Premier Webinar: Tricks of the Trade for Successful MSA Outcomes

July 5, 2022

details about webinar on MSA outcomes

Not all Medicare Set-Asides (MSAs) are the same. There are specialty areas for unusual cases and many questions about these:

  • Criteria for successful $0 MSA approvals
  • Whether to include PQMEs, AMEs, IMEs in the MSA
  • Use of court orders to limit medical care in the MSA
  • When and how to use the MSA Amended Review process
  • Correct verbiage for treating physician statements

Claims professionals and attorneys often receive conflicting or unclear information around these topics and other matters that make not only working with the MSA but the whole settlement process, tricky.

Tower is pleased to feature our Chief Compliance Officer Dan Anders, who will share tricks of the trade at a webinar on Wednesday, July 20, at 2:00 PM ET. Dan has written and submitted thousands of MSAs to CMS for almost two decades. His unique knowledge is an asset for anyone who uses an MSA in a case settlement.

A Q&A session will follow the presentation, and you can provide questions at the time you register. Please click the link below and register today!

REGISTER HERE

MSA Second Opinion Success Story – $46,691 in savings

June 23, 2022

This success story demonstrates how an MSA Second Opinion can lead to a successful result with settlement of a WC case.

CHALLENGE:

An MSA was prepared by another MSP provider for approximately $110,000. Based on this MSA amount, the parties reached a tentative settlement. Prior to MSA submission the other MSP provider revised the MSA to $145,500 which was outside the parties settlement range. The cost drivers in the MSA were injections, surgeries and physician visits.

SOLUTION:

Tower’s MSA 2nd opinion review found the injured worker had repeatedly declined injection therapy and one of the two surgeries had not been recommended in the past two years. Consequently, Tower recommended eliminating the surgery and injections from the MSA. Our Physician Follow Up service contacted the treating physician and obtained the physician’s written statement that injections were no longer part of the treatment plan.  The physician also agreed to reduce the number of physician visits to a single annual visit.

RESULTS:  $46,691 in Savings

In addition to eliminating a surgery that fell outside the two years of medical records required by CMS, injections were removed, and physician visit frequency was reduced yielding an MSA of $98,809. The MSA report was submitted and approved by CMS and the parties were able to move forward with settlement and claim closure.

Tower’s MSA 2nd Opinion, offered at no charge, identifies, from another MSP provider’s report, discrepancies and inappropriate treatment which unnecessarily increases the MSA along with recommending interventions which may result in a lower CMS-approved MSA amount.

Tower’s Physician Follow Up Service, also offered at no charge, reaches out to the treating physician to confirm ongoing Rx and reduce excessive or unneeded treatments.

More Tower Success Stories can be found here!

MSA Optimization Yields $175,867 in Savings

June 15, 2022

stethoscope and insurance claim form

CHALLENGE:

Tower was engaged to prepare an MSA for a 54-year-old partial quadriplegic. The lack of current medical records, the erratic behavior of the patient, the quality of the provider’s treatment coding, and unknown treatment outside of the WC Plan were challenges to preparing an accurate MSA. The preliminary MSA amount was $424,528.

SOLUTION:

In review of the treatment records, Tower’s medical experts were able to identify several instances where Medicare covered expenses could be reduced as part of Tower’s Optimized MSA process.

At Tower’s request, the client obtained current medical records. Tower’s clinical team reviewed those records and the corresponding billing codes used for all treatments. By analyzing the provider’s treatment methods against Medicare’s reimbursement requirements, Tower was able to identify items that were more accurately priced with alternative codes. One instance identified was a determination that a catheterization code (A4353) was used incorrectly. By using the correct billing code and applying other cost savings strategies to the treatment regimen, the MSA dollars were significantly reduced.

To ensure that CMS would accept the updated medical coding, Tower detailed how the original billing code was incorrectly used and then provided the correct coding.

RESULTS: $175,867 in Savings

Upon finalization of the optimized MSA, a total allocation amount of $248,661 was submitted to CMS for review and approval. CMS accepted the proposed MSA amount and responded with a Full Approval. Using Tower’s proprietary processes and technology, the client carrier was able to reduce the Medicare exposure of this settlement resulting in total savings of $175,867.

More Tower Success Stories can be found here!

South Florida Business Journal Recognizes Tower MSA Partners as a Top 25 Women-Owned Business

June 9, 2022

banner featuring photo of CEO Rita Wilson and COO Kristine Dudley to announce Tower MSA being named to Women Owned Business list

Tower MSA Partners is recognized as a Top 25 women-owned business by South Florida Business Journal.

