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Tower Premier Webinar: A Prescription for Settling Legacy Claims

April 20, 2020

Banner for webinar on A Prescription for Settling Legacy Claims

As claims age, the percentage of spend for prescription drugs increases.  Further, as claims age, the likelihood that the injured worker becomes a Medicare beneficiary as a result of age or disability increases. The result, high prescription drug costs allocated in the Medicare Set-Aside (MSA) become a barrier to settlement of these legacy claims.

Tower has addressed this barrier through clinical interventions which have resulted in the majority of Tower’s CMS-approved MSAs containing no prescription drugs.  However, there remain legacy claims with high prescription drug spend which continue to stymie settlement.

Accordingly, Tower has partnered with the leading workers’ compensation pharmacy benefit manager, myMatrixx, to add its renowned clinical pharmacy team to the effort at breaking down the remaining barriers to settlement of these legacy claims.

What then can a PBM do to help with settling legacy claims?  How does a PBM work with an MSA company to settle these claims?

Tower is pleased to host a premier webinar panel with Phil Walls, RPh, Chief Clinical Officer for myMatrixx, and Dan Anders, Esq., Chief Compliance Officer for Tower on the following topics:

  • Define and quantify legacy claims with analytics
  • Identify factors driving up Rx costs in these claims
  • Explain how data can identify opportunities for clinical intervention
  • How to work effectively with PBM and MSA provider to reduce Rx and close claims
  • Provide examples/case scenarios demonstrating successful Rx intervention and settlement in legacy claims
  • Best practices for Rx management to prevent claims from becoming legacy claims

Please plan to attend the webinar on May 20 at 2 pm ET.

Thank you,

Dan Anders

Chief Compliance Officer

Register Now

Tower is Here for You

April 14, 2020

Overhead image of people working at a conference table overlaid with type reading "we are here to help"

While the COVID-19 pandemic represents a new challenge, as a company that has faced its share of hurricanes, we made a seamless transition to working remotely while continuing to serve our partner clients. As our CEO, Rita Wilson recently related, “We Are Here to Help“. While we apologize for the occasional barking dog or screaming child when you call us, you will nonetheless receive the same high level of service that you have come to expect from Tower and which we highlight below.

Expert MSP Consultation

Do I need an MSA?

Are these settlement terms appropriate?

Is a Zero MSA feasible?

How can we reduce the MSA amount?

What are my reporting obligations?

Does a Medicare Advantage plan have a lien?

As always, the Tower Team is readily available to answer these questions and address any other Medicare Secondary Payer compliance concern you encounter when resolving a claim.

Settlement-Driven Pre-MSAs and MSAs

Whether through an MSA or a Pre-MSA Triage, Tower’s clinical team continues to deliver our reports in an average 4 business days.   These reports identify MSA exposure and provide recommendations to address cost drivers and inappropriate care prior to submission of the MSA to CMS. 

Physician Follow-up

Many of you use our crack physician follow-up team that reaches out to treating physician offices to confirm when injury-related medical treatment was completed or clarify the ongoing need for treatment.  Despite some businesses closing, medical offices are either open or available by phone.  If anything, Tower has had even better success at obtaining the needed physician statements since many of these offices are seeing less patients.  This allows us to quickly obtain the necessary medical information and seek prompt CMS approval of the MSA facilitating settlement.

CMS Processes

Thus far, CMS and its various contractors, WCRC for MSA review and BCRC and CRC for Mandatory Insurer Reporting and conditional payment recovery, are responding and completing their services at turnaround times consistent with what we saw prior to the pandemic.

Social Security Verifications

All local Social Security offices have suspended responses to SSDI verification requests because of the coronavirus and Social Security has not announced when it will again respond to these requests.  We assume there will be a significant backlog since these requests are not a high priority for Social Security.  We will of course resume these verification requests when possible. 

Cybersecurity

As has been noted in many publications, the dramatic increase in employees working for home has made conditions ripe for threat actors to infiltrate systems through malware inadvertently downloaded to home laptops via local internet.  More than 2 years ago, Tower made the security of systems and our clients’ data a priority by investing in proactive measures to stop cyberattacks in their tracks.  This protection extends throughout Tower’s network and down to the individual employee working from their home.   

