March 11, 2025
The Centers for Medicare and Medicaid Services (CMS) has scheduled a webinar on March 27, 2025, at 1:00 PM ET to support the attorney and beneficiary representative communities. Per CMS, the webinar will “review the basics of MSP, Group Health vs. Non-Group Health Coordination of Benefits and MSP Recovery.”
There is no pre-registration for the webinar. Full details, including how questions can be submitted before the webinar, can be found here and on the “What’s New” section of the CMS website.
October 31, 2024
Stay up-to-date with the latest CMS developments! This month, we’re covering the release of the NGHP Section 111 Reporting User Guide Version 7.7, the annual update to the ICD exclusion list, and key insights from the CMS Section 111 Civil Money Penalties webinar.
On October 7, 2024, CMS published Version 7.7 of the NGHP (Non-Group Health Plan) Section 111 Reporting User Guide. Here are notable updates:
In Chapter III; Policy Guidance, Section 6.5.1.4, CMS provided the following clarification:
“Note: Settlements, judgments, awards, or other payments obtained entirely under the wrongful death theory of liability, which do not claim and release medicals, or have the effect of releasing medicals, are not required to be reported because Medicare would have no recovery claim against such a payment.”
This statement is consistent with CMS’s previous guidance that Total Payment Obligation to Claimant (TPOC) amounts are reported only when medicals are claimed and/or released, or the settlement has the effect of releasing medicals.
In Chapter IV: Technical Information, CMS has renamed “Compliance Flags” in Section 7.4 to “Warning Flags.” Additionally, a new “04” warning flag has been introduced. This flag applies to claim response files with open Ongoing Responsibility for Medicals (ORM) records when the later date of either the CMS Date of Incident or the Part A Add Date is more than 135 calendar days after the Start Date of the Responsible Reporting Entity’s (RRE’s) submission period.
It’s important to note that warning flags do not necessarily equate to a potential civil monetary penalty for late Section 111 reporting. Here’s the key difference:
Why the different timeframes? We assume it is to encourage RREs to report promptly, ensuring CMS has the necessary information to coordinate benefits properly. Warning flags act as a reminder to the RRE that repeated reporting delays could lead to more significant issues, including potential penalties.
CMS published its annual update of valid and excluded liability and no-fault ICD-9 and ICD-10 codes for Section 111 reporting purposes. The list can be found here.
On October 17, 2024, CMS hosted a webinar on Section 111 Civil Money Penalties. The webinar slides can be found here. Key takeaways:
If you have any questions about these updates, please contact Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com.
October 30, 2024
At Tower MSA Partners, we recognize that in today’s digital age, cybersecurity isn’t just a technical issue—it’s a critical component of trust and integrity in our industry. As cyber threats become increasingly sophisticated, it’s essential for all of us to stay informed and proactive, working together to protect our industry.
As National Cybersecurity Awareness Month concludes, we’re excited to share that our very own Chief Technology Officer, Jesse Shade, has authored an insightful article published in WorkCompWire: The Evolving Landscape of Cybersecurity: Essential Measures for Trusted Industry Partners.
Cybersecurity is more than firewalls and encryption; it’s about cultivating a culture of security awareness and resilience. Jesse’s article provides valuable perspectives on how organizations like ours can navigate the complexities of cyber threats while maintaining the highest standards of service and compliance.
We encourage all our clients, partners, and colleagues to read the full article to gain deeper insights into safeguarding your operations against cyber risks.
Read the full article here: The Evolving Landscape of Cybersecurity: Essential Measures for Trusted Industry Partners.
October 24, 2024
Starting January 1, 2025, Florida is making some significant changes to its fee schedule, which will lead to higher MSA (Medicare Set-Aside) costs – sometimes significantly so. Here’s what you need to know.
