MSA 2nd Opinions - Tower MSA

Medicare Set Asides (MSA) can get in the way of claim settlements and closures. Learn how Tower’s MSA 2nd Opinions can resolve problems and save you money!

The Problem: MSAs Can Prevent Settlements and Claim Closures

The MSA is too high
The attorney or injured party considers it too low
CMS issued a counter-higher

The Solution: Turn to Tower for our MSA 2nd Opinions

Our MSP Automation Suite is always up to date to capture:

State-specific FS overlaid with WCMSA Reference Guide
What is and is not covered under Medicare
Pharmacy price changes, e.g., Lyrica’s generic, Meloxicam price change

We measure everything, analyzing CMS responses line by line. So, we know:

What CMS will – and won’t – accept
Where to find cost drivers and discrepancies
When to push for a more favorable response
Which interventions to apply at the right time to reduce costs.
How to explain and document treatment changes so CMS can approve

Here are just a few of the issues we’ve found in when reviewing Medicare 2nd Opinions:

UDS test frequency and coding issues
Never filled or discontinued drugs
Brand drugs never changed to generics or drugs changed, but prices didn’t
Treatment for non-covered body parts
Allocations for future surgeries/procedures that may never happen
Lag time in price changes, e.g., lower price of Meloxicam not reflected in MSA
Use of inaccurate CPT codes and number of physician visits/year

If you have claims that just won’t close or received an MSA that seems unreasonably high or low, get a free MSA 2nd opinion from Tower.

Related

Getting Real Value Out of Your MSA

Case Study: 2nd Opinion MSA Review Yields $98,120 in Savings