MSP Compliance Blog

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

Build a Better Tower: Partnerships Speed Settlements of Workers’ Comp Claims with Medicare Set-Asides

Posted on March 15, 2021 by Rita Wilson

Tower MSA Partners knows our strengths.  And we know our business.

We’re in the Medicare Set-Aside settlement business. Everything we do, we do to make workers’ compensation settlements possible — whether they have MSAs or not. Tower has built its business processes and technology around making settlements easier, faster, smoother, and less expensive.

We recognize that the value of an MSA is its ability to facilitate workers’ compensation and liability claim settlement and closure.  We also recognize that MSAs can become stumbling blocks to injured workers and their attorneys when it comes to settling claims.  Since Tower’s goal is to break through all barriers to settlement, we formed a strategic partnership with Ametros, the leader in the professional administration of Medicare Set-Asides.

Helping Injured Workers Settle Well

Ametros, which does not produce MSAs, helps injured individuals manage their Medicare Set-Asides and medical allocations after settlement.  During the settlement process, its team educates injured workers and their attorneys on their responsibilities and the resources available to them through professional administration after the settlement. Ametros frequently attends mediations and settlement conferences to help educate all parties on the post-settlement reality of managing a Medicare Set-Aside and how its services support compliance with Medicare Secondary Payer guidelines.

CareGuard, Ametros’ professional administration service, helps injured individuals navigate the healthcare system after settlement. CareGuard Members receive significant discounts for their injury-related medical and pharmacy expenses, durable medical equipment, home health care, and other services. Ametros handles the payment of all medical bills from their settlement funds and takes care of the Medicare reporting associated with an MSA.

Once injured workers understand they can have these services after they close their claims, they’re more likely to move forward to settle the case.

Many of Tower’s clients already work with Ametros and understand the value they bring. This made the idea of working with Ametros to simplify the settlement process for clients and adjusters a natural evolution.

Taking Work Off the Adjuster’s Desk

To further boost efficiency, Tower and Ametros developed a real-time electronic data interchange (EDI) to exchange MSA, CMS, and settlement data. MSA information is automatically updated directly in Ametros’ system at the time of MSA delivery to the client, enabling the Ametros team to begin educating the injured worker, their family, and attorneys.

This is another way we take work off adjusters’ desks and accelerate settlements that involve MSAs.

Speed Settlements

Recently, Tower launched a new program with Ametros to speed settlements. Using our powerful data analytics capabilities, Tower identifies claims that meet criteria for closure and creates a settlement candidate report. Ametros is then engaged to reach out to these injured workers or their attorneys to offer professional administration as an added benefit and to gauge interest in settlements.

When settlement is indicated, Tower prepares the MSA, executes all cost-mitigation strategies and postures the claim for closure.

This is an exciting new way to proactively address claims that may have slipped out of view and generate interest in settling.  There’s no extra work for adjusters and no cost for the payer until a claim is ready to settle and an MSA is prepared.

Future posts will share other strategic partnerships that Tower has forged to build a better, stronger Tower to help you efficiently and cost effectively settle claims.

Meanwhile, have Tower create an MSA settlement candidate report for you. To learn more, contact Hany Abdelsayed hany.abdelsayed@towermsa.com (916) 878-8062.

Rita Wilson

Chief Executive Officer

 

Related:

Legacy Claim Settlement Initiatives 

 

Questions About Medicare Conditional Payments? Join Our Upcoming Free Webinar

Posted on March 10, 2021 by Tower MSA Partners

When it comes to Medicare conditional payments, we get questions!  We’re commonly asked about CMS Medicare conditional payment policies, practices of CMS recovery contractors, the extent of Treasury Department debt recovery and more. It’s important to get the right answers because 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. If you have questions like these:

  • 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

… why not join us for our free webinar Medicare Conditional Payment Tune-up next week? We’ll be holding a Q&A session after the presentation.  Here are the details – be sure to scroll down and click our sign-up button!

 

Photo of Dan Anders with details about Webinar regarding  Medicare Conditional Payments

Related:

CMS to Host Reporting and Medicare Conditional Payment Recovery Town Hall

$750 Medicare Conditional Payment Recovery Threshold Remains for 2021

CMS Introduces Pre-CPNs and Open Debt Reports in Conditional Payment Recovery Process

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.”

For Media Inquires, Contact:

Helen King Patterson
813.690.4787
helen@kingknight.com

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