New DOI Reporting Rules for Cumulative Injuries in Section 111 NGHP Guide The new update of the Section 111 NGHP User Guide, Version 7.6, clarifies how to report the Date of Incident (DOI) in a Cumulative Injury.  The Centers for Medicare and Medicaid Services added the following to Chapter III … Continue reading CMS Section 111 Reference Guide Update Clarifies Date of Incident Reporting

It’s time to get everything set up to accommodate new Section 111 reporting fields for WCMSAs. While compliance has long been required, Civil Money Penalties (CMPs) are real now. Tower’s Chief Technology Officer Jesse Shade joined our Chief Compliance Officer Dan Anders for the “Premier Webinar: Get Ready for Section … Continue reading Section 111 Reporting for WCMSAs & Avoiding Civil Penalties

Nothing can stall settlement faster than a Medicare Set-Aside (MSA) that includes an unnecessary or unwanted medical procedure. Procedures like surgeries, spinal cord stimulators (SCSs), and intrathecal pain pumps significantly raise the costs of MSA allocations. Fortunately, Tower’s client partners have access to our complimentary Physician Follow-up service that Save … Continue reading Tower’s Physician Follow-Up Service Kicks Costly SCS Out of MSA

Our Chief Compliance Officer Dan Anders learned how to write Medicare Set-Asides (MSA) the hard way through trial and error in the days before the Centers for Medicare and Medicaid published complete guidelines.  Even now, the manuals and regulations don’t cover every detail. And with MSAs details matter.  Proper documentation, … Continue reading How to Manage Medicare Set-Asides: Tips from Dan Anders

Tower’s Section 111 Reporting Audit Service Can Help You Fix Systemic Issues and Avoid Penalties. Workers’ compensation payers and other Responsible Reporting Entities (RREs) have a little over five months to get their Section 111 reporting houses in order. And Tower’s Section 111 reporting audit service is here to help … Continue reading Avoid Penalties: Tower’s Section 111 Reporting Audit Service

CMS Announces Section 111 Mandatory Insurer Reporting Changes: Penalties and New WCMSA Requirements The Centers for Medicare and Medicaid Services (CMS) has released several announcements regarding Section 111 Mandatory Insurer Reporting over recent months.  Some relate to Section 111 penalties and some to the new requirement to add Workers’ Compensation … Continue reading Premier Webinar: Get Ready for Section 111 Reporting Penalties and WCMSA Reporting

CMS delays start date for Section 111 reporting of WCMSAs to April 2025 and announces new webinar for Q&A During last week’s webinar, the Centers for Medicare and Medicaid Services (CMS) announced an extension of the start date for Section 111 reporting of WCMSAs from January 2025 to April 4, … Continue reading CMS Moves Start Date for WCMSA Reporting to April 2025

CMS Releases Updates to MMSEA Section 111 NGHP User Guide and WCMSA Reference Guide The Centers for Medicare and Medicaid Services (CMS) began April with updates to two of its popular user guides, the MMSEA Section 111 NGHP User Guide and the WCMSA Reference Guide.  Notably, the NGHP User Guide, … Continue reading CMS Updates Section 111 NGHP User Guide and WCMSA Reference Guide

Navigating cybersecurity landscape: Insights from CTOs on cybercrime trends Cybercrime continues to mount, threatening organizations of all sizes and types. The right cybersecurity measures matter. And which cyber risks worry Chief Technology Officers the most?  That would be the danger of an employee accidentally opening the door to an attack. … Continue reading Tower’s Cybersecurity Measures Go the Extra Mile to Protect Your Data

Prepare for Change: CMS Webinar on Expanding Section 111 NGHP TPOC Reporting to Include WCMSA Information The Centers for Medicare and Medicaid Services has scheduled a webinar for April 16, 2024, at 2 PM ET to provide updates on the implementation of Section 111 reporting of Workers Compensation Medicare Set-Asides … Continue reading CMS Sets April 16 for Webinar on Section 111 Reporting of WCMSAs

What are conditional payments?  How and when should payers respond to Conditional Payment Letters, Notices and Demands? What happens if you don’t? Our Chief Compliance Officer Dan Anders and Director of MSP Compliance Services Ada Lopez covered these topics and much more in our February 7 webinar.  Here’s a quick … Continue reading Tower Webinar Shared the Best Ways to Manage Conditional Payments

The Centers for Medicare and Medicaid Services has announced that Total Payment Obligation to Claimant (TPOC) Section 111 reporting must include Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs) effective April 4, 2025.  This means CMS will require workers’ compensation payers to report MSA amounts, even if $0, concurrently with settlement amounts, … Continue reading CMS Sets Date for Start of Section 111 WCMSA Reporting

The Centers for Medicare and Medicaid Services (CMS) issued a series of updates over the past month, which include an updated NGHP Section 111 User Guide, the latest Top 10 Section 111 Reporting errors, and its 2024 conditional payment recovery threshold.  We have summarized these for you below. Updated NGHP … Continue reading Section 111 Mandatory Insurer Reporting Updates

Tune-up your conditional payment resolution processes with Tower’s Feb. 7 webinar! Medicare conditional payment resolution should be a standard practice when settling workers’ compensation or liability claims that involve an injured worker or claimant who is a Medicare beneficiary.  While most settling parties recognize this obligation, many have questions about … Continue reading Medicare Conditional Payment Tune-up, a Tower MSA Partners Webinar

On January 18, 2024, the Centers for Medicare and Medicaid Services (CMS) held a Section 111 Civil Monetary Penalties webinar to provide important information on timelines, non-compliance definitions and safe harbors associated with the rule. A copy of a screenshot of the webinar slides can be found here. Some key … Continue reading Recap of CMS Section 111 Penalties Webinar

As we start the new year, here’s a look at the top five Medicare Secondary Payer (MSP) compliance stories of 2023 and what to watch for in 2024.  A Look Back Centers for Medicare and Medicaid Section 111 Penalties Rule Released The long-awaited Section 111 penalties rule was published in … Continue reading Top 5 MSP Stories of 2023 & What to Expect in 2024

Tower wishes you a happy holiday season filled with peace, joy and laughter! We hope you can connect with loved ones and have time to relax and recharge. This is a time to reflect on the past and prepare for new opportunities in the upcoming year. As we do this, … Continue reading Happy Holidays From Your Friends at Tower MSA Partners

The Centers for Medicare and Medicaid Services (CMS) has released 2023 data that provides insight into its Workers’ Compensation Medicare Set-Aside (WCMSA) reviews.  This is the second year in a row CMS has published such detailed metrics. We thank CMS for publishing these annual statistics on the WCMSA review program.  … Continue reading CMS Releases 2023 WCMSA Metrics; Announces January Section 111 Penalties Webinar

The Centers for Medicare and Medicaid Services (CMS) has published a Frequently Asked Questions (FAQ) document to supplement its recently released Section 111 penalties rule.  There were a few crucial clarifications that we highlight below.  Start Date for Reporting Data Subject to Penalties Given the multiple dates provided in the … Continue reading CMS Releases FAQs on Section 111 Penalties

In its November 13, 2023 webinar, the Centers for Medicare and Medicaid Services (CMS) announced plans to require the report of a Workers’ Compensation Medicare Set-Aside (WCMSA) amount concurrently with the report of Total Payment Obligation to the Claimant (TPOC) as part of Section 111 Mandatory Insurer Reporting.  CMS’s purpose … Continue reading CMS to Require Section 111 Reporting of WCMSA Amounts

On October 18 Tower’s Chief Compliance Officer Dan Anders and Chief Technology Officer Jesse Shade presented an informative webinar on Section 111 reporting and the final rule on Civil Monetary Penalties for untimely reporting. As shared in our post, these range from $250 per calendar day to $1,000 for each … Continue reading Recap–Special Webinar: Your Need-to-Know Guide on Section 111 Reporting Penalties

Tower’s Chief Compliance Officer Dan Anders’ enthusiasm for Amended Reviews kept the audience engaged during our recent Premier Webinar: Amended Review MSA Provides Second Bite at the Apple. Several criteria dictate whether payers can submit an Amended Review, including the fact CMS needed to have approved the first MSA more than … Continue reading MSA Amended Reviews – Key to Settlements of Old Dog Legacy Claims

Based on a recent webinar invitation, the Centers for Medicare and Medicaid Services (CMS) plans to expand Section 111 reporting to include data from Workers’ Compensation Medicare Set-Asides (WCMSAs). Per CMS: CMS will be hosting a webinar regarding the expansion of Section 111 Non-Group Health Plan (NGHP) Total Payment Obligation … Continue reading Nov. 13 CMS Webinar to Discuss Adding WCMSA Info to Section 111 Reporting of TPOC

CMS recently published its final rule on the imposition of Section 111 Mandatory Insurer Reporting penalties.  While we addressed the specifics of the rule in our article, CMS Section 111 Penalties Rule Focuses on Untimely Reporting, we know that many questions remain. In a special webinar on October 18 at … Continue reading Special Webinar: Your Need-to-Know Guide on Section 111 Reporting Penalties

On October 11, 2023, CMS published a final rule on the imposition of Civil Monetary Penalties for failure to comply with the Section 111 Mandatory Insurer Reporting requirements.  The rule’s focus and the sole reason for penalties will be untimely reporting.  Even if a Responsible Reporting Entity (RRE) reports untimely, … Continue reading CMS Section 111 Penalties Rule Focuses on Untimely Reporting

The long-awaited Section 111 Mandatory Insurer Reporting Civil Monetary Penalties (CMPs) rule has been released.  Recall that the purpose of the rule is to set out specific criteria for when CMS may impose penalties for what it considers a failure to report or improper reporting.  The rule is unpublished but … Continue reading Section 111 Reporting Penalties Rule Released

The Centers for Medicare and Medicaid Services recently announced that the maximum settlement amount for use of the Fixed Percentage Option will increase from $5,000 to $10,000, effective 10/2/2023. The Fixed Percentage Option is available to the claimant in a liability settlement and allows them to agree to pay 25% … Continue reading Fixed Percentage Option Now Available for Liability Settlements up to $10,000