In June 2024, the governor signed a new law that increases the maximum reimbursement rates for physicians and surgical procedures. For doctors, the rates will jump from 110% to 175% of the Medicare allowable reimbursement rate, while surgical procedures rates will rise from 140% to 210%. The Florida Association of Orthopaedic Executives said “that represents an unprecedented increase in physician reimbursement of 59% for non-surgical codes and 50% for surgical care.” These rates haven’t changed in 20 years, and Florida is presently the lowest in the nation.
What does this mean for MSAs? Since MSA pricing is based on the relevant workers’ compensation fee schedule, there is an opportunity to lock in lower costs for Florida MSAs if you get CMS approval before January 1, 2025.
Remember, once CMS approves an MSA, that approval does not expire. So, even if settlement occurs after the fee changes, the approved MSA amount remains valid.
If you have any questions, feel free to reach out to Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com. And, if you’re ready to move forward with a Florida MSA submission or preparation, please contact us at referrals@towermsa.com.
October 9, 2024
The Centers for Medicare and Medicaid Services (CMS) has scheduled an important webinar on October 17, 2024, at 1:00 PM ET, specifically covering Section 111 reporting Civil Money Penalties (CMPs) and their implications for all relevant stakeholders involved in compliance and reporting.
CMS will be hosting a comprehensive webinar regarding Certain Civil Money Penalties for NGHP Responsible Reporting Entities (RREs). This informative session aims to clarify the implications of these penalties and ensure that all RREs are well-informed. The format will include opening remarks from CMS officials, followed by a detailed presentation that will cover essential topics. Attendees can expect reminders about the Final Rule, insights into the auditing process, and critical dates that RREs need to remember. After the presentation, there will be a dedicated question-and-answer session, allowing participants to seek clarification and address specific concerns related to the Civil Money Penalties. This interactive component is designed to enhance understanding and foster engagement among all attendees.
RREs who would like to submit questions in advance of the webinar are encouraged to do so using the dedicated resource mailbox at Sec111CMP@cms.hhs.gov.
There is no pre-registration for the webinar. Full details can be found here.
The upcoming webinar focuses on Section 111 penalties, while a previous webinar covered Section 111 reporting best practices and upcoming changes. A copy of the slides and notes of the prior session are here.
CMS recently added a new page to its website, which provides NGHP Civil Money Penalties information, including a flow chart. CMPs are applicable starting October 11, 2024, and audits begin in January 2026. We encourage a review of CMS’ website and articles Tower has published on the topic, including Section 111 Reporting for WCMSAs & Avoiding Civil Penalties.
September 25, 2024
We are excited to share that Dan Anders, Chief Compliance Officer at Tower MSA Partners, was recently featured on Ametros’ podcast, “It’s Settled.” In this engaging episode, Dan sat down with Andrea Mills, Ametros’ Chief Client Officer, and John Kane, Senior Vice President of Strategy, to dive deep into the latest news and developments surrounding Medicare Set-Asides (MSAs). This discussion covered essential topics that impact the workers’ compensation and liability settlement space, including upcoming changes to Section 111 reporting, best practices for preparing MSAs, and the value of professional administration.
One of the key topics covered was the upcoming changes to Section 111 reporting and their implications for insurers and self-insured entities. Dan provided insightful commentary on what these changes mean and how they will affect the reporting process. With new compliance requirements on the horizon, now is the time for stakeholders to review their reporting strategies and ensure they are prepared for these regulatory shifts.
Another critical topic discussed was when to prepare an MSA. Dan highlighted the importance of evaluating the need for an MSA early in the settlement process to avoid costly delays. He also provided insights into how Tower MSA Partners helps clients navigate complex cases by offering expert guidance on when and how to prepare MSAs effectively.
The conversation also touched on the value of professional administration for MSAs, emphasizing how Ametros helps individuals manage their settlement funds to ensure compliance with Medicare’s requirements. Dan, Andrea, and John discussed how professional administration not only ensures the longevity of settlement funds but also helps alleviate the administrative burden on injured individuals.
