Tower News Archives - Page 2 of 3

Tower MSA Partners Receives 2022 SOC 2 Type II Attestation

May 3, 2022

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?

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.
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.

Highlighting worker fatalities: Workers Memorial Day

April 28, 2022

Banner for Worker Fatalities for Memorial day

As an industry, we must all work to eliminate worker fatalities through an ongoing commitment to safety. April 28 is Worker Memorial Day, a time to memorialize those who died on the job.

Every year, April 28 is earmarked as Workers Memorial Day, a global day to remember and memorialize workers who lost their lives on the job. The day has several purposes: Through a series of national and local events, it offers a way to call attention to the number of worker fatalities, to put a face on the workers who died, and to highlight the impact these deaths have on their families, co-workers, and communities. The day also sheds light on the fact that most workplace incidents are preventable and serves as a reminder for employers and workers alike to recommit to the important work of building safer workplaces.

April 28 is a fitting day for this event because it is also the day OSHA was established in 1971. Under the Occupational Safety and Health Act of 1970, “employers are responsible for providing safe and healthful workplaces for their workers. OSHA’s role is to ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance.” OSHA’s mission encompasses 130 million workers, employed at more than 8 million worksites around the nation.

Of the 2022 Memorial, OSHA says:

“This year, we also recognize that, more than a year into the pandemic, every day essential workers, many of whom are people of color and immigrants, have put their lives on the line during the COVID-19 pandemic. Many were sickened or died as a result of just going to work – for simply doing what they had to do to support their families. They were healthcare workers, grocery workers, meatpackers, nurses, delivery drivers, farmworkers, law enforcement officers, teachers, and sanitation workers. We remember and honor every worker who has lost their life to largely preventable fatal injuries and illnesses, and we commit ourselves to fighting to make sure that others do not suffer the same terrible fate.”

The impact of OSHA on worker fatalities can be seen in the statistics: Worker deaths in America dropped from about 38 worker deaths a day or 13,900+ per year in 1970 to 15 a day or 5,300+ per year in 2019.

The most recent Census of Fatal Occupational Injuries was issued by the Bureau of Labor Statistics in December 2021 and noted a significant decrease in worker fatalities. The report noted that there were 4,764 fatal work injuries recorded in the United States in 2020, a 10.7-percent decrease from 5,333 in 2019 and the lowest annual number since 2013. The fatal work injury rate was 3.4 fatalities per 100,000 full-time equivalent (FTE) workers, down from 3.5 per 100,000 FTE in 2019. A worker died every 111 minutes from a work-related injury in 2020.

But the number of fatalities for 2020 needs to be put in the context of the pandemic, when many workplaces were shuttered for varying lengths of time. Some safety and health experts warn that we are likely to see an increase in the numbers going forward: Serious Work Injuries and Fatalities Spike as Labor Shortages Exacerbate the Problem

“ Fewer workers died or suffered severe injuries in the workplace in 2020.

However, the rate of serious injuries and fatalities rose from 366 per 100,000 workers in 2019 to 429 per 100,000 workers in 2020, according to risk management software firm ISN.

The rate was 406 per 100,000 in 2018.

The problem could worsen as companies around the U.S. contend with a shortage of labor, which can translate into longer hours on the job by less-experienced workers, as well as a greater reliance on outside contractors.”

Working to reduce worker injuries and deaths is the right thing to do. It’s also usually the least costly thing to do and the smart thing for employers to do. Workers are concerned about workplace safety and appreciate employers who demonstrate a commitment. A recent survey showed that:

Almost all (97%) respondents said feeling safe is a major factor in choosing where to work. Asked how they would respond if their employer failed to communicate effectively about an emergency or other potentially dangerous event, 44% said they would feel unsafe and 58% said they would reconsider working there or seek employment elsewhere.

For more information on Workers Memorial Day:

OSHA: Worker Memorial Day Events
NIOSH: Workers Memorial Day
National Safety Council: Remember Those We’ve Lost, Pledge to Work Safely
AFL-CIO: Workers Memorial Day events

Previously on Tower MSA Partners

Marking Insurance Careers Month During “The Great Resignation”

February 22, 2022

Two employees walking into office building during The great resignation

How is the insurance industry faring in the choppy waters of “The Great Resignation”? February is Insurance Careers Month, the perfect time to assess where we are after two years of the pandemic.

