Events Archives

Significant Changes Coming to Florida Fee Schedule: What It Means for Your MSA Costs

October 24, 2024

Florida’s 2025 Fee Schedule Changes Will Raise MSA Costs

Starting January 1, 2025, Florida is making some significant changes to its fee schedule, which will lead to higher MSA (Medicare Set-Aside) costs – sometimes significantly so. Here’s what you need to know.

Increased Physician Reimbursement Rates in Florida’s New Fee Schedule

In June 2024, the governor signed a new law that increases the maximum reimbursement rates for physicians and surgical procedures. For doctors, the rates will jump from 110% to 175% of the Medicare allowable reimbursement rate, while surgical procedures rates will rise from 140% to 210%. The Florida Association of Orthopaedic Executives said “that represents an unprecedented increase in physician reimbursement of 59% for non-surgical codes and 50% for surgical care.” These rates haven’t changed in 20 years, and Florida is presently the lowest in the nation.

How Florida’s New Fee Schedule Affects MSA Pricing

What does this mean for MSAs? Since MSA pricing is based on the relevant workers’ compensation fee schedule, there is an opportunity to lock in lower costs for Florida MSAs if you get CMS approval before January 1, 2025.

What Should You Do?

Already Have an MSA Prepared? If Tower has already prepared a Florida MSA for you and the estimated settlement exceeds CMS MSA review thresholds, submit it as soon as possible to achieve cost-savings.
No MSA Yet, But Settlement Coming Soon? If you’re expecting a settlement in the coming months, now is the time to get an MSA prepared and submitted for approval.

Remember, once CMS approves an MSA, that approval does not expire. So, even if settlement occurs after the fee changes, the approved MSA amount remains valid.

If you have any questions, feel free to reach out to Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com. And, if you’re ready to move forward with a Florida MSA submission or preparation, please contact us at referrals@towermsa.com.

CMS Sets October 17 for Webinar on Section 111 Reporting Penalties

October 9, 2024

Upcoming CMS Webinar on Section 111 Reporting Penalties

The Centers for Medicare and Medicaid Services (CMS) has scheduled an important webinar on October 17, 2024, at 1:00 PM ET, specifically covering Section 111 reporting Civil Money Penalties (CMPs) and their implications for all relevant stakeholders involved in compliance and reporting.

Webinar Format and Focus From CMS

CMS will be hosting a comprehensive webinar regarding Certain Civil Money Penalties for NGHP Responsible Reporting Entities (RREs). This informative session aims to clarify the implications of these penalties and ensure that all RREs are well-informed. The format will include opening remarks from CMS officials, followed by a detailed presentation that will cover essential topics. Attendees can expect reminders about the Final Rule, insights into the auditing process, and critical dates that RREs need to remember. After the presentation, there will be a dedicated question-and-answer session, allowing participants to seek clarification and address specific concerns related to the Civil Money Penalties. This interactive component is designed to enhance understanding and foster engagement among all attendees.

RREs who would like to submit questions in advance of the webinar are encouraged to do so using the dedicated resource mailbox at Sec111CMP@cms.hhs.gov.

There is no pre-registration for the webinar. Full details can be found here.

Previous Webinar Insights

The upcoming webinar focuses on Section 111 penalties, while a previous webinar covered Section 111 reporting best practices and upcoming changes. A copy of the slides and notes of the prior session are here.

CMS recently added a new page to its website, which provides NGHP Civil Money Penalties information, including a flow chart. CMPs are applicable starting October 11, 2024, and audits begin in January 2026. We encourage a review of CMS’ website and articles Tower has published on the topic, including Section 111 Reporting for WCMSAs & Avoiding Civil Penalties.

Tower MSA Partners’ Chief Compliance Officer Dan Anders Featured on Ametros Podcast “It’s Settled”

September 25, 2024

Dan Anders, Chief Compliance Officer at Tower MSA Partners, was recently featured on Ametros’ podcast, “It’s Settled.

We are excited to share that Dan Anders, Chief Compliance Officer at Tower MSA Partners, was recently featured on Ametros’ podcast, “It’s Settled.” In this engaging episode, Dan sat down with Andrea Mills, Ametros’ Chief Client Officer, and John Kane, Senior Vice President of Strategy, to dive deep into the latest news and developments surrounding Medicare Set-Asides (MSAs). This discussion covered essential topics that impact the workers’ compensation and liability settlement space, including upcoming changes to Section 111 reporting, best practices for preparing MSAs, and the value of professional administration.