With 24 / 7 detection and response oversight overlaid with 2 factor authentication and managed endpoint services, our systems and data are secure.   All data exchanged between Tower’s systems and remote users is encrypted from the source and monitored through to the endpoint.  If a threat is identified at any point from laptop to server, the transmission is halted, our IT team is immediately notified and the IP address of the source is identified.  

Claim Closure Settlement Projects

Many businesses and injured workers face difficult financial challenges as a result of the pandemic’s economic impact. Tower is working with employers on claim closure settlement projects that mitigate exposure to open-ended medical claims and provide the injured worker with much-needed funds while still protecting their access to future injury-related medical.  Please contact your dedicated Tower account representative to discuss how Tower can coordinate such a project on your behalf.

Multiple Referral Methods

As a result of working from home, you may need to change your referral method.  Tower has multiple methods for making referrals:

  • Via e-mail:  referrals@towermsa.com
  • Via mail:  Tower MSA Partners, 223 NE 5th Ave., Suite 101, Delray Beach, FL 33483
  • Via web portal:  www.towermsa.com (Click refer and compete referral form)
  • Via phone:  (888) 331-4941

If making a referral by phone, e-mail or web, upon receipt, we will provide you a username and password to log in to the TowerConnect portal for secure upload of referral documents.

Note, when you log in to the TowerConnect Portal, you will be directed to enter a phone number to receive a code via SMS or phone call for verification. Additionally, you can download Duo Mobile to your phone to allow you to receive a “push” notification to easily authenticate. Your device can be registered and remembered for up to 7 days. More information is available here: https://guide.duo.com/enrollment. 

If there is any other way we can assist you, please do not hesitate to contact us at referrals@towermsa.com or (888) 331-4941.

Please keep safe,

The Tower Team!

The Penalties are Coming

April 6, 2020

graphic of dollar signs with the word panalties overlaid

The Penalties Are Coming

With COVID-19, it’s understandable if Civil Monetary Penalties (CMPs) have slipped your mind.  CMS has proposed stiff penalties—up to $1,000 per day per claimant—for incorrect MSP reporting or failure to report. (Our Chief Compliance Officer Dan Anders posted on these in February.) For a well-written synopsis of how they could affect you, read this article by Michael Stack, CEO of AMAXX, LLC: Increased Penalties are Coming for Incorrect Medicare Secondary Payer Reporting.

Tower is Here to Help

March 24, 2020

Overhead image of people working at a conference table overlaid with type reading "we are here to help"

I hope you, your family and coworkers are safe and, like all of us, learning to adjust to a new personal and work environment in this worldwide effort to control the spread of coronavirus.  We realize that Medicare Secondary Payer compliance is not the most important matter in life right now, even for Tower which normally lives and breathes MSAs and conditional payments. 

Tower realizes that people continue to work, some remotely for the first time.  This work transition itself presents unique challenges and uncertainties let alone the changes to our personal lives.

We are here to help.  When the need arises, Tower will be there for you, promptly and securely with the care, concern and expertise we apply to every customer matter (Please see below regarding our secure referral process).

Please keep safe.

Sincerely,

Rita Wilson
Chief Executive Officer
Tower MSA Partners

Secure electronic referrals: If you previously mailed referrals or referral documentation to Tower, but cannot do so as you are now working remotely, referrals and the transmittal of documentation can be made through our TowerConnect Portal. Please contact us at (888) 331-4941 or referrals@towermsa.com and we will provide you a username and password to log in to the portal. You can also make referral here and we will send you a username and password.

Once you log in to the TowerConnect Portal, you will be directed to enter a phone number to receive a code via SMS or phone call for verification. Additionally, you can download Duo Mobile to your phone to allow you to receive a “push” notification to easily authenticate. You can register your device to allow for the Duo push. More information is available here: https://guide.duo.com/enrollment. Your device can be remembered for up to 7 days.

CMS’s Revised Consent to Release Form Becomes Mandatory April 1

March 18, 2020

illustration of Revised Consent to Release form signing

As of April 1, 2020, submissions of Workers’ Compensation Medicare Set-Asides (WCMSAs) must include CMS’s revised Consent to Release form.  The form indicates that the need and process for the WCMSA have been explained to the injured worker, and that the injured worker has approved the contents of the submission, including the allocated funds.

