Terry, Author at Tower MSA

Marking Insurance Careers Month During “The Great Resignation”

February 22, 2022

Two employees walking into office building during The great resignation

How is the insurance industry faring in the choppy waters of “The Great Resignation”? February is Insurance Careers Month, the perfect time to assess where we are after two years of the pandemic.

As a specialty provider of Medicare Secondary Payer (MSP) compliance and Medicare Set-Aside (MSA) services, Tower MSA Partners is a member of the workers’ compensation industry. We’re happy then to commemorate and promote the Sixth Annual Insurance Careers Month. Insurance and related services have been a great career path for many of us at Tower and we’re glad to do our part to raise awareness for the next generations.

At the close of 2021, the Department of Labor/Bureau of Labor Statistics (BLS) put the insurance sector’s employee census at more than 2.8 million employees, with a 1.9% unemployment rate. It’s generally been a stable and resilient business, weathering the pandemic and various other catastrophes fairly well. This is borne out by a new report by Capital Relocation Services (CapRelo), which says that the insurance industry has managed to retain employees relatively better than many industries both in volume and tenure.

But as we look hopefully towards a post-pandemic future, what’s in the cards on the employment front? Will “The Great Resignation” take a terrible toll on the insurance sector as it has with so many other industries?

First, let’s look at what people are talking about when they refer to The Great Resignation. Start with this: In December 2021, the “quit” rate was 2.9% as 4.3 million workers voluntarily left their jobs. This was down from November’s highwater mark of a 3.0% quit rate (4.5 million jobs). (Source: BLS – Job Openings and Labor Turnover Summary, or “JOLTS” report). This massive flight from jobs is not just happening in the U.S., it’s a global phenomenon, and there are various theories and explanations for why this is happening, with the only commonality agreed upon is that it is related to the pandemic. And there were 4.6 million more job openings than unemployed workers in December. Whatever the reason, it’s an employee’s market, leaving employers struggling to retain and recruit workers.

Industries with low paying jobs and public-facing jobs are among the hardest hit, but there are other reasons beyond low pay and poor conditions that lead to job quits. Gallup surveys put burnout as #1 on the list of reasons why employees are quitting jobs. Feeling unsafe is another frequently cited reason. People don’t want to return to the physical workplace if they don’t feel safe from contracting an illness that they may bring home to children or elderly parents.

But what’s happening to all the workers who quit? Are they just staying home and abandoning the job market entirely? Well, yes, some are – in the form of retirement or launching a new business. Others are seizing the opportunity to trade up on a job, exit a low-paying company/industry, or rethink and re-engineer their career in some other way. While the phenomena of the post-pandemic labor market has been popularly dubbed “The Great Resignation,” other observers think it is more precise to define it as a “Great Realignment” or a “Great Reshuffle.”

In its Q3 2021 U.S. Insurance Labor Market Study and the related whitepaper, Coming Out Ahead in the Great Reshuffle, The Jacobsen Group, a leading insurance recruitment organization, talked about this:

“While the overall economy is experiencing what many are calling “the Great Resignation,” the insurance industry is encountering more of a “Great Reshuffle.” Professionals who were waiting to make moves earlier on in the pandemic are exploring their options. Individuals are reevaluating their place within their current companies, considering future opportunities and looking forward as offices reopen and the economy continues its recovery.”

In fact, the insurance industry was grappling with certain employment challenges well before the pandemic. As an industry with an aging workforce, we’ve been faced with the daunting challenge of a retirement talent drain of about half the workforce over the next decade. And to attract young Gen Z workers and retain millennials, there is the critical need to re-examine and redefine our industry’s value and meaning to generations for whom a sense of “mission” is table stakes. Plus, as with many long-term industry sectors, there’s been a need to bolster the workforce with deep technology expertise.

Regardless of whether it’s called a great resignation, realignment or reshuffle, employees are sitting in the proverbial catbird seat right now. Insurance organizations need to be proactive in both retaining the talent and expertise they currently have and in retooling to compete aggressively for the talent of the future.