Upcoming Section 111 Reporting Changes

One of the key topics covered was the upcoming changes to Section 111 reporting and their implications for insurers and self-insured entities. Dan provided insightful commentary on what these changes mean and how they will affect the reporting process. With new compliance requirements on the horizon, now is the time for stakeholders to review their reporting strategies and ensure they are prepared for these regulatory shifts.

When to Prepare an MSA

Another critical topic discussed was when to prepare an MSA. Dan highlighted the importance of evaluating the need for an MSA early in the settlement process to avoid costly delays. He also provided insights into how Tower MSA Partners helps clients navigate complex cases by offering expert guidance on when and how to prepare MSAs effectively.

The Value of Professional Administration

The conversation also touched on the value of professional administration for MSAs, emphasizing how Ametros helps individuals manage their settlement funds to ensure compliance with Medicare’s requirements. Dan, Andrea, and John discussed how professional administration not only ensures the longevity of settlement funds but also helps alleviate the administrative burden on injured individuals.

Tips for Preparing an MSA

During the episode, Dan shared several tips and tricks for preparing an MSA, helping listeners understand the importance of accuracy and thoroughness when it comes to documentation. He also explained how Tower MSA Partners’ streamlined approach helps clients minimize risks and expedite settlements.

Upcoming Webinars and Conferences

As the discussion wrapped up, the group previewed upcoming educational opportunities, including a webinar, A Claims Professional’s Guide to Successful Settlements with MSAs, hosted by Tower MSA Partners on October 2^nd. Dan encouraged attendees to sign up for this and other webinars to stay informed on compliance topics and best practices in the MSA industry.

Listen Now

You can catch this insightful episode of “It’s Settled” featuring Dan Anders by clicking here.

Stay tuned for more updates from Tower MSA Partners as we continue to provide our clients with the latest compliance and settlement strategies. Be sure to sign up for our upcoming October 2nd webinar to stay informed on these important issues.

Tower MSA Partners Maintains  SOC 2 Type II Compliance, Affirms Commitment to Highest Security Standards

September 18, 2024

Tower MSA Partners is proud to announce the successful completion of our annual SOC 2 Type II compliance examination, performed by independent service auditor Insight Assurance. This milestone underscores our unwavering commitment to maintaining and enhancing the highest standards of data security and integrity, essential in today’s fast-evolving digital landscape.

Understanding SOC 2 Type II: A Comprehensive Audit of Non-Financial Reporting Controls

A SOC 2 Type II compliance examination is a rigorous assessment performed by an independent auditor to evaluate a service organization’s non-financial reporting controls over time. This involves testing the operational effectiveness of a company’s controls related to the applicable criteria for the security, availability, processing integrity, confidentiality, and/or privacy trust services categories developed by the American Institute of Certified Public Accountants (AICPA).

This year’s SOC 2 audit added the availability and processing integrity trust service categories (TSCs) to the previously examined security and confidentiality TSCs.

Rita Wilson on Tower MSA Partners’ Commitment to Security

Rita Wilson, CEO of Tower MSA Partners, said, “Achieving the SOC 2 Type II attestation is not just about meeting a regulatory standard, but about affirming our commitment to protect our client’s data with the highest standards of security and confidentiality. This audit reflects the robustness of our internal controls and processes, and it reassures our clients and partners that we are dedicated to the highest levels of trust and integrity.”

From the onset, Tower has integrated technology-driven processes with stringent security measures to ensure the privacy and security of client data. The successful completion of the SOC 2 Type II examination is a testament to our team’s hard work and dedication to excellence.

Tower Premier Webinar: A Claims Professional’s Guide to Successful Settlements with MSAs

September 12, 2024

Overcoming Medicare Set-Asides Challenges: Key Strategies for Successful Settlements

Navigating Medicare Set-Asides can often feel like a daunting challenge during settlement. Even when all parties agree on the need to include an MSA, the allocation may be too high or the documentation requirements too burdensome.
However, the MSA hurdle can be overcome with the right approach.

Understanding when an MSA is appropriate, what’s needed to prepare a reasonable MSA, and how to manage cost and time factors are key to overcoming these obstacles.

Join Our Webinar: Expert Guide to MSAs on October 2, 2024

Join us on October 2, 2024, at 2 pm ET, as Tower’s Chief Compliance Officer, Dan Anders, and Brittney O’Neal, Director of Clinical Operations, present a claims professional’s guide to successful settlements with MSAs. In this webinar, we’ll cover:

• The appropriate time to obtain an MSA
• Essential documentation for drafting an MSA
• Differentiating between Medicare-covered or non-Medicare-covered treatment
• Understanding the difference between submitted and non-submitted MSAs
• Strategies when a CMS-approved MSA cannot be obtained
• Utilizing the CMS re-review and amended review process effectively
• Circumstances when a $0 MSA is appropriate
• The value of MSA professional administration and structured settlements

If you are interested in the ins and outs of MSAs, this free webinar is for you. Plus, if there is something about MSAs you’ve always wondered about, ask us! When you click on the registration link below, you will not only be able to register, but you can also submit a question to be answered during the webinar.