Tower MSA Partners recently marked our 12 years in business with the rollout of a new, streamlined website that emphasizes our focus on your settlements.  We facilitate claim closure by aggressively seeking savings and making Medicare Secondary Payer (MSP) compliance and Medicare Set-Aside (MSA) prep better, faster and easier. Working … Continue reading Tower MSA Partners Launches New Website and Celebrates 12th Anniversary

CMS now allows any previously approved MSA to have a one-time Amended Review.  This means that CMS will consider a new MSA submission that may be lower or higher than the previously approved MSA. Essentially, it is a second bite at the apple for old MSAs that, for whatever reason–they … Continue reading Premier Webinar: Amended Review MSA Provides Second Bite at the Apple

Tower’s structured settlement partner, Arcadia Settlements Group, gave an in-depth overview of how Medicare Set-Asides, structured settlements, and professional administration facilitate workers’ comp settlements during our recent Premiere Webinar. Our Chief Compliance Officer, Dan Anders, moderated the informative session that featured Alisa Hofmann, Arcadia’s VP of Workers’ Comp and Medicare … Continue reading Easy MSA Cost Savings Through Structured Settlements

The Centers for Medicare and Medicaid Services (CMS) recently released Version 7.2 of its MMSEA Section 111 User Guide. The guide contains some notable updates for Ongoing Responsibility for Medicals (ORM) reporting, determination of the ORM termination date with a physician letter, and use of the NOINJ code in certain … Continue reading CMS Changes Rules for ORM and NOINJ Reporting in the Latest Update of its Section 111 Reporting User Guide

The Centers for Medicare and Medicaid Services (CMS) recently released a how-to guide for appealing Medicare conditional payment demands. The Non-Group Health Plan (NGHP) Applicable Plan Appeals Reference Guide consolidates conditional payment rules and best practices that the agency has issued through webinars, slides and its website. Section 2.0 gives … Continue reading CMS News Roundup: New Conditional Payment Appeals Guide & Webinar on Section 111 Reporting

One of the easiest ways to lower the settlement cost is through a structured Medicare Set-Aside. Not only does this reduce the payer’s cost of funding the MSA, but it also provides the injured worker a consistent stream of funds for injury-related medical care over their lifetime.  On June 7 … Continue reading Premier Webinar: Easy MSA Cost Savings Through Structured Settlements

The Centers for Medicare and Medicaid Services (CMS) announced the expansion of its Amended Review policy to significantly more MSAs in the latest update to its WCMSA Reference Guide, Version 3.9. The Amended Review process was previously limited to MSAs approved within the last 12 to 60 months. The 60-month … Continue reading CMS Significantly Expands Amended Review MSA Availability

In the second installment of our quarterly series, “Tower Partners: People Behind the Settlements,” and in celebration of Nurses Week, we spotlight Brittney O’Neal, our Director of Clinical Operations. A nurse, Brittney oversees the team of nurses that produces our Medicare Set-asides (MSAs). There are so many elements and areas of … Continue reading The Critical Care Nurses Give MSAs

In an update to its Section 111 MSP Mandatory Reporting User Guide (Version 7.1 Chapter III Policy Guidance) CMS made clear that in a subscription insurance policy arrangement, the lead insurer is solely responsible for Section 111 mandatory reporting requirements. The new section of the guide, Section 6.1.13 states: In … Continue reading CMS: Lead Insurer is RRE for Subscription Insurance Policy Section 111 Reporting

Workers’ comp payers regularly measure the performance of different aspects of their programs. Understanding injury frequency rates, the average cost per claim, timeliness of claims processing, lost-time and return-to-work rates help them identify cost drivers and improve processes. Payers also evaluate the performance of external partners — provider networks, bill … Continue reading Does Your MSA Program Measure Up?

In response to a Medicare conditional payment demand, payers can access a five-level appeals process, including a hearing before a Centers for Medicaid and Medicaid Services (CMS) administrative law judge (ALJ). Most conditional payment demand appeals are resolved at the first two levels: redetermination and reconsideration.  However, some are escalated … Continue reading Successful Appeal to CMS ALJ Yields $80K Reduction in Conditional Payments

There was much expectation that the Centers for Medicare and Medicaid Services (CMS) would meet the February 18, 2023 deadline to release a final rule on Section 111 reporting civil money penalties (CMPs). However, it was not to be.  CMS extended its deadline for publishing the final rule by a … Continue reading CMS Extends Deadline for Publication of Final Section 111 Penalties Rule

Tower MSA Partners is pleased to launch “Tower Partners: People Behind the Settlements.”  This quarterly series will dig into the elements that go into smooth, cost-effective settlements and introduce Tower’s team members and corporate partners who make them possible. First up is Kevin Puckett, owner and president of KP Underwriting, … Continue reading Tower Partners: People Behind the Settlements Interview with Kevin Puckett of KP Underwriting

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

A $0 MSA remains an option in some workers’ compensation case settlements, although strict criteria must be met if CMS approval is necessary.  It is essential then for claims professionals to understand this criteria as steps taken early in claims handling can sometimes be the difference between a $0 and … Continue reading Premier Webinar: Zeroing in on $0 MSAs

People in the MSP compliance business rattle off acronyms and abbreviations, such as AWP, MMSEA, and TPOC like it’s second nature. People immersed in Section 111 reporting and Medicare Set-Asides understand the abbreviations, but most people listening to us do not. So, here’s a quick cheat-sheet (or handy guide) to … Continue reading A Claims Professional’s Guide to Common MSP Acronyms and Abbreviations

Starting July 2023, Responsible Reporting Entities (RREs) can access updates/changes that another source has made to their claims for Ongoing Responsibility for Medicals (ORM).  The Centers for Medicare and Medicaid Services (CMS) announced this in an update to its MMSEA Section 111 NGHP User Guide, Version 7.0. It may surprise … Continue reading CMS to Provide RREs with Response File on ORM Record Changes

As we launch into 2023, here’s a look back at the top five Medicare Secondary Payer (MSP) compliance stories of 2022 and what to watch for this year. Addition of Non-Submit MSA Policy to CMS WCMSA Reference Guide 2022 certainly got off with a bang when CMS added Section 4.3 … Continue reading Top 5 MSP Stories of 2022 & What to Watch for in 2023

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 … Continue reading Happy Holidays From Your Friends at Tower MSA Partners

This past October, the Centers for Medicare and Medicaid Services (CMS) withdrew its proposed rule on future medicals in liability settlements from review by the White House Office of Information and Regulatory Affairs (OIRA). (See CMS Withdraws Proposed Rule on Future Medicals in Liability Settlements). Right now, we don’t know … Continue reading Tower Releases White Paper on Future Medicals in Liability Settlements

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

While workers’ comp payers invest considerable resources to manage and settle claims, they don’t always prepare Medicare-eligible injured workers for life after settlement. These patients have usually been in the workers’ comp system for several years. And the system has paid for their injury’s treatment and medication, and in some … Continue reading Post-Settlement Care, Cost and Compliance Through Professional Administration

The Centers for Medicare and Medicaid Services (CMS) recently published a Section 111 reporting webinar notice and an update to its CMS WCMSA Reference Guide. CMS Section 111 Reporting Webinar CMS will hold a Section 111 NGHP Webinar on December 6, 2022, at 1:00 PM ET.  The notice says: CMS … Continue reading CMS Announces Upcoming Section 111 Webinar / WCMSA Reference Guide Update Released

The Centers for Medicare and Medicaid Services (CMS) recently released data that provides insight into its Workers’ Compensation Medicare Set-Aside (WCMSA) reviews.  This is the first time CMS has released such detailed metrics. CMS shared statistics for a 3-year period of 2020 through 2022 (CMS’s fiscal year ends on Sept. … Continue reading For the First Time, CMS Releases Key Metrics on WCMSA Review Program

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

We rightly invest time to draft a Medicare Set-Aside (MSA) that accurately considers future medical care and, when appropriate, obtain approval of the allocation from the Centers for Medicare and Medicaid Services (CMS). However, we don’t always dedicate enough time to address the MSA’s post-settlement implications for the injured or … Continue reading Premier Webinar: Care, Cost & Compliance Through MSA Professional Administration

On October 13, 2022, the Centers for Medicare and Medicaid Services (CMS) withdrew its proposed rule on future medicals in liability settlements from review by the White House Office of Information and Regulatory Affairs (OIRA review and approval is required before a proposed rule is published). While never published to … Continue reading CMS Withdraws Proposed Rule on Future Medicals in Liability Settlements

Technology isn’t everything.  It may seem hard to believe that I have said this because most of my career was steeped in technology. In my past life, I developed automation systems for pharmacies and workers’ comp pharmacy benefit management (PBM) models. Rules-based adjudication platform allowed for automatic Rx fills for … Continue reading Automation has its place, but it can’t replace people in MSP compliance

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

A common question we receive is whether a CMS-approved $0 MSA is still possible.  The answer is, yes– if it meets the criteria. There are three different ways a $0 MSA can be obtained, each with its own criteria and documentation requirements. Denied Claim $0 MSA This is a $0 … Continue reading Is a CMS-approved $0 MSA Still Possible?

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 … Continue reading Catch Tower’s Dan Anders on the popular ADJUSTED podcast

Not all Medicare Set-Asides (MSAs) are the same. There are specialty areas for unusual cases and many questions about these: Criteria for successful $0 MSA approvals Whether to include PQMEs, AMEs, IMEs in the MSA Use of court orders to limit medical care in the MSA When and how to … Continue reading Premier Webinar: Tricks of the Trade for Successful MSA Outcomes

This success story demonstrates how an MSA Second Opinion can lead to a successful result with settlement of a WC case. CHALLENGE: An MSA was prepared by another MSP provider for approximately $110,000. Based on this MSA amount, the parties reached a tentative settlement. Prior to MSA submission the other … Continue reading MSA Second Opinion Success Story – $46,691 in savings

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 … Continue reading MSA Optimization Yields $175,867 in Savings

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

CHALLENGE: A Medicare Set-Aside was prepared by another MSP provider for $221,384.00.  In addition to extensive medical treatment and surgical procedures, the MSA included the medications omeprazole, ibuprofen, sertraline, and hydroxyzine.  As a settlement was not feasible with that MSA amount, it was submitted to Tower for a 2nd Opinion … Continue reading MSA 2nd Opinion Success Story – $98,120 in savings

Attendees of Tower’s Premier Webinar on April 20 received sound advice on how to work with Medicare Part C (Advantage) and D (Drug Benefits) plans. Our guest presenter was Brian Bargender, Consultant, Subrogation and Third-Party Liability with Humana, a nationally recognized expert on these plans. Bargender noted that these plans … Continue reading Humana’s Brian Bargender Gives Tips on How to Work with Medicare Part C & D Plans

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 … Continue reading Tower MSA Partners Receives 2022 SOC 2 Type II Attestation

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 … Continue reading Highlighting worker fatalities: Workers Memorial Day

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 … Continue reading Premier Webinar: Medicare Advantage Plan Reimbursement – What Now?

