CHALLENGE:
Initial MSA exposure was $285,151 for a Medicare beneficiary claimant with low back, groin, hip and left knee pain. The injured worker was benefiting from oral opiate medication and injection therapy under the care of his pain management provider. The primary cost driver was Amrix, Celebrex, & Amitriptyline which had not been documented as terminated in the medical records.
SOLUTION:
Tower recommended confirming with the treating physician that the only medication being prescribed for the work injury was Oxycodone/APAP 5/325mg BID and that three (3) injections per year was sufficient. After following the state’s jurisdictional requrements for communication with a medical provider, Tower’s Physician Follow-up service drafted and obtained a signed attestation letter from the treating physician confirming the only medication being prescribed is Oxycodone/APAP 5/325mg and that three injections per year will suffice.
RESULTS: $231,487 in Savings
Tower documend the treating physician’s statement and submitted a $53,664 MSA to CMS for approval. Nine days later, CMS issued a full approval of the MSA without Development or a counter-higher. The result was $231,487 in savings!!
Tower’s Physician Follow-Up Service is provided at no charge with initiated as part of the MSA and CMS submission process.