As a specialty provider of Medicare Secondary Payer (MSP) compliance and Medicare Set-Aside (MSA) services, Tower MSA Partners is a member of the workers’ compensation industry. We’re happy then to commemorate and promote the Sixth Annual Insurance Careers Month. Insurance and related services have been a great career path for many of us at Tower and we’re glad to do our part to raise awareness for the next generations.

At the close of 2021, the Department of Labor/Bureau of Labor Statistics (BLS) put the insurance sector’s employee census at more than 2.8 million employees, with a 1.9% unemployment rate. It’s generally been a stable and resilient business, weathering the pandemic and various other catastrophes fairly well. This is borne out by a new report by Capital Relocation Services (CapRelo), which says that the insurance industry has managed to retain employees relatively better than many industries both in volume and tenure.

But as we look hopefully towards a post-pandemic future, what’s in the cards on the employment front? Will “The Great Resignation” take a terrible toll on the insurance sector as it has with so many other industries?

First, let’s look at what people are talking about when they refer to The Great Resignation. Start with this: In December 2021, the “quit” rate was 2.9% as 4.3 million workers voluntarily left their jobs. This was down from November’s highwater mark of a 3.0% quit rate (4.5 million jobs). (Source: BLS – Job Openings and Labor Turnover Summary, or “JOLTS” report). This massive flight from jobs is not just happening in the U.S., it’s a global phenomenon, and there are various theories and explanations for why this is happening, with the only commonality agreed upon is that it is related to the pandemic. And there were 4.6 million more job openings than unemployed workers in December. Whatever the reason, it’s an employee’s market, leaving employers struggling to retain and recruit workers.

Industries with low paying jobs and public-facing jobs are among the hardest hit, but there are other reasons beyond low pay and poor conditions that lead to job quits. Gallup surveys put burnout as #1 on the list of reasons why employees are quitting jobs. Feeling unsafe is another frequently cited reason. People don’t want to return to the physical workplace if they don’t feel safe from contracting an illness that they may bring home to children or elderly parents.

But what’s happening to all the workers who quit? Are they just staying home and abandoning the job market entirely? Well, yes, some are – in the form of retirement or launching a new business. Others are seizing the opportunity to trade up on a job, exit a low-paying company/industry, or rethink and re-engineer their career in some other way. While the phenomena of the post-pandemic labor market has been popularly dubbed “The Great Resignation,” other observers think it is more precise to define it as a “Great Realignment” or a “Great Reshuffle.”

In its Q3 2021 U.S. Insurance Labor Market Study and the related whitepaper, Coming Out Ahead in the Great Reshuffle, The Jacobsen Group, a leading insurance recruitment organization, talked about this:

“While the overall economy is experiencing what many are calling “the Great Resignation,” the insurance industry is encountering more of a “Great Reshuffle.” Professionals who were waiting to make moves earlier on in the pandemic are exploring their options. Individuals are reevaluating their place within their current companies, considering future opportunities and looking forward as offices reopen and the economy continues its recovery.”

In fact, the insurance industry was grappling with certain employment challenges well before the pandemic. As an industry with an aging workforce, we’ve been faced with the daunting challenge of a retirement talent drain of about half the workforce over the next decade. And to attract young Gen Z workers and retain millennials, there is the critical need to re-examine and redefine our industry’s value and meaning to generations for whom a sense of “mission” is table stakes. Plus, as with many long-term industry sectors, there’s been a need to bolster the workforce with deep technology expertise.

Regardless of whether it’s called a great resignation, realignment or reshuffle, employees are sitting in the proverbial catbird seat right now. Insurance organizations need to be proactive in both retaining the talent and expertise they currently have and in retooling to compete aggressively for the talent of the future.

The Transitions

In 2021 a group of leaders in the workers’ compensation industry founded The Transitions with the mission to think strategically about how to handle the influx and outflux of talent over the coming decade. The Transitions offers an extensive webinar series on such topics as reimagining management style, communication models and technology models in WC. Additionally, a mentorship program to help recruit and retain talented individuals through professional and personal growth. We encourage you to check out their website and follow the organization on LinkedIn.

