Risk & Insurance: Am I Allocating Enough for a Medicare Set-Aside? Take These Pointers from a Pro to Find Out

January 26, 2023

Man in business suit looking confused about Conditional Payments

Tower’s MSP Compliance blog analyzes the nuances of Medicare Set-Asides (MSAs) and other aspects of Medicare Secondary Payer Compliance. It covers topics like re-reviews and the termination of ongoing responsibility for medicals (ORM), along with tweaks to WCMSA Reference Guide. Most of our posts drill down into the fine details that our readers need to know.

Every now and then, though, it’s good to pull back and take a high-level view of MSAs as our Chief Compliance Officer Dan Anders does in this Risk and Insurance article. Keep it handy in case you need to explain MSAs to an injured employee … or a colleague.

Happy Holidays From Your Friends at Tower MSA Partners

December 21, 2022

Happy Holidays sign

We’ve had an exciting year of growth at Tower MSA Partners in 2022 and would like to extend our appreciation to you, our valued partners, who have supported us.  Whether this is your first year as a Tower client, or one who has been with us for many years, Tower’s success results from your loyalty.

Our team works diligently each and every day to earn your trust by providing a service level unmatched in the MSP industry.  And we can do that only through the expertise, knowledge, professionalism and commitment of our amazing staff, also unmatched in our industry Together with our team, we hope we have met and exceeded your service expectations throughout the past year.  

We extend our warmest wishes to you and yours. A Merry Christmas and Happy Holidays from your friends at Tower MSA Partners. 

 

AASCIF Publishes Tower Article on MSA Submit vs. Non-Submit Debate

December 12, 2022

Tower MSA Logo used in an article on Am I Allocating Enough for a Medicare Set-Aside

In its fall newsletter, the American Association of State Compensation Insurance Funds (AASCIF) published an article entitled “Despite the Controversy, MSA Submission is Still Okay.”  Written by Tower’s Chief Compliance Officer, Dan Anders, the article details the pros and cons of Centers for Medicare and Medicaid Services (CMS) approval of an MSA.

As the article concludes, “While the submit vs. non-submit dispute will undoubtedly continue, the MSA approval process allows parties to obviate the risk of shifting future injury-related medical care to Medicare by obtaining a stamp of approval.”  Recognizing that the submission process can sometimes increase settlement costs, the article provides tips on obtaining a quick CMS MSA approval and reducing cost drivers.

CIO Review Magazine Ranks Tower MSA Partners Among Top 10 Compliance Technology Services Companies

November 3, 2022

Pict of award congratulating Tower on its Technology

The honors keep coming. Earlier this year, Tower ranked in South Florida Business Journal’s Top 25 Women-Owned Business list and now there’s national recognition of our technology driven compliance services. CIO Review: The Enterprise Technology Magazine just listed us among its 10 Most Promising Technology Compliance Services Companies for 2022 and featured Tower in this article.

When our Co-founders Rita Wilson and Kristine Dudley looked at the Medicare Set-Aside (MSA) landscape back in 2010, they found it littered with paper and inefficient processes. Everything was manual. Few providers tried to mitigate costs. And MSAs took so long to produce that some settlements fell through.

After talking with prospective clients to determine their pain points, Rita and Kristie knew they needed to accelerate MSA production. They automated Medicare Secondary Payer (MSP) compliance and MSA best practices into Tower’s MSP Automation Suite.

Because the suite easily integrates with any claims system and gathers data needed to prepare the MSA, it immediately reduced payers’ administrative burden. For the first time, clients also had 24/7 visibility into the entire claim. They could pull reports and check the status of an MSA anytime.

The suite also prompts for next steps and missing data to help keep claims moving. MSAs can be produced in days instead of weeks.

Tower’s MSP Automation Suite was designed so modules could be easily added to quickly adapt to changes from the Centers for Medicare and Medicaid Services. For example, when the agency announced plans to impose high penalties for inaccurate or slow Section 111 Mandatory Insurer reporting, Tower built a dashboard to steer compliance efforts to help clients avoid these future penalties.

The technology helps us mitigate MSA costs and immediately implement CMS changes. It also makes compliance more efficient for Tower’s clients and employees.  It frees our professionals to concentrate on clinical and legal interventions to reduce allocations and focus on our clients.

One of our clients said,Tower MSA has been a great partner for us! I have been very impressed with their level of communication and availability to help answer questions. Their easy referral process and fast turnaround times are much appreciated.”

Naturally, we enjoy external validation from honors like the CIO Review recognition. But it’s a real honor to serve our client partners who are some of the most respected payer organizations in the industry.

We’re constantly looking for ways to improve, meet clients’ needs, and exceed their expectations. Please contact Rita Wilson, rita.wilson@towermsa.com with any questions, suggestions, or other ideas.

Tower MSA Partners’ WCI-TV Interviews Reveal How Workers’ Compensation Companies Use Claims Data

August 19, 2022

WCI TV logo for ads on Data analytics

The workers’ compensation industry has extolled the promises of data analytics and automation for years.