The Transitions

In 2021 a group of leaders in the workers’ compensation industry founded The Transitions with the mission to think strategically about how to handle the influx and outflux of talent over the coming decade. The Transitions offers an extensive webinar series on such topics as reimagining management style, communication models and technology models in WC. Additionally, a mentorship program to help recruit and retain talented individuals through professional and personal growth. We encourage you to check out their website and follow the organization on LinkedIn.

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Study Shows Post-Settlement Medicare Treatment Denials Do Occur

February 1, 2022

Medicare card and info on handling Medicare Treatment Denials

A recent study finds Medicare treatment denials systematically occur in medical claims for Medicare beneficiaries with Medicare Set-Asides (MSAs).

“Don’t worry so much about the Medicare Set-Aside; Medicare will never deny post-settlement treatment claims.” That is the refrain from some when the matter of an MSA inclusion in settlement arises.

Tower has consistently warned that Medicare has steadily increased efforts to protect the agency’s interests. One need only look at CMS’s Section 111 Mandatory Insurer Reporting platform or its two conditional payment recovery contractors, the CRC and BCRC, to see CMS is serious about enforcing the Medicare Secondary Payer (MSP) Act. Still, some believe that Medicare will not deny claims post-settlement.

Thanks to our Professional Administrator Partner Ametros, we now know CMS will deny post-settlement claims for injury-related treatment.

Ametros wanted to know what happened when a Medicare beneficiary with a fully funded, CMS-approved MSA failed to report proper exhaustion of funds to Medicare and then billed Medicare for injury-related claims. To find out, Ametros’ General Counsel Shawn Deane and Senior Strategic Account Executive Jayson Gallant worked with the Research Data Assistance Center (ResDac) to analyze Part B claim data.

The result?

Researchers examined a random sample of five percent of the Medicare beneficiary population over a three-year period. They estimated the following number of claims were denied because WCMSA funds were responsible for their payment.

35,980 in 2018
36,060 in 2019
30,720 in 2020

The key conclusion of the report is “Medicare is systematically denying MSA recipients’ claims, and with steady frequency.”

You can download the free report “A Study of CMS Policy on Treatment Denials for Injured Workers with a Medicare Set Aside from Ametros’ website (ametros.com/medicaredenials). Plus, Ametros will present the study’s findings in a February 15 webinar starting at 1 p.m. EST. Register here.

Practical Implications

As Tower always suspected–and as CMS always warned–the agency will deny claims that should be covered by an MSA. Consequently, the most important implication is the need for the proper administration of those funds whether that is with professional administration or self-administration assistance. Both services are available through our partner Ametros and are recommended for most MSAs.

The study specifically indicated it did not consider non-submit MSAs or non-CMS-approved MSAs. One might argue then that a non-submit MSA is the better option because if CMS is not aware of the MSA, it will not deny payment for injury-related medical care. Such a position is problematic for the following reasons:

While CMS may not be aware of a non-submit MSA, it is aware of any settlement involving a Medicare beneficiary claimant because these are reported through the Section 111 reporting process.
CMS recently updated its WCMSA Reference Guide to add Section 4.3 which views non-submit/evidence-based MSAs “as a potential attempt to shift financial burden” to Medicare. The guidance goes on to state that “CMS will deny payment for medical services related to the WC injuries or illness requiring attestation of appropriate exhaustion equal to the total settlement less procurement costs before CMS will resume primary payment obligation for settled injuries or illnesses.”
Given CMS has a process in place to deny injury-related treatment in CMS-approved MSAs, where a CMS-approved MSA is not on records, CMS can presumably use the Section 111 reporting information to deny payment for medical treatment up to the settlement amount.

Accordingly, a non-submit MSA when the MSA qualifies for CMS review/approval presents its own risks and with CMS’s increased focus on non-submit MSAs, these risks are heightened.

Whether a CMS-approved MSA or non-submit MSA is used, payers should commit to producing MSAs that balance care, cost and compliance and strongly encourage those MSAs are professionally administered by a company like Ametros.

Tower will host a webinar on February 5 at 2 p.m. ET, WC Settlements in Light of CMS Policy on Non-Submit MSAs which will touch on the Ametros study and further discuss the implications of CMS policy toward non-submit MSAs. Register here.