Related posts

How Did Workers’ Comp Execs Fare During COVID-19?

December 10, 2021

WCI-TV Rower sponsorship banner. indicating that Covid-19 will be a primary programming focus.

How has the Covid-19 affected workers’ comp organizations? What changed professionally for risk managers and claims professionals during the pandemic? Did temporary policies become permanent? Tune to WCI-TV to find out.

Tower MSA Partners has been the exclusive sponsor of WCI-TV since its inception.

“Instead of commercials for our Medicare Secondary Payer compliance services, we’ve explored topics like opioid management, how success is measured, and ways to overcome barriers to claim closures,” said CEO Rita Wilson.

Naturally, an ongoing, international Covid-19 pandemic rated attention. “We wanted to hear how organizations maintained a sense of unity while working from home and how lockdowns changed sales, marketing, and purchasing practices,” explained Chief Compliance Officer Dan Anders.

Among Tower’s TV guests will be Susan Shemanski, Vice President of Corporate Risk Management of the Adecco Group, Joe Berardo, CEO of Carisk Partners, Porter Leslie, CEO of Ametros, and Mark Meyer, Claim Attorney with the Montana State Fund.

WCI-TV airs throughout the convention center and shuttles, in hotel guest rooms and on WCI’s website YouTube channel. These interviews will also be available on Tower’s LinkedIn homepage.

Tower is pleased to be part of the 75^th Annual WCI Conference; see for more https://www.wci360.com/conference/ information.

Carisk® Partners, Tower MSA Partners, and Ametros to Provide Patient-Centered Case Closure and Settlement Solution in Workers’ Compensation

October 12, 2021

Carisk, Ametros & Tower logs for Case Closure

Carisk^® Partners, a specialty risk transfer and care coordination company, Tower MSA Partners, a settlement-focused MSP compliance company, and Ametros, a post-settlement medical administration company, are launching a novel, patient-centered case closure and settlement solution. The integrated program provides continuity in care and accurate medical cost projections while improving the settlement process for injured patients and workers’ compensation payers.

“We’re excited to partner with industry leaders Tower and Ametros on this innovative program that extends the trusted relationship built with the patient in our Pathways™ 2 Recovery program,” says Carisk CEO Joseph Berardo, Jr. “This bundled program benefits all parties by ensuring an accurate, fair and acceptable settlement and post-settlement experience for the patients we are entrusted to serve.”

As the patient approaches achievement of their care plan outcomes and goals, the Case Closure and Settlement Program introduces patient settlement resources delivered by Tower and Ametros into the Carisk Pathways™ 2 Recovery (P2R) process.

“Tower identifies all the treatment and legal barriers to settlement,” said Tower CEO Rita Wilson. “With the payer’s authorization, we proactively apply interventions to resolve pharmaceutical, medical, legal, and jurisdictional issues before we prepare a Medicare Set-Aside. This yields appropriate future care for workers’ comp patients, complies with the Centers for Medicare and Medicaid’s review policies, and facilitates closure. We are thrilled to overlay our settlement-focused workflow with Carisk and Ametros to create win-win outcomes for both payers and patients.”

Ametros advocates for Carisk patients during and after the settlement process, educating them about the multiple benefits available through professional administration of their MSA.

“Our mission is to help the injured person live a better life after they accept a settlement with an MSA. In addition to paying bills from their MSA, providing discounts on their treatments, and completing required CMS reporting, we have a Member Care Team to help them navigate the health care system after settlement every step along the way,” said Ametros CEO Porter Leslie.

This comprehensive solution extends patient advocacy for workers’ compensation patients whose cases Carisk manages during and after their claims settlements by ensuring that their future medical expenses are accurately covered and that the patients receive on-going support post-settlement. Working together, our Case Closure and Settlement Program accelerates claims closure, reducing payers’ claims portfolios, adjuster burdens, along with their medical, pharmacy, and indemnity costs.

To learn more, please contact Kristine Dudley, Tower’s Chief Operating Officer, at (888) 331-4941 or Kristine.dudley@towermsa.com.

