Blog Archives

Tower MSA Partners Completes SOC 2 Type II Audit

April 28, 2021

In our unwavering commitment to data privacy and security, Tower MSA Partners has completed its SOC 2 Type II audit. The SOC 2 Type II audit reports on a service organization’s non-financial reporting controls and processes as they relate to the Trust Services Criteria developed by the American Institute of Certified Public Accountants (AICPA). It tests the organization’s controls related to security, availability, processing integrity, confidentiality, and privacy over an extended period of time.

From the beginning, Tower has been committed to technology driven processes to bring efficiency and measured results to our clients. The SOC 2 Type II attestation demonstrates how our corporate governance effectively assesses and manages risks and ensures the integrity of the systems and processes delivered by Tower and its business partners to execute the same high level of protection throughout the supply chain. I’m extremely proud of this leadership team and its accomplishments.

Conducted by KirkpatrickPrice, the audit verified the fairness of the presentation of management’s description of the service organization’s system and the suitability of the design and operating effectiveness of the controls to achieve the related control objectives included in the description throughout a specified period.

“Tower delivers trust-based services to their clients, and by communicating the results of this audit, their clients can be assured of their reliance on its controls,” said KirkpatrickPrice President Joseph Kirkpatrick.

Related Prior Posts:

Tower MSA Partners Receives SOC 2 Type I Attestation

Building a Better Tower

CMS Updates Section 111 Model Language Form

April 26, 2021

Man signing a document to illustrate CMS updates to Section 111 Model Language Form

Recently, the Section 111 Model Language form was updated by the Centers for Medicare and Medicaid Services (CMS), The form is used by Responsible Reporting Entities (RREs) to collect the Medicare Beneficiary Identifier (MBI) and/or a Social Security Number (SSN) from claimants. The SSN or MBI, along with the claimant’s First and Last Name, Gender, and Date of Birth, are needed by the RRE to query CMS to determine whether the claimant is a Medicare beneficiary for Section 111 Mandatory Insurer Reporting purposes.

The most notable change to the form is that the Section I language was revised from “Are you presently, or have you ever been, enrolled in Medicare Part A or Part B?” to “Are you presently, or have you ever been, enrolled in Medicare?” We assume this language was modified because the claimant’s enrollment in Parts A, B, or C (which isn’t even mentioned) is irrelevant for purposes of Section 111 reporting. The simpler language, just asking for Medicare enrollment status, should avoid confusion that may have arisen from the prior language.

Practical Implications of the Section 111 Model Language form

As we wait for CMS to issue final rules around mandatory insurer reporting penalties, it is important for RREs and those administering claims for RREs to collect this identifying information or document their efforts to collect it by using this model language. As we discussed in CMS Issues Proposed Rule for Mandatory Insurer Reporting Penalties, RREs will have a safe harbor from reporting penalties if they document good faith efforts to attempt to obtain an MBI or SSN from the claimant, and this model form will help document those efforts.

Please contact Dan Anders at Daniel.anders@towermsa.com or (888) 331-4941 with comments or questions.

Related Posts

Section 111 Reporting

Dan Anders in WorkCompWire: Avoiding Section 111 Reporting Penalties

CMS Section 111 Mandatory Insurer Reporting Webinar Recap

April 7, 2021

man on keyboard for Section 111 Mandatory Insurer Reporting

Leaders from the Centers for Medicaid and Medicare Services (CMS) Division of MSP Program Operations, Commercial Repayment Center (CRC), and Benefits Coordination and Recovery Center (BCRC) held an April 1 webinar on the intersection of the BCRC and CRC in Section 111 Mandatory Insurer Reporting and the resolution of Medicare conditional payments.

While mostly a Q&A format, the webinar unveiled a new CMS/BCRC policy for reporting partial settlement of medical when Ongoing Responsibility for Medical (ORM) ends for certain diagnoses and continues for others. Set to rollout in June, the new reporting policy provides for three scenarios:

Partial settlement of medical prior to initial reporting

Scenario: Claimant is identified as a Medicare beneficiary which triggers the requirement to report ORM and/or Total Payment Obligation to the Claimant (TPOC) through the Section 111 reporting process. Both ORM and TPOC are for the same insurance type, policy, and claim number. The only difference is the accepted and denied diagnoses on the claim. The parties agree to a partial settlement for the denied diagnoses and leave the accepted diagnoses open on the claim.

