This success story demonstrates how an MSA Second Opinion can lead to a successful result with settlement of a WC case.

CHALLENGE:

An MSA was prepared by another MSP provider for approximately $110,000. Based on this MSA amount, the parties reached a tentative settlement. Prior to MSA submission the other MSP provider revised the MSA to $145,500 which was outside the parties settlement range. The cost drivers in the MSA were injections, surgeries and physician visits.

SOLUTION:

Tower’s MSA 2^nd opinion review found the injured worker had repeatedly declined injection therapy and one of the two surgeries had not been recommended in the past two years. Consequently, Tower recommended eliminating the surgery and injections from the MSA. Our Physician Follow Up service contacted the treating physician and obtained the physician’s written statement that injections were no longer part of the treatment plan.  The physician also agreed to reduce the number of physician visits to a single annual visit.

RESULTS:  $46,691 in Savings

In addition to eliminating a surgery that fell outside the two years of medical records required by CMS, injections were removed, and physician visit frequency was reduced yielding an MSA of $98,809. The MSA report was submitted and approved by CMS and the parties were able to move forward with settlement and claim closure.

Tower’s MSA 2^nd Opinion, offered at no charge, identifies, from another MSP provider’s report, discrepancies and inappropriate treatment which unnecessarily increases the MSA along with recommending interventions which may result in a lower CMS-approved MSA amount.

Tower’s Physician Follow Up Service, also offered at no charge, reaches out to the treating physician to confirm ongoing Rx and reduce excessive or unneeded treatments.

More Tower Success Stories can be found here!

CHALLENGE:

A Medicare Set-Aside was prepared by another MSP provider for $221,384.00.  In addition to extensive medical treatment and surgical procedures, the MSA included the medications omeprazole, ibuprofen, sertraline, and hydroxyzine.  As a settlement was not feasible with that MSA amount, it was submitted to Tower for a 2^nd Opinion MSA Review.

Tower’s 2nd Opinion MSA Review is offered at no charge.

SOLUTION:

Following Tower MSA Partners’ standard MSA workflow, the Intake team compared the reported “accepted” body parts against information in the client’s claim system and determined that sertraline, intended to treat stress and depression, should be removed as “psyche/stress” was not an accepted body part. This yielded a savings of $58,320. Additionally, Tower identified inappropriate medical treatment, including an unnecessary bladder surgery, resulting in a further $37,234 reduction. Finally, Tower obtained a rated age from K.P. Underwriting, which lowered the treatment and prescription cost over life expectancy. Tower’s MSA totaled $123,263.68.

RESULTS:  $98,120 in Savings

In addition to eliminating Rx unrelated to the injury and appropriately allocating for medical treatment, Tower recommended the following pre-CMS submission to mitigate exposure and further lower the MSA:

1. Tower drafted Body Part Letter to confirm accepted compensable conditions and specifically identified all other conditions discussed in the medical records as not “accepted” or paid for by our client.
2. Tower’s Physician Follow Up Service, offered at no charge, to reach out to the treating physician to confirm if hydroxyzine is related to the WC injury and whether omeprazole and ibuprofen can be switched from prescription to over-the-counter versions.

More Tower Success Stories can be found here!

Download more information here or refer an MSA for a 2^nd Opinion by contacting our Intake Team at 888-331-4941 or referrals@towermsa.com.

       Building a Better Tower – Through Technology

You may not think about the technology that drives Tower’s Medicare Secondary Payer compliance and Medicare Set-Aside preparation services very often – and that’s understandable.  You may like our simple user interface or the proactive communication our software generates to identify issues, make recommendations, and drive MSA optimization, or appreciate the S111 Management Dashboard, all without thinking about the technology behind the scenes.  That’s ok because we think about it everyday.  In fact, Tower’s  CEO Rita Wilson put technology front and center when she and co-founder Kristine Dudley started the company, automating much of the MSP compliance and MSA preparation operations, quality assurance, and analytics for maximum efficiency, accuracy, and productivity.

With cybersecurity in the news and hurricane season upon us, we wanted to remind you that Tower has you covered in these areas, as well.  Tower stores and manages all data, both internal and client information, securely via a cloud management partner, and has a dedicated “hot site” disaster recovery backup to ensure business continuity should our primary data center fail. For us, business continuity means Section 111 reporting, conditional payment negotiation and resolution, MSA triage, clinical interventions, final preparation, and submission all go on.

“Hurricanes do not affect Tower’s systems, data or internal processes,” Rita explained. “We have employees based all over the country, and before a hurricane impacts our Florida headquarters, our local employees have safely relocated to areas where they can continue to do their jobs with the assurance that the network, infrastructure and cybersecurity protection will be available.  If a natural disaster strikes our primary data center location, an automatic process fails over to our private hot backup site.”

Tower had mastered the IT infrastructure to support a remote workforce long before COVID-19. Aware of steadily increasing cybersecurity threat over the last several years,  the company had already secured Vigilant Technology Solutions’ services for 24/7 monitoring, intrusion detection and prevention.  With VPN access that included multi-factor authentication and secure computer and telephone systems in place, it took less than two hours for employees to transition to work from home

Tower’s complex technology is overseen by Jesse Shade, who was recently promoted to Chief Technology Officer.  This was Jesse’s third promotion in less than four years, which says a lot about how we feel his contributions and talents. Last year, Jesse designed our S111 dashboard to help clients avoid the upcoming penalties associated with erroneous or late reporting and to provide end-to-end visibility to your claims.

This year Jesse worked closely with Rita to secure our SOC 2 Type II attestation.  The SOC 2 audit is designed to give clients and prospects a level of assurance as to how a company organizes and executes its business processes and technology in a structure that provides security, privacy, and confidentiality.

It is one thing for Tower to protect our data and yours, but a major data vulnerability occurs during data transfer between Tower and its business partners.  To ensure that all data exchanged between Tower and any outside entity remains secure, we implemented a third-party risk assessment program to assess and monitor ourselves and our business partners to ensure that privacy, security and cybersecurity best practices are consistently followed.

In addition, Tower is committed to educating clients and other stakeholders.  We hosted a webinar on cybersecurity for our clients and published articles in WorkCompWire last year to help educate others in the industry.

Technology changes all the time, and Tower stays abreast of these changes, always seeking new ways to build a better Tower and a better way to serve the MSP community.  If you have questions about this article or technology in the industry, please contact Rita Wilson, Rita.Wilson@TowerMSA.com or Jesse Shade, Jesse.Shade@TowerMSA.com