We know we’re good, but we enjoy external validation as much as the next guy – or woman. So, we were quite pleased to learn Tower MSA Partners not only made the South Florida Business Journal’s list of Women Owned Businesses, but we ranked among the Top 25.

The publication covers companies in the densely populated Miami-Dade, Broward, and Palm Beach counties. When you consider how many women-owned businesses are in this market, the honor is even more impressive. A 2016 Sun Sentinel story said nearly half of all the women-owned businesses in Florida were based in this area.

Among the metrics used to produce the list is the percentage of the company that is owned by women. For Tower, that’s 100%. CEO Rita Wilson and COO Kristine Dudley co-founded the company more than 10 years ago. You can read more about the company’s start in this article.

Tower is not only women-owned but 85% of our employees, including most of our managers and supervisors are women.

Tower is also a certified member of WBENC or the Women’s Business Enterprise National Council, a leading non-profit organization dedicated to helping women-owned businesses thrive.

If you’d like to connect with Rita or Kristie email them at rita.wilson@towermsa.com or kristine.dudley@towermsa.com.

MSA 2nd Opinion Success Story – $98,120 in savings

June 7, 2022

nurse conducting research for a Medicare Set Aside Second Opinion in a manual

CHALLENGE:

A Medicare Set-Aside was prepared by another MSP provider for $221,384.00.  In addition to extensive medical treatment and surgical procedures, the MSA included the medications omeprazole, ibuprofen, sertraline, and hydroxyzine.  As a settlement was not feasible with that MSA amount, it was submitted to Tower for a 2nd Opinion MSA Review.

Tower’s 2nd Opinion MSA Review is offered at no charge.

SOLUTION:

Following Tower MSA Partners’ standard MSA workflow, the Intake team compared the reported “accepted” body parts against information in the client’s claim system and determined that sertraline, intended to treat stress and depression, should be removed as “psyche/stress” was not an accepted body part. This yielded a savings of $58,320. Additionally, Tower identified inappropriate medical treatment, including an unnecessary bladder surgery, resulting in a further $37,234 reduction. Finally, Tower obtained a rated age from K.P. Underwriting, which lowered the treatment and prescription cost over life expectancy. Tower’s MSA totaled $123,263.68.

RESULTS:  $98,120 in Savings

In addition to eliminating Rx unrelated to the injury and appropriately allocating for medical treatment, Tower recommended the following pre-CMS submission to mitigate exposure and further lower the MSA:

  1. Tower drafted Body Part Letter to confirm accepted compensable conditions and specifically identified all other conditions discussed in the medical records as not “accepted” or paid for by our client.
  2. Tower’s Physician Follow Up Service, offered at no charge, to reach out to the treating physician to confirm if hydroxyzine is related to the WC injury and whether omeprazole and ibuprofen can be switched from prescription to over-the-counter versions.

More Tower Success Stories can be found here!

Download more information here or refer an MSA for a 2nd Opinion by contacting our Intake Team at 888-331-4941 or referrals@towermsa.com.

Highlighting worker fatalities: Workers Memorial Day

April 28, 2022

Banner for Worker Fatalities for Memorial day

As an industry, we must all work to eliminate worker fatalities through an ongoing commitment to safety. April 28 is Worker Memorial Day, a time to memorialize those who died on the job.

Every year, April 28 is earmarked as Workers Memorial Day, a global day to remember and memorialize workers who lost their lives on the job. The day has several purposes:  Through a series of national and local events, it offers a way to call attention to the number of worker fatalities, to put a face on the workers who died, and to highlight the impact these deaths have on their families, co-workers, and communities. The day also sheds light on the fact that most workplace incidents are preventable and serves as a reminder for employers and workers alike to recommit to the important work of building safer workplaces.

April 28 is a fitting day for this event because it is also the day OSHA was established in 1971. Under the Occupational Safety and Health Act of 1970, “employers are responsible for providing safe and healthful workplaces for their workers. OSHA’s role is to ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance.” OSHA’s mission encompasses 130 million workers, employed at more than 8 million worksites around the nation.

Of the 2022 Memorial, OSHA says:

“This year, we also recognize that, more than a year into the pandemic, every day essential workers, many of whom are people of color and immigrants, have put their lives on the line during the COVID-19 pandemic. Many were sickened or died as a result of just going to work – for simply doing what they had to do to support their families. They were healthcare workers, grocery workers, meatpackers, nurses, delivery drivers, farmworkers, law enforcement officers, teachers, and sanitation workers. We remember and honor every worker who has lost their life to largely preventable fatal injuries and illnesses, and we commit ourselves to fighting to make sure that others do not suffer the same terrible fate.”

