MSP Compliance Blog

Expert summary, analysis and recommendations on issues impacting Medicare Secondary Payer compliance.

Technology Drives Better Medicare Secondary Payer Compliance

Posted on August 4, 2021 by Tower MSA Partners

Build a better tower with Technology       Building a Better Tower – Through Technology

You may not think about the technology that drives Tower’s Medicare Secondary Payer compliance and Medicare Set-Aside preparation services very often – and that’s understandable.  You may like our simple user interface or the proactive communication our software generates to identify issues, make recommendations, and drive MSA optimization, or appreciate the S111 Management Dashboard, all without thinking about the technology behind the scenes.  That’s ok because we think about it everyday.  In fact, Tower’s  CEO Rita Wilson put technology front and center when she and co-founder Kristine Dudley started the company, automating much of the MSP compliance and MSA preparation operations, quality assurance, and analytics for maximum efficiency, accuracy, and productivity.

With cybersecurity in the news and hurricane season upon us, we wanted to remind you that Tower has you covered in these areas, as well.  Tower stores and manages all data, both internal and client information, securely via a cloud management partner, and has a dedicated “hot site” disaster recovery backup to ensure business continuity should our primary data center fail. For us, business continuity means Section 111 reporting, conditional payment negotiation and resolution, MSA triage, clinical interventions, final preparation, and submission all go on.

“Hurricanes do not affect Tower’s systems, data or internal processes,” Rita explained. “We have employees based all over the country, and before a hurricane impacts our Florida headquarters, our local employees have safely relocated to areas where they can continue to do their jobs with the assurance that the network, infrastructure and cybersecurity protection will be available.  If a natural disaster strikes our primary data center location, an automatic process fails over to our private hot backup site.”

Tower had mastered the IT infrastructure to support a remote workforce long before COVID-19. Aware of steadily increasing cybersecurity threat over the last several years,  the company had already secured Vigilant Technology Solutions’ services for 24/7 monitoring, intrusion detection and prevention.  With VPN access that included multi-factor authentication and secure computer and telephone systems in place, it took less than two hours for employees to transition to work from home

Tower’s complex technology is overseen by Jesse Shade, who was recently promoted to Chief Technology Officer.  This was Jesse’s third promotion in less than four years, which says a lot about how we feel his contributions and talents. Last year, Jesse designed our S111 dashboard to help clients avoid the upcoming penalties associated with erroneous or late reporting and to provide end-to-end visibility to your claims.

This year Jesse worked closely with Rita to secure our SOC 2 Type II attestation.  The SOC 2 audit is designed to give clients and prospects a level of assurance as to how a company organizes and executes its business processes and technology in a structure that provides security, privacy, and confidentiality.

It is one thing for Tower to protect our data and yours, but a major data vulnerability occurs during data transfer between Tower and its business partners.  To ensure that all data exchanged between Tower and any outside entity remains secure, we implemented a third-party risk assessment program to assess and monitor ourselves and our business partners to ensure that privacy, security and cybersecurity best practices are consistently followed.

In addition, Tower is committed to educating clients and other stakeholders.  We hosted a webinar on cybersecurity for our clients and published articles in WorkCompWire last year to help educate others in the industry.

Technology changes all the time, and Tower stays abreast of these changes, always seeking new ways to build a better Tower and a better way to serve the MSP community.  If you have questions about this article or technology in the industry, please contact Rita Wilson, Rita.Wilson@TowerMSA.com or Jesse Shade, Jesse.Shade@TowerMSA.com

The Patel Memo Launched the Medicare Set-Aside Review Process

Posted on July 28, 2021 by Daniel Anders

The Patel Memo Launched the Medicare Set-Aside Review Process

Last week, July 23, 2021, to be precise, marked the 20th anniversary of the Patel Memo, which set the stage for the Medicare Set-Aside industry as we know it. Released under the name of Parashar B. Patel, Deputy Director, Purchasing Policy Group for the Centers for Medicare and Medicaid Services (CMS), the memo was directed to the CMS Associate Regional Administrators on the subject of “Workers Compensation: Commutation of Future Benefits.”

It addressed questions sent to CMS regional offices from attorneys who were settling workers’ compensation cases and submitting MSAs to regional offices for review and approval. Although there were some MSAs before this time, the Patel Memo of July 23, 2001, had a pivotal impact and led to the start of several MSA and MSP compliance companies, including Tower MSA Partners 10 years ago.

The memo cited regulatory authority and gave a green light for the regional office review and approval process for submitted MSAs, including criteria and thresholds for review for non-Medicare beneficiary claimants.  It established instructions for the regional office to add the MSA to the CMS common working file and annual accounting requirement for the MSA administrator once the MSA was funded.  The memo also acknowledged structured set-aside arrangements, confirmed that an MSA should be allocated over life expectancy and allowed for fee schedules as a basis for allocating care.