Please contact Dan Anders at daniel.anders@towermsa.com or 888.331.4941 with any questions.

Premier Webinar: WC Settlements in Light of CMS Policy on Non-Submit MSAs

January 25, 2022

pictures of Dan Anders & Kristine Dudley and details for webinar on Non-Submit MSAs

The Centers for Medicare and Medicaid Services (CMS) recent policy statement which considers non-submit/evidence-based MSAs “as a potential attempt to shift financial burden” to Medicare left many questions in its wake (See CMS: Non-Submit MSAs Potentially Shift Costs to Medicare). It has triggered many payers, along with injured workers and their attorneys, to reconsider the choice to avoid the CMS MSA review and approval process.

On Thursday, February 3 at 2:00 PM ET, Tower’s Chief Operations Officer Kristine Dudley and Chief Compliance Officer Dan Anders will address the many questions which arise out of this announcement and walk attendees through how a move from a non-submit to submit MSA program can still yield cost-effective settlements with the added protection of CMS approval.

Here’s just some of what you will learn:

Background on CMS policy on submit vs. non-submit MSAs and what it means for the future of MSAs
Potential defenses to CMS claim that a non-submit MSA was deficient
A how-to guide to transition from non-submit to submit MSA program which still settles WC cases
Tools available to contain MSA costs whether the MSA is submitted or not

While the webinar focus is on those that have primarily pursued a non-submit MSA course, portions on MSA cost containment and ensuring the availability of MSA funds over a lifetime are important to submitters and non-submitters alike.

A Q&A session will follow the presentation, and you can send your questions to Daniel.Anders@TowerMSA.com now. Please click the link below and register today!

Register here

Tower’s Dan Anders Reviews MSP Policies from Last Year and Predicts 2022 Actions

January 20, 2022

blocks showing 2022 for review of Medicare Secondary Payer

WorkersCompensation.com’s Nancy Grover captured the thoughts of Tower’s Chief Compliance Officer Dan Anders on a variety of Medicare Secondary Payer and Medicare Set-Aside issues from 2021 and 2022 in a recent article. MSAs cost less than you think, opioid allocations are down, and the PAID Act makes obtaining Medicare Advantage Plan data easier. Plus, the Centers for Medicare and Medicaid Services flat-out said that MSAs that are not approved by CMS could be “a potential attempt to shift financial burden” to Medicare.

The article, “MSA Policy Updates, Changes Likely in Store for 2022, Expert Predicts,” can be read here. Remember it’s just a one-time process of subscribing to this free section of Workerscompensation.com.

A Holiday Wish from Tower MSA Partners

December 22, 2021

Holiday themed Holiday Wishes from Tower

Earlier this year Tower MSA Partners celebrated its 10^th anniversary. As 2021 comes to a close we again thank you, our client partners, for your support and loyalty, some for all of those 10 years and some for only the past few months. Your trust in us to provide MSP compliance services and settlement solutions is never taken for granted . . . nor do we rest on our laurels.

The Tower team looks forward to launching into a new year with new initiatives and enhancements to provide you the best in customer service, systems and controls which keep client data secure from cyber threats and a commitment as your partner to help settle claims that provide the best in care, cost and compliance.

Our wish to you is a safe, happy and healthy holiday season filled with warmth and laughter. Merry Christmas and best wishes in the new year.

How Did Workers’ Comp Execs Fare During COVID-19?

December 10, 2021

WCI-TV Rower sponsorship banner. indicating that Covid-19 will be a primary programming focus.

How has the Covid-19 affected workers’ comp organizations? What changed professionally for risk managers and claims professionals during the pandemic? Did temporary policies become permanent? Tune to WCI-TV to find out.

Tower MSA Partners has been the exclusive sponsor of WCI-TV since its inception.

“Instead of commercials for our Medicare Secondary Payer compliance services, we’ve explored topics like opioid management, how success is measured, and ways to overcome barriers to claim closures,” said CEO Rita Wilson.

Naturally, an ongoing, international Covid-19 pandemic rated attention. “We wanted to hear how organizations maintained a sense of unity while working from home and how lockdowns changed sales, marketing, and purchasing practices,” explained Chief Compliance Officer Dan Anders.