Problem: How to report a partial settlement of the denied diagnoses and still report ORM for the accepted diagnoses.

CMS Solution: CMS’s solution is to submit two add records. Specifically, one record will be added for ORM that will describe all of the diagnoses that have been accepted for ORM. ORM will be ‘Y’ with no TPOC date or amounts. A second record will be added for TPOC which will describe all of the denied diagnoses that are being settled. ORM will be ‘N’ with a TPOC date and amount.

Partial settlement of medical post initial reporting

Scenario: A claim with multiple diagnoses was reported for ORM through the Section 111 Mandatory Insurer Reporting process. The parties agree to a settlement for certain diagnoses while keeping ORM open for other diagnoses.

Problem: How to report a partial settlement for certain diagnoses while keeping ORM open for the non-settled diagnoses.

CMS Solution: CMS’s solution is to submit one update record and one add record. The update record will remove the diagnoses that are subject to the partial settlement and keep the diagnoses codes where ORM continues. Then, an add record with the TPOC date, amount and diagnoses codes that are subject to the partial settlement will be submitted. ORM will remain “N” in the add record.

Partial ORM closure with no settlement

Scenario: Acceptance of ORM is initially reported though the Section 111 Mandatory Insurer Reporting process with multiple diagnoses. Subsequent to this initial report, there is a basis to terminate one or more of the initially accepted diagnoses, but not all of the diagnoses. This is not a situation where a partial settlement has occurred, rather there is a basis to terminate one or more diagnoses absent a settlement. For example, a claimant’s cardiac condition was exacerbated as a result of a fall and the medical providers confirm resolution of the exacerbation. While the carrier continues to accept the orthopedic condition, the ORM can end for the cardiac diagnosis.

Problem: How to end ORM for one or more diagnoses while keeping it open for other diagnoses.

CMS Solution: CMS’s solution is to send an update record that removes the diagnosis or diagnoses where ORM has ended. In this situation a TPOC date is not submitted, rather this is only submitted when ORM is completely terminated for all diagnoses.

The purpose behind these new policies is to improve coordination of benefits such that a Medicare beneficiary’s medical care is not denied when unrelated to a claim and prevent the recovery contractors from attempting to seek reimbursement for Medicare payments unrelated to a claim.

While we thank CMS and the BCRC for identifying solutions to the above reporting problems, we believe RREs may face some technical challenges in the ability to, for example, report two add records on the same claim. We await issuance of the formal policy from CMS and will review how this policy change can best be incorporated into the Section 111 reporting process.

In addition to announcing the new reporting policy, CMS and the contractors provided the following advice:

Respond to correct contractor – Carefully review the correspondence and make sure to respond to the contractor that sent the letter, whether it’s to obtain further information, dispute/appeal charges, or to make payment.

As a reminder, CMS noted, the BCRC is generally recovering conditional payments when the identified debtor is the Medicare beneficiary while the CRC is recovering conditional payments when the insurer/WC carrier is the identified debtor.

CMS provided the following guidance regarding key timeframes:

Interest accrues from the date of the demand letter and is assessed on debt if not resolved within 60 days.
- When CMS issues a demand letter directly to the applicable plan, the applicable plan has formal administrative appeal rights.
- The applicable plan has 120 days from the date the applicable plan receives the demand letter to file a redetermination (first level of appeal). Interest will still accrue during this time.
- If the appeal is not filed within 120 days, and “good cause” for untimely filing is not provided, the appeal will be dismissed.
- Failure to resolve the debt will result in referral to treasury at 180 days.

Note: When you are appealing to the ALJ please be sure to cc the CRC so that they can appropriately place a hold on a case so that it is not referred to treasury while the appeal is in process.