Some of its provisions did not stand the test of time and were eliminated by subsequent CMS memos. These included a prohibition on the use of the MSA funds before Medicare entitlement, indexing the MSA for inflation, and regional office review of the administrative fee and expenses to be charged to the arrangement.

Although the WCMSA Reference Guide officially supplanted the Patel Memo, the memo laid the foundation for the WCMSA review process.

If you’d like to know more about the man behind the memo, listen to this interview conducted by Shawn Deane, General Counsel of our professional administration partner Ametros.

Take Those Legacy Claims to Settlement!

Posted on July 13, 2021 by Tower MSA Partners

Tower’s Legacy Claims to Settlement Initiative identifies claims that can settle now or with intervention and produces smooth, efficient settlements.

Legacy claims. Old dog claims. Whatever you call them, these are the claims that languish on the books and just won’t close for any number of reasons.  If you missed Tower’s webinar hosted by Hany Abdelsayed, EVP of Strategic Services last month, here is a synopsis:

Legacy Claims Defined

Legacy claims can fall into one of several categories:

  • Long-term open medical claims
  • Run-off claims
  • Claims from mergers and acquisitions
  • Claims in a guaranteed cost program
  • Loss portfolio transfers
  • Non-acute cases with a high monthly medical and/or prescription drug spend

Often, legacy claims are left in the rear-view mirror as claims representatives take on new claims.  Sometimes, the injured worker or their attorney has an issue that needs to be addressed or the anticipated high cost of the Medicare Set-Aside stops the insurance carrier or employer from heading to the settlement table.  However, these legacy claims can represent significant reserves and liability for these payers that impact their entire workers’ compensation programs.

Tower’s Legacy Claims Initiatives service reviews your portfolio and identifies claims that have the potential to close, both those that that can close immediately and those that can close with intervention. We provide interventions for those that need them, customizing them to your needs and workflows.  We also identify claims that have no possibility of settling and position those for ongoing cost reduction. As the settlement project manager, Tower assembles a team with our partner professional administration Ametros and a structured settlement broker to smoothly and efficiently bring your legacy claims to closure.

We know that an MSA’s cost can pose a barrier to settlement. And we know exactly how to reduce unnecessary medical and pharmacy costs.  When scrutinizing medical records, we often find inappropriate use of opioids, muscle relaxants and benzodiazepines, often with multiple prescribers. Our free Physician Follow-up service contacts treating physicians and obtains written changes to the drug regimen. In addition, the switch of brand drugs to generics and verification of discontinued drugs and confirmation of ongoing treatment when properly documented so Medicare can approve the MSA, can result in thousands of dollars of savings on claims.

Injured workers and their attorneys can also be reluctant to settle claims.  This is where Tower’s partner Ametros, as the MSA professional administrator, can step in to talk with the injured worker and their attorney to allay any concerns they may have with closing out medical care and utilizing the MSA for future treatment.  Ametros provides medical and pharmaceutical discounts and has 24/7 care advocates available to help injured parties find providers. While injured workers often complain about the workers’ comp system, some don’t want to lose their adjusters help navigating the healthcare system, and Ametros gives them that post-settlement support.  Structured settlements help people who are afraid of spending all their money in a few years.  Tower, Ametros and the structured settlement broker also may attend mediahttps://ametros.com/tions when in-person settlements return.

When injured workers and their attorneys understand the post-settlement benefits available Ametros and structured settlement partners, they often agree to settle.

Results:

 In a settlement initiative for a large national employer, Tower and its partners were able to work with the client to settle cases with MSAs that resulted in a 43% reduction in open claims and 26% reduction in total claim costs along with a 55% reduction in CMS-approved MSA amounts compared to prior MSAs.

In a current settlement initiative started in March 2021, so far 23% of pursued claims have been settled with $60K in MSA savings because of Tower interventions.

Goal is Claim Closure

Keeping claims open is usually not the answer.  At no cost, Tower is ready to assist you as your project champion in selecting the right partners for the legacy claim settlement project and developing a plan which is customized to your type of claims and your claims team.  Further, this plan will identify and implement interventions to mitigate the MSA amount and alleviate the injured workers’ concerns in closing out their medical.

For more information or to consult on a potential legacy claims project, please contact Hany Abdelsayed at (916) 878-8062 or hany.abdelsayed@towermsa.com.