Among Tower’s TV guests will be Susan Shemanski, Vice President of Corporate Risk Management of the Adecco Group, Joe Berardo, CEO of Carisk Partners, Porter Leslie, CEO of Ametros, and Mark Meyer, Claim Attorney with the Montana State Fund.

WCI-TV airs throughout the convention center and shuttles, in hotel guest rooms and on WCI’s website YouTube channel. These interviews will also be available on Tower’s LinkedIn homepage.

Tower is pleased to be part of the 75^th Annual WCI Conference; see for more https://www.wci360.com/conference/ information.

Forbes Features Tower CTO‘s Article, “How to Help the Masses Make Sense of Cybersecurity”

December 8, 2021

hands on a keyboard overlaid with a lock symbol to illustrate cybersecurity

Tower’s Chief Technology Officer Jesse Shade has published an article on the Forbes Technology Council channels, reminding fellow IT pros that most tech users don’t understand cybersecurity. And that when IT folks explain why doing certain things are important, users are more likely to do them. Here’s his explanation of Multi Factor Authentication or MFA:

MFA stands for multifactor authentication. It is a security solution that requires more than one method of proving (authenticating) your identity. You have already used MFA if you have ever logged into an online account and were asked to provide information so you could:

Receive a verification code via text or email.

Provide an answer to a security question.
Receive a verification code on a phone or computer authenticator application.
Use biometrics (fingerprint or facial recognition) on your computer or phone.

The rationale behind MFA is that if a bad actor gains access to your username and password, they aren’t likely to also have your mobile phone or computer where you will receive the second factor. It is even less likely they will have your fingerprint, retinal scan or the answers to your security questions. There are multiple factors to authenticate that you are who you say you are, hence, MFA.

How to Help the Masses Make Sense of Cybersecurity is a must-read piece on the role of IT pros in arming non-IT tech users to serve as the front-line cybersecurity force they must be.

Feel free to reach out to Jesse at jesse.shade@towermsa.com.

Tower MSA Partners Arranges for CMS Officials to Headline WCI’s MSP Sessions

November 30, 2021

When the WCI Conference invited Tower MSA Partners to produce the first day of its Medicare Secondary Payer (MSP) compliance track, Tower asked representatives from the Centers for Medicare and Medicaid Services (CMS) to kick-off a trio of MSP panels.

“It’s the 20^th anniversary of CMS launching its Medicare Set-Aside (MSA) review program,” said Tower’s Chief Compliance Officer Dan Anders. “We thought this would be a great opportunity for attendees to listen and ask questions of the key policymakers on all matters related to MSP enforcement.”

The section will start with a CMS Townhall covering such matters as the implantation of the PAID Act and how not to run afoul of CMS when submitting an MSA at 1 p.m. on Tuesday, December 14. Anders will moderate the Townhall. Panelists appearing via video will be Deputy Director of MSP Program Operations Jackie Cipa, Director MSP Program Operations Steve Forry, and John Jenkins, Jr., Health Insurance Specialist, Division of MSP Program Operations, CMS.

Following at 2 p.m. is “Don’t Forget Medicare Conditional Payments!” moderated by Tower’s Chief Operating Officer Kristine Dudley and featuring Rasa Fumagalli, Director of MSP Compliance with Synergy Settlement Solutions and Heather Schwartz Sanderson of the Sanderson Firm.

“Conditional payment matters frequently take a backseat to Medicare Set-Asides,” Dudley said. “These experts will show you how to discharge Medicare conditional payment and Medicare Advantage plan reimbursement demands with confidence for both injured worker and payer.”

Anders returns as a panelist with Ametros General Counsel Shawn Deane and Mark Meyer, Claim Attorney for Montana State Fund, for the 3:15 p.m. session, “It’s Still Ok to Submit an MSA.” Sanderson will moderate the discussion designed to show how to balance care, cost and compliance to secure a CMS-approved MSA.

The 75^th Annual WCI Conference will be held December 12-15 at the Orlando World Center Marriott. Please see https://www.wci360.com/conference/.