About Carisk Partners and Pathways™ 2 Recovery

Carisk is a specialty risk transfer, care coordination company serving insurers, government entities, self-insured plan sponsors, and other managed care organizations. With a foundation in behavioral health, Carisk’s end-to-end combined solutions include risk-transfer and care coordination of delayed recovery, complex catastrophic cases and MBHO services. Carisk’s Pathways™ 2 Recovery program guarantees to improve outcomes and reduce overall cost of quality care by applying best practices and a patient-centered approach to manage complex challenges for the Group Health, Casualty and Auto markets. Carisk is the first and only Managed Behavioral Healthcare Organization with dual accreditations from both the National Committee for Quality Assurance (NCQA) and the Accreditation Association for Ambulatory Healthcare, Inc. (AAAHC). Visit www.cariskpartners.com to learn more.

About Tower MSA Partners

Based in Delray Beach, Florida, Tower MSA Partners provides MSP compliance and MSA services nationally. The company leverages the latest technology to seamlessly integrate, automate, measure, and manage every process from Section 111 reporting, conditional payment resolution and MSA optimization through claim closure and settlement. Tower is a nationally certified Women’s Business Enterprise (WBENC) and has received its SOC2 Type II attestation. For more information, visit https://towermsa.com/ and https://towermsa.com/blog/.

About Ametros

Ametros is the industry leader in post-settlement medical administration and a trusted partner for thousands of members receiving funds from workers’ compensation and liability settlements. Founded in 2010, Ametros provides post-settlement medical management services with significant medical and pharmacy discounts along with automated payment technology and Medicare reporting tools. Headquartered just north of Boston in Wilmington, Massachusetts, Ametros may be reached at 877.275.7415 or via www.ametros.com

The Patel Memo Launched the Medicare Set-Aside Review Process

July 28, 2021

The Patel Memo Launched the Medicare Set-Aside Review Process

Last week, July 23, 2021, to be precise, marked the 20^th anniversary of the Patel Memo, which set the stage for the Medicare Set-Aside industry as we know it. Released under the name of Parashar B. Patel, Deputy Director, Purchasing Policy Group for the Centers for Medicare and Medicaid Services (CMS), the memo was directed to the CMS Associate Regional Administrators on the subject of “Workers Compensation: Commutation of Future Benefits.”

It addressed questions sent to CMS regional offices from attorneys who were settling workers’ compensation cases and submitting MSAs to regional offices for review and approval. Although there were some MSAs before this time, the Patel Memo of July 23, 2001, had a pivotal impact and led to the start of several MSA and MSP compliance companies, including Tower MSA Partners 10 years ago.

The memo cited regulatory authority and gave a green light for the regional office review and approval process for submitted MSAs, including criteria and thresholds for review for non-Medicare beneficiary claimants. It established instructions for the regional office to add the MSA to the CMS common working file and annual accounting requirement for the MSA administrator once the MSA was funded. The memo also acknowledged structured set-aside arrangements, confirmed that an MSA should be allocated over life expectancy and allowed for fee schedules as a basis for allocating care.

Some of its provisions did not stand the test of time and were eliminated by subsequent CMS memos. These included a prohibition on the use of the MSA funds before Medicare entitlement, indexing the MSA for inflation, and regional office review of the administrative fee and expenses to be charged to the arrangement.

Although the WCMSA Reference Guide officially supplanted the Patel Memo, the memo laid the foundation for the WCMSA review process.

If you’d like to know more about the man behind the memo, listen to this interview conducted by Shawn Deane, General Counsel of our professional administration partner Ametros.

Tower MSA Partners Completes SOC 2 Type II Audit

April 28, 2021

In our unwavering commitment to data privacy and security, Tower MSA Partners has completed its SOC 2 Type II audit. The SOC 2 Type II audit reports on a service organization’s non-financial reporting controls and processes as they relate to the Trust Services Criteria developed by the American Institute of Certified Public Accountants (AICPA). It tests the organization’s controls related to security, availability, processing integrity, confidentiality, and privacy over an extended period of time.