On April 13, 2022, at 1:00 pm ET, the Centers for Medicare and Medicaid Services (CMS) will host a webinar on the “Go Paperless” option in the Medicare Secondary Payer Recovery Portal.  The selection of this option will provide for more expeditious receipt of correspondence from the CMS Medicare conditional … Continue reading CMS to Hold Webinar on “Go Paperless” Feature in MSPRP

CMS is serious about protecting Medicare’s funds. Over the years, the agency has had policies that were not enforced, including sizeable civil monetary penalties for not complying with Section 111 reporting rules and denying payment for medical treatment when another payer was responsible.  But things are changing.  CMS has denied … Continue reading Dan Anders Quoted in Claims Journal on Non-Submit MSAs and Section 111 Penalties

The January 2022 addition of Section 4.3 to the CMS WCMSA Reference Guide that discussed the agency’s treatment of non-submit Medicare Set-Asides caused quite a stir throughout the MSA industry and raised many questions for those who use non-submit MSAs in workers’ comp settlements.  A February CMS webinar addressed some … Continue reading CMS Clarifies Policy on Non-Submit MSAs in Updated Reference Guide

Cybercriminals love pandemics, natural disasters, and wars. Global distractions are good for their business. Russia’s invasion of Ukraine elevates cyber security risks, which were already on the minds of global business leaders. So far, the incursion has delivered new distributed denial of service (DDoS) attacks and a novel malware, Hermetic … Continue reading Cyber Concerns Rise in the Wake of Russia’s Invasion of Ukraine

The Centers for Medicare and Medicaid Services recently hosted a webinar on Workers’ Compensation Medicare Set-Asides (WCMSAs). While the webinar covered several topics around MSA submissions, CMS policy toward non-submit and evidence-based MSAs was an attendance-driver, according to its presenter, John Jenkins, Health Insurance Specialist for the CMS Division of … Continue reading CMS Webinar Delves Further into Non-Submit MSA Matters

The Centers for Medicare and Medicaid Services now provides ACH payment option for Medicare conditional payment debts. The Centers for Medicare and Medicaid Services (CMS) is now accepting recovery debt (Medicare conditional payment recovery) payments via ACH (Automated Clearing House) transactions. CMS’s February 18, 2022 announcement says this applies to … Continue reading CMS Rolls Out ACH Payment Option for Recovery Debts

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 … Continue reading Marking Insurance Careers Month During “The Great Resignation”

CMS to Hold WCMSA Webinar on February 17 The Centers for Medicare and Medicaid Services updated its Workers’ Compensation Medicare Set Aside (WCMSA) Reference Guide on 1/10/22 adding a section that addresses non-submit MSAs or evidence-based MSAs. The new section makes it clear that CMS will treat the use of … Continue reading CMS Letter Confirms that Denial for Non-Submit MSAs is Real

A recent study finds Medicare treatment denials systematically occur in medical claims for Medicare beneficiaries with Medicare Set-Asides (MSAs). “Don’t worry so much about the Medicare Set-Aside; Medicare will never deny post-settlement treatment claims.”  That is the refrain from some when the matter of an MSA inclusion in settlement arises. … Continue reading Study Shows Post-Settlement Medicare Treatment Denials Do Occur

The Centers for Medicare and Medicaid Services (CMS) recent policy statement which considers non-submit/evidence-based MSAs “as a potential attempt to shift financial burden” to Medicare left many questions in its wake (See CMS: Non-Submit MSAs Potentially Shift Costs to Medicare).  It has triggered many payers, along with injured workers and … Continue reading Premier Webinar: WC Settlements in Light of CMS Policy on Non-Submit MSAs

WorkersCompensation.com’s Nancy Grover captured the thoughts of Tower’s Chief Compliance Officer Dan Anders on a variety of Medicare Secondary Payer and Medicare Set-Aside issues from 2021 and 2022 in a recent article.  MSAs cost less than you think, opioid allocations are down, and the PAID Act makes obtaining Medicare Advantage … Continue reading Tower’s Dan Anders Reviews MSP Policies from Last Year and Predicts 2022 Actions

The Centers for Medicare and Medicaid Services’ updated Workers’ Compensation Medicare Set-Aside Reference Guide (Version 3.5) has a new section on the use of “Non-CMS Approved Products to Address Future Medical” that says CMS views non-submit/evidence-based MSAs “as a potential attempt to shift financial burden” to Medicare.  Below is the … Continue reading CMS: Non-Submit MSAs Potentially Shift Costs to Medicare

The Centers for Medicare and Medicaid Services (CMS) has released Version 6.6 of its Section 111 NGHP User Guide.  Below is a summary of the notable updates and practical implications. Funding Delayed Beyond TPOC Start Date Field Last month we discussed an 11/03/2021 Alert from CMS on the use of … Continue reading CMS Releases Updated Section 111 NGHP User Guide

Earlier this year Tower MSA Partners celebrated its 10th anniversary. As 2021 comes to a close we again thank you, our client partners, for your support and loyalty, some for all of those 10 years and some for only the past few months.  Your trust in us to provide MSP compliance services … Continue reading A Holiday Wish from Tower MSA Partners

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

Tower’s Chief Technology Officer Jesse Shade has published an article on the Forbes Technology Council channels, reminding fellow IT pros that most tech users don’t understand cybersecurity. And that when IT folks explain why doing certain things are important, users are more likely to do them.  Here’s his explanation of … Continue reading Forbes Features Tower CTO‘s Article, “How to Help the Masses Make Sense of Cybersecurity”

When the WCI Conference invited Tower MSA Partners to produce the first day of its Medicare Secondary Payer (MSP) compliance track, Tower asked representatives from the Centers for Medicare and Medicaid Services (CMS) to kick-off a trio of MSP panels. “It’s the 20th anniversary of CMS launching its Medicare Set-Aside … Continue reading Tower MSA Partners Arranges for CMS Officials to Headline WCI’s MSP Sessions

Over the past month the Centers for Medicare and Medicaid Services issued two alerts reminding Responsible Reporting Entities (RREs) to make sure data reported through the Section 111 Mandatory Insurer Reporting process is accurate and updated. This appears to be part of an ongoing effort by CMS to avoid unnecessary … Continue reading CMS Alerts Remind RREs to Accurately Report Section 111 Data

Thanks to the Provide Accurate Information Directly (PAID) Act effective December 11, 2021, payers will have access to Medicare beneficiary enrollment status in Medicare Part C (Medicare Advantage [MA]) plans or Part D (prescription drug) plans. Enrollment information will be provided through the Section 111 query response file for the … Continue reading The PAID Act: Implementation and Implications for Claims Handling

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

We’re celebrating the Tower MSA Partners 10-year anniversary this year! To commemorate this landmark year for our business, we’ve compiled 10 distinguishing achievements over the decade that we’re proud of and that we think differentiate us from others in our field. Our single focus. We don’t try to be all … Continue reading Tower MSA Partners 10-Year Anniversary and 10 Distinguishing Achievements

To submit or not submit a Medicare Set-Aside for approval from the Centers for Medicare and Medicaid Services (CMS) has been a hot-button issue for several years.    While some follow a global non-submit strategy others opt to follow CMS’s guidance, where possible, considering a non-submit MSA only in specific situations.   … Continue reading Tower Non-Submit MSA: A Reasonable Alternative

The National Medicare Secondary Payer Network (MSPN) will hold its virtual MSPN Annual Conference on September 29 and 30.  With the theme of the Roaring ‘20s, the conference celebrates surviving, revamping, and emerging stronger. MSPN is the only national MSP organization with an influential membership base of claims adjusters, insurance … Continue reading Attend the Virtual MSPN Annual Conference!

Join Tower’s Webinar for PAID Act implementation “How to Guide”  on September 15th. Because of the PAID Act, self-insured employers, insurers and other non-group health plans will finally have access to Medicare Part C Advantage Plan and Part D prescription drug plan information for Medicare beneficiary claimants, starting December 11, … Continue reading PAID Act Implementation How-to Guide Webinar, Sept. 15

On Thursday, September 9, 2021, at 1 p.m. ET the Centers for Medicare and Medicaid Services (CMS) will be hosting a second webinar on the implementation of the Provide Accurate Information Directly (PAID) Act.  Per the notice: CMS will be hosting a second webinar regarding the impacts to Section 111 … Continue reading CMS to Host Webinar on PAID Act Implementation and Upcoming Testing

       Building a Better Tower – Through Technology You may not think about the technology that drives Tower’s Medicare Secondary Payer compliance and Medicare Set-Aside preparation services very often – and that’s understandable.  You may like our simple user interface or the proactive communication our software generates to … Continue reading Technology Drives Better Medicare Secondary Payer Compliance

The Patel Memo Launched the Medicare Set-Aside Review Process Last week, July 23, 2021, to be precise, marked the 20th 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 … Continue reading The Patel Memo Launched the Medicare Set-Aside Review Process

Tower’s Legacy Claims to Settlement Initiative identifies claims that can settle now or with intervention and produces smooth, efficient settlements. Legacy claims. Old dog claims. Whatever you call them, these are the claims that languish on the books and just won’t close for any number of reasons.  If you missed … Continue reading Take Those Legacy Claims to Settlement!

