May 25, 2018
Tower MSA Partners Kathleen Losada looks forward to seeing you at the upcoming 43rd Annual Florida RIMS Educational Conference, June 19-23, 2018 at the RITZ-Carlton in Naples, Florida.
Reach out to Kathleen at Kathleen.losada@towermsa.com or 561-609-9313 to learn more about Tower’s Technology Driven MSP Compliance.
Tower MSA Partners is proud to be an Exhibitor and Sponsor at the 27th Claims Management & Leadership Conference, June 10th-13th, 2018 at the beautiful Hyatt Regency Coconut Point, Bonita Springs, FL.
Stop by our booth to meet Kathleen Losada, V.P. of Strategic Services and learn about Tower MSA Partners Technology Driven MSP Compliance.
You can also contact Kathleen directly to schedule a meeting at Kathleen.losada@towermsa.com or 561-609-9313.
December 19, 2017
As 2017 winds down, it seems like an appropriate time to feature some of the top content that has been provided by Leaders from the industry for our Leaders Speak section.
So, as we close out the year and prep to bring you more great thought leadership in 2017, check out the list below for our most popular Leaders Speak posts from the first half of this year (in no particular order)…
The full article may be found here.
December 6, 2017
“I start to think we are making progress and we are getting somewhere and opioid use in comp is down, and then you come across something like this,” said Alex Swedlow, president of the Oakland-based California Workers’ Compensation Institute, which conducted a study that found 70% of federally mandated and approved California workers compensation Medicare set-aside settlements for injured workers include money earmarked for decades of opioid use.
“It’s a confirmation of what we believe has existed,” said Rita Wilson, CEO and co-founder of Delray Beach, Florida-based Tower MSA Partners L.L.C., which helps insurers and employers remain Medicare-compliant and began tackling the opioids in Medicare set-asides in mid-2015. “(It) quantifies the concern of too much opioids in the Medicare set-asides,” she said of the study that was released in the fall.
The full article may be found here.
It’s the week of our industry’s biggest conference of the year. There will be a lot of great content, but be sure not to miss these 5 sessions:
The full article may be found here.
November 3, 2017
If seeing the word opioids one more time doesn’t trigger some sort of reaction, whether sadness, anger, desperation, or possibly hope at what appears to be traction to ‘Turn the Tide’ of addiction, then I can only surmise that you must live under a rock! That certainly isn’t the case here, as in our world of MSP compliance, the word opioids is either read, spoken or written every single day. It permeates our industry and our lives.
The most recent example of the profound impact opioids continue to have on workers’ compensation, the MSP industry, and specifically on the Medicare Set Aside (MSA), came from a study released earlier this week by the California Workers’ Compensation Institute (http://www.cwci.org). Those who saw the study became painfully aware that in the state of California,
“Nearly 70% of federally mandated and approved Medicare settlements for injured workers require funding for decades of opioid use, often at dangerously high levels and in conjunction with other high-risk drugs.”
The CWCI examined data from 7,926 California WCMSA plans completed, submitted and approved by the Centers for Medicare and Medicaid Services (CMS) in 2015 and 2016. To achieve a representative cross section of the state’s MSA cases, the authors compiled its dataset of 7,926 WCMSAs from four national vendors whose work product represented more than 50% of the state’s MSA market.
Overall findings were as follows:
Also significant were CWCI’s findings when the authors compared opioids found in WCMSAs to a case-matched control group of closed workers’ comp permanent disability claims for similar injuries. This comparison demonstrated that the WCMSA allocations included much stronger opioids, with average morphine milligram equivalents (MMEs) at 45 times the level used in the control group during the life of the claim. In addition, the WCMSAs with opioids required funding for an average daily dose of 54.7 morphine equivalents (MEDs) for a period of 20.9 years.
The realization that opioids represent a major problem with the WCMSA did not come as a surprise to Tower, or to the National Alliance of MSA Professionals (NAMSAP). For the past 2 years, NAMSAP, through its Evidence Based Medicine and Data and Development committees, has been working tirelessly to educate the MSP community as to what happens in the MSA when opioids are prescribed over the life of the claim and remain as standard treatment when the MSA is prepared and submitted to CMS. NAMSAP has hosted multiple webinars to bring industry, regulatory and legislative experts together to discuss the opioid impact, and sent representatives to Washington to discuss our concerns with CMS. At our most recent annual conference, NAMSAP hosted Assistant Surgeon General, RADM Pamela Schweitzer, Pharm.D., BCACP, who shared both her concern for our situation, and her enthusiasm for our passion and our efforts.
With a singular focus among our members, I am hopeful that NAMSAP can successfully modify prescribing behavior and ultimately impact WCMSA outcomes. Unfortunately, this doesn’t benefit carriers, employers, third party administrators and injured workers today.
At Tower, the issue of opioid misuse and the importance of pre-MSA intervention has been in the forefront of our business model, our technology platform and our workflow from day 1. Our Pre-MSA Triage service identifies issues long before the MSA and provides practical recommendations to address obstacles. Our integrated technology platform tracks pharmacy triggers and interventions, escalates to our Internal Pharm. D. to contact the treating physician and diaries to track progress until treatment has been optimized. We then finalize the MSA and submit to CMS for approval.
The result of our workflow, our technology and the internal team of clinical, legal and medical experts we’ve built is a streamlined, end-to-end process that identifies issues, tracks progress and drives results for our clients.
Results achieved across all clients:
These are numbers we track monthly through our CMS Reconciliation Module to confirm that CMS performance continues to improve. Our belief is that until prescribing habits change and best practices in opioid treatment can be implemented and enforced, our responsibility is to drive better outcomes through both formal intervention services and consultative oversight. Our clear focus is to limit pharmacy to those medications that are appropriate for long term use, to discontinue opioids where possible and to reduce MED to the lowest level possible when opioids must be included in the WCMSA.
In the words of HHS Secretary, Tom Price, M.D. and Kellyanne Conway, counselor to President Trump,
“Ending the opioid epidemic will require an all hands on deck effort”.
Stay tuned.
October 11, 2017
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.
September 21, 2017
The NAMSAP Annual Conference – 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 (MSP) 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.”
The NAMSAP Annual Conference – MSP Policy Palooza2017 – will be held at the Renaissance Baltimore Harborplace Hotel September 27-29, 2017.
For more information on the conference, see:
For more information on the Tower MSA Partners presenters, see:
September 14, 2017
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:
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.
August 7, 2017
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:
