS has gone down this road before, having issued an Advanced Notice of Proposed Rulemaking in 2012 which provided proposed options for considering Medicare’s interests in liability settlements. CMS ultimately withdrew its proposal, but in June 2016 announced that it was again considering expanding the WCMSA review process to liability. Notably, CMS included a provision in the contract with the new Workers’ Compensation Review Contractor for an expansion of reviews to liability. However, no such expansion can occur into there are rules and a policy in place to review what would be effectively Liability MSAs.

In regard to those rules, we are somewhat surprised by CMS proceeding the regulatory route. It was our expectation that CMS would follow a similar course as they have done with workers’ compensation, namely a voluntary review process in which a policy has been laid out through a series of CMS memos which culminated in a CMS WCMSA Reference Guide. CMS has either decided to proceed with the regulatory route for a policy pertaining to liability and future medical or they are keeping their options open.

Given the September 2019 date to have a NPRM issued, this signals that a final regulation would not even be in place until at least 2020. And as we have seen before (See below regarding regulations on penalties), the regulatory process can take many years.

 

Mandatory Reporting Penalties

The second notice issued by CMS through the OMB is titled Civil Money Penalties and Medicare Secondary Payer Reporting Requirements (CMS-6061-P) and states as follows:

Section 516 of the Medicare Access and CHIP Reauthorization Act of 2015 amended the Social Security Act (the Act) by repealing certain duplicative Medicare Secondary Payer reporting requirements. This rule would propose to remove obsolete Civil Money Penalty (CMP) regulations associated with this repeal. The rule would also propose to replace those obsolete regulations by soliciting public comment on proposed criteria and practices for which CMPs would and would not be imposed under the Act, as amended by Section 203 of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act).

While the verbiage in this notice is somewhat confusing, what this refers to is CMS is planning to issue a formal document requesting comments and proposed criteria for when CMS would impose what are called Civil Money Penalties (CMPs) for improper reporting or a failure to report under the Medicare Secondary Payer Act. As many will recall, the inducement for workers’ compensation, liability and no-fault carriers and plans to abide by the Section 111 Mandatory Insurer Reporting provisions was the possibility of a $1,000 per day, per claim penalty contained in the statute. However, since the start of mandatory reporting in 2010, no penalties have been issued.

Part of the reason penalties have yet to be issued is because the SMART Act of 2012 required CMS to issue regulations detailing the criteria for imposing penalties before CMS could take such action against what we know as Responsible Reporting Entities (RREs). In December 2013 CMS did issue an Advanced Notice of Proposed Rulemaking (ANPRM) to solicit comments and proposals for criteria under which Civil Monetary Penalties would be imposed under the reporting provisions of the MSP Act. A 60-day period was provided for stakeholders to provide comment to CMS. It was assumed that following this response period the regulatory process would move forward with a final regulation on the imposition of CMPs.

Surprisingly, post the comment period, no further action was taken by CMS. Five years later we now have this notice indicating CMS will once again solicit public comment on imposing CMPs. A due date is given of September 2019.

The implication of this notice is at some point between now and September 2019 CMS will publish a document requesting comment on the criteria for imposing CMPs for failure to comply with MSP reporting requirements. We will keep you apprised of any developments in this regard. Nonetheless, this is one area, penalties, where RREs are likely fine with CMS taking its time.

Connect with Tower at NWCDC 2018

December 4, 2018

banner for 2018 National Workers Compensation and Disability Conference

Our numbers speak for themselves. Challenging conventional methodologies, we pursue the best path to settlement with innovative solutions, like MSA Optimization, Simplified Medicare Conditional Payment Resolution, and Legacy Claim Settlement Initiatives.

Do you know your numbers?

What is the percentage of your CMS-approved MSAs which include prescription medication?

How often are opioids included in your MSAs?

What percentage of counter-higher MSAs are submitted for a re-review to CMS and how successful are those re-reviews?

What is the success rate for appealing Medicare conditional payment demands?

Without such benchmark analytics, it is difficult to measure the cost-effectiveness of your MSP compliance program and ways to better optimize your program.  Tower constantly defines, measures and manages the metrics that yield the best balance in care, cost, and compliance.

We have a variety of interventions that will optimize your claims outcomes — many at no additional charge. If the numbers above don’t convince you, then perhaps you need another number that will — 5420.

Visit us at Booth 5420 to learn more about what Tower MSA Partners can do for you.