Blog Archives

CMS to Host Webinar on CRC Appeals

September 23, 2020

CMS webinar on CRC Appeals to focus on the procedures and best practices for redeterminations.

This Thursday, September 24 at 1 p.m. ET the Centers for Medicare and Medicaid Services (CMS) will be hosting a Commercial Repayment Center NGHP Applicable Plan appeals webinar.

According to the notice:

CMS will be hosting a CRC NGHP Applicable Plan webinar to review the procedures and best practices for redeterminations. The format will be opening remarks by CMS followed by a presentation from the CRC. This webinar will primarily focus upon how to effectively submit a redetermination request (sometimes called a first level appeal). During the presentation, we will also be reviewing appeal requirements, what is and is not subject to appeal, and details about what documentation is needed to support the appeal request in various situations.

We encourage anyone involved in Medicare conditional payment appeals stemming from demands from the CRC attend the webinar.

Slides and Q&A Available from August Reporting Webinar

On another note, the slides and Q&A from CMS’s August 13, 2020 Section 111 Non-Group Health Plan (NHGP) Reporting webinar are now available. Tower provided a summary of this webinar in a prior article entitled CMS: Indemnity Only Settlements are Not Reportable.

Learn from the MSP Experts at the NAMSAP Virtual Conference

September 22, 2020

2020 NAMSAP Virtual Annual Conference banner

The National Alliance of Medicare Set-Aside Professionals (NAMSAP) is the leading educational organization on Medicare Secondary Payer compliance. Its annual conference, which is sponsored by Tower, brings together the best minds in the industry, including representatives from CMS and its contractors, for presentations and discussions on the latest in Medicare compliance and MSAs.

Tower’s Chief Compliance Officer and Vice President of NAMSAP, Dan Anders, Esq., is a panelist for the session Reference Guide Lesser Known Facts and Fallacies.

This year’s virtual conference, which will be held October 6 and 7, provides a unique opportunity to learn from these professionals from the comfort of your home office. We encourage anyone who is involved with MSP compliance on a regular or semi-regular basis–or is just interested in learning more–to attend. Attendees can earn continuing education credits, such as CLE, MSCC, CMSP and CLCP.

Find out more about the conference here.

If you are interested in attending the virtual conference or have additional questions, please contact Dan Anders at daniel.anders@towermsa.com or (888) 331-4941. We hope you can attend!

New Section 111 Dashboard Can Help You Avoid Penalties

September 1, 2020

Tower MSA Partners has created an intuitive, easy-to-use Section 111 dashboard to help you avoid CMS’s penalties for non-compliance with Section 111 reporting. Once in effect, the penalties can amount to up to $1,000 per day per claimant for things like failing to accurately ORM and TPOC.

Our new Section 111 dashboard provides 24/7 access to your claims data and reporting oversight for all aspects of the reporting process. It will even remind you to update ORM Term Dates when claims settle. You can run all kinds of reports and correct errors on the fly.

For details, please see the news release: Tower MSA Partners Releases Medicare Mandatory Reporting Dashboard. And, for a quick refresher on CMS’s proposed penalties, see Tower’s Feb. 18 and April 27 posts:

CMS Issues Proposed Rule for Mandatory Insurer Reporting Penalties

CMP Comments Submitted

Tower MSA Partners Receives SOC 2 Type I Attestation

August 21, 2020

Tower MSA Partners has completed its SOC 2 Type I audit. Performed by KirkpatrickPrice, this attestation provides evidence of Tower’s strong commitment to security and delivering high-quality services to its clients by demonstrating that it has the necessary internal controls and processes in place.

A SOC 2 Type I audit provides an independent, third-party validation that a service organization’s information security practices meet industry standards stipulated by the AICPA. During the audit, an organization’s non-financial reporting controls as they relate to security, availability, processing integrity, confidentiality, and privacy of a system are tested. The SOC 2 report delivered by KirkpatrickPrice verifies the suitability of the design of Tower’s controls to meet the standards for these criteria.

“Tower’s processes have been technology driven from its beginning with the privacy and security of client data at the forefront of internal policy and procedure development,” said Tower CEO Rita Wilson. “We are pleased to receive this affirmation from an independent analysis.”

“The SOC 2 audit is based on the Trust Services Criteria. Tower MSA Partners has selected the security and confidentiality criteria for the basis of their audit,” said Kirkpatrick Price President Joseph Kirkpatrick. “Tower delivers trust-based services to its clients and by communicating the results of this audit, its clients can be assured of their reliance on this company’s controls.”

Towers’ VP of IT Jesse Shade on The Hot Seat

August 5, 2020

Jesse Shade, Tower’s Vice President of Information Technology, will be a panelist on the “Cybersecurity Threats: What You Can’t See Can Hurt You” webinar. Presented by WorkersCompensation.com as part of its The Hot Seat series, the free webinar starts at noon EDT on August 6.