With great pride, we announce Jesse Shade’s promotion to Chief Technology Officer.  As we continue to build a better tower, we recognize its foundation of technology and the people who manage it. Technology drives Tower’s Medicare Secondary Payer and Medicare Set-Aside processes. Our technology was designed specifically for MSP compliance … Continue reading Jesse Shade has been promoted to Chief Technology Officer

Tower’s free Physician Follow-up service is one of our most effective tools for reducing your MSA costs. This case history offers a deeper dive on how we use this tool. Physicians often need to try different medications as they search for the best way to manage pain, and medical records do … Continue reading MSA Physician Follow-up Service Saves Over $200,000

The Centers for Medicare and Medicaid Services (CMS) has issued guidance for the implementation of the PAID Act.  The agency also announced criteria for an additional option for the termination of Ongoing Responsibility for Medicals (ORM) in the Section 111 reporting process. PAID Act Implementation On June 8, 2021, CMS … Continue reading CMS: PAID Act Implementation Guidance & New ORM Termination Option

Trying to bring more of your legacy claims to settlement?  This could be the most valuable webinar you’ll ever attend! Do you have aging claims that continue to draw down on indemnity and medical reserves?  Perhaps there is no ongoing medical, but the injured worker was unwilling to settle. Or maybe … Continue reading PREMIER WEBINAR: Learn How to Take MSA Legacy Claims to Settlement

On Wednesday, June 23 at 1 p.m. ET the Centers for Medicare and Medicaid Services (CMS) will be hosting a webinar on the implementation of the Provide Accurate Information Directly (PAID) Act.  Per the notice: CMS will be hosting a webinar to discuss upcoming impacts to Section 111 Non-Group Health … Continue reading CMS to Host PAID Act Webinar

Tower believes strongly that the true business value of a Medicare Set Aside (MSA) is in its ability to facilitate the settlement of a workers’ compensation claim.  Dan Anders shared insight on this topic in this week’s WorkCompWire’s Leaders Speak column, Getting Real Value out of Your MSA. Some WC … Continue reading Dan Anders in WorkCompWire: Getting Real Value Out of Your Medicare Set Aside

According to the American Nurses Association (ANA), May is Nurses Month, dedicated to honor, thank, and support nurses and all those in the nursing profession. They’ve designated the 2021 theme as “Nurses Make a Difference.” Plus, ANA joins the World Health Organization (WHO) and global colleagues in extending the Year … Continue reading Paying Tribute to Dedicated Professionals During Nurses’ Month

With a name like “Mandatory Insurer Reporting” and potential reporting penalties of up to $1,000 per day per injured worker, one would think payers would take Section 111 reporting penalties pretty seriously. But since these penalties have never been enforced, avoidance of penalties has not been a top concern. It … Continue reading Dan Anders in WorkCompWire: Avoiding Section 111 Reporting Penalties

An updated CMS policy change to the Workers’ Compensation MSA Reference Guide changes the Medicare Set-Aside seed calculation On April 19, 2021, the Centers for Medicare and Medicaid Services (CMS) released an updated Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide, Version 3.3, which made a slight but notable addition to … Continue reading Updated CMS Policy Changes Medicare Set-Aside Seed Calculation

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 … Continue reading Tower MSA Partners Completes SOC 2 Type II Audit

Recently, the Section 111 Model Language form was updated by the Centers for Medicare and Medicaid Services (CMS), The form is used by Responsible Reporting Entities (RREs) to collect the Medicare Beneficiary Identifier (MBI) and/or a Social Security Number (SSN) from claimants.  The SSN or MBI, along with the claimant’s … Continue reading CMS Updates Section 111 Model Language Form

Leaders from the Centers for Medicaid and Medicare Services (CMS) Division of MSP Program Operations, Commercial Repayment Center (CRC), and Benefits Coordination and Recovery Center (BCRC) held an April 1 webinar on the intersection of the BCRC and CRC in Section 111 Mandatory Insurer Reporting and the resolution of Medicare … Continue reading CMS Section 111 Mandatory Insurer Reporting Webinar Recap

Last year the Centers for Medicare and Medicaid Services (CMS) proposed regulations on Section 111 civil money penalties (CMPs). See Tower MSA Partners’ detailed prior post, CMS issues Proposed Rule for Mandatory Insurer Reporting Penalties related to inaccurate or untimely Section 111 Medicare Mandatory Insurer Reporting. Some of these are … Continue reading Tower MSA Partners Ready to Steer Clients Through Pending Section 111 Civil Money Penalties

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

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

When it comes to Medicare conditional payments, we get questions!  We’re commonly asked about CMS Medicare conditional payment policies, practices of CMS recovery contractors, the extent of Treasury Department debt recovery and more. It’s important to get the right answers because resolving Medicare conditional payments should be standard practice when … Continue reading Questions About Medicare Conditional Payments? Join Our Upcoming Free Webinar

The Centers for Medicare and Medicaid Services (CMS) recently announced it will be hosting a town hall on April 1, 2021 at 1 pm ET to discuss common Non-Group Health Plan topics.  Specifically, representatives from CMS, the Benefits Coordination and Recovery Center (BCRC) and the Commercial Repayment Center (CRC) will … Continue reading CMS to Host Reporting and Medicare Conditional Payment Recovery Town Hall

Resolving Medicare conditional payments should be standard practice when settling a workers’ compensation or liability claim involving an injured worker who is a Medicare beneficiary.  However, there are still many questions around CMS Medicare conditional payment policies, practices of CMS recovery contractors and the extent of Treasury Department debt recovery. … Continue reading Medicare Conditional Payment Tune-up

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 … Continue reading Tower MSA Partners Supports Insurance Careers Month!

Tower has invested in significant cybersecurity initiatives to “Build a Better Tower” for our clients.  I provided a brief overview of those initiatives in a recent article and this week I highlight Tower’s investment in protecting Tower and our clients’ data. Tower’s Cybersecurity Defenses Long before COVID-19 came along, bringing … Continue reading Building a Better Tower – Cybersecurity

To master an understatement, 2020 was an unprecedented year of uncertainty and challenge for Tower MSA Partners. When travel came to a halt and face-to-face meetings, conferences, and other business activities transitioned to a virtual environment, a new “normal” arrived. Tower MSA Partners, like many other companies, acclimated to these … Continue reading Building a Better Tower

Tower’s Chief Compliance Officer, Dan Anders, has been elected president of the National Medicare Secondary Payer Network (MSPN).  MSPN is the premier organization for individuals, companies and law firms who want to stay apprised of Medicare Secondary Payer compliance developments and collaborate on industry leading education and advocacy efforts.  Check … Continue reading MSPN Elects Dan Anders as President

The Centers for Medicare and Medicaid Services (CMS) has begun the new year with some updates to its MMSEA Section 111 NGHP User Guide.  This guide provides everything and anything you ever wanted to know about mandatory insurer reporting by non-group health plans.  Version 6.2 provides the following updates: $750 Reporting Threshold In follow-up … Continue reading CMS Releases Technical Updates to Section 111 User Guide

We take a look at what’s in the crystal ball for Medicare Secondary Payer (MSP) short-term issues in the year ahead. This year marks the 20th anniversary of the famous —or infamous, depending on your perspective— “Patel Memo” that formally launched CMS’s Workers’ Compensation Medicare Set-Aside review process.  It was probably … Continue reading Three Medicare Secondary Payer (MSP) Predictions for 2021

The recently enacted PAID Act fixes long-term annoyances for MSA companies in securing accurate information about beneficiaries’ Medicare Advantage prescriptions drugs plans. Right now, the Centers for Medicare and Medicaid Services (CMS) can tell payers which workers’ compensation claimants are Medicare beneficiaries. However, the agency has historically said that privacy … Continue reading WorkCompCentral Explains the PAID Act

Medicare Set Aside (MSA) companies and insurers will soon get help accessing accurate information necessary for Medicare reimbursements and settling workers compensation and liability claims. Business Insurance’s Louise Esola wrote a nice article on a new law – the PAID Act – that clarifies expenses that workers’ comp insurers  may … Continue reading Business Insurance: New law clears air on Medicare reimbursements for comp insurers

This year has brought deeper meaning to traditional holiday wishes.  We are thinking about our health, families, and partners in different ways and re-thinking priorities.  But as we adapt to new realities, our commitment to you–our partners–is unwavering.  Thank you for your loyalty during this challenging year. We sincerely hope … Continue reading Tower MSA Partners Wishes You a Warm & Restful Holiday Season

The recently enacted PAID Act ensures that insurance carriers have access to Medicare Advantage plan enrollment information On December 11, 2020, President Trump signed into law HR 8900, Further Continuing Appropriations Act, 2021, which included the provisions of the Provide Accurate Information Directly Act or PAID Act (It is named Transparency … Continue reading PAID Act Becomes Law

Recently, the lowest average wholesale price of Celebrex 200mg and the price of multiple strengths of Abilify dropped dramatically resulting in major MSA reductions.  A widely used, non-steroidal anti-inflammatory drug, Celebrex (Celecoxib), is FDA-approved for several conditions: Ankylosing spondylitis Juvenile rheumatoid arthritis Acute migraines Osteoarthritis Acute pain Primary dysmenorrhea Rheumatoid arthritis Per … Continue reading Celebrex and Abilify Price Drops Trigger MSA Reductions

In an 11/25/2020 Alert, the Centers for Medicare and Medicaid Services (CMS) announced that the 2021 conditional payment recovery threshold for liability, no-fault and workers’ compensation settlements will remain at $750. Accordingly, Total Payment Obligations to the Claimant, TPOCs, in the amount of $750 or less are not required to be … Continue reading Medicare Conditional Payment Recovery Threshold for 2021

Here’s a recap of recently announced CMS news: CMS News #1: Medicare Conditional Payment Appeals Guide In follow-up to its September 2020 webinar on Medicare conditional payment appeals through the Commercial Repayment Center (CRC), CMS converted the slides into an appeals guide.  The guide, which can be found here, provides … Continue reading November CMS News: Mandatory Reporting and Conditional Payment Updates

Tower’s cybersecurity partners, Avertium and Vigilant, have advised us of a major ransomware attack, primarily targeting the healthcare sector.  The threat actor, known as “Ryuk,” uses phishing e-mails to gain access and then control of the victim’s computer and ultimately the company’s network.  Once in control, files are encrypted and … Continue reading New Ransomware Attack Threatens Healthcare Sector

Seeking the formula for success in settling work comp cases with Medicare Set Asides (MSAs)? We’ve got you covered.  A Chinese proverb says, “The temptation to quit will be greatest just before you are about to succeed.”  For workers’ compensation practitioners case closure represents success.  However, the impediments presented by … Continue reading WEBINAR – Grasp Success in Settling Work Comp Cases

Has a Medicare Set Aside ever disrupted one of your settlements?  Any one of these things — unexpected medical, surgical or pharmacy costs, compliance issues, the way MSA administration will be handled, or the presence or absence of a structured settlement–can halt negotiations.  Tower addresses cost drivers and deals with … Continue reading Need a Medicare Set Aside Second Opinion?