First announced with the release of an updated WCMSA Reference Guide on October 10, 2019 (Version 3.0), the revised consent must include the following language:

Further, I have had the Workers’ Compensation Medicare Set-Aside Arrangement need and process explained to me, and I approve of the contents of the submission.

Beneficiary Initials: ____

A copy of the revised consent to release can be found here.

Practical Implications

If the claimant is represented by an attorney, the attorney will typically explain why an MSA is needed in settlement of their WC case.  If not represented, this responsibility may fall to the adjuster or defense attorney.

CMS provides resources to assist with the MSA explanation in both the WCMSA Reference Guide and the Self-Administration Toolkit.  Additionally, for professionally administered MSAs, our partner Ametros provides general information as well as individual consultation to walk the injured worker through how the MSA will work post-settlement.

As mentioned above, the revised consent requires the claimant to approve the contents of the MSA submission.  While a review of the MSA report alone by the claimant or their attorney may be enough to obtain the beneficiary’s approval, if the injured worker requires additional documentation prior to their approval, Tower will provide it.

Finally, keep in mind, consent without the revised Consent to Release language will no longer be valid as of April 1.  Consequently, Tower may provide a revised consent form to be executed by the claimant prior to submission or resubmission of the MSA to CMS.

If you have any questions please contact Tower’s Chief Compliance Officer, Dan Anders, at (888) 331-4941 or daniel.anders@towermsa.com.

Meloxicam’s Price Drop – Good News for MSAs

March 16, 2020

Prescription drug bottle to illustrate Meloxican's price drop

Our Chief Compliance Officer Dan Anders’ blog post on the huge price drop of Meloxicam prompted a WorkCompCentral article, quoting Dan.  Previously priced at $4.25 per pill for 15 milligrams, it’s now 5 cents per pill.  Over a 20-year life expectancy of an injured worker taking 15 milligrams a day, the old price meant an MSA allocation of $30,000. With the reduced price, that allocation would be $300.  For details, see http://bit.ly/2IHjYwn (subscription required).

Significant Drop in Meloxicam Price Yields MSA Reductions

March 11, 2020

white prescription pills spilling out of an orange pill container - illustrating Drop in Meloxicam Pricing post

The price of the non-steroidal anti-inflammatory (NSAID) Meloxicam took a major nosedive from $2.78 per pill to $0.05 per pill for 7.5 mg and $4.25 to $0.05 for 15 mg.  Meloxicam (Brand name: Mobic) is commonly used to treat osteoarthritic pain and is frequently allocated in WC claims and MSAs.  This is the medication’s first price reduction in more than a decade.

Tower Actions

Tower will contact our clients to report any non-CMS-approved MSAs where we identify an allocation for Meloxicam and qualify for a revision.  You can also contact us immediately to determine whether a particular MSA qualifies for a reduction.  Revisions to the MSA can be done now or prior to MSA submission to CMS, if needed. 

Please contact Dan Anders at Daniel.anders@towermsa.com or (888) 331-4941 with questions.

Tower’s Dan Anders Comments on NY Ban on Hold-Harmless Clauses in Settlement Agreements

March 6, 2020

Dan Anders who was quoted in the Claims Journal

New York Workers’ Compensation Board recently issued a bulletin indicating it will not approve settlements requiring injured workers to indemnify or hold insurers harmless if Medicare demands future reimbursements. Tower’s Chief Compliance Officer Dan Anders said the board may be responding to a growing trend of MSAs and settlements that are not submitted to Medicare for review. See WorkCompCentral’s coverage here (subscription required)

Business Insurance: Insurers could face stiff MSP penalties

March 3, 2020

Tower MSA Partners analyzes CMS final Section 111 penalties rule and compliance requirements for RREs.

Business Insurance’s Angela Childers examined CMS’s proposed rules for Section 111 Mandatory Insurer Reporting penalties in this Feb. 26 article.  She quoted Tower’s Chief Compliance Officer Dan Anders on the severity of the possible $1,000 per-day-per-claim penalty for not reporting MSP data or not reporting it with sufficient accuracy. You don’t want to face a $365,000 or more penalty. See Dan’s post for proposal details and contact him at Daniel.anders@towermsa.com for direction on how to submit comments and prepare for the impending penalties.