Hope you can join us on October 2 at 2 pm ET!

Empathy in Action: Highlights from WCI

September 6, 2024

Empathy being show by care giver to patient

At the recent Workers’ Compensation Educational Conference in Orlando, FL, empathy took center stage during the WCI-TV segments, sponsored for the ninth consecutive year by Tower MSA Partners. This year’s theme, “Empathy in Workers’ Compensation,” showcased how various industry leaders infuse empathy throughout the claims process, even when they don’t directly interact with injured workers.

Empathy: A vital component

Empathy is a vital component in workers’ compensation, influencing culture, product design, and service delivery across the industry. It ensures that injured workers feel supported and understood, which can lead to improved outcomes, reduced fear, and even a decrease in litigation. By fostering collaboration, care, and consistency, companies across the workers’ compensation landscape are making significant strides in incorporating empathy into their processes.

United Airlines: The Power of Caring

Joan Vincenz, Managing Director of Corporate Safety at United Airlines, spoke about the lasting impact of empathy on injured workers. “People will never forget how they’re treated when they are injured at work. It matters how we treat people when they’re in trouble,” she stated. United Airlines’ philosophy is rooted in safety and care. Beyond preventing injuries, United prioritizes getting immediate, quality care for employees after an injury and helping them navigate the complex workers’ compensation system to return them to health. Vincenz emphasized that the most empathetic thing companies can do is to communicate regularly with injured workers and guide them through the complex workers’ compensation process.

Berkley Industrial Comp: Empathetic Resolution Model

Greg Hamlin, SVP and Chief Claims Officer at Berkley Industrial Comp, highlighted their efforts to embed empathy into the claims process through the Empathetic Resolution Model. This model was developed with input from adjusters on the front lines, who offered suggestions for making the process more human and compassionate. One such suggestion was to rewrite the letters sent to injured workers, making them more empathetic and less formal. Berkley also implemented thoughtful gestures, such as sending cookies to injured workers post-surgery and maintaining regular contact through texts and calls. These small but meaningful actions demonstrate Berkley’s commitment to authentic empathy at every step of the claims process.

Tower MSA Partners: Advocates for Injured Workers

While Tower MSA Partners doesn’t regularly interact with injured workers, it plays a crucial role in supporting claims professionals and attorneys in the settlement process. Kristine Dudley, COO of Tower MSA Partners, explained Tower’s philosophy of the “3 C’s”: Care, Cost, and Compliance. Care, in this context, doesn’t mean providing the most care but rather the most appropriate care for the long-term well-being of injured workers. Tower’s team works closely with treating providers to clarify and confirm treatment plans, ensuring that the right care is included in the MSA. Their aim is to allay fears, answer questions, and make the settlement process as smooth as possible for injured workers.

Ametros: Empathy Through Care and Support

Porter Leslie, CEO of Ametros, emphasized that empathy begins with caring for every individual who interacts with their platform. Ametros’ flagship product, CareGuard, is designed to administer injured workers’ settlement funds, ensuring that they receive ongoing support. At the core of Ametros’ philosophy is “care”, which Leslie describes as the foundation of their empathetic approach. By providing continuous assistance and ensuring that workers feel cared for, Ametros exemplifies how empathy can be embedded in the very fabric of a company’s operations.

The WCI-TV segments at this year’s Workers’ Compensation Conference highlighted how empathy can transform the workers’ compensation experience. From Ametros’ ongoing support to Berkley’s empathetic resolution model and United Airlines’ commitment to caring, companies across the industry are proving that empathy is not just a buzzword but a powerful tool for improving outcomes and reducing litigation. Through thoughtful actions, clear communication, and a focus on the well-being of injured workers, the workers’ compensation industry can continue to evolve with empathy at its core.

CMS Sets September 12 for Webinar on Section 111 Reporting

August 28, 2024

Webinar on Section 111 Reporting of WCMSAs

Don’t Miss the CMS Webinar on Section 111 Reporting

The Centers for Medicare and Medicaid Services has scheduled a September 12, 2024 webinar on Section 111 reporting. Per the announcement:

The format will be opening remarks by CMS, a presentation that will include NGHP reporting best practices and reminders, followed by a question and answer session. For questions regarding Section 111 reporting, prior to the webinar, please utilize the Section 111 Resource Mailbox PL110-173SEC111-comments@cms.hhs.gov.