From the beginning, Tower has been committed to technology driven processes to bring efficiency and measured results to our clients. The SOC 2 Type II attestation demonstrates how our corporate governance effectively assesses and manages risks and ensures the integrity of the systems and processes delivered by Tower and its business partners to execute the same high level of protection throughout the supply chain. I’m extremely proud of this leadership team and its accomplishments.

Conducted by KirkpatrickPrice, the audit verified the fairness of the presentation of management’s description of the service organization’s system and the suitability of the design and operating effectiveness of the controls to achieve the related control objectives included in the description throughout a specified period.

“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 its controls,” said KirkpatrickPrice President Joseph Kirkpatrick.

Related Prior Posts:

Tower MSA Partners Receives SOC 2 Type I Attestation

Building a Better Tower

Women’s History Month: Celebrating Tower’s History as a Women-Owned Business

March 18, 2021

Portraits of Rita Wilson and Kristine Dudley. executive team of Tower, a women-owned business

As a women-owned business serving the workers’ compensation and liability insurance industry in the Medicare Set Aside (MSA) sector, we thought a great way to celebrate this month is to take a chapter from our own history. We’re pretty proud of our leadership team as well as being certified members of WBENC or the Women’s Business Enterprise National Council, a leading non-profit organization dedicated to helping women-owned businesses thrive.

Tower is not only a women-owned business, 85% of employees, including the majority of our managers and supervisors, are women.

The company was co-founded in 2011 by Rita Wilson and Kristine Wilson Dudley.

Tower Co-Founder: Rita Wilson

Rita’s path to Medicare Set-Asides wound through technology and pharmacy. She graduated summa cum laude with a BS degree from Presbyterian College in Clinton, SC, completed graduate studies at Converse College in Spartanburg, and started her tech career with a textile company.

She later became Director of Research & Development for a company that developed pharmacy management software. Her team developed standards for information exchange between group health pharmacy benefit managers (PBMs) and pharmacies. Her next move was to build out the operations and technology for a start-up workers’ comp PBM and ultimately become its CEO.

“We took insurance billing from a labor-intensive and mostly paper-bill environment into electronic adjudication,” Rita said.

In 2006, she moved to Florida and founded a diagnostic company and did some technology consulting with Speedy MSA, which was owned by Behn Wilson. He introduced Rita to his daughter, Kristie.

Tower Co-Founder: Kristine Wilson Dudley

Kristie had grown up in the workers’ comp industry and recalls going to the conference that is now WCI when she was just seven years old. Kristie went to the University of Tennessee at Chattanooga on a tennis scholarship, scoring the honor of NCAA Academic All-American in 2004. She earned her law degree from Florida State University School of Law in Tallahassee.

She practiced law for a while, gaining workers’ comp experience with the firm of Eraclides & Gelman. While MSAs did come up, the firm saw them as necessary, but problematic. “And that’s still true with some law firms and even some adjusters today,” she said. “If you don’t do MSAs every day, they can seem like hurdles instead of opportunities to settle claims.”

While she liked practicing law, Kristie really wanted to operate a business. With Rita’s technology and pharmacy expertise, their joint understanding of MSAs, and Kristie’s legal background, the women knew they could offer deliver MSAs with a better balance of care, cost and compliance than any others in the market.

Tower MSA Facilitates Settlement

The MSA environment of the late 2000s was paper intensive, technology hungry and lacking structure, not unlike pharmacy billing before the ‘90s, according to Rita. It was hard to tell exactly what was happening at any given time with a claim and what action needed to be taken. Claims languished and collected unnecessary expenses.

“I had seen the birth of on-line pharmacy bill adjudication and the standardization of data transfer protocols and knew we could leverage technology to efficiently manage MSA production and approval processes, consistently execute workflow, drive results and accelerate settlements,” she said.

And so, these two women entered a mature market, developed a methodology that changed the paradigm as to how MSAs can facilitate settlement and created metrics to manage performance. From the ground floor, Tower MSA Partners developed a sophisticated platform that targets cost drivers, documents recommendations of clinical and legal interventions, prompts next steps and keeps claims moving toward settlements.

Is Tower run by pushy women?