Earlier this month CMS released an updated MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting User Guide (Version 6.0).  Here are the key updates with analysis and practical implications. Additional Definition of Total Payment Obligation to Claimant (TPOC) Section 6.4 of Volume 3 (Policy Guidance) of the user guide defines … Continue reading CMS Rolls Out Updates to NGHP User Guide

In a recent update to its WCMSA Reference Guide, the Centers for Medicare and Medicaid Services released a state-by-state list of the major medical centers it uses for pricing future medical expenses in proposed MSAs.  This zip code-based list (See Appendix 7 of the guide) will help MSA preparers and … Continue reading CMS Adds New Pricing Resource to WCMSA Reference Guide

We passionately focus on metrics – it’s our driving force in making Tower Measurably Better. In today’s digital environment, if you are an employer, carrier or TPA, you are likely inundated with data.  You get claims data, medical and pharmacy data, predictive analytics, benchmark performance data, claim reports, drug interaction, … Continue reading What Gets Measured Gets Managed…. What’s Your Number?

CMS webinar on CRC Appeals to focus on the procedures and best practices for redeterminations. This Thursday, September 24 at 1 p.m. ET the Centers for Medicare and Medicaid Services (CMS) will be hosting a Commercial Repayment Center NGHP Applicable Plan appeals webinar.  According to the notice: CMS will be … Continue reading CMS to Host Webinar on CRC Appeals

The National Alliance of Medicare Set-Aside Professionals (NAMSAP) is the leading educational organization on Medicare Secondary Payer compliance. Its annual conference, which is sponsored by Tower, brings together the best minds in the industry, including representatives from CMS and its contractors, for presentations and discussions on the latest in Medicare … Continue reading Learn from the MSP Experts at the NAMSAP Virtual Conference

Tower MSA Partners has created an intuitive, easy-to-use Section 111 dashboard to help you avoid CMS’s penalties for non-compliance with Section 111 reporting. Once in effect, the penalties can amount to up to $1,000 per day per claimant for things like failing to accurately ORM and TPOC. Our new Section … Continue reading New Section 111 Dashboard Can Help You Avoid Penalties

Payers do not need to report indemnity only settlements (no release of medicals) through Section 111 Mandatory Reporting because they are not considered a Total Payment Obligation to Client (TPOC). This reporting question that had long plagued/confused workers’ compensation payers.was recently clarified by CMS during the Q & A portion … Continue reading CMS: Indemnity Only Settlements are Not Reportable

Tower MSA Partners has completed its SOC 2 Type I audit. Performed by KirkpatrickPrice, this attestation provides evidence of Tower’s strong commitment to security and delivering high-quality services to its clients by demonstrating that it has the necessary internal controls and processes in place. A SOC 2 Type I audit … Continue reading Tower MSA Partners Receives SOC 2 Type I Attestation

Jesse Shade, Tower’s Vice President of Information Technology, will be a panelist on the “Cybersecurity Threats: What You Can’t See Can Hurt You” webinar. Presented by WorkersCompensation.com as part of its The Hot Seat series, the free webinar starts at noon EDT on August 6. Shade, who is a member … Continue reading Towers’ VP of IT Jesse Shade on The Hot Seat

WorkCompCentral.com covered Tower’s recent webinar “Avoiding the Medicare Mandatory Reporting Penalty” with Chief Compliance Officer Dan Anders and VP of Information Technology Jesse Shade.  CMS has yet to respond to comments or finalize the regulation proposed in February, but its proposal contained alarmingly high penalties for relatively minor infractions, like … Continue reading Prepping for Penalties

Nancy Grover of workerscompensation.com wrote an in-depth article on Tower MSA Partner’s “Avoiding Medicare Mandatory Reporting Penalties” webinar.  CMS is considering comments received to its proposed regulation that included penalties as high as $1,000 per day per claim. Final regs could publish any time.  “There probably won’t be a lot … Continue reading Avoid Anticipated Medicare Mandatory Reporting Penalties

New CMS User Guides released. The Centers for Medicare and Medicaid Services (CMS) recently released updated user guides for Non-Group Health Plan MMSEA Section 111 Mandatory Insurer Reporting and the Medicare Secondary Payer Recovery Portal (MSPRP).  CMS also just announced an August webinar on Section 111 reporting matters. CMS User … Continue reading CMS Releases Updated Section 111 and MSPRP User Guides – Schedules Reporting Webinar

Is it time for an MSA do-over for open claims? Given the amended review process, we think it is. Michael Stack’s recent article – Case Study: $101,312 Savings Through MSA Amended Review Process – in www.reduceyourworkerscomp.com points out that not every claim with a CMS-approved MSA settles on the first … Continue reading Time for an MSA Do-over?

Regulations for Medicare Mandatory Reporting Penalty are in the process of being formalized! Under the threat of up to a $1,000 per-day, per-claim penalty, most insurers and self-insurers have implemented processes to ensure Medicare beneficiary claimants are reported to Medicare per Section 111 of the Medicare, Medicaid, and SCHIP Extension … Continue reading PREMIER WEBINAR: Avoiding the Medicare Mandatory Reporting Penalty

Tower’s Vice President of Technology Jesse Shade has joined Forbes Technology Council, a prestigious invitation-only forum of senior CIOs, CTOs, and technology execs.  Members collaborate to help solve daily business challenges—like cybersecurity threats—and share insights in Forbes.com articles. Read the related release: Tower MSA Partners’ Vice President of IT, Jesse … Continue reading Forbes Technology Council Welcomes Tower’s Jesse Shade

CMS has recently issued two notices, one pertaining to mandatory Section 111 reporting and one relevant to Medicare conditional payment recovery. First, in a “teaser” notice, CMS announced that on July 13, 2020 the Medicare Secondary Payer Recovery Portal (MSPRP) is scheduled to be enhanced to allow authorized users to … Continue reading CMS Provides Notices on Section 111 Reporting and Conditional Payment Processes

Business Insurance’s Louise Esola wrote an interesting More legacy comp claim closures anticipated with pandemic on an unexpected side effect of the coronavirus.  Injured workers who previously rejected settlement offers are rethinking their decisions.  When researching the story, Esola contacted our Chief Compliance Officer, Dan Anders, who noted that insurers … Continue reading Dan Anders Weighs in on Legacy Comp Claim Closures

“The older the claim, the higher the costs—especially for prescription drugs,” wrote WorkersCompensation.com’s Nancy Grover, in this excellent recap of A Prescription for Settling Legacy Claims webinar.  The May 19 webinar was presented by Dan Anders, Tower MSA Partners’ Chief Compliance Officer, and Phil Walls, Chief Clinical and Compliance Officer … Continue reading WorkersCompensation.com’s Coverage of the Pharmacy/Legacy Claims Webinar

Tower MSA Partners’ SVP of IT Jesse Shade offers advice to workers’ compensation companies on best practices for cybersecurity. Did you know that personal health information (PHI) is more valuable on the black market than financial data?  This makes workers’ comp organizations very attractive targets for cyber criminals. “Payers and … Continue reading Best Practices for Cybersecurity

A federal magistrate judge got a full education in Section 111 Mandatory Insurer Reporting when a plaintiff refused to provide his Social Security Number (SSN) in a liability settlement with the State of Rhode Island. The April 27, 2020 Rhode Island U.S. District Court decision came in the case of … Continue reading Federal Court Rules on Plaintiff Refusal to Provide SSN

When Tower held its cybersecurity webinar in February, presenters stressed that cyberattacks increase dramatically during a crisis. This certainly holds true for COVID-19. Attacks soared by 330% in its early weeks, according to an Atlas VPN report. Workers’ compensation payers, third-party administrators, ancillary care providers, and MSP compliance companies pose … Continue reading Tower’s Jesse Shade Warns of Cyberattacks During COVID-19 and Tells How to Mitigate Them

On April 20, 2020, Tower MSA Partners responded to CMS’s request for comments on its proposed regulation for Section 111 Mandatory Insurer Reporting civil money penalties (CMPs).  Please see Tower’s Feb. 18 post on CMS’s proposal. Tower’s comments mirrored those submitted by the National Alliance of Medicare Set-Aside Professionals (NAMSAP) … Continue reading CMP Comments Submitted

As claims age, the percentage of spend for prescription drugs increases.  Further, as claims age, the likelihood that the injured worker becomes a Medicare beneficiary as a result of age or disability increases. The result, high prescription drug costs allocated in the Medicare Set-Aside (MSA) become a barrier to settlement … Continue reading Tower Premier Webinar: A Prescription for Settling Legacy Claims

While the COVID-19 pandemic represents a new challenge, as a company that has faced its share of hurricanes, we made a seamless transition to working remotely while continuing to serve our partner clients. As our CEO, Rita Wilson recently related, “We Are Here to Help“. While we apologize for the … Continue reading Tower is Here for You

The Penalties Are Coming With COVID-19, it’s understandable if Civil Monetary Penalties (CMPs) have slipped your mind.  CMS has proposed stiff penalties—up to $1,000 per day per claimant—for incorrect MSP reporting or failure to report. (Our Chief Compliance Officer Dan Anders posted on these in February.) For a well-written synopsis … Continue reading The Penalties are Coming

I hope you, your family and coworkers are safe and, like all of us, learning to adjust to a new personal and work environment in this worldwide effort to control the spread of coronavirus.  We realize that Medicare Secondary Payer compliance is not the most important matter in life right … Continue reading Tower is Here to Help