The impact of OSHA on worker fatalities can be seen in the statistics:  Worker deaths in America dropped from about 38 worker deaths a day or 13,900+ per year in 1970 to 15 a day or 5,300+ per year in 2019.

The most recent Census of Fatal Occupational Injuries was issued by the Bureau of Labor Statistics in December 2021 and noted a significant decrease in worker fatalities. The report noted that there were 4,764 fatal work injuries recorded in the United States in 2020, a 10.7-percent decrease from 5,333 in 2019 and the lowest annual number since 2013. The fatal work injury rate was 3.4 fatalities per 100,000 full-time equivalent (FTE) workers, down from 3.5 per 100,000 FTE in 2019. A worker died every 111 minutes from a work-related injury in 2020.

But the number of fatalities for 2020 needs to be put in the context of the pandemic, when many workplaces were shuttered for varying lengths of time. Some safety and health experts warn that we are likely to see an increase in the numbers going forward: Serious Work Injuries and Fatalities Spike as Labor Shortages Exacerbate the Problem

Fewer workers died or suffered severe injuries in the workplace in 2020.

However, the rate of serious injuries and fatalities rose from 366 per 100,000 workers in 2019 to 429 per 100,000 workers in 2020, according to risk management software firm ISN.

The rate was 406 per 100,000 in 2018.

The problem could worsen as companies around the U.S. contend with a shortage of labor, which can translate into longer hours on the job by less-experienced workers, as well as a greater reliance on outside contractors.”

Working to reduce worker injuries and deaths is the right thing to do. It’s also usually the least costly thing to do and the smart thing for employers to do. Workers are concerned about workplace safety and appreciate employers who demonstrate a commitment. A recent survey showed that:

Almost all (97%) respondents said feeling safe is a major factor in choosing where to work. Asked how they would respond if their employer failed to communicate effectively about an emergency or other potentially dangerous event, 44% said they would feel unsafe and 58% said they would reconsider working there or seek employment elsewhere.

For more information on Workers Memorial Day:

Previously on Tower MSA Partners

Premier Webinar: Medicare Advantage Plan Reimbursement – What Now?

April 7, 2022

In December 2021, the Centers for Medicare and Medicaid Services (CMS) started providing access to data showing a claimant’s enrollment in Medicare Part C and D plans. Now payers are wondering how to best interact with Medicare Advantage (MA) plans and prescription drug plans. What are their reimbursement rights? How does this work with Section 111 reporting?

Tower is pleased to feature a guest presentation by Brian Bargender, Management Consultant, Subrogation and Other Payer Liability for Humana on Wednesday, April 20 at 2:00 PM ET.  Brian is arguably the industry’s foremost expert on Part C and D plan subrogation. Humana is the second-largest Medicare Advantage Plan and Part D plan in the country and has been the leading advocate for reimbursement under the MSP Act.

Here’s just some of what you will learn:

  • Role of Part C and D plans in providing services to Medicare beneficiaries.
  • Reimbursement rights of Part C and D plans under the Medicare Secondary Payer (MSP) Act.
  • Interplay between CMS and Part C and D plans in use of Section 111 Mandatory Insurer Reporting data.
  • Part C and D plans role in Workers’ Compensation MSAs.
  • Best practices for working with Part C and D plans to resolve reimbursement claims.

A Q&A session will follow the presentation, and you can provide questions at the time you register. Please click the link below and register today!

REGISTER HERE

Dan Anders Quoted in Claims Journal on Non-Submit MSAs and Section 111 Penalties

March 24, 2022

Dan Anders who was quoted in the Claims Journal

CMS is serious about protecting Medicare’s funds. Over the years, the agency has had policies that were not enforced, including sizeable civil monetary penalties for not complying with Section 111 reporting rules and denying payment for medical treatment when another payer was responsible.  But things are changing.  CMS has denied payments and has taken steps towards collecting those penalties.  Claims Journal Editor Jim Sams explores these actions in this piece, which quotes Tower’s Chief Compliance Officer Dan Anders.

CMS Rules on Settlement Reporting May Sting Insurers and Claimants Both (claimsjournal.com)

Cyber Concerns Rise in the Wake of Russia’s Invasion of Ukraine

March 11, 2022

threatening hooded figure with the word cyber security superimposed to illustrate post on best practices for cybersecurity

Cybercriminals love pandemics, natural disasters, and wars. Global distractions are good for their business.