But how are organizations really using claims data?  What strategies have worked best? And what have they learned?  Several executives will share their experiences during WCI-TV interviews sponsored by Tower MSA Partners.

Guests include Dave Strange, the Yellow Corporation’s Workers’ Compensation Manager and Greg Hamlin, Senior Vice President, Resolution with Berkley Industrial Comp. Ametros CEO Porter Leslie and Alisa Hofman, Vice President of Workers’ Compensation and Medicare Practices for Arcadia will discuss the use of data during and after settlement.

In addition, Tower’s Chief Compliance Officer Dan Anders and Chief Operations Officer Kristine Dudley will share how the technology driven company uses data to streamline Medicare Secondary Payer compliance, protect clients from penalties, and optimize Medicare Set-Asides.

Tower has been the exclusive sponsor of WCI-TV since it first aired in 2015. WCI-TV airs throughout the convention center, in hotel guest rooms and shuttles, on You Tube and CI’s website. Tower’s interviews will also be shared on the company’s LinkedIn page.

 The 76th Annual WCI Conference will be held August 21-24 at the Orlando World Center Marriott. For more information, please see https://www.wci360.com/conference/.

 

Catch Tower’s Dan Anders on the popular ADJUSTED podcast

July 13, 2022

Dan Anders who was quoted in the Claims Journal

The latest episode of the popular ADJUSTED podcast features our Chief Compliance Officer Dan Anders on one of his favorite topics, Medicare Set-Asides. When are they needed? How do you mitigate their costs? What’s the deal with rated ages? Host Greg Hamlin and Guest-host Matt Yehling, Director of Claims at Midwest Employers Casualty wanted to know.

The hosts posed the all-important question of when should workers’ comp claim with a Medicare beneficiary claimant be settled: now, later or not at all? Dan guides listeners through the various elements to consider when coming to this decision. Is the Medicare beneficiary’s condition stable? Is surgery imminent? Are they still tapering off certain medications? Are there ways to lower costs without compromising care? What are the barriers to Centers for Medicare and Medicaid (CMS) approval?

While talking about ways to mitigate costs, Dan stresses the need to obtain physician statements to clarify treatment, including which medications are discontinued. CMS requires the costs for these to be included in the MSA unless changes are documented in certain ways. Tower’s Physician Follow-up service does this and has been used on nearly half of our CMS-submitted MSAs.

If you’re new to MSAs or need to know more about reducing their costs, this podcast is for you. Find it on Apple, Google, Spotify, other platforms and here: Medicare Set Asides with Dan Anders (buzzsprout.com).

Even better, you’ll learn a little more about Dan. Did you know he considered a career in politics?

Produced by Berkley Industrial Comp, ADJUSTED presents interviews with experts on a variety of topics touching workers’ comp. Other recent episodes on settlement issues were Ametros’ Andrea Wells and Brad Cantwell with Arcadia Structured Settlements. Visit the Berkley Industrial Comp blog for these and more.

MSAs are complicated and confusing—they even stump the specialists at times. Sometimes you just need to talk to an expert in a certain area. If you ever have a question about an MSA, Dan is happy to talk to you. Get in touch with him at Daniel.anders@towermsa.com.

Related posts

Premier Webinar: Tricks of the Trade for Successful MSA Outcomes

Medicare Set-Asides

MSA Optimization Yields $175,867 in Savings

June 15, 2022

stethoscope and insurance claim form

CHALLENGE:

Tower was engaged to prepare an MSA for a 54-year-old partial quadriplegic. The lack of current medical records, the erratic behavior of the patient, the quality of the provider’s treatment coding, and unknown treatment outside of the WC Plan were challenges to preparing an accurate MSA. The preliminary MSA amount was $424,528.

SOLUTION:

In review of the treatment records, Tower’s medical experts were able to identify several instances where Medicare covered expenses could be reduced as part of Tower’s Optimized MSA process.

At Tower’s request, the client obtained current medical records. Tower’s clinical team reviewed those records and the corresponding billing codes used for all treatments. By analyzing the provider’s treatment methods against Medicare’s reimbursement requirements, Tower was able to identify items that were more accurately priced with alternative codes. One instance identified was a determination that a catheterization code (A4353) was used incorrectly. By using the correct billing code and applying other cost savings strategies to the treatment regimen, the MSA dollars were significantly reduced.

To ensure that CMS would accept the updated medical coding, Tower detailed how the original billing code was incorrectly used and then provided the correct coding.

RESULTS: $175,867 in Savings

Upon finalization of the optimized MSA, a total allocation amount of $248,661 was submitted to CMS for review and approval. CMS accepted the proposed MSA amount and responded with a Full Approval. Using Tower’s proprietary processes and technology, the client carrier was able to reduce the Medicare exposure of this settlement resulting in total savings of $175,867.

More Tower Success Stories can be found here!

