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.
Contact us at 888.331.4941 or info@TowerMSA.com and get started today.