MSP Compliance Blog

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

CMS to Host Reporting and Medicare Conditional Payment Recovery Town Hall

Posted on March 2, 2021 by Daniel Anders

The Centers for Medicare and Medicaid Services (CMS) recently announced it will be hosting a town hall on April 1, 2021 at 1 pm ET to discuss common Non-Group Health Plan topics.  Specifically, representatives from CMS, the Benefits Coordination and Recovery Center (BCRC) and the Commercial Repayment Center (CRC) will be on hand to answer questions related to Section 111 mandatory insurer reporting and Medicare conditional payment recovery.

Complete information can be found here.

In follow-up to Tower’s Medicare Conditional Payment Tune-up webinar, which will be held on March 18, CMS is providing an excellent opportunity to directly address questions with both the policymakers and the recovery contractors.

If your responsibilities touch on Section 111 reporting and/or Medicare conditional payment recovery, we encourage you to attend the town hall.

Medicare Conditional Payment Tune-up

Posted on February 26, 2021 by Tower MSA Partners

Resolving Medicare conditional payments should be standard practice when settling a workers’ compensation or liability claim involving an injured worker who is a Medicare beneficiary.  However, there are still many questions around CMS Medicare conditional payment policies, practices of CMS recovery contractors and the extent of Treasury Department debt recovery.

Join Dan Anders, Tower’s Chief Compliance Officer, on Thursday, March 18 at 2:00 PM ET, for a Medicare conditional payment “tune-up.”  The free webinar will focus on:

  • When and how to communicate with the Commercial Repayment Center (CRC) vs. the Benefits Coordination and Recovery Center (BCRC).
  • Requesting and reacting to Medicare conditional payment recovery correspondence.
  • Dispute and appeal conditional payments: What works, doesn’t work and sometimes works.
  • Resolving Treasury Department debt recovery actions

Dan will also provide an explanation of the PAID Act and expectations for the implementation of its provisions over the course of 2021.

A Q&A session will follow the presentation.  Please click the link below and register today!

Tower MSA Partners Supports Insurance Careers Month!

Posted on February 24, 2021 by Tower MSA Partners

Polish up those resumes because February is Insurance Careers Month! Although Tower MSA Partners is not an insurance company, we are in the insurance solar system.  We provide Medicare Secondary Payer (MSP) compliance services including Medicare Set-Asides (MSA) to workers’ compensation and liability insurance companies, third-party administrators, and self-insured employers in all 50 states.

Plus, we’ll take any excuse to celebrate and promote the industry that we serve. Insurance Careers Month is a grassroots initiative “that seeks to inspire young people to choose insurance as a career, share what makes the industry a great one to work in, and collaborate to retain emerging leaders in insurance.” That’s something we can get behind!

Insurance Jobs Are Plentiful & Resilient

Jobs in insurance and insurance-related fields are great jobs that aren’t necessarily high on the radar for new graduates and young professionals, but they should be. First, it’s a huge component of the financial services sector. Using U.S. Department of Labor data, the Insurance Information Institute put the number of employees at 2.8 million in 2019. Of those, 1.6 million people worked for insurance companies, including life and health insurers (923,000 workers), property and casualty insurers (647,000 workers) and reinsurers (28,500 workers). The remaining 1.2 million people worked for insurance agencies, brokers, and other insurance-related enterprises.   It is a resilient business. Because people need insurance and it is sometimes required by law, it generally fares well even when the economy takes a downturn.  There are a wide variety of job opportunities, too – learn more at III Careers in insurance.

Insurance-Related Jobs Are Rewarding

To commemorate the month, we’d like to highlight two Tower MSA employees and let them tell you what they like about working in an insurance-related industry.

Brittney O'Neal

Brittney O’Neal, CCA, MSCC is a Medicare Set Aside Specialist – Quality Assurance Manager who oversees the team of registered nurses (RNs) who prepare Medicare Set Asides and the Physician Follow-Up team. Brittney works closely with intake and operations departments to ensure Tower receives all the information needed to complete the MSAs, reviews them for accuracy and researches ways to mitigate costs, and presents intervention strategies to clients.

Brittney brought a pharmacy background to Tower when she joined in 2015.  “Understanding how a medication could be contraindicated by another and knowing what is and isn’t covered by Medicare was useful,” she said. “Next, I was all about what do I need to do to get this Medicare Set Aside Specialist certification (MSCC)?”

Now, she’s studying to become an RN to help her better understand the clinical side of the documentation.

Ada Lopez

Like Brittney, Ada Lopez wears a lot of hats as Tower’s MSP Compliance Manager.  She supervises the Social Security Disability Insurance (SSDI) verification and conditional payment processes. In addition, after clients review MSAs, her team submits the MSA and shepherds it through CMS approval. In addition, Ada oversees the Mandatory Section 111 Reporting processes using Tower’s MSP Automation Suite to validate claims data so any discrepancies can be corrected before quarterly filings with the Centers for Medicare & Medicaid Services (CMS).

Ada and Brittney agree that people who are well suited for a career in insurance and its related fields enjoy research and have good attention to detail.  “A college degree is preferred,” Ada said, “At least some college along with experience and transferable skills, especially analytical and critical thinking.”

Superior customer service, especially when it comes to SSDI verification, is important, according to Ada.  “You have to give clients the subject matter expertise they expect,” she noted.