As of April 1, 2020, submissions of Workers’ Compensation Medicare Set-Asides (WCMSAs) must include CMS’s revised Consent to Release form.  The form indicates that the need and process for the WCMSA have been explained to the injured worker, and that the injured worker has approved the contents of the submission, … Continue reading CMS’s Revised Consent to Release Form Becomes Mandatory April 1

Our Chief Compliance Officer Dan Anders’ blog post on the huge price drop of Meloxicam prompted a WorkCompCentral article, quoting Dan.  Previously priced at $4.25 per pill for 15 milligrams, it’s now 5 cents per pill.  Over a 20-year life expectancy of an injured worker taking 15 milligrams a day, … Continue reading Meloxicam’s Price Drop – Good News for MSAs

The price of the non-steroidal anti-inflammatory (NSAID) Meloxicam took a major nosedive from $2.78 per pill to $0.05 per pill for 7.5 mg and $4.25 to $0.05 for 15 mg.  Meloxicam (Brand name: Mobic) is commonly used to treat osteoarthritic pain and is frequently allocated in WC claims and MSAs.  … Continue reading Significant Drop in Meloxicam Price Yields MSA Reductions

New York Workers’ Compensation Board recently issued a bulletin indicating it will not approve settlements requiring injured workers to indemnify or hold insurers harmless if Medicare demands future reimbursements. Tower’s Chief Compliance Officer Dan Anders said the board may be responding to a growing trend of MSAs and settlements that … Continue reading Tower’s Dan Anders Comments on NY Ban on Hold-Harmless Clauses in Settlement Agreements

Cybersecurity is a hot topic and a major threat to all businesses and organizations – especially those handling personal health data.  Risk & Insurance’s Courtney DuChene covers the threat in detail, including data from Tower MSA Partners’ cybersecurity webinar and a separate webinar featuring Safety National’s Mark Walls.  Read it … Continue reading Cybersecurity Webinar Garners More Coverage

Business Insurance’s Angela Childers examined CMS’s proposed rules for Section 111 Mandatory Insurer Reporting penalties in this Feb. 26 article.  She quoted Tower’s Chief Compliance Officer Dan Anders on the severity of the possible $1,000 per-day-per-claim penalty for not reporting MSP data or not reporting it with sufficient accuracy. You … Continue reading Business Insurance: Insurers could face stiff MSP penalties

Many businesses don’t think a data breach will happen to them; small businesses especially assume they’re too small to attack. However, Tower’s Feb. 19 cybersecurity webinar featured a survey that showed that 11% of very small businesses and 44% of midsized organizations experienced a data breach in the last 12 … Continue reading Cybersecurity Threats & You

On February 18, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a proposed regulation which would specify how and when CMS will calculate and impose what are called civil money penalties (CMPs) when group health plan (GHP) and non-group health plan (NGHP) responsible reporting entities (RREs) fail to … Continue reading CMS Issues Proposed Rule for Mandatory Insurer Reporting Penalties

WCI notified Tower MSA Partners that our proposal on Managing CAT Claims was accepted for the National Trends track at the 2020 conference (August 16-19).  The session will present strategies for managing and settling complicated, high-cost catastrophic claims.  Using case studies, a panel of experts examine key decisions that led … Continue reading Tower to Speak at WCI

The National Alliance of Medicare Set-Aside Professionals (NAMSAP) has announced its 2020 Board of Directors, including our Chief Compliance Officer Dan Anders, who was elected by the board as Vice President. Dan will work closely with NAMSAP President Ciara Koba of Gordon Rees and other board members to continue their … Continue reading Tower’s Dan Anders is New NAMSAP VP

After needling from the medical community, in a sharply written January 21, 2020 decision memo, the Centers for Medicare and Medicaid Services (CMS) got right to the point in announcing Medicare will now cover acupuncture for chronic low back pain.  The coverage rule provides up to 12 visits in 90 … Continue reading Medicare Covers Acupuncture for Chronic Low Back Pain

Understanding and Preventing Cybersecurity Threats February 19, 2 PM ET Minnesota Hospital Breach Impacts Personal and Medical Data of 50,000 Patients A Billion Medical Images Exposed, but Doctors Ignore Warnings Names, Social Security Numbers Exposed in Moss Adams Breach These headlines ran in just the past 30 days.  How secure … Continue reading How Do You Know Your MSP Compliance Data is Secure?

On January 14, 2020 CMS held a Town Hall to discuss common Commercial Repayment Center (CRC) NGHP ORM Recovery topics.  In attendance on the call were various officials from CMS as well as Performant Recovery the CRC contractor.  For the most part, the presentation reiterated well-known Medicare conditional payment processes … Continue reading CMS Introduces Pre-CPNs and Open Debt Reports in Conditional Payment Recovery Process

Obtaining CMS recognition of state statutory limitations on medical care in order to limit the MSA allocation has always proven difficult, but not impossible.  As those who have Georgia WC claims know, since July 1, 2013, the state limits medical care in non-catastrophic comp claims to 400 weeks from the … Continue reading Georgia 400-Week Statutory Limitation on Medical Care Limits MSAs

As we come to the end of 2019, put on your party hats, toot your horns and clink your champagne glasses, as we introduce Tower’s MSP Compliance Countdown.  The MSP Compliance Countdown provides a quick summary of, in our opinion, the top ten Medicare Secondary Payer compliance stories in 2019.  … Continue reading Tower’s Medicare Secondary Payer (MSP) Compliance Countdown

The Tennessee Bureau of Worker’ Compensation recently published the “30-Minute Guide to Medical Treatment after Settlement.”  Tower’s Chief Compliance Officer Dan Anders was a significant contributor to the guide, along with Ametros’ Dorothy Holland and Humana’s Brian Bargender, CRSP.  An educational resource for the state’s injured workers who are deciding … Continue reading New Guide to Medical Treatment After Settlement

The Centers for Medicare and Medicaid Services (CMS) recently announced a town hall “to discuss common Commercial Repayment Center (CRC) NGHP ORM Recovery topics.”  The town hall will be held on Tuesday, January 14, 2020 (There is a typo in CMS’s announcement which lists 2019) at 1:00 PM ET.  The … Continue reading CMS to Hold Town Hall on Medicare Conditional Payment Matters

In a 11/26/2019 Alert, the Centers for Medicare and Medicaid Services (CMS) announced that the 2020 recovery threshold for liability, no-fault and workers’ compensation settlements will remain at $750. Accordingly, Total Payment Obligations to the Claimant, TPOCs, in the amount of $750 or less are not required to be reported to … Continue reading Magic Number Remains $750 for Medicare Conditional Payment Recovery

Almost a year ago the U.S. Office of Management and Budget posted two rulemaking notices from the Centers for Medicare and Medicaid Services (CMS) entitled Civil Money Penalties and Medicare Secondary Payer Reporting Requirements and Miscellaneous Medicare Secondary Payer Clarifications and Updates.  Per our understanding, the purpose of this rulemaking … Continue reading Proposed Rules on LMSAs and Section 111 Penalties Again Delayed

DELRAY BEACH, Fla.–As part of its commitment to continually enhance its technology, improve data security and combat cyber threats, Tower MSA Partners, which provides Medicare Secondary Payer services to the workers’ compensation and liability industries, has entered a partnership agreement with Vigilant Technology Solutions. An Ohio-based cybersecurity firm, Vigilant is … Continue reading Tower MSA Partners Engages Vigilant Technology Solutions to Add Another Layer of Data Security

CMS recently released Version 3.0 of its WCMSA Reference Guide, what we informally call the “MSA bible.”  The reference guide provides most CMS policy and procedures relating to its review of Workers’ Compensation Medicare Set-Asides. The updated guide can be found here. Notable additions or changes to this version are … Continue reading CMS Expands MSA Amended Reviews & Modifies Consents to Release in Updated Reference Guide

Some employers, carriers and other payers think Medicare Set-Asides (MSAs) are all pretty much the same, a commodity.  A company calculates future medical expenses and sends a report with an allocation to the Centers for Medicare and Medicaid Services (CMS), and there’s not much to be done about it.  That … Continue reading Get Measurably Better Results with Tower MSA Partners

In an October 10, 2019 decision from the U.S. Court of Appeals for the Ninth Circuit, the California Insurance Guarantee Association (CIGA) was found not to be a primary plan under the Medicare Secondary Payer (MSP) Act.  The result of this decision, if not reversed on further appeal, is that … Continue reading U.S. Appellate Court Holds Guaranty Fund Not a Primary Plan Under the MSP Act

Tower’s Chief Compliance Officer Dan Anders to present at NWCDC! You may not realize how much your relationship with your Medicare Set-Aside vendor affects MSA allocation amounts and the time it takes to settle and close a claim.  Tower’s Chief Compliance Officer Dan Anders and Anne Alabach, Workers’ Compensation Department … Continue reading NWCDC Panel to Feature Tower’s Dan Anders & Anne Alabach of CPC Logistics

On October 7, 2019, the Centers for Medicare and Medicaid Services (CMS) released an updated Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) User Guide (Version 5.9) which adds the capability for both MSA self and professional administrators to electronically submit annual attestations for CMS-approved MSAs.  Previously, the sole option for an … Continue reading CMS Adds Electronic Submission Option for MSA Attestations

In light of the positive response to our July webinar, “Everything you wanted to know about MSAs, but were afraid to ask,” Tower will tackle Medicare conditional payments and related topics in our next webinar, October 23 at 2 p.m. ET.  Tower’s Chief Compliance Officer, Dan Anders, will discuss a … Continue reading Everything You Wanted to Know About Conditional Payments But Were Afraid To Ask

The famed University of Alabama head coach, Paul “Bear” Bryant said, “when you make a mistake, there are only three things you should ever do about it: admit it, learn from it, and don’t repeat it.”  These wise words are particularly applicable to termination of Ongoing Responsibility for Medicals (ORM) … Continue reading Why “Whoops, I Forgot to Terminate ORM” Can Lead to Big Problems

Tower’s Executive Vice President of Clinical Operations, Patricia Smith, RN, BSN, MSCC, CDMS, CLCP, will be on the “Sources Right at Your Fingertips” panel of the National Alliance for Medicare Professionals (NAMSAP) 2019 Educational Conference. Scheduled for the morning of September 18, the presentation focuses on the resources used to determine … Continue reading PATRICIA SMITH & DAN ANDERS TO SPEAK AT NAMSAP

Here’s another great reason to go to NWCDC this year.  Tower’s Chief Compliance Officer Dan Anders and Anne Alabach, Workers’ Compensation Department Manager for CPC Logistics, will discuss the art of partnering for optimal MSA outcomes.  You may not realize how much your MSA vendor relationship affects MSA allocation amounts … Continue reading Tower’s Dan Anders to Speak at NWCDC

Attending WCI this year? Be sure to watch WCI-TV, which Tower is sponsoring for the 5th year. Representatives from American Airlines, Sedgwick, MedRisk, AMAXX, Safety National, and Tower will share the ways they measure the performance of their programs, including the metrics used and what they do with the results. … Continue reading Tower-Sponsored WCI-TV: “Metrics for Success”

On July 19, 2019, the Food and Drug Administration (FDA) approved multiple applications for the first generics of Lyrica (pregabalin). This follows the expiration of Pfizer’s patent on Lyrica at the end of June. The generic is expected to be available at pharmacies in the coming weeks.   Lyrica remains … Continue reading What Does Generic Lyrica Mean for MSAs?