Russia’s invasion of Ukraine elevates cyber security risks, which were already on the minds of global business leaders. So far, the incursion has delivered new distributed denial of service (DDoS) attacks and a novel malware, Hermetic Wiper.

While most attacks have targeted Ukraine’s government, infrastructure, and financial services, US companies need to be on guard against spillover and direct attacks. The US/British-owned insurance broker AON was attacked on February 25. Although no direct connection has been reported, this was one day after the invasion.

But business leaders around the world did not need a war to stir their anxieties about cyber-attacks. The Allianz Risk Barometer, which surveys over 2,650 risk management experts around the world, identified cyber risk as the number-one threat to global businesses for 2022.

That means companies worry more about potential data breaches, ransomware attacks, and major IT outages than supply chain disruptions, COVID-19, or natural disasters. The second highest-rated concern was a business interruption, which can result from a catastrophic cyber-attack.

Not being able to provide products and services on time or–at all–is a frightening prospect. Business interruptions can have long-lasting, and for some companies, fatal impacts.

Tower’s commitment to business continuity relies on our powerful cybersecurity system and exacting protocols. These include the installation of anti-malicious software and its updates, the use of multi-factor authentication (MFA), VPNs, and real-time, 24/7 monitoring to detect and mitigate cyber intrusions. In addition, our employees receive extensive cybersecurity training and understand how to do their part to prevent breaches. We invest considerable time, thought, effort, and money to secure our data and our clients’ data.

Because data transfer presents a vulnerability, we also have a Vendor Risk Assessment Process for all third parties that can access Tower’s data, networks, and servers. In a digital age, companies need to be as concerned about their partners’ cybersecurity practices as they are about their own.

Hopefully, the war in Ukraine will not provoke massive cyber-attacks, but now is the time to secure your perimeters. To help you tell if your organization is as cyber secure as it can be, here’s a checklist gleaned from our partner, Palo Alto Networks, and the Shields Up site from the US government’s Cybersecurity & Infrastructure Security Agency (CISA).

  • Implement multi-factor authentication on your accounts.
  • Lockdown your network. Disable all applications, ports, and protocols that are not essential to operations.
  • Ensure software is up to date
  • Reinforce employee training, especially regarding clicking on strange emails. According to CISA, 90% of ransomware attacks come through phishing
  • Renew your plan for managing an attack.
    • Walkthrough scenarios in table-top exercises.
    • Test back-up and recovery plans and continuity of operations in case a network is disabled.
    • Make sure the emergency contact information for your people and partners is updated and available.
    • Revisit your crisis communications plan.

Most cyber threats can be managed, but we must be proactive. If your IT professionals have been requesting funds to strengthen cyber security, take this time to analyze the proposed solutions. Invest while you can.

Our CEO Rita Wilson has a strong technology background and a keen interest in these issues. If you have questions or just want to discuss your cyber security concerns, contact her at rita.wilson@towermsa.com

Meantime, shields up!

CMS Rolls Out ACH Payment Option for Recovery Debts

February 23, 2022

Red Medicare button on a keyboard to illustrate Medicare conditional payment.

The Centers for Medicare and Medicaid Services now provides ACH payment option for Medicare conditional payment debts.

The Centers for Medicare and Medicaid Services (CMS) is now accepting recovery debt (Medicare conditional payment recovery) payments via ACH (Automated Clearing House) transactions. CMS’s February 18, 2022 announcement says this applies to Non-Group Health Plans (NGHP) as well as Group Health Plans (GHP).

Employers, insurers, third-party administrators, attorneys, and plan sponsors can send payments electronically to the Commercial Repayment Center (CRC) or Benefit Coordination & Recovery Center (BCRC) for processing. ACH setup must be coordinated with the CRC and/or BCRC.

The CMS announcement states:

“ To begin sending payments using ACH, please send an email to the appropriate email address below with “ACH Set Up” in the subject line. Be sure to include a specific point of contact with your organization for the CRC or BCRC. The BCRC/CRC will reach out directly to get the process started.

For the CRC: Please submit an e-mail to CRCACHpayments@performantcorp.com

For the BCRC: Please submit an e-mail to BCRC_Finance@GDIT.com

Practical Implications

The ACH payment option means that CMS is now allowing payers to provide their bank account routing and account numbers to facilitate payment of Medicare conditional payment debts.  This is a benefit to the payer in not only avoiding the cost of a postage stamp but to having a quick electronic confirmation of receipt of payment.   This can avoid a “lost in the mail” or a late payment situation which can result in the imposition of interest charges from Medicare.

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