During the episode, Dan shared several tips and tricks for preparing an MSA, helping listeners understand the importance of accuracy and thoroughness when it comes to documentation. He also explained how Tower MSA Partners’ streamlined approach helps clients minimize risks and expedite settlements.
As the discussion wrapped up, the group previewed upcoming educational opportunities, including a webinar, A Claims Professional’s Guide to Successful Settlements with MSAs, hosted by Tower MSA Partners on October 2nd. Dan encouraged attendees to sign up for this and other webinars to stay informed on compliance topics and best practices in the MSA industry.
You can catch this insightful episode of “It’s Settled” featuring Dan Anders by clicking here.
Stay tuned for more updates from Tower MSA Partners as we continue to provide our clients with the latest compliance and settlement strategies. Be sure to sign up for our upcoming October 2nd webinar to stay informed on these important issues.
September 18, 2024
Tower MSA Partners is proud to announce the successful completion of our annual SOC 2 Type II compliance examination, performed by independent service auditor Insight Assurance. This milestone underscores our unwavering commitment to maintaining and enhancing the highest standards of data security and integrity, essential in today’s fast-evolving digital landscape.
A SOC 2 Type II compliance examination is a rigorous assessment performed by an independent auditor to evaluate a service organization’s non-financial reporting controls over time. This involves testing the operational effectiveness of a company’s controls related to the applicable criteria for the security, availability, processing integrity, confidentiality, and/or privacy trust services categories developed by the American Institute of Certified Public Accountants (AICPA).
This year’s SOC 2 audit added the availability and processing integrity trust service categories (TSCs) to the previously examined security and confidentiality TSCs.
Rita Wilson, CEO of Tower MSA Partners, said, “Achieving the SOC 2 Type II attestation is not just about meeting a regulatory standard, but about affirming our commitment to protect our client’s data with the highest standards of security and confidentiality. This audit reflects the robustness of our internal controls and processes, and it reassures our clients and partners that we are dedicated to the highest levels of trust and integrity.”
From the onset, Tower has integrated technology-driven processes with stringent security measures to ensure the privacy and security of client data. The successful completion of the SOC 2 Type II examination is a testament to our team’s hard work and dedication to excellence.
September 12, 2024
Navigating Medicare Set-Asides can often feel like a daunting challenge during settlement. Even when all parties agree on the need to include an MSA, the allocation may be too high or the documentation requirements too burdensome.
However, the MSA hurdle can be overcome with the right approach.
Understanding when an MSA is appropriate, what’s needed to prepare a reasonable MSA, and how to manage cost and time factors are key to overcoming these obstacles.
Join us on October 2, 2024, at 2 pm ET, as Tower’s Chief Compliance Officer, Dan Anders, and Brittney O’Neal, Director of Clinical Operations, present a claims professional’s guide to successful settlements with MSAs. In this webinar, we’ll cover:
• The appropriate time to obtain an MSA
• Essential documentation for drafting an MSA
• Differentiating between Medicare-covered or non-Medicare-covered treatment
• Understanding the difference between submitted and non-submitted MSAs
• Strategies when a CMS-approved MSA cannot be obtained
• Utilizing the CMS re-review and amended review process effectively
• Circumstances when a $0 MSA is appropriate
• The value of MSA professional administration and structured settlements
If you are interested in the ins and outs of MSAs, this free webinar is for you. Plus, if there is something about MSAs you’ve always wondered about, ask us! When you click on the registration link below, you will not only be able to register, but you can also submit a question to be answered during the webinar.
Hope you can join us on October 2 at 2 pm ET!
September 6, 2024
At the recent Workers’ Compensation Educational Conference in Orlando, FL, empathy took center stage during the WCI-TV segments, sponsored for the ninth consecutive year by Tower MSA Partners. This year’s theme, “Empathy in Workers’ Compensation,” showcased how various industry leaders infuse empathy throughout the claims process, even when they don’t directly interact with injured workers.