A Variety of Talent and Skills Are Needed

Insurance companies need a variety of talent including information technology specialists, marketing and public relations practitioners, lawyers, physicians, nurses, pharmacists, customer service representatives, and financial and administrative professionals. Legal, medical and pharmacy expertise is particularly valuable in the MSA world, as are excellent project management and time management skills. “You need to be able to read, write and summarize patient records, and quickly. There are internal and external turnaround time expectations,” Brittney said.

People who think insurance is boring are just plain wrong, these women say.  It’s interesting how much things can vary from state to state and nationally.  “The same procedure will be covered in one geography and not another,” Brittney added. “You have to be careful reading the records, checking the diagnosis and making sure the physician has documented things correctly.”

Although the workflow can be similar from one day to the next, Brittney said, “Each file and client is different. Every case, treatment, various state rules, guidelines, and interventions are different…it’s a continuous learning experience.”

Both women came to Tower wanting to learn something new and make an impact.

“What is really great is when a client understands what we’ve done for them and appreciates it,” Brittney said.  “When they say, ‘we thought the allocation for this claim would be over $1 million, and it’s only $300,000?  How did you do that?’”

Knowing she’s played a part in helping an injured person settle their claim and move forward with their life brings Ada a great deal of satisfaction.  She believes working in the insurance field – and Tower specifically – gives her a chance to truly help people.  “Once I was at Tower, I learned new things, gained new responsibilities and had more opportunities.”

Building a Better Tower – Cybersecurity

Posted on February 18, 2021 by Rita Wilson

Tower has invested in significant initiatives to “Build a Better Tower” for our clients.  I provided a brief overview of those initiatives in a recent article and this week I highlight Tower’s investment in protecting Tower and our clients’ data.

Tower’s Cyber Defenses

Long before COVID-19 came along, bringing a tsunami of cyberattacks, Tower had already proactively strengthened our internal IT defenses.

During the fall of 2019 we partnered with Vigilant Technology Solutions to use a service that combines passive monitoring technology with certified information security analysts. Through a customized deployment of Vigilant’s NDR (Network Detection and Response) and EDR (Endpoint Detection and Response) technology, Vigilant’s analysis engines and human threat hunting has reduced the time to detect and contain threats by 99.97% over the industry average.  Without this kind of 24/7/365 monitoring and action, bad actors can enter a system undetected and stay there for months learning how to circumvent security measures and destroying backup data resources.

The graph below shows the timeline of the recent attack on SolarWinds that ultimately compromised 18,000 through deployed software.  SolarWinds CEO disclosed an updated attack timeline, indicating that hackers had first accessed SolarWinds on September 4, 2019.  SourceSolarWinds blog, January 11, 2021.

But it is not sufficient to protect our own technology. We also educated our clients and others in the industry so they could understand and prevent cyber threats. Vigilant’s CEO Chris Nyhuis joined our VP of Information Technology Jesse Shade and another expert, Rob Kolb of Premier Mindset, for an eye-opening webinar in February.  It’s available on demand. Jesse also wrote two WorkCompWire articles with excellent advice that you can read here and here.

Third-Party Risk Assessments

In addition to ensuring the protection of its internal data, Tower also implemented a Vendor Risk Assessment Process for all third parties that had access to Tower data or networks or housed servers that stored our data. Our philosophy is that we are only as strong as our weakest link.  The result of this assessment is a vendor management process that continuously measures and monitors our partners to ensure that as per the AICPA Trust Criteria, we consistently honor the commitments made to our clients.

These are just a few of the ways that Tower is continually and proactively enhancing our infrastructure, processes and offerings to deliver measurably better services to you.

Rita Wilson,
Chief Executive Officer

 

Building a Better Tower

Posted on February 4, 2021 by Rita Wilson

To master an understatement, 2020 was an unprecedented year of uncertainty and challenge for Tower MSA Partners.

When travel came to a halt and face-to-face meetings, conferences, and other business activities transitioned to a virtual environment, a new “normal” arrived. Tower MSA Partners, like many other companies, acclimated to these changes, believing that we could wait out the pandemic. 

Very quickly though, our leadership team realized that by looking inward, this time of external change could be used as time of growth for our company.  Our introspection produced actions to further strengthen our technology and services and to identify best-in-class partners in order to provide greater value to our clients and to build a “better Tower” for all stakeholders.  

When work from home (WFH) was mandated, Tower managed the transition seamlessly.  With 24/7/365 cybersecurity protection already in place for our network and data, full business continuity was achieved.  We consistently hit our target metrics in MSA turnaround time, cost mitigation and prescription drug treatment reductions without exception.

By looking at the internal controls that protect, monitor, and drive our business, we also created a stronger Tower that included:  Tower that included:

  • Increased cybersecurity – protecting Tower’s network and its clients’ data from a cyber threat.
  • Completed an intense SOC 2 Type 1 audit
  • Pursued strategic partnerships to extend best-in-class service
  • Created and delivered valuable educational content to help clients secure their own systems and data, enhance MSP compliance, and optimize MSAs
  • Introduced a free service — a 2nd Opinion on questionable MSAs
  • Deployed a Section 111 Management Dashboard to easily identify and correct errors, avoiding the potential for monetary penalties

Over the next few weeks we’ll explain these initiatives and others designed to provide secure and cost-effective MSP compliance services for our clients.

Rita Wilson

Chief Executive Officer
 

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