Carisk® Partners, Tower MSA Partners, and Ametros to Provide Patient-Centered Case Closure and Settlement Solution in Workers’ Compensation

October 12, 2021

Carisk, Ametros & Tower logs for Case Closure

Carisk^® Partners, a specialty risk transfer and care coordination company, Tower MSA Partners, a settlement-focused MSP compliance company, and Ametros, a post-settlement medical administration company, are launching a novel, patient-centered case closure and settlement solution. The integrated program provides continuity in care and accurate medical cost projections while improving the settlement process for injured patients and workers’ compensation payers.

“We’re excited to partner with industry leaders Tower and Ametros on this innovative program that extends the trusted relationship built with the patient in our Pathways™ 2 Recovery program,” says Carisk CEO Joseph Berardo, Jr. “This bundled program benefits all parties by ensuring an accurate, fair and acceptable settlement and post-settlement experience for the patients we are entrusted to serve.”

As the patient approaches achievement of their care plan outcomes and goals, the Case Closure and Settlement Program introduces patient settlement resources delivered by Tower and Ametros into the Carisk Pathways™ 2 Recovery (P2R) process.

“Tower identifies all the treatment and legal barriers to settlement,” said Tower CEO Rita Wilson. “With the payer’s authorization, we proactively apply interventions to resolve pharmaceutical, medical, legal, and jurisdictional issues before we prepare a Medicare Set-Aside. This yields appropriate future care for workers’ comp patients, complies with the Centers for Medicare and Medicaid’s review policies, and facilitates closure. We are thrilled to overlay our settlement-focused workflow with Carisk and Ametros to create win-win outcomes for both payers and patients.”

Ametros advocates for Carisk patients during and after the settlement process, educating them about the multiple benefits available through professional administration of their MSA.

“Our mission is to help the injured person live a better life after they accept a settlement with an MSA. In addition to paying bills from their MSA, providing discounts on their treatments, and completing required CMS reporting, we have a Member Care Team to help them navigate the health care system after settlement every step along the way,” said Ametros CEO Porter Leslie.

This comprehensive solution extends patient advocacy for workers’ compensation patients whose cases Carisk manages during and after their claims settlements by ensuring that their future medical expenses are accurately covered and that the patients receive on-going support post-settlement. Working together, our Case Closure and Settlement Program accelerates claims closure, reducing payers’ claims portfolios, adjuster burdens, along with their medical, pharmacy, and indemnity costs.

To learn more, please contact Kristine Dudley, Tower’s Chief Operating Officer, at (888) 331-4941 or Kristine.dudley@towermsa.com.

About Carisk Partners and Pathways™ 2 Recovery

Carisk is a specialty risk transfer, care coordination company serving insurers, government entities, self-insured plan sponsors, and other managed care organizations. With a foundation in behavioral health, Carisk’s end-to-end combined solutions include risk-transfer and care coordination of delayed recovery, complex catastrophic cases and MBHO services. Carisk’s Pathways™ 2 Recovery program guarantees to improve outcomes and reduce overall cost of quality care by applying best practices and a patient-centered approach to manage complex challenges for the Group Health, Casualty and Auto markets. Carisk is the first and only Managed Behavioral Healthcare Organization with dual accreditations from both the National Committee for Quality Assurance (NCQA) and the Accreditation Association for Ambulatory Healthcare, Inc. (AAAHC). Visit www.cariskpartners.com to learn more.

About Tower MSA Partners

Based in Delray Beach, Florida, Tower MSA Partners provides MSP compliance and MSA services nationally. The company leverages the latest technology to seamlessly integrate, automate, measure, and manage every process from Section 111 reporting, conditional payment resolution and MSA optimization through claim closure and settlement. Tower is a nationally certified Women’s Business Enterprise (WBENC) and has received its SOC2 Type II attestation. For more information, visit https://towermsa.com/ and https://towermsa.com/blog/.