During the Q&A portion of the webinar CMS and its contractors addressed varied questions; some are summarized below:

What can be done if we cannot obtain a Social Security number from the claimant? CMS advised them to document their efforts at obtaining the SSN. It was noted CMS has model language found on the CMS website which can be used to document claimant’s refusal to provide SSN.
In response to a question concerning the many charges found on conditional payment notices and demands that are unrelated to the injury, CMS/CRC acknowledged that it is not a perfect process. The CRC explained that when conditional payment information is requested what is sent to the requestor may have only been produced through an automated search of charges related to the injury. CRC did advise that when it comes to actual issuance of a demand that there is a human validating process.
In response to a question concerning why in response to a dispute of a Conditional Payment Notice, one might receive another CPN with new charges, the CRC explained that this is the result of the system constantly reviewing for additional charges deemed related to the injury.
There were several questions regarding problems with the CRC recognizing out-of-pocket reimbursements to claimants in a no-fault/med-pay claim as counting towards the exhaustion of the no-fault maximum amount. CRC’s response was to advise entities to provide plan documents and proof of payment to the claimant along with a reason for the payment. Its leader said, “We are aware that no-fault payors have run into problems with CRC rejecting out-of-pocket expenses as included within the no-fault exhaustion amount.”

If you have any questions, please contact Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com or 888.331.4941.

Related prior posts:

CMS RELEASES TECHNICAL UPDATES TO SECTION 111 USER GUIDE

Tower MSA Partners Ready to Steer Clients Through Pending Section 111 Civil Money Penalties

April 1, 2021

View from Dashboard over highway to illustrate Section 111 Civil Money Post

Last year the Centers for Medicare and Medicaid Services (CMS) proposed regulations on Section 111 civil money penalties (CMPs). See Tower MSA Partners’ detailed prior post, CMS issues Proposed Rule for Mandatory Insurer Reporting Penalties related to inaccurate or untimely Section 111 Medicare Mandatory Insurer Reporting. Some of these are shocking – up to $1,000 per day per claimant in some cases. Tower and others in the Medicare Secondary Payer (MSP) industry collaborated on comments to CMS’s proposal.

Then, Tower went well beyond simply responding to CMS. We took proactive measures to prepare our clients for the eventual penalties. We educated clients with a webinar focused specifically on the subject matter, and we have communicated frequently.

Tower’s proprietary tech tools help prevent Section 111 Civil Money Penalties

In addition to education and communication, with Tower’s focus on technology to measure, manage and drive results, we built a dashboard to steer our clients through MSP compliance so they can avoid CMPs when they go into effect. See our news release for details: Tower MSA Partners Releases Medicare Mandatory Reporting Dashboard.

Our S111 Management Dashboard gives you the 24/7 data and reporting oversight for every aspect /of the reporting process. Workers’ compensation and liability payers usually have limited visibility into claims history through their Section 111 providers’ reporting systems. They may receive compliance error reports but aren’t able to quickly verify compliance accuracy. Few systems remind responsible reporting entities to update the ongoing responsibility for medicals (ORM) termination dates when claims are settled.

The dashboard gives clients full visibility into their claims from a global level all the way down into the details of a specific claim. You can manage the accuracy of data, such as ICD 10 codes or ORM to avoid unnecessary conditional payment or MSA exposure in addition to avoiding CMPs.

“The dashboard is intuitive and simple to use,” said Todd Venneri, Business Intelligence Project Manager for BETA Healthcare Group, who tested its features. “The ability to quickly access and verify claim information is invaluable.”

While our intuitive S111 Management Dashboard was being developed, we also updated our client portal and MSP Automation Suite. Keep in mind, Tower’s system was built specifically by us for this industry. It seamlessly manages Section 111 reporting, conditional payments, Medicare Set-Aside triage, clinical and legal interventions, MSA preparation, and CMS submission activities that take clients through settlement and closure.

We don’t know when CMPs will be announced or how Section 111 civil money penalties will be assessed. What we do know, however, is that our clear, concise dashboard has replaced uncertainty with knowledge and information.

We are ready and we want you to be ready, too. If you have not used the dashboard yet, take it for a spin. Get in touch with Hany Abdelsayed at hany.abdelsayed@towermsa.com or 916-878-8062 for a demo.

Women’s History Month: Celebrating Tower’s History as a Women-Owned Business

March 18, 2021

Portraits of Rita Wilson and Kristine Dudley. executive team of Tower, a women-owned business

As a women-owned business serving the workers’ compensation and liability insurance industry in the Medicare Set Aside (MSA) sector, we thought a great way to celebrate this month is to take a chapter from our own history. We’re pretty proud of our leadership team as well as being certified members of WBENC or the Women’s Business Enterprise National Council, a leading non-profit organization dedicated to helping women-owned businesses thrive.