“Tower differentiates itself by aggressively seeking ways to mitigate costs and secure savings for clients,” Rita said. “Technology makes that possible.” Through claims feeds from clients, MSA specialists look for things that add unnecessary expense like possible surgeries that have not been discussed in a long time, prescriptions that were never filled, or brand drugs being used when generics could be.

“We’re different because we keep pushing. We listen to what CMS says and we push back when we disagree with a finding, we bring evidence, we intervene. We don’t just roll over,” Kristie insists. “Technology and measurements enable us to confidently do this.”

Is Tower run by pushy women? “We prefer ‘proactive,” Rita said, “but if the stiletto fits….”

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

Related

Rita Wilson, Chief Executive Officer

Kristine M. Dudley, Esq., Chief Operations Officer

Build a Better Tower: Partnerships Speed Settlements of Workers’ Comp Claims with Medicare Set-Asides

March 15, 2021

People sitting around conference table discussing MSA settlements.

Tower MSA Partners knows our strengths. And we know our business.

We’re in the Medicare Set-Aside settlement business. Everything we do, we do to make workers’ compensation settlements possible — whether they have MSAs or not. Tower has built its business processes and technology around making settlements easier, faster, smoother, and less expensive.

We recognize that the value of an MSA is its ability to facilitate workers’ compensation and liability claim settlement and closure. We also recognize that MSAs can become stumbling blocks to injured workers and their attorneys when it comes to settling claims. Since Tower’s goal is to break through all barriers to settlement, we formed a strategic partnership with Ametros, the leader in the professional administration of Medicare Set-Asides.

Helping Injured Workers Settle Well

Ametros, which does not produce MSAs, helps injured individuals manage their Medicare Set-Asides and medical allocations after settlement. During the settlement process, its team educates injured workers and their attorneys on their responsibilities and the resources available to them through professional administration after the settlement. Ametros frequently attends mediations and settlement conferences to help educate all parties on the post-settlement reality of managing a Medicare Set-Aside and how its services support compliance with Medicare Secondary Payer guidelines.

CareGuard, Ametros’ professional administration service, helps injured individuals navigate the healthcare system after settlement. CareGuard Members receive significant discounts for their injury-related medical and pharmacy expenses, durable medical equipment, home health care, and other services. Ametros handles the payment of all medical bills from their settlement funds and takes care of the Medicare reporting associated with an MSA.

Once injured workers understand they can have these services after they close their claims, they’re more likely to move forward to settle the case.

Many of Tower’s clients already work with Ametros and understand the value they bring. This made the idea of working with Ametros to simplify the settlement process for clients and adjusters a natural evolution.

Taking Work Off the Adjuster’s Desk

To further boost efficiency, Tower and Ametros developed a real-time electronic data interchange (EDI) to exchange MSA, CMS, and settlement data. MSA information is automatically updated directly in Ametros’ system at the time of MSA delivery to the client, enabling the Ametros team to begin educating the injured worker, their family, and attorneys.

This is another way we take work off adjusters’ desks and accelerate settlements that involve MSAs.

Speed Settlements

Recently, Tower launched a new program with Ametros to speed settlements. Using our powerful data analytics capabilities, Tower identifies claims that meet criteria for closure and creates a settlement candidate report. Ametros is then engaged to reach out to these injured workers or their attorneys to offer professional administration as an added benefit and to gauge interest in settlements.

When settlement is indicated, Tower prepares the MSA, executes all cost-mitigation strategies and postures the claim for closure.

This is an exciting new way to proactively address claims that may have slipped out of view and generate interest in settling. There’s no extra work for adjusters and no cost for the payer until a claim is ready to settle and an MSA is prepared.

Future posts will share other strategic partnerships that Tower has forged to build a better, stronger Tower to help you efficiently and cost effectively settle claims.

Meanwhile, have Tower create an MSA settlement candidate report for you. To learn more, contact Hany Abdelsayed hany.abdelsayed@towermsa.com (916) 878-8062.

Rita Wilson

Chief Executive Officer

Related:

Legacy Claim Settlement Initiatives

Tower MSA Partners Supports Insurance Careers Month!

February 24, 2021

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, 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.

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.”