About Ametros

Ametros is the industry leader in post-settlement medical administration and a trusted partner for thousands of members receiving funds from workers’ compensation and liability settlements. Founded in 2010, Ametros provides post-settlement medical management services with significant medical and pharmacy discounts along with automated payment technology and Medicare reporting tools. Headquartered just north of Boston in Wilmington, Massachusetts, Ametros may be reached at 877.275.7415 or via www.ametros.com

Tower Non-Submit MSA: A Reasonable Alternative

September 1, 2021

To submit or not submit a Medicare Set-Aside for approval from the Centers for Medicare and Medicaid Services (CMS) has been a hot-button issue for several years. While some follow a global non-submit strategy others opt to follow CMS’s guidance, where possible, considering a non-submit MSA only in specific situations. Whether a Non-Submit MSA is utilized for settlement depends on several factors and risk tolerances, and Tower MSA Partners stands ready to analyze your claim and help you decide.

A Non-Submit MSA, sometimes called an Evidence-Based MSA, may be a reasonable alternative when the settlement does not meet CMS’s Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) review thresholds. It may seem obvious to use a Non-Submit MSA when the MSA will not be submitted to CMS, but as the methodology in drafting the Non-Submit MSA varies from CMS policy (as detailed below) some prefer to stick to CMS policy for drafting the MSA, even when not submitted.

Besides utilizing a Non-Submit MSA when CMS MSA review thresholds are not met, as the review process is voluntary, settling parties may choose a Non-Submit MSA even when the review thresholds are met. This carries with it inherent risks in that CMS takes the position that if the funds set-aside prove insufficient “Medicare will refuse to pay for services related to the WC injury (and otherwise reimbursable by Medicare) until such expenses have exhausted the entire dollar amount of the entire WC settlement.”

A Non-Submit MSA report may have a lower allocation amount than a CMS-approved MSA because of the following features:

Full Use of Evidence-Based Medicine – Use of evidence-based medicine, i.e., Official Disability Guidelines (ODG) or state treatment guidelines to determine reasonable care to allocate in MSA.
- CMS inconsistently uses evidence-based medicine in its MSA review process. Using ODG and state treatment guidelines may result, for example, in a lower frequency of diagnostic testing or physical therapy visits compared to a CMS-approved MSA.
Examining Physician Opinions Considered – Both treating and examining physician recommendations are considered in drafting the Non-Submit MSA.
- CMS gives little consideration to examining physician opinions in its approval process. Depending on the case, the examining physician may be in a better position to provide appropriate recommendations for current and future medical care because of their expertise and the timing of their opinion. For example, a recent IME opinion on the necessity of surgery may be followed as opposed to a treating physician recommendation from a year ago.
State Statutes and Regulations Followed – Fully follow state statutory, regulatory, and other legal bases for including or excluding care from the MSA.
- While CMS approval requires an “Alternative Treatment Plan” when medical care is denied through a statutory utilization review (UR) process, a Non-Submit MSA will exclude care solely based on the UR determination. For example, a prescription medication will not be allocated in the MSA when a UR determination supports denial.
Claimant Statements and Agreements Considered – Consideration of claimant statements and settling party agreements concerning future medical care.
- CMS will not usually exclude the cost of care from an MSA for a procedure or device, such as a spinal cord stimulator, based on a claimant’s statement that they will not pursue that care. Yet that statement or an agreement among the parties that certain medical care is disputed and not included in the settlement, is sufficient for a Non-Submit MSA. For example, evidence of the claimant repeatedly refusing surgery will usually result in its exclusion from the MSA.

Professional Administration Recommended: Except for minor MSA allocations, Tower strongly recommends having a professional administrator manage the Non-Submit MSA funds. If CMS ever questions the use of these funds, proper administration will confirm they were spent properly, enabling a seamless transition to Medicare for payment if the funds run out. And, Tower proudly partners with Ametros for professional administration of all MSAs: Non-Submit MSAs and those that are CMS-approved.

Depending on the facts of the case, a Non-Submit MSA can have a significantly lower allocation than a CMS-approved MSA and still reasonably consider Medicare’s interests. Nonetheless, using a Non-Submit MSA poses risks to the settling parties that should be fully considered and accepted prior to settlement.

Tower offers free consultations on Non-Submit MSAs. If you have any questions about these or other areas of Medicare Secondary Payer compliance, please contact Dan Anders, Chief Compliance Officer, at daniel.anders@towermsa.com or 888.331.4941.