Empathy is a vital component in workers’ compensation, influencing culture, product design, and service delivery across the industry. It ensures that injured workers feel supported and understood, which can lead to improved outcomes, reduced fear, and even a decrease in litigation. By fostering collaboration, care, and consistency, companies across the workers’ compensation landscape are making significant strides in incorporating empathy into their processes.
Joan Vincenz, Managing Director of Corporate Safety at United Airlines, spoke about the lasting impact of empathy on injured workers. “People will never forget how they’re treated when they are injured at work. It matters how we treat people when they’re in trouble,” she stated. United Airlines’ philosophy is rooted in safety and care. Beyond preventing injuries, United prioritizes getting immediate, quality care for employees after an injury and helping them navigate the complex workers’ compensation system to return them to health. Vincenz emphasized that the most empathetic thing companies can do is to communicate regularly with injured workers and guide them through the complex workers’ compensation process.
Greg Hamlin, SVP and Chief Claims Officer at Berkley Industrial Comp, highlighted their efforts to embed empathy into the claims process through the Empathetic Resolution Model. This model was developed with input from adjusters on the front lines, who offered suggestions for making the process more human and compassionate. One such suggestion was to rewrite the letters sent to injured workers, making them more empathetic and less formal. Berkley also implemented thoughtful gestures, such as sending cookies to injured workers post-surgery and maintaining regular contact through texts and calls. These small but meaningful actions demonstrate Berkley’s commitment to authentic empathy at every step of the claims process.
While Tower MSA Partners doesn’t regularly interact with injured workers, it plays a crucial role in supporting claims professionals and attorneys in the settlement process. Kristine Dudley, COO of Tower MSA Partners, explained Tower’s philosophy of the “3 C’s”: Care, Cost, and Compliance. Care, in this context, doesn’t mean providing the most care but rather the most appropriate care for the long-term well-being of injured workers. Tower’s team works closely with treating providers to clarify and confirm treatment plans, ensuring that the right care is included in the MSA. Their aim is to allay fears, answer questions, and make the settlement process as smooth as possible for injured workers.
Porter Leslie, CEO of Ametros, emphasized that empathy begins with caring for every individual who interacts with their platform. Ametros’ flagship product, CareGuard, is designed to administer injured workers’ settlement funds, ensuring that they receive ongoing support. At the core of Ametros’ philosophy is “care”, which Leslie describes as the foundation of their empathetic approach. By providing continuous assistance and ensuring that workers feel cared for, Ametros exemplifies how empathy can be embedded in the very fabric of a company’s operations.
The WCI-TV segments at this year’s Workers’ Compensation Conference highlighted how empathy can transform the workers’ compensation experience. From Ametros’ ongoing support to Berkley’s empathetic resolution model and United Airlines’ commitment to caring, companies across the industry are proving that empathy is not just a buzzword but a powerful tool for improving outcomes and reducing litigation. Through thoughtful actions, clear communication, and a focus on the well-being of injured workers, the workers’ compensation industry can continue to evolve with empathy at its core.
August 28, 2024
The Centers for Medicare and Medicaid Services has scheduled a September 12, 2024 webinar on Section 111 reporting. Per the announcement:
The format will be opening remarks by CMS, a presentation that will include NGHP reporting best practices and reminders, followed by a question and answer session. For questions regarding Section 111 reporting, prior to the webinar, please utilize the Section 111 Resource Mailbox PL110-173SEC111-comments@cms.hhs.gov.
There is no pre-registration for the webinar. Full details can be found here.
While CMS does not indicate the webinar is specific to Section 111 Civil Money Penalties, given that CMPs become applicable as of October 11, 2024, this presents an opportunity to have any questions addressed before that date. Questions around the April 4, 2025 implementation of Section 111 Reporting of WCMSAs would also be encouraged.