Tower is not only a women-owned business, 85% of employees, including the majority of our managers and supervisors, are women.

The company was co-founded in 2011 by Rita Wilson and Kristine Wilson Dudley.

Tower Co-Founder: Rita Wilson

Rita’s path to Medicare Set-Asides wound through technology and pharmacy. She graduated summa cum laude with a BS degree from Presbyterian College in Clinton, SC, completed graduate studies at Converse College in Spartanburg, and started her tech career with a textile company.

She later became Director of Research & Development for a company that developed pharmacy management software. Her team developed standards for information exchange between group health pharmacy benefit managers (PBMs) and pharmacies. Her next move was to build out the operations and technology for a start-up workers’ comp PBM and ultimately become its CEO.

“We took insurance billing from a labor-intensive and mostly paper-bill environment into electronic adjudication,” Rita said.

In 2006, she moved to Florida and founded a diagnostic company and did some technology consulting with Speedy MSA, which was owned by Behn Wilson. He introduced Rita to his daughter, Kristie.

Tower Co-Founder: Kristine Wilson Dudley

Kristie had grown up in the workers’ comp industry and recalls going to the conference that is now WCI when she was just seven years old. Kristie went to the University of Tennessee at Chattanooga on a tennis scholarship, scoring the honor of NCAA Academic All-American in 2004. She earned her law degree from Florida State University School of Law in Tallahassee.

She practiced law for a while, gaining workers’ comp experience with the firm of Eraclides & Gelman. While MSAs did come up, the firm saw them as necessary, but problematic. “And that’s still true with some law firms and even some adjusters today,” she said. “If you don’t do MSAs every day, they can seem like hurdles instead of opportunities to settle claims.”

While she liked practicing law, Kristie really wanted to operate a business. With Rita’s technology and pharmacy expertise, their joint understanding of MSAs, and Kristie’s legal background, the women knew they could offer deliver MSAs with a better balance of care, cost and compliance than any others in the market.

Tower MSA Facilitates Settlement

The MSA environment of the late 2000s was paper intensive, technology hungry and lacking structure, not unlike pharmacy billing before the ‘90s, according to Rita. It was hard to tell exactly what was happening at any given time with a claim and what action needed to be taken. Claims languished and collected unnecessary expenses.

“I had seen the birth of on-line pharmacy bill adjudication and the standardization of data transfer protocols and knew we could leverage technology to efficiently manage MSA production and approval processes, consistently execute workflow, drive results and accelerate settlements,” she said.

And so, these two women entered a mature market, developed a methodology that changed the paradigm as to how MSAs can facilitate settlement and created metrics to manage performance. From the ground floor, Tower MSA Partners developed a sophisticated platform that targets cost drivers, documents recommendations of clinical and legal interventions, prompts next steps and keeps claims moving toward settlements.

Is Tower run by pushy women?

“Tower differentiates itself by aggressively seeking ways to mitigate costs and secure savings for clients,” Rita said. “Technology makes that possible.” Through claims feeds from clients, MSA specialists look for things that add unnecessary expense like possible surgeries that have not been discussed in a long time, prescriptions that were never filled, or brand drugs being used when generics could be.

“We’re different because we keep pushing. We listen to what CMS says and we push back when we disagree with a finding, we bring evidence, we intervene. We don’t just roll over,” Kristie insists. “Technology and measurements enable us to confidently do this.”

Is Tower run by pushy women? “We prefer ‘proactive,” Rita said, “but if the stiletto fits….”

If you’d like to connect with Rita or Kristie or Tower MSA Partners, email them at rita.wilson@towermsa.com or kristine.dudley@towermsa.com.

Related

Rita Wilson, Chief Executive Officer

Kristine M. Dudley, Esq., Chief Operations Officer

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

March 15, 2021

People sitting around conference table discussing MSA settlements.

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

March 10, 2021

Man in business suit looking confused about Conditional Payments

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!

$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

March 2, 2021

Red Medicare button on a keyboard to illustrate Medicare conditional payment.

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

February 26, 2021

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!

February 24, 2021

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, 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.

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.”