South Florida Business Journal Recognizes Tower MSA Partners as a Top 25 Women-Owned Business

June 9, 2022

banner featuring photo of CEO Rita Wilson and COO Kristine Dudley to announce Tower MSA being named to Women Owned Business list

Tower MSA Partners is recognized as a Top 25 women-owned business by South Florida Business Journal.

We know we’re good, but we enjoy external validation as much as the next guy – or woman. So, we were quite pleased to learn Tower MSA Partners not only made the South Florida Business Journal’s list of Women Owned Businesses, but we ranked among the Top 25.

The publication covers companies in the densely populated Miami-Dade, Broward, and Palm Beach counties. When you consider how many women-owned businesses are in this market, the honor is even more impressive. A 2016 Sun Sentinel story said nearly half of all the women-owned businesses in Florida were based in this area.

Among the metrics used to produce the list is the percentage of the company that is owned by women. For Tower, that’s 100%. CEO Rita Wilson and COO Kristine Dudley co-founded the company more than 10 years ago. You can read more about the company’s start in this article.

Tower is not only women-owned but 85% of our employees, including most of our managers and supervisors are women.

Tower is also a certified member of WBENC or the Women’s Business Enterprise National Council, a leading non-profit organization dedicated to helping women-owned businesses thrive.

If you’d like to connect with Rita or Kristie email them at rita.wilson@towermsa.com or kristine.dudley@towermsa.com.

Tower MSA Partners Receives 2022 SOC 2 Type II Attestation

May 3, 2022

logo for AICPA. which conducts the SOC 2 Type II Audit

Independent Audit Verifies Tower MSA Partners’ Internal Controls and Processes

Delray Beach, FL – Tower MSA Partners, a Medicare Secondary Payer compliance services company, today announced that it has completed its annual SOC 2 Type II audit, performed by KirkpatrickPrice. This attestation provides evidence that Tower has a strong commitment to security and to delivering high-quality services to its clients by demonstrating that they have the necessary internal controls and processes in place.

A SOC 2 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, a service organization’s non-financial reporting controls as they relate to security, availability, processing integrity, confidentiality, and privacy of a system are reviewed, examined and reported on. The SOC 2 report delivered by KirkpatrickPrice verifies the suitability of the design and operating effectiveness of Tower MSA Partners’s controls to consistently meet the standards for these criteria throughout the full audit period.

“The SOC 2 audit is based on the Trust Services Criteria,” said Joseph Kirkpatrick, President of KirkpatrickPrice. “Tower delivers trust-based services to their clients, and by communicating the results of this audit, their clients can be assured of their reliance on Tower’s controls.”

“It’s an honor to again earn an unqualified 2022 SOC 2 Type II outcome” said Wilson. “It’s an attestation that Tower’s systems, policies and procedures meet the trust services criteria of security, availability, processing integrity, confidentiality, and privacy.”

What does this mean for you?

  1. Peace of mind.
    If you partner with Tower, you can be assured that

    • Our human processes and our highly automated system– have been validated by third-party auditors after a stringent analysis.
    • Your data is transferred safely, used appropriately, stored securely, and is accessible for the required amount of time.
    • You can partner with a best-in-class MSP services provider and superior technology.
  2. Cybersecurity assurance. Auditors recognized Tower’s commitment to keep up with cyber threats, patching, monitoring methods and cybersecurity technology. They saw that we monitor all internal systems for patching cadence and antivirus/antimalware activity, we regularly train staff on how to avoid the latest scams, and we execute multi-factor authentication and password changes to prevent breaches. In addition, we partner with reliable and well-respected cloud storage, monitoring, and security companies.

While the complete report is confidential and proprietary, a redacted synopsis of the report, SOC 3, can be downloaded here. I’m happy to answer questions and discuss the value of partnering with Tower for your MSP compliance and MSA needs. Please contact me at Rita.Wilson@TowerMSA.com to arrange for a conversation.

Premier Webinar: Medicare Advantage Plan Reimbursement – What Now?

April 7, 2022

In December 2021, the Centers for Medicare and Medicaid Services (CMS) started providing access to data showing a claimant’s enrollment in Medicare Part C and D plans. Now payers are wondering how to best interact with Medicare Advantage (MA) plans and prescription drug plans. What are their reimbursement rights? How does this work with Section 111 reporting?

Tower is pleased to feature a guest presentation by Brian Bargender, Management Consultant, Subrogation and Other Payer Liability for Humana on Wednesday, April 20 at 2:00 PM ET.  Brian is arguably the industry’s foremost expert on Part C and D plan subrogation. Humana is the second-largest Medicare Advantage Plan and Part D plan in the country and has been the leading advocate for reimbursement under the MSP Act.

Here’s just some of what you will learn:

  • Role of Part C and D plans in providing services to Medicare beneficiaries.
  • Reimbursement rights of Part C and D plans under the Medicare Secondary Payer (MSP) Act.
  • Interplay between CMS and Part C and D plans in use of Section 111 Mandatory Insurer Reporting data.
  • Part C and D plans role in Workers’ Compensation MSAs.
  • Best practices for working with Part C and D plans to resolve reimbursement claims.

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

REGISTER HERE