Blog Archives - Page 11 of 25

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.”

Building a Better Tower – Cybersecurity

February 18, 2021

hands on a keyboard overlaid with a lock symbol to illustrate cybersecurity

Tower has invested in significant cybersecurity 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 Cybersecurity 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. Source: SolarWinds 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

February 4, 2021

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

MSPN Elects Dan Anders as President

February 3, 2021

Dan Anders who was quoted in the Claims Journal

Tower’s Chief Compliance Officer, Dan Anders, has been elected president of the National Medicare Secondary Payer Network (MSPN). MSPN is the premier organization for individuals, companies and law firms who want to stay apprised of Medicare Secondary Payer compliance developments and collaborate on industry leading education and advocacy efforts. Check out the news release: Tower MSA Partners Dan Anders Elected President of the National Medicare Secondary Payer Network.

This is the second time in three years Tower has had one of our executives at the helm of this organization. Our CEO, Rita Wilson, served as president in 2018.

Dan takes office as the organization completes rebranding itself from its former name of the National Alliance of Medicare Set-Aside Professionals (NAMSAP) to the National MSP Network. Over the years, the Centers for Medicare and Medicaid Services (CMS) expanded its MSP enforcement mechanisms beyond Medicare Set-Asides. The organization kept pace, adding Medicare conditional payment recovery, mandatory insurer reporting to Medicare, and MSA professional administration and settlement structuring to its education and advocacy initiatives.

Dan looks forward to working with MSPN’s Executive Committee and Board, consisting of the most experienced and knowledgeable professionals in the MSP compliance community, to accomplish the organization’s 2021 goals.

Additionally, he will continue the organization’s positive working relationship with CMS’s Division of MSP Program Operations, which enables MSPN members to ask questions and raise concerns and provide solutions directly with those who develop and implement MSP policy while learning the agency’s reasoning and viewpoint firsthand.

If you would like to learn more about MSPN, please contact Dan Anders at daniel.anders@towermsa.com or (888) 331-4941, ext. 219.

CMS Releases Technical Updates to Section 111 User Guide

January 26, 2021

CMS User Guides for Section 111 Reporting. open book with colored page markers

The Centers for Medicare and Medicaid Services (CMS) has begun the new year with some updates to its MMSEA Section 111 NGHP User Guide. This guide provides everything and anything you ever wanted to know about mandatory insurer reporting by non-group health plans. Version 6.2 provides the following updates:

$750 Reporting Threshold

In follow-up to its November 2020 announcement that it will be maintaining the $750 TPOC threshold for reporting and Medicare conditional payment recovery, CMS states:

As of January 1, 2021, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals (Sections 6.4.2, 6.4.3, and 6.4.4).

Key takeaway: Maintaining the $750 threshold means there are no changes to the reporting processes, determinations of claims that should be reported, or when conditional payments should be investigated or resolved.

Reporting Future ORM Termination Date

Per CMS:

To address situations where Responsible Report Entities (RREs) can identify future ORM termination dates based on terms of the insurance contract, RREs can now enter a future Ongoing Responsibility for Medicals (ORM) Termination Date (Field 79) up to 75 years from the current date (Section 6.7.1)

Key takeaway: A future ORM termination date can only be submitted if it is certain, e.g., the date is specified in an insurance contract or a statutory limitation provides for its exact determination. The prior policy only allowed the reporting of an ORM termination date that was six months into the future. The expansion to 75 years should allow for most date certain ORM terminations to be reported.

Data Exchange Update

Per CMS:

As part of CMS’ commitment to the modernization of the Coordination of Benefits & Recovery (COB&R) operating environment, changes are being implemented to move certain electronic file transfer data exchanges to the CMS Enterprise File Transfer (EFT) protocol. As part of this change the exchange of data with the COB&R program via Connect:Direct to GHINY SNODE will be discontinued. The final cutover is targeted to occur in April 2021. File naming conventions and other references have been updated in this guide. Contact your EDI Representative for details (Sections 10.2 and 10.3).

Key takeaway: Right now, CMS offers four methods of data transmission that Section 111 RREs or their reporting agents can use to submit and receive electronic files. CMS is discontinuing the Connect:Direct method, and since Tower does not communicate with CMS via this method there will be no impact to our reporting processes.

Policy Number Now a Key Field

Per CMS:

To support previous system changes, Policy Number (Field 54) has been added as a key field. If this field changes, RREs must submit a delete Claim Input File record that matches the previously accepted add record, followed by a new add record with the changed information (i.e., delete/add process) (Sections 6.1.2, 6.6.1, 6.6.2, and 6.6.4).

Key takeaway: Previously, if a claim input file was updated with a different policy number for the same claim it would create two records with the BCRC. This could duplicate Medicare conditional payment recovery efforts. CMS’s solution is to have the RRE delete the prior record with the old policy number and add a new record with the new policy number.

