Tower MSA Partners’ case study series reveals ten important lessons for claims professionals. Drawing from real-world cases, the series demonstrates how early intervention, clinical oversight, accurate documentation, and consistent review can improve Medicare Set-Aside and settlement outcomes. 

The cases have involved high-cost medications, outdated treatment plans, inaccurate allocations, conditional payment demands, amended reviews, and stalled legacy claims. 

Although every claim was different, one theme appeared repeatedly: meaningful MSA savings begin with accuracy. 

Here are the ten most important lessons from the series and what they mean for claims professionals. 

Lesson 1: Intervene Before MSA Preparation 

Early review can prevent unsupported treatment and pharmacy expenses from entering an allocation in the first place. 

In How Pre-MSA Triage Prevented $774K in Unnecessary Costs, Tower MSA Partners identified medical and pharmaceutical issues before the MSA was prepared. This early intervention prevented $774,583 in projected costs. 

What this means for claims teams:  

Do not wait until an MSA is ready for submission to question outdated treatment plans, medication histories, or unsupported projections. 

Lesson 2: Physician Peer Review Can Transform a High-Cost MSA 

Some medical questions require more than an administrative review. They require a qualified physician who can determine whether treatment remains clinically appropriate. 

In $1 Million Saved with Physician Peer Review, Tower identified overlapping therapies, high-cost medications, and treatment that had not been reevaluated for clinical necessity. Physician involvement, treatment changes, and supporting documentation ultimately produced more than $1 million in MSA savings. 

What this means for claims teams:  

Physician peer review can provide the clinical evidence needed to address complex, outdated, or duplicative treatment. 

Lesson 3: A Second Opinion Can Prevent an Expensive Mistake 

An MSA can look complete and still contain inaccurate information. 

In A $98K Mistake Avoided with a Second Opinion MSA Review, Tower found duplicate treatment, outdated information, and a discontinued high-cost medication in an allocation prepared by another vendor. Correcting these issues prevented approximately $98,000 in unnecessary funding. 

What this means for claims teams:  

Consider a second opinion MSA review when an allocation appears unusually high, includes substantial pharmacy exposure, or does not match the most recent medical records. 

Lesson 4: MSA Optimization Starts with Accuracy 

MSA optimization is not about cutting medically necessary care. It is about making sure every projected treatment, medication, frequency, and cost is supported by current evidence. 

In Trimming the Fat: $175K in Savings Through MSA Optimization, Tower identified duplicate entries, outdated treatment, replaced medications, and unsupported therapy projections. Correcting those discrepancies reduced the allocation by $175,000. 

What this means for claims teams:  

Sustainable MSA savings come from correcting inaccurate projections, not from targeting an arbitrary reduction. 

Lesson 5: Physician Follow-Up Can Fill Critical Information Gaps 

Medical records do not always clearly state whether a medication remains active, therapy is still recommended, or a treatment plan has changed. 

In $231K in Savings from Free Physician Follow-Up, Tower contacted the treating provider to confirm the claimant’s current treatment and medication needs. The resulting documentation supported a $231,487 reduction, and CMS accepted the revised allocation without development. 

What this means for claims teams:  

When the records do not answer an important clinical question, physician follow-up may provide the missing evidence. 

Lesson 6: Clinical Oversight Must Continue as Claims Change 

An MSA reflects the information available at one point in time, but claims continue to evolve. 

Medications are discontinued. Dosages change. Therapy frequency decreases. Providers revise their recommendations. Without continued review, an allocation can stop reflecting the claimant’s actual care. 

In $210K Saved: Why Clinical Oversight Is the Hidden MSA Advantage, Tower identified medications that were no longer prescribed, unsupported treatment, and frequencies that did not match current care. The review reduced the projected allocation by $210,143. 

What this means for claims teams:  

Clinical review should not be treated as a one-time event, especially when a claim has a long treatment history or multiple prescribing providers. 

Lesson 7: Updated Evidence Can Move Legacy Claims Forward 

 Legacy claims often remain open because the available information no longer provides an accurate picture of the claimant’s care. 