There is no pre-registration for the webinar. Full details can be found here.

While CMS does not indicate the webinar is specific to Section 111 Civil Money Penalties, given that CMPs become applicable as of October 11, 2024, this presents an opportunity to have any questions addressed before that date. Questions around the April 4, 2025 implementation of Section 111 Reporting of WCMSAs would also be encouraged.

Tower-sponsored WCI-TV Segments Focus on Empathy

August 14, 2024

Empathy. We know we need it, but what exactly is it and how do we use it to help injured employees?

The Miriam-Webster dictionary defines empathy as the “action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts and experience of another.” The Society for General Internal Medicine tweaked the definition to apply to healthcare as “the act of correctly acknowledging the emotional state of another without experiencing that state oneself.”

Empathy: A Key to Enhancing Worker Satisfaction and Streamlining Claims in Workers’ Compensation

The workers’ compensation community has embraced the concept of empathy. In articles and at conferences, experts say that injured employees who receive empathy from their providers, employers and insurers report higher levels of satisfaction with their care and are less likely to hire attorneys. It makes sense that an injured worker who feels heard and understood will be more apt to participate in their care, recover faster and return to work. Settlement professionals, like our partner Ametros, have seen empathetic communication break down barriers to the settlement of claims.

So how does one acknowledge the emotional state of another? What does empathy look like in the real world? Is it a skill that can be taught? Can you be too empathetic? Are there ways to incorporate empathy into claims management processes?

Tower will explore these questions during our sponsored WCI-TV interviews. Our guests include Joan Vincenz, Managing Director, Corporate Safety for United Airlines and Greg Hamlin, Senior Vice President and Chief Claims Officer of Berkley Industrial Comp. Other interviews feature Kristi Montoya, Director of Claims Operations for UPS, and Denise Evans, the Director of Claims for Staffmark. Our Chief Compliance Officer Dan Anders and our Chief Operating Officer Kristine Dudley will also share their views.

Tower is the founding sponsor of WCI-TV, which airs during the WCI conference, in hotel rooms and on shuttles as well as on You Tube and WCI’s website. You can see the interviews on Tower’s Linked In home page, too. The 78^th Annual WCI Conference will be held August 18-21 at the Orlando World Center Marriott.

While at WCI, Dan Anders will also moderate a Medicare Secondary Payer Compliance Panel. The “Pre-Settlement Considerations” session runs from 2-3 p.m. on Tuesday, August 20 and features Ametros’ John Kane, Brian Broznowicz with the Centers for Medicare and Medicaid Services, Ringler’s Jarrod Zea, and Kristi Montoya with UPS.

WCI is always busy, but we’d love to catch up with you there! Dan, Kristine Dudley and Hany Abdelsayed will attend the conference. To schedule a meeting before WCI, email daniel.anders@towermsa.com. Otherwise, grab us in the hallways or at the WCI-TV studio.

Section 111 Reporting for WCMSAs & Avoiding Civil Penalties

June 28, 2024

It’s time to get everything set up to accommodate new Section 111 reporting fields for WCMSAs. While compliance has long been required, Civil Money Penalties (CMPs) are real now.

Tower’s Chief Technology Officer Jesse Shade joined our Chief Compliance Officer Dan Anders for the “Premier Webinar: Get Ready for Section 111 Reporting Penalties and WCMSA Reporting” to help attendees do just that. Here are the highlights:

Important Section 111 penalty and WCMSA reporting dates

October 11, 2024
The date that CMS starts to make Responsible Reporting Entities (RREs) accountable for the timely reporting of ongoing responsibility for medicals (ORM) and of the Total Payment Obligation to the Claimant (TPOC). Any claims with ORM or TPOC on or after October 11, 2024, can be audited and subject to penalties.

April 1, 2025
CMS requires the reporting of WCMSA information when a TPOC is reported

October 11, 2025
Date that CMS starts its compliance review process.

April 1, 2026
CMS begins Section 111 reporting audits.

About those penalties

No penalties will be issued for claims that are reported within one year of the date of acceptance of ORM or the TPOC date. And no claims with ORM or TPOC dates prior to October 11, 2024, will be reviewed.

If a claim is not reported within one year, the RRE can incur penalties of $357 per calendar day. This per-day penalty increases to $1,428 if it’s not reported for three years. (These are 2024 inflation-adjusted rates.)

The good news is that CMS caps the amount of a penalty for a single instance of noncompliance by a non-group health RRE. The bad news is that cap is $365,000!

