In Tower MSA Partners’ previous post, we showed how a MSA second opinion review helped a payer avoid ninety-eight thousand dollars in unnecessary allocation. This month, we look at a case study on how targeted MSA optimization can uncover even larger savings. Tower MSA Partners reviewed a complex claim with significant pharmacy exposure and identified an opportunity to reduce projected costs by $175,000. This case shows how structured review protocols and clinical oversight create precise and defensible MSAs.

Identifying the Problem

The claimant had a long-term injury that included frequent therapy, diagnostics, and multiple ongoing prescriptions. The initial MSA prepared by another vendor included duplicate entries, outdated treatments, and medications that had been replaced with safer and more cost-effective alternatives. Therapy frequency was also projected far beyond what the medical records supported. These inaccuracies created an inflated allocation that did not reflect current treatment patterns.

The MSA Optimization Solution

Tower MSA Partners completed a full optimization review and reconciled every projection with the latest medical records. Our clinical team verified treatment frequency, evaluated pharmacy histories, and confirmed whether each medication remained clinically appropriate. Outdated therapy, legacy prescriptions, and inaccurate frequency projections were removed or corrected. Each modification included detailed clinical reasoning and clear documentation. After optimization, the MSA decreased by $175,000 and remained fully aligned with CMS expectations. The updated allocation represented the claimant’s true medical needs without unnecessary inflation.

Collaboration and Communication

As with all Tower reviews, collaboration played a significant role. The clinical team walked the claims professional through each correction and clarified why the original allocation overstated ongoing care. Defense counsel and treating providers were updated as needed to confirm accuracy and alignment with the medical record. The optimized MSA was submitted to CMS with strong supporting documentation and was approved without development requests.

Why Oversight Makes the Difference

MSA optimization is not simply cost-cutting. It is a structured validation process that ensures every projected service is clinically necessary and supported by current documentation. Removing outdated items protects payers and claimants from unnecessary costs and strengthens the defensibility of every file. This case demonstrates how careful review drives savings.

Lessons Learned

1. MSA optimization identifies inaccurate or outdated projections that inflate lifetime medical costs.
2. Clinical oversight ensures medications and treatments reflect current best practice.
3. Documentation clarity leads to predictable CMS approval.
4. Savings come from precision. The $175,000 reduction resulted from accurate alignment with the medical record.

Results That Reflect Expertise

The optimized MSA saved the payer settlement monies and produced a compliant, defensible allocation supported by current documentation. Tower MSA Partners continues to demonstrate how clinical accuracy, alignment with CMS, and detail-oriented review generate meaningful and measurable results. Optimization is an essential tool in responsible claims management.

FAQs

What is MSA optimization
MSA optimization is a detailed clinical review that removes outdated treatments, corrects inaccurate projections, and ensures the allocation reflects current medical necessity.

How does optimization reduce allocation amounts
Optimization aligns treatment and pharmacy projections with the actual medical record, which eliminates unnecessary costs and outdated services.

When should an MSA be optimized
It is recommended for claims with long-term treatment, complex pharmacy needs, or significant changes in care since the initial projection.

Does CMS accept optimized MSAs
Yes. CMS accepts optimized MSAs when the updated allocation includes clear clinical documentation and accurate reasoning for the projected future medical.