Through our quarterly webinars and in-person trainings, Tower offers our partners recent and relevant information combined with best practices in Medicare Secondary Payer compliance. However, once a year, a unique opportunity is presented by the National Alliance of Medicare Set-Aside Professionals (NAMSAP) at its educational conference. This annual conference, which … Continue reading NAMSAP Provides Unique Opportunity to Expand Your Medicare Compliance Knowledge

Tower’s Dan Anders and American Airline’s Kris Sallee will present during two panels at the Workers’ Compensation Institute (WCI) Workers’ Compensation Educational Conference (WCI2019) this year. Starting at 9 a.m. on Aug. 14, “Optimizing Settlement Outcomes by Measuring and Managing MSA Costs” stresses the importance of determining and using metrics … Continue reading METRICS, MSAS & SETTLEMENT STRATEGIES AT WCI2019

Why does CMS do what they do when it comes to MSAs? Many a claims professional and injured worker have probably pondered this question. Well, the wait for answers is over. On July 24, 2019 at 2 pm ET, Tower MSA Partners EVP of Clinical Services Patricia Smith and Chief … Continue reading Everything You Wanted To Know About MSAs, But Were Afraid To Ask — Tower Premier Webinar – July 24, 2019 2PM ET

Two years ago, CMS rolled out a policy that enabled submission of a new MSA even if an MSA had previously been approved for the same date of injury. The purpose of this “Amended Review” is to provide parties who have not settled the case an opportunity to update the … Continue reading MSA Amended Reviews Promote Case Closures

WCI comes a little earlier this year (August 11-14), so make plans to attend now. Tower will present in two back-to-back sessions on August 14. Starting at 9 a.m., “Optimizing Settlement Outcomes by Measuring and Managing MSA Costs” stresses the importance of determining which metrics to use and how to … Continue reading Tower MSA Partners will Present 2x at WCI

Just like all of us, CMS makes occasional errors. Believe it or not, the government is not infallible! To protect our clients from unnecessary allocation costs, Tower takes a “lead, not follow” approach to deliver Medicare-compliant MSAs that are not overfunded. This means that we don’t just follow CMS’s rules … Continue reading Lead, Not Follow Approach Yields Compliant & Cost-Effective MSAs

Business Insurance’s Angela Childers turned to Tower’s Dan Anders for insight into how claims become catastrophic. Brand-name medications, opioids and the meds required to treat their side effects, and ineffective initial treatment are among the causes he cites. Payers can prevent cost escalation by having a “settlement mindset” from the … Continue reading Business Insurance Article on CAT Claims Features Dan Anders

Dan Anders shared Tower’s experience on a possible trend to shift drug spend to ancillary services and alternative treatment (like acupuncture) and any effect on MSAs with WorkCompCentral’s Elaine Goodman. While another company said its average MSA amount was up 5.1% in 2018, Tower’s data shows a 13% decline in … Continue reading Tower’s Average MSA Amount Dropped by 13%

The concept of not submitting a Medicare Set-Aside (MSA) for approval from the Centers for Medicare and Medicaid Services has become an increasingly popular topic in workers’ compensation.  This week’s WorkCompWire Leaders Speak features Tower Chief Compliance Officer Dan Anders’ insight on why it’s still OK to submit an MSA. … Continue reading Tower’s Dan Anders says “It’s Still OK to Submit an MSA” in WorkCompWire article

How can you use metrics to evaluate your MSP compliance and MSA programs? And, what metrics apply? Tower CEO Rita Wilson shares key performance indicators, ways payers can use them in the settlement process and apply settlement strategies to on-going claims management in this week’s WorkCompWire Leaders Speak. Here’s a … Continue reading Tower CEO Rita Wilson Talks MSAs and Metrics in WorkCompWire’s Leaders Speak

On April 24, Tower MSA Partners CEO Rita Wilson and Chief Compliance Officer Dan Anders will host a lively hour-long webinar that explains how to measure the performance of an MSA program and identifies the metrics needed. They also discuss ways to strengthen the payer/provider relationship in order to produce … Continue reading Tower MSA Partners Presents a Premier Webinar: Leveraging Metrics and MSA Partner Relationship to Settle Claims

On March 18, 2019 the U.S. Attorney for the District of Maryland announced a $250,000 settlement agreement (See Press Release) with the law firm of Meyers, Rodbell & Rosenbaum, P.A., as a result of allegations the firm failed to reimburse the United States for Medicare payments made to medical providers … Continue reading U.S. Attorney Again Takes on Plaintiff’s Attorney for Failure to Reimburse Medicare

Our Chief Compliance Officer Dan Anders discusses how the Medicare Secondary Payment Recovery Portal’s e-payment option works and its potential benefits and drawbacks in this workerscompensation.com article. Scheduled to go live on April 1, the portal allows full or partial demand payments to be made electronically. “It brings it into … Continue reading Coming Soon: CMS Portal for Full or Partial Demand Payments

In a March 13, 2019 webinar, CMS provided a high-level overview of the electronic payment option to be added to the Medicare Secondary Payer Recovery Portal (MSPRP) effective April 1, 2019. Below are the step-by-step instructions for using this E-Payment service:   Login to the MSPRP and select the Case … Continue reading April 1st Brings Electronic Payment Option to MSPRP

“Medicare for All” is a big news story these days. WorkCompCentral’s William Rabb interviewed our Chief Compliance Officer Dan Anders for this in-depth examination of how universal health care could affect workers’ compensation. (Subscription required.)   Read it Here.

CMS recently announced it will hold a webinar on March 13, 2019 at 1:00 PM ET for the purpose of introducing an electronic payment functionality to the Medicare Secondary Payer Recovery Portal (MSPRP). This functionally will become available on April 1st. For some time, payors have been asking CMS for … Continue reading CMS to Hold Webinar on Electronic Payment Enhancement to MSPRP

Daniel M. Anders, JD, MSCC, the Chief Compliance Officer for Tower MSA Partners, has been elected to the board of directors of the National Alliance of Medicare Set Aside Professionals (NAMSAP) and will serve on its executive committee as treasurer for 2019. An attorney who holds the Medicare Set-Aside Consultant … Continue reading Tower MSA Partners’ Dan Anders Elected Treasurer of NAMSAP

2019 MSP Compliance issues Medicare Secondary Payer policies and processes are always in flux, whether CMS tweaks what is included or excluded in the MSA or introduces a new contractor who brings their own take on MSA reviews or Medicare conditional payment recovery. Below we take a look at changes … Continue reading The Year in MSP Compliance

Michael Stack, CEO of AMAXX and publisher of the Reduce Your Workers Comp blog, has authored another exceptional article, Steps to Optimize Medicare Set Asides Before — and After — Settlement, which, among other topics, provides key indicators of an effective MSA partner and details the importance of clinical intervention … Continue reading Michael Stack: Steps to Optimize Medicare Set Asides Before — and After — Settlement

Tower MSA Partners is launching a free, quarterly webinar series to help payers become more proficient in settling workers’ compensation claims, Medicare Secondary Payer compliance and Medicare Set-Asides. The first webinar on January 23 at 2 p.m. Eastern features a special guest instructor, Kerri Poe, CSCC, on the topic “Simple … Continue reading Tower MSA Partners Launches Quarterly Webinar Series

In the recently released updated WCMSA Reference Guide (See Version 2.9, January 4, 2019), CMS provides both notable and minor changes to its policies and procedures surrounding its review of workers’ compensation MSAs. Significantly, CMS clarifies its reasoning behind expanded inclusion of Lyrica in MSAs and, through a policy statement … Continue reading Updated WCMSA Reference Guide Clarifies Lyrica Policy & Admonishes Parties to Protect Medicare’s Interests

Over the past year, the Centers for Medicare and Medicaid Services (CMS) has been enhancing its web-based Medicare Secondary Recovery Portal (MSPRP) which has improved its usefulness in identifying and resolving Medicare conditional payments. CMS’s latest improvement, effective January 5, 2019, is the addition of a self-reporting function providing for … Continue reading New Year Brings New Enhancements to the MSPRP

Wednesday, January 23, 2018 at 2:00 PM ET One of the simplest ways to lower the cost of settlement is through a structured Medicare Set-Aside. Not only does this reduce the employer or insurer’s cost of funding the MSA, it also provides the injured worker a consistent stream of funds … Continue reading Simple Cost Savings with a Structured MSA Premier Webinar

As 2018 comes to a close, it’s a good time to evaluate the effectiveness of your MSA program and make improvements. But, where to start? Step one is to measure the current program’s performance and Michael Stack’s thoughtful recent post, 12 Questions and Metrics to Assess Work Comp MSA Cost … Continue reading Optimize your MSAs for 2019

