CHALLENGE:
CMS approved an MSA on 5/7/2015 for $147,483. The parties were unable to settle the workers’ compensation case at that time. Nearly four years later, the parties were again ready to consider settlement, but the 2015 MSA no longer reflected the injured worker’s current course of medical care.
SOLUTION:
CMS’s Amended Review process provides for submitting a new MSA, but such submission must take place within one to four years after the original CMS MSA approval. Upon receipt of the referral, Tower had left less than two months to meet the 5/7/2019 deadline to submit a new MSA.
A review of recent medical records caused Tower to suspect that a supplemental oxygen delivery system was no longer used and that the injured worker could switch from brand-name Crestor to generic. Tower’s Physician Follow-Up service obtained a signed statement from the treating physician confirming the oxygen system was discontinued and that the injured worker now used the generic.
Based on this physician’s statement, Tower revised the MSA down to $46,171 and submitted shortly before the Amended Review deadline. CMS approved the new MSA amount on 5/13/2019.
RESULTS:Savings of $101,312
While CMS’s Amended Review process is a valuable tool to facilitate settlement where a prior MSA approval does not reflect current care, it is Tower’s Physicians Follow-Up solution that obtains the necessary documentation to substantiate the requested changes to the previously approved MSA. Tower’s Physician Follow-Up is provided at no charge when initiated as part of the MSA and CMS submission process.