Jesse Shade has been promoted to Chief Technology Officer

Posted on June 30, 2021 by Tower MSA Partners

With great pride, we announce Jesse Shade’s promotion to Chief Technology Officer.  As we continue to build a better tower, we recognize its foundation of technology and the people who manage it.

Technology drives Tower’s Medicare Secondary Payer and Medicare Set-Aside processes. Our technology was designed specifically for MSP compliance processes and MSA best practices with modern development tools. It takes someone with the Jesse’s experience to really understand its complexity to continually enhance, improve and maintain it.

As CTO, Jesse is responsible for the strategic planning, development, and management of Tower’s complex technologies. These include systems architecture, cybersecurity, data transfer, business continuity, and disaster recovery.

Jesse possesses an unusual blend of interpersonal and communication skills as well as technical expertise. He is a valued member of Tower’s executive leadership team, responsible for strategic planning and the education of clients and other stakeholders.

He belongs to the Forbes Technology Council, an invitation-only community of world-class CIOs, CTOs, and technology executives with track records of successfully impacting business growth metrics. A thought leader in the areas of technology and security, Jesse has presented and written on these topics, while working closely with CEO Rita Wilson to ensure that Tower has state-of-the art technology and security.

During the pandemic, he managed the work-from-home technology transition and successfully defeated countless cyberattacks. Jesse also designs and develops new products like our S111 Dashboard to help clients maintain Section 111 reporting compliance that launched along with a major upgrade to the client portal and MSP Automation Suite. Most recently, he was instrumental in helping the company successfully complete its SOC 2 Type II audit.

This is Jesse’s third promotion since joining Tower in 2017 as Director of Information Technology, bringing with him 35 years of experience in IT in the insurance, aviation, healthcare and other industries. He became Senior Vice president of Information Technology two years later. Congratulate Jesse by emailing jesse.shade@towermsa.com.

MSA Physician Follow-up Service Saves Over $200,000

Posted on June 17, 2021 by Tower MSA Partners

Tower’s free Physician Follow-up service is one of our most effective tools for reducing your MSA costs. This case history offers a deeper dive on how we use this tool.

Physicians often need to try different medications as they search for the best way to manage pain, and medical records do not always show that drugs had been discontinued. That happened in a case where the initial Medicare Set-Aside exposure was $285,181.

Physician Follow-up Case Study

An injured worker suffered from low back pain along with significant pain in his groin, hip, and left knee. By the time it came to settle the case, he was seeing a pain management specialist and benefiting from oral opiates and injection therapy.

Tower’s review of his medical records detected Amrix, Celebrex, and Amitriptyline as potential unnecessary cost drivers.  We recommended having our Physician Follow-up service contact the treating physician to confirm the current drug regimen and, if appropriate, document clarifications to the medical records.

First, our Physician Follow-up professionals determined that the drug regimen for the work injury was limited to oxycodone/APAP 5/325mg BID and three injections per year and that all other medications listed in the medical records had been discontinued. Then, following the state’s jurisdictional requirements, they drafted an attestation letter stating this and obtained the doctor’s signature.

By scrutinizing the medical records and properly wording and documenting the statement, Tower submitted an MSA of $53,664 to CMS.  CMS approved the MSA within nine days with no development letter or counter-higher for a savings of $231,487.

Physician Follow-up is Comprehensive

Tower’s Physician Follow-up addresses open-ended, ambiguous and contradictory medical records and can replace a physician peer review in many cases.  With client approval and per jurisdictional requirements our team will contact the treating physician(s) to:

  • Clarify ambiguous medical treatment
  • Find out if procedures, surgeries, or other therapies are still being considered
  • Share information about multiple prescribers or pharmacies and duplicative or very similar medications
  • Discuss high doses of opioids and other addictive drugs
  • Ask the provider to consider tapering programs and alternative pain management options
  • Determine the current frequency of urine drug tests if applicable
  • Confirm the discontinuance of medications
  • Request a switch from brand drugs to generics
  • Obtain the last treatment date
  • Confirm the current injury-related drug regimen

This an area where Tower excels.  We obtain the doctor’s statement in language that is clear, concise and in a format acceptable to CMS.  Notably, 83% of the MSAs we submitted in 2020 were approved with no Development Letters.  Next time there’s an opportunity to use our Physician Follow-up service, do it.  There’s nothing to lose and a lot to save.

To see this and some of our other case studies, go to Successes, and if you need help with settling the claim right now, get in touch with Hany Abdelsayed, hany.abdelsayed@towermsa.com, (916) 878-8062.

For Media Inquires, Contact:

Helen King Patterson
813.690.4787
helen@kingknight.com

    Subscribe to our blog & news

    Search our blog:

    Contact Us for a FREE Consultation