In From Backlog to Breakthrough: Reducing 43 Percent of Legacy Claims, Tower reviewed outdated treatment histories, discontinued medications, and old medical projections. By replacing outdated assumptions with current evidence, Tower helped move 43% of the payer’s legacy claim backlog toward resolution. 

What this means for claims teams: 

A claim that has been open for years is not necessarily impossible to settle. It may simply need an updated legacy claims settlement strategy. 

Lesson 8: Verify Every Conditional Payment Charge 

A Medicare conditional payment demand may include unrelated treatment, incorrect dates, duplicate charges, or services associated with broad diagnosis codes. 

In How Tower Reduced Conditional Payments to $0, Tower reviewed each charge against the claimant’s medical history and documented why unrelated services should be removed. Medicare accepted the dispute and reduced the conditional payment demand to zero. 

What this means for claims teams:  

Do not assume every charge listed in a conditional payment demand is the payer’s responsibility. Each line item should be reviewed and validated. 

Lesson 9: New Medical Evidence Can Support an Amended Review 

A CMS-approved MSA may no longer reflect the claimant’s medical needs if treatment changes after approval. 

In Amended Review Strategy Drops MSA by $101K, updated records showed that medications had been discontinued, therapy frequency had decreased, and previously projected testing was no longer recommended. Tower used this new evidence to support an amended review that reduced the MSA by $101,312. 

CMS allows for a one-time Amended Review MSA submission in situations like these, where medical costs have decreased since the original MSA was approved. 

What this means for claims teams:  

An existing approval should not end the review process when significant, documented treatment changes occur. 

Lesson 10: The Strongest Outcomes Come from a Coordinated Strategy 

The case study series shows that no single review method produces every result. The strongest outcomes came from combining early intervention, clinical oversight, current medical evidence, physician engagement, accurate documentation, and clear communication among everyone involved in the claim. 

Tower MSA Partners does more than identify potential errors or outdated treatment. Its clinical and compliance teams help translate those findings into documented, defensible actions that support cost containment and move claims toward settlement. 

What this means for claims teams:  

Better outcomes rarely come from one isolated step. They come from coordinating the clinical, compliance, claims, and settlement strategy from beginning to end. 

What These MSA Lessons Have in Common 

These cases involved different claims, medical histories, and settlement challenges. Yet the strongest outcomes shared several qualities: 

• Claims were reviewed before outdated assumptions became permanent obstacles. 

• Medical records were compared with projected future care. 

• Clinical professionals evaluated treatment and pharmacy exposure. 

• Treating providers were contacted when the records left important questions unanswered. 

• Recommended changes were supported by documentation. 

• Claims, clinical, legal, and compliance teams remained aligned. 

• Savings resulted from accuracy, not from removing medically necessary care. 

This is the larger lesson from the series: MSA cost containment and Medicare compliance should not be treated as competing priorities. When an allocation accurately reflects current medical evidence, it can support both. 

Experience Behind the Results 

Tower MSA Partners provides Medicare Secondary Payer compliance and Medicare Set-Aside services to insurers, self-insured employers, third-party administrators, and attorneys. 

Tower’s clinical and compliance professionals combine medical review, regulatory knowledge, claims experience, and technology-enabled processes to help clients: 

• Prepare accurate and defensible MSAs. 

• Identify appropriate opportunities for MSA savings. 

• Address complex treatment and pharmacy exposure. 

• Resolve conditional payment demands and Medicare liens. 

• Improve Section 111 reporting coordination. 

• Move difficult and legacy claims toward settlement. 

The outcomes featured in this series reflect actual Tower MSA Partners case studies. Results vary based on each claim’s facts, medical evidence, documentation, and applicable CMS guidance. 

Explore the complete Tower MSA Partners case study library for more examples of these strategies in action. 

Put These MSA Lessons to Work 

If an inaccurate allocation, outdated treatment plan, conditional payment demand, or legacy claim is delaying settlement, the next step is to determine what the current evidence supports. 

Submit a referral or contact Tower MSA Partners to discuss the claim and identify the appropriate review strategy. 

Frequently Asked Questions About Medicare Set-Asides and Cost Savings