Challenge

Tower was engaged to prepare an MSA for a 54-year-old partial quadriplegic. Several issues made it difficult to prepare an accurate allocation. These included limited current medical records, erratic patient behavior, inconsistent provider treatment coding, and unknown treatment outside the workers’ compensation plan.

The preliminary MSA amount was $424,528.

Solution

Tower’s medical experts reviewed the treatment records and identified several areas where Medicare-covered expenses could be reduced through Tower’s Optimized MSA process.

At Tower’s request, the client obtained current medical records. Tower’s clinical team then reviewed those records along with the billing codes used for each treatment.

The team compared the provider’s treatment methods against Medicare reimbursement requirements. This review showed that some items could be priced more accurately with alternative codes.

For example, Tower determined that catheterization code A4353 had been used incorrectly. By using the correct billing code and applying other cost-saving strategies, Tower significantly reduced the MSA allocation.

To support CMS review, Tower explained why the original billing code was incorrect. Tower also provided the corrected coding for consideration.

Results: $175,867 in Savings

After the optimized MSA was finalized, Tower submitted a total allocation amount of $248,661 to CMS for review and approval.

CMS accepted the proposed MSA amount and issued a Full Approval.

Using Tower’s proprietary processes and technology, the client carrier reduced the Medicare exposure of the settlement. The final result was $175,867 in total savings.

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