Tower MSA Partners Supports Insurance Careers Month!

February 24, 2021

Logo - Insurance Careers Month - illustration of silhouetted people

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

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.

Ada Lopez

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.”

WEBINAR – Grasp Success in Settling Work Comp Cases

October 28, 2020

banner promoting Tower webinar on settling work comp cases

Seeking the formula for success in settling work comp cases with Medicare Set Asides (MSAs)? We’ve got you covered. 

A Chinese proverb says, “The temptation to quit will be greatest just before you are about to succeed.”  For workers’ compensation practitioners case closure represents success.  However, the impediments presented by the need for an MSA to close a case often are a temptation to quit when success is within your grasp.

On Thursday, November 18 at 2:00 PM ET, Tower’s Chief Operations Officer, Kristine Dudley and Chief Compliance Officer, Dan Anders, will be joined by special guest, Nicole Chapelle, VP of Settlement Solutions for Ametros, to provide the formula for success in settling work comp cases with MSAs.

Here’s just some of what you will learn:

  • The latest on ways Medicare makes CMS MSA approval difficult or drives up MSA costs and how to meet these challenges.
  • Straightforward clinical interventions and case settlement strategies which reduce the MSA amount and allow for quick CMS MSA approval.
  • Easing the settlement concerns of the injured worker by transitioning to MSA professional administration or self-administration assistance for future medical care.

You will also learn that all of this can be done without increasing your work in successfully resolving the case.

A Q&A session will follow the presentation.  Please click the link below and register today!

 
Related:
 
 

CMS to Host Webinar on CRC Appeals

September 23, 2020

graphic for CRC Appeals webinar

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.

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

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

June 1, 2020

stethoscope and insurance claim form

“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

Tower Premier Webinar: A Prescription for Settling Legacy Claims

April 20, 2020

Banner for webinar on A Prescription for Settling Legacy Claims

As claims age, the percentage of spend for prescription drugs increases.  Further, as claims age, the likelihood that the injured worker becomes a Medicare beneficiary as a result of age or disability increases. The result, high prescription drug costs allocated in the Medicare Set-Aside (MSA) become a barrier to settlement of these legacy claims.

Tower has addressed this barrier through clinical interventions which have resulted in the majority of Tower’s CMS-approved MSAs containing no prescription drugs.  However, there remain legacy claims with high prescription drug spend which continue to stymie settlement.

Accordingly, Tower has partnered with the leading workers’ compensation pharmacy benefit manager, myMatrixx, to add its renowned clinical pharmacy team to the effort at breaking down the remaining barriers to settlement of these legacy claims.

What then can a PBM do to help with settling legacy claims?  How does a PBM work with an MSA company to settle these claims?

Tower is pleased to host a premier webinar panel with Phil Walls, RPh, Chief Clinical Officer for myMatrixx, and Dan Anders, Esq., Chief Compliance Officer for Tower on the following topics:

  • Define and quantify legacy claims with analytics
  • Identify factors driving up Rx costs in these claims
  • Explain how data can identify opportunities for clinical intervention
  • How to work effectively with PBM and MSA provider to reduce Rx and close claims
  • Provide examples/case scenarios demonstrating successful Rx intervention and settlement in legacy claims
  • Best practices for Rx management to prevent claims from becoming legacy claims

Please plan to attend the webinar on May 20 at 2 pm ET.

Thank you,

Dan Anders

Chief Compliance Officer

Everything You Wanted To Know About MSAs, But Were Afraid To Ask — Tower Premier Webinar – July 24, 2019 2PM ET

July 2, 2019

banner for 2019 tower msa partners webinar details

Why does CMS do what they do when it comes to MSAs? Many a claims professional and injured worker have probably pondered this question. Well, the wait for answers is over. On July 24, 2019 at 2 pm ET, Tower MSA Partners EVP of Clinical Services Patricia Smith and Chief Compliance Officer Dan Anders host an engaging hour-long webinar discussing all matters MSA.

 

With over 30 years of MSA experience between them, Pat and Dan will tackle some of the routine and unusual questions that arise when drafting an MSA and submitting it to CMS for approval, like:

 

  • Do I need an MSA?
  • What documentation is necessary to draft the MSA?
  • What does Medicare-covered or not Medicare-covered mean to the MSA?
  • Is the allocation different if the MSA isn’t submitted to CMS?
  • How are costs of treatment and prescription medication calculated?
  • How is life expectancy calculated and how does a rated age impact this calculation?
  • IMEs, AMEs, PQMEs, UR, and IMRs, oh my. What role do these play in the MSA calculation?
  • Rechargeable vs. non-rechargeable spinal cord stimulator, why does it matter?
  • When can I use an Amended Review?
  • Under what circumstances is a $0 MSA appropriate?

 

If you want to know more about the how and why of MSAs, this free webinar is for you. And, 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 July 24 at 2 pm ET!

 

Dan Anders

 

Chief Compliance Officer

 

Register Here

 

Tower MSA Partners Presents a Premier Webinar: Leveraging Metrics and MSA Partner Relationship to Settle Claims

April 2, 2019

banner for 2019 tower msa partners webinar details

On April 24, Tower MSA Partners CEO Rita Wilson and Chief Compliance Officer Dan Anders will host a lively hour-long webinar that explains how to measure the performance of an MSA program and identifies the metrics needed. They also discuss ways to strengthen the payer/provider relationship in order to produce lower allocations on CMS-approved MSAs and quicker claims closures. Discussion points include:

 

  • How to measure your MSA program performance – what metrics should you use?
  • MSA drafting and review factors that impact MSA performance
  • Implement simple strategies to effectively work with your MSA partner and settle claims
  • Make your MSA provider part of your settlement team

The webinar also highlights how Tower’s key performance metrics compare to some national standards, giving examples of metrics that determine whether a program is successful. The free webinar will be held April 24 at 2 p.m. Eastern.

 

Hope you will join!

 

Dan Anders

Chief Compliance Officer

 

Register Here