MEDICARE SET-ASIDE SERVICE
The true business value of an MSA is in its ability to facilitate settlement and closure. If the MSA prevents settlement, it has no value, and may even sabotage claim closure. Our aggressive pre-MSA approach — powered by proprietary TowerConnect software — identifies and tracks key triggers to ensure compliance and accelerate the process of settlement.
Collaborating with our clients, we:
- Forensically analyze the last two years of treatment history to identify cost drivers that may create obstacles to settlement
- Make case-specific recommendations to address issues and remove them prior to starting the MSA
- Contact treating physicians to clarify treatment, confirm discontinuations and obtain written documentation to address medical and pharmacy treatment issues
- Use Physician Peer Review, depositions and other legal strategies to ensure that only appropriate medical and pharmacy treatment and costs are included in the settlement
- Manage conditional payment notice (CPN) issues through proactive resolution
- Stay involved until the claim closes
Every Tower MSA is prepared by a registered nurse or attorney who holds the Medicare Set-Aside Certified Consultant (MSCC) certification, with both legal and clinical sign-off for every MSA.
Built upon MSA best practices, TowerConnect automates so much of the process that your claims professionals and our legal/medical specialists can focus on complex claims.
- Runs a five-tier QA verification to guarantee that the MSA is comprehensive and accurate
- Embeds current state fee schedules within its software to automate price accuracy
- Reconciles CMS’s responses at a detail level, comparing each line item against CMS’s allocated procedure, frequency and price to identify CMS errors and re-review situations
- Analyzes CMS performance to deliver benchmark performance metrics and identify trending changes in CMS’s review process
- Automatically alerts client-administrators each time an action occurs
- Seamlessly tracks every action from referral through intervention and treating physician contact to final documentation of treatment changes and CMS submission
- Provides end-to-end visibility into your MSA 24/7
This technology powered approach protects Medicare’s interests and ensures that patients receive appropriate funds for future medical and pharmacy care. It also streamlines the MSA process and has saved clients tens of thousands of dollars on individual claims.