Retraction of Soft Code Error

Per CMS:

In Version 6.1, we announced that several input errors will become “soft” errors starting April 5, 2021. However, CP03 will not become a soft edit. The Office Code/Site ID (Field 53), which triggers CP03, is used to identify correspondence addresses, and if incorrect, could result in mail being sent to the wrong place. Therefore this error will continue to reject the record (Appendix F).

Key Takeaway: An error in Office Code/Site ID (Field 53) will not be considered a soft edit and will result in file rejection. An earlier Tower article, November CMS Mandatory Reporting and Conditional Payment Updates, explained these so-called “soft” code errors.

If you have any questions on these updates to the Section 111 User Guide, please reach out to Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com or 888.331.4941.

Three Medicare Secondary Payer (MSP) Predictions for 2021

January 14, 2021

rainbow over a highway with the year 2021 painted, illustrating predictions for Medicare Secondary Payer in 2021

We take a look at what’s in the crystal ball for Medicare Secondary Payer (MSP) short-term issues in the year ahead.

This year marks the 20^th anniversary of the famous —or infamous, depending on your perspective— “Patel Memo” that formally launched CMS’s Workers’ Compensation Medicare Set-Aside review process. It was probably safe to assume that a government program like this would still be around two decades later. However, the expansion of CMS’s authority to require mandatory reporting along with stepped up efforts to recover conditional payments by both Medicare and Medicare Advantage plans was less predictable.

I won’t hazard a guess on what Medicare Secondary Payer compliance will be like 20 years from now but will predict the outcomes of some short-term issues.

Liability MSAs

In June 2012 CMS issued an Advanced Notice of Proposed Rulemaking (ANPRM) with ideas as to how Medicare’s interests could be considered in the settlement of future medicals in a liability case. Ultimately, the ANPRM was withdrawn in October 2014.

Nothing further was heard from CMS management until December 2018 when it indicated proposed rules would be issued in September 2019. Subsequent notices postponed the date to March 2021.

Prediction: Since CMS will have new leadership and its attention has turned to vaccine distribution, I suspect we will not see proposed rules on LMSAs this year. Even if CMS proposes regulations, they would not be implemented until after a comment period followed by revisions, which would likely stretch into 2022.

Section 111 Penalties

On February 18, 2020, CMS issued its proposed regulations specifying how and when it would impose civil money penalties if Non-Group Health Plans fail to meet Section 111 Mandatory Insurer Reporting responsibilities. A comment period ended on April 20, 2020 (Please see CMP Comments Submitted for Tower’s comments on the proposal).

Prediction: Since CMS completed the process of releasing the proposed rule and receiving comment and the issuance of this regulation is statutorily required by the SMART Act of 2012 prior to issuing any penalties, I expect the final rule will be issued in 2021. Once issued, it will likely become effective within 60 days.

PAID Act

On December 11, 2020, President Trump signed into law HR 8900, Further Continuing Appropriations Act, 2021, which included the provisions of the Provide Accurate Information Directly Act or PAID Act.

The PAID Act requires CMS to provide applicable plans (liability insurance, no-fault insurance and workers’ compensation laws or plans) access to Medicare beneficiary enrollment status in Medicare Advantage and Part D Prescription Drug plans through the Section 111 Mandatory Insurer Reporting process. (Please review PAID Act Becomes Law for a full explanation of the law and its implications.)

Prediction: Per the law, CMS must provide access to Medicare Advantage and Part D plan information by December 11, 2021 (one year from the date of enactment). As CMS must implement technical changes to the Section 111 reporting platform to provide such access, it may not be ready by that date.

Beyond these three predictions, some issues to watch in the coming year:

Continued trend toward non-submit MSAs
More professional administration of MSAs
Cases affecting Medicare Advantage plan recovery rights
Per proposal from President-elect Biden, lowering of Medicare eligibility age to 60
“New” MSA reform legislation

A happy and safe new year to you and your families.

WorkCompCentral Explains the PAID Act

January 4, 2021

The recently enacted PAID Act fixes long-term annoyances for MSA companies in securing accurate information about beneficiaries’ Medicare Advantage prescriptions drugs plans.

Right now, the Centers for Medicare and Medicaid Services (CMS) can tell payers which workers’ compensation claimants are Medicare beneficiaries. However, the agency has historically said that privacy concerns prevent it from sharing which Medicare Advantage Plans or Prescription Drug Plans these beneficiaries have joined. This means Medicare Set Aside (MSA) companies and insurers have to ask claimants or their attorneys and the information was sketchy at best, leading to conditional payment demands – and some lawsuits – post settlement.

In mid-December, the Provide Accurate Information Directly (PAID) Act was passed and signed into law, enabling Medicare to respond to queries by providing the name and address of beneficiary’s Medicare Advantage or prescription drug plans. The law should help end years of aggravation over Medicare Advantage Plan identification, according to Tower MSA Partners’ Dan Anders, who was interviewed for WorkCompCentral’s article on the law: Medicare Set-Aside Firms Applaud Passage of PAID Act Provisions.

PAID Act Becomes Law