In the somewhat good news department, CMS will randomly select only 1,000 claims to audit each year and audit 250 claims every quarter. Additionally, the agency will randomly select claims from group health as well as non-group health plan (NGHP) claims from workers’ compensation, liability and no-fault programs. This greatly mitigates your risk of an audit even if you have instances of late ORM or TPOC reporting.

How does CMS notify RREs of penalties?

CMS first emails an informal notice, so it is important to keep contact information updated in the Section 111 Profile. This initial notice allows the RRE to present mitigating evidence and this must be presented within 30 days.

Examples of the type of evidence to submit include: ORM was not reported because the claim was under investigation OR a good-faith effort was made to obtain claimant information, such as a social security number, but the claimant refused to provide it or did not respond. (See CMS Section 111 Penalties Rule Focuses on Untimely Reporting – Tower MSA for details on “good-faith efforts” to establish Medicare eligibility.)

If the RRE does not respond to the informal notice or CMS rejects the explanation, the agency mails a formal written notice. At this point, an RRE either needs to pay a fine or appeal to an administrative law judge within 60 days.

WCMSA Reporting Fields

Jesse Shade reviewed the upcoming changes CMS will implement to collect additional information on WCMSAs through Section 111 reporting. New fields and the information for them were covered in this post.

Tower smooths the transition for its Section 111 clients.

Jesse also described Tower’s IT efforts to make things as easy as possible for our Section 111 reporting clients. Our goal is to improve your ability to monitor the pivotal events in a claim.

The first step for Tower reporting clients is adding the new WCMSA fields to the end of your current claim input file. Once the fields are added to the feed file, testing will be scheduled to confirm that the data is properly transmitted to Tower. Tower will, in turn, participate in a testing period with CMS that begins in October.

The additional fields will require those who enter the Section 111 reporting information to be trained on when to enter the WCMSA date, what date to enter, and how to enter the data.

Additionally, Tower will highlight in our MSA delivery correspondence the importance of completing this information at the time of settlement.

Tower will continue to provide comprehensive reports to our Section 111 reporting clients, ensuring the accuracy of the data reported.

Our commitment is to make this transition easy and seamless for everyone involved and we will customize systems where needed so the process works for all our clients.

Practices that protect RREs from penalties

Dan advised clients to do the following to maintain compliance with the reporting rules:

Query claims to identify Medicare beneficiaries monthly and document when a social security number cannot be obtained.
Report ORM acceptance and TPOCs on the next quarterly submission.
Correct errors in reporting data to avoid report rejection (if they reject a submission, it will be considered untimely if not corrected within the reporting deadline).
When WCMSA reporting begins, make sure these fields are completed anytime a TPOC is reported.

The webinar also provided several examples of how ORM and TPOC penalties could work and how they could be mitigated. Slides and access to the recorded webinar can be requested from Dan Anders, daniel.anders@towermsa.com.

Tower’s proactive audit

To ensure your organization’s readiness for the coming audits and penalties, have Tower audit your processes, policies and systems to see if there are any holes in your compliance. Not only will we identify errors and other issues that could lead to penalties, but we also help you fix issues that lead to them. For more information on our Section 111 audit offer, please contact hany.abdelsayed@towermsa.com.

Premier Webinar: Get Ready for Section 111 Reporting Penalties and WCMSA Reporting

May 3, 2024

CMS Announces Section 111 Mandatory Insurer Reporting Changes: Penalties and New WCMSA Requirements

The Centers for Medicare and Medicaid Services (CMS) has released several announcements regarding Section 111 Mandatory Insurer Reporting over recent months. Some relate to Section 111 penalties and some to the new requirement to add Workers’ Compensation MSAs to Section 111 reporting.

Timely and accurate Section 111 reporting is essential if you want to avoid penalties. And WCMSA reporting will introduce new tasks for claims professionals and potentially affect how WC cases with Medicare beneficiary claimants are settled.

To help you and your organization prepare for these changes

Tower will hold a “Get Ready for Section 111 Reporting Penalties and WCMSA Reporting” webinar on May 22.

Please join Tower’s Chief Compliance Officer Dan Anders and Chief Technology Officer Jesse Shade for this valuable, instructional session. Scheduled for Wednesday, May 22, 2024, at 2 pm ET, the hour-long webinar will address:

Criteria and timeline for the implementation of Section 111 Reporting penalties.
Practices to mitigate and eliminate the potential for penalties.
How a Section 111 reporting audit can identify errors, blind spots and recommend corrective actions to your systems and processes.
Criteria and timeline for Workers Compensation MSA reporting.
Implication of WCMSA reporting for claims professionals, attorneys, and settling parties.

A Q&A session will follow the presentation, and you can provide questions ahead of time at registration. Please click the link below and register today!