Shade, who is a member of the Forbes Technology Council, brings more than 35 years of IT experience to the panel. He oversees all aspects of Tower’s technologies, including data security.

Joining Jesse Shade in the information-packed session is the George State Board of Workers’ Compensation’s Director of Information Technology Bobby Allen and WorkersCompensation.com’s Media Director Nancy Grover.

Among the topics Jesse Shade will cover are:

Misconceptions about cybersecurity
Should organizations outsource cybersecurity efforts?
How can you guard against internet attack?

The webinar will be moderated by WorkersCompensation.com President and CEO Bob Wilson and Judge David Langham. There is no charge for the webinar.

CMS Releases Updated Section 111 and MSPRP User Guides – Schedules Reporting Webinar

July 17, 2020

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

New CMS User Guides released.

The Centers for Medicare and Medicaid Services (CMS) recently released updated user guides for Non-Group Health Plan MMSEA Section 111 Mandatory Insurer Reporting and the Medicare Secondary Payer Recovery Portal (MSPRP). CMS also just announced an August webinar on Section 111 reporting matters.

CMS User Guides: Updated MMSEA Section 111

On June 29, CMS released Version 5.9 of the NGHP MMSEA Section 111 User Guide. Highlights of the updated user guide:

A reminder has been added that while the threshold for physical trauma-based liability insurance settlements remains at $750, this threshold does not apply to non-trauma liability reporting for alleged ingestion, implantation, or exposure cases. Any settlement, regardless of amount, should be reported for these types of cases. (Sections 6.4.2, 6.4.3, and 6.4.4).

The limit dollar amount that triggers a threshold error has been adjusted from $99,999,999 to $99,999,999.99. This error occurs any time the No-Fault Insurance Limit amount or the cumulative value of all reported TPOCs (detailed and auxiliary records) exceed this limit. Additionally, the No-Fault Insurance Limit field number has been corrected under “Exceptions.” (Section 7.3.2).

When considering the requirements for the Ongoing Responsibility for Medicals (ORM), remember, per current policy, that the dollar limit for No-Fault Insurance Limits (Field 61) represents a combined total of Med-Pay and Personal Injury Protection (PIP) (Section 6.7.1).

When considering the requirements for the Ongoing Responsibility for Medicals (ORM), remember, per current policy, that the dollar limit for No-Fault Insurance Limits (Field 61) represents a combined total of Med-Pay and Personal Injury Protection (PIP) (Appendix A).

The CR02 claim response file error code field number has been corrected (Appendix F) (Table F-4).

CMS User Guides: Updated MSPRP

On July 13, CMS released Version 4.9 of its MSPRP User Guide. The MSPRP is a web-based application which allows authorized users to, among other tasks, investigate, dispute and resolve Medicare conditional payments. Updates can be found on page 1-1 of the user guide. Significantly, users can now view and print outgoing correspondence from the MSPRP. This is correspondence that has been received or letters that have been sent related to a BCRC or CRC case.

Section 111 Reporting Webinar

CMS will be hosting a Section 111 NGHP webinar on August 13, 2020 at 1:00 PM ET. According to the notice, “the format will be opening remarks by CMS followed by a presentation that will include NGHP reporting best practices and reminders.” The webinar notice can be found here.

If you have any questions regarding the updates, please contact Dan Anders, Chief Compliance Officer at daniel.anders@towermsa.com or 888.331.4941.

PREMIER WEBINAR: Avoiding the Medicare Mandatory Reporting Penalty

June 29, 2020

Avoiding the Medicare Mandatory Penalty webinar banner

Regulations for Medicare Mandatory Reporting Penalty are in the process of being formalized!

Under the threat of up to a $1,000 per-day, per-claim penalty, most insurers and self-insurers have implemented processes to ensure Medicare beneficiary claimants are reported to Medicare per Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA).

Penalties have never been imposed as the SMART Act specified that the Centers for Medicare and Medicaid Services (CMS) must formalize regulations prior to issuing them. This past February, CMS released proposed regulations, which we detailed in this article: CMS Issues Proposed Rule for Mandatory Insurer Reporting Penalties. Comments on the proposal were due in April and now we await a final regulation.

In a timely webinar, a full analysis of CMS’s penalties proposal will be provided by Tower’s Chief Compliance Officer, Daniel Anders, Esq. Joining Dan will be Jesse Shade, Tower’s VP of Information Technology, who will break down new user-friendly enhancements to Tower’s Mandatory Insurer Reporting platform that are designed specifically to avoid the penalties CMS seeks to impose.

A Q&A session will follow the presentation. Plan to attend the webinar on Wednesday, July 22, at 2 pm ET.

Thank you,

Dan Anders
Chief Compliance Officer

CMS Provides Notices on Section 111 Reporting and Conditional Payment Processes

June 17, 2020

People using laptop and mobile phones to update Section 111 Reporting

CMS has recently issued two notices, one pertaining to mandatory Section 111 reporting and one relevant to Medicare conditional payment recovery.