This past week the Office of Management and Budget posted two rulemaking notices from the Centers for Medicare and Medicaid Services (CMS), one with implications for the consideration of future medicals in liability settlements and the other regarding criteria for imposing penalties under the Medicare Secondary Payer Act related to … Continue reading CMS Rulemaking Notices Provide Possible Timeline for Criteria on LMSAs and Reporting Penalties

Our numbers speak for themselves. Challenging conventional methodologies, we pursue the best path to settlement with innovative solutions, like MSA Optimization, Simplified Medicare Conditional Payment Resolution, and Legacy Claim Settlement Initiatives. Do you know your numbers? What is the percentage of your CMS-approved MSAs which include prescription medication? How often … Continue reading Connect with Tower at NWCDC 2018

$750 Threshold on Reporting and Conditional Payment Recovery Maintained In a 11/15/2018 Alert, CMS announced that the 2019 recovery threshold for liability, no-fault and workers’ compensation settlements will remain at $750. Accordingly, Total Payment Obligations to the Claimant, TPOCs, in the amount of $750 or less are not required to … Continue reading CMS to Keep $750 Recovery Threshold & Announces Upcoming Webinar on MSPRP Enhancement

Our numbers speak for themselves. Challenging conventional methodologies, we pursue the best path to settlement with innovative solutions, like MSA Optimization, Simplified Medicare Conditional Payment Resolution, and Legacy Claim Settlement Initiatives. Do you know your numbers? What is the percentage of your CMS-approved MSAs which include prescription medication? How often … Continue reading Connect with Tower at NWCDC 2018

Tower’s expertise on MSP compliance and MSAs was reinforced by some good coverage last week.  Ametros sought the insight of our CEO Rita Wilson for its blog post “About the Evolution of Professional Administration,” which can be found here.  And, WorkCompCentral’s Elaine Goodman interviewed Chief Compliance Officer Dan Anders for her … Continue reading Tower Opinions Sought

Lyrica is a brand name only medication which costs $8.91 per pill at 150mg. Over a 20-year life expectancy, this is close to $200K in an MSA allocation. Until recently, CMS largely excluded Lyrica from the MSA on the basis that the diagnosis for which it is being prescribed, typically … Continue reading Apparent Change in CMS Policy Expands Inclusion of Lyrica in MSAs

On 10/1/2018, the Centers for Medicare and Medicaid Services (CMS) released updates to the Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide, the Medicare Secondary Payer Recovery Portal (MSPRP) User Guide and the MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting NGHP User Guide. These updates to the reference guide and … Continue reading Updated CMS Reference and User Guides Reveal Minor Changes

Two of Tower’s MSP subject matter experts, Dan Anders and Rita Wilson, have been asked to speak at the upcoming National Alliance of Medicare Set Aside Professionals (NAMSAP) Annual Educational Conference. Dan will highlight trends in MSA reviews in a lively Q&A panel discussion on the new Workers’ Compensation Review … Continue reading Two Tower Experts to Speak at NAMSAP Conference

“Lawyers are concerned that CMS may seek reimbursement from attorneys, injured parties and even insurers—or simply deny payment for injury-related medical care,” said Dan Anders, Tower’s Chief Compliance Officer. “Navigating through the Fog: Medicare, Future Medicals & Liability Settlements” recaps CMS’s process to date and provides advice to settling parties … Continue reading TOWER PUBLISHES WHITE PAPER THAT EXPLORES LIABILITY MSAS

What is the story on Liability MSAs? Tower’s Dan Anders gives some background and offers ways to prepare liability claims until CMS provides more direction in a new white paper, publicized in this WorkCompCentral.com article. Download the white paper from here.

CMS has signaled its intent to expand its voluntary WCMSA review program to liability. While a liability review policy has yet to be announced, CMS has made clear it expects the burden of post-settlement medicals should not be shifted to the Medicare program. However, the measures settling parties must take … Continue reading Tower Publishes White Paper on Medicare and Future Medical Considerations in Liability Settlements

The trusted source for the latest news in workers’ compensation, WorkCompCentral.com, hosts the leading innovators in Medicare Set-Aside development and administration, Tower MSA Partners and Ametros, in an upcoming webinar on the topic of Optimizing MSAs: Before & After Settlement. This free one-hour webinar will be presented by Tower Chief … Continue reading WorkCompCentral, Tower MSA Partners & Ametros Invite You to a Webinar on Optimizing MSAs: Before & After Settlement

Tower MSA Partners was pleased to once again sponsor WCI-TV at the recently concluded 2018 WCI Educational Conference. Following last year’s theme, which explored opioids in WC claims, this year Tower MSA featured interviews with the preeminent professionals in the Workers’ Compensation Industry on the topic of Knocking Down Barriers to … Continue reading Tower MSA Partners Sponsored WCI-TV Highlights WC Leaders at the 2018 WCI Conference

Tower MSA Partners was pleased to once again sponsor WCI-TV at the recently concluded 2018 WCI Educational Conference. Following last year’s theme, which explored opioids in WC claims, this year Tower MSA featured interviews with the preeminent professionals in the Workers’ Compensation Industry on the topic of Knocking Down Barriers to … Continue reading Tower MSA Partners Sponsored WCI-TV Highlights WC Leaders at the 2018 WCI Conference

Recently, the National Alliance of Medicare Set-Aside Professionals (NAMSAP) released a Special Edition Bulletin providing insight into a meeting between CMS and NAMSAP representatives on the topic of the planned expansion of the Workers’ Compensation MSA review process to liability MSA Reviews.  NAMSAP’s April 2018 meeting was one of several … Continue reading NAMSAP Bulletin Highlights Meeting with CMS on Liability MSA Reviews

CWC & Risk Conference Monarch Beach Resort, Dana Point, CA September 4th-7th, 2018 Tower MSA will be exhibiting at the CWC & Risk Conference September 4th-7th. We will be available to discuss how Tower’s technology-driven MSP compliance can benefit you. In addition, we have solutions to knock down the barriers … Continue reading CWC & Risk Conference

Montana Governor’s Conference August 22-24 2018 Tower MSA is pleased to be a Silver Sponsor and exhibitor at the annual Montana Governor’s Conference August 22nd-24th, 2018. Reach out to Hany at hany.abdelsayed@towermsa.com or 916-878-8062 to learn about Tower’s technology driven MSP compliance.

For the fourth consecutive year, Tower MSA Partners is sponsoring WCI-TV, the televised coverage of WCI 2018. “Our theme this year is ‘Knocking Down Barriers to the Settlement of Claims,’” said Dan Anders, Tower’s Chief Compliance Officer. Unreasonably high pharmacy costs, inappropriate use of opioids and other drugs, vague references to … Continue reading Tower MSA Partners Sponsors WCI-TV

Tower MSA Partners brings you WCI-TV, the televised coverage of the WCI Conference (Aug. 19-22). Be sure to tune into WCI-TV in the conference hall or your hotel or while shuttling back and forth for insights on the topic of Knocking Down Barriers to Settlement of Claims. #WCI2018 Read it … Continue reading TOWER MSA PARTNERS SPONSORS WCI-TV

CMS recently announced it is hosting a webinar on Thursday, August 16, 2018, at 1:00 PM ET to “present the benefits of using the MSPRP.”  The webinar will also include an update on the new MSPRP features which Tower MSA highlighted in a recent article, Enhancements to MSPRP Improve Conditional … Continue reading CMS to Host Webinar on Benefits of Medicare Secondary Payer Recovery Portal (MSPRP)

Since its introduction six years ago, the Medicare Secondary Payer Recovery Portal (MSPRP) has increasingly become more reliable and useful in communicating to and receiving information from the Medicare conditional payment recovery contractors (BCRC and CRC).  Earlier this month, a revised version of the MSPRP User Guide was released (Version … Continue reading Enhancements to MSPRP Improve Conditional Payment Processes

In today’s digital environment, if you are an employer, carrier or TPA, you are likely inundated with data.  You get claims data, medical and pharmacy data, predictive analytics, benchmark performance data, claim reports, drug interaction, duplicate therapy and contraindication notices, even drug triggers like poly-pharmacy notices, opioid utilization reports, and … Continue reading What Gets Measured Gets Managed…. What’s Your Number?

CMS approval is not a legal requirement for an MSA. However, the potential financial repercussions for providing an inadequate MSA are such that many industry stakeholders find it wise to submit proposed MSAs to the agency. Estimating the future medical costs takes enormous skill. For example, the final amount takes … Continue reading Case Study: $951,189 in Savings Through MSA Optimization

Since April 2018 the Centers for Medicare and Medicaid Services (CMS) has been issuing new Medicare identification numbers to some 60 million active Medicare beneficiaries. Pursuant to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, a Medicare Beneficiary Identifier (MBI) is replacing the Social Security Number (SSN) based … Continue reading New Medicare Numbers to Have Limited Impact on MSP Compliance Processes

A Philadelphia personal injury firm and its principal recently entered into a settlement agreement with the U.S. Attorney for the Eastern District of Pennsylvania to pay a lump sum of $28,000 for repayment of Medicare conditional payments. The June 18, 2018 press release from the U.S. Attorney’s Office explains that … Continue reading U.S. Attorney Recovers Against Plaintiff Attorney for Failure to Reimburse Medicare

Tower created an extremely sophisticated technology to drive best practices for MSP compliance and seamlessly link everything from Section 111 reporting through conditional payments, interventions, and MSA preparation and closure. The technology is complex on our end to make things easier for our customers, and it takes an expert to … Continue reading Tower MSA Partners Names Jesse Shade Director of Information Technology.

Tower MSA Partners Chief Compliance Officer Dan Anders weighs in on a proposed Senate bill that would – among other things – formalize the appeals process in WorkCompCentral article (subscription required) Read it Here  

Tower CEO and NAMSAP President Rita Wilson and other NAMSAP officers warned employers about MSAs allocating for opioids when speaking at the National Council of Self-Insurers (NCSI) last week. Tower MSA Partners’ Rita Wilson and Other NAMSAP Directors Discussed Opioids and MSAs at the National Council of Self-Insurers Conference

On 5/18/2018, the Provide Accurate Information Directly Act (or the proposed PAID Act) was introduced in Congress for