First, in a “teaser” notice, CMS announced that on July 13, 2020 the Medicare Secondary Payer Recovery Portal (MSPRP) is scheduled to be enhanced to allow authorized users to view and print correspondence.

According to the notice,

MSPRP users who log in using Multi Factor Authentication will be able to view and print CMS mailed correspondence that is displayed on the Letter Activity tab. Additional information on how to use this new functionality will be available in Section 14.1.1.4 of the July version of the MSPRP User Guide.

Second, in an alert entitled “Reporting No-Fault Insurance Limit on Non-Group Health Plan (NGHP) Claim Input Files,” CMS reminds Responsible Reporting Entities (RREs) that they must combine both Med Pay and Personal Injury Protection (PIP) coverage limits for Section 111 reporting purposes. This would be under circumstances where separate Med Pay and PIP coverages are being paid out on claims for the same injured party and incident under a single policy.

CMS also reminded RREs that ORM cannot be terminated until both Med Pay and PIP coverage limits are exhausted. Further, that when providing the dollar amount for the policy limit, that it must accurately reflect two decimal places. For example, a policy limits of $5,000 should be reported as 500000.

Practical Implications

In regard to the MSPRP enhancement to print documents, while we will have to see the specific guidance in the July update, this may prove quite useful in not having to wait for correspondence to come in the mail, print letters that were not received via the mail or reprint letters.

As for the alert to remind No-Fault carriers to report Med Pay and PIP coverage limits as a combined amount, while this guidance is already included in the NGHP User Guide, there was apparently some confusion that led CMS to provide this alert as a reminder of how such coverage must be reported.

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

WorkersCompensation.com’s Coverage of the Pharmacy/Legacy Claims Webinar

June 1, 2020

“The older the claim, the higher the costs—especially for prescription drugs,” wrote WorkersCompensation.com’s Nancy Grover, in this excellent recap of A Prescription for Settling Legacy Claims webinar.

The May 19 webinar was presented by Dan Anders, Tower MSA Partners’ Chief Compliance Officer, and Phil Walls, Chief Clinical and Compliance Officer of myMatrixx.

They said that aging claims increase the likelihood that the injured worker may become a Medicare beneficiary. “That means those higher drug costs must be included in a Medicare Set-Aside,” she wrote.

The fast-paced webinar explains how and why prescription drug costs increase during the life of a claim. Brand name drugs, compounds (yes, still), and “prescription cascade” (prescribing new meds to address the side effects of other meds) top the list of cost-drivers.

To gain CMS approval of an MSA, medications that may not be needed or even being used must be allocated in the MSA. What’s more, they are priced at Redbook’s lowest average wholesale price (AWP), eliminating discounts the pharmacy benefit manager (PBM) once provided. Side note: Phil describes issues with AWP in detail during the Q&A at the end of the webinar.

Dan and Phil discussed ways an MSA provider and PBM can partner to identify and address unnecessary costs—without negatively impacting the injured worker’s treatment. “We reach out to the treating physician for last dates of service to see what’s going on,” Dan said. “We also do drug reviews to see if there are alternatives that can be implemented.”

Presenters cited a case where an intervention reduced the total morphine equivalent dosage from a dangerous 480 mg per day to 120 mg per day. The changes produced a savings of about $1 million.

“Our goal is never to keep the injured worker from obtaining the therapy they need, but not to expose them to unnecessary prescribing,” Phil said.

To download the recording of this valuable webinar, please go to: https://register.gotowebinar.com/recording/7163259288372148492

Best Practices for Cybersecurity

May 26, 2020

Tower MSA Partners’ SVP of IT Jesse Shade offers advice to workers’ compensation companies on best practices for cybersecurity.

Did you know that personal health information (PHI) is more valuable on the black market than financial data? This makes workers’ comp organizations very attractive targets for cyber criminals.

“Payers and other workers’ compensation organizations need to guard this sensitive data within their own enterprises. And, since these companies regularly exchange data with each other, each company needs to be just as concerned about the cybersecurity practices of its partners as its own,” says Tower’s Senior Vice President of Information Technology, Jesse Shade in this informative WorkCompWire article: Securing Data During COVID-19 and Beyond.

In last week’s article – COVID-19 Response Triggers Cybersecurity Threats to Workers’ Comp – Jesse described the scope of the cybersecurity issue especially in the midst of COVID-19. In this one, he outlines out best practices for cybersecurity in the form practical ways to protect PHI and other data and discusses the tools your IT department needs. He also gives you questions for your managed care organizations, MSP compliance companies and other service providers to ensure that their security practices can withstand attacks.

Cyberattacks have risen astronomically during COVID-19 and will continue long after the pandemic passes. The IBM Cost of a Data Breach Report put the average cost of a data breach in the U.S. at $8.19 million in 2019. In addition to the financial hit, companies risk their reputations and the trust of their clients, customers and partners.

As Jesse says, you can’t afford to ignore cybersecurity.

Related:

Building a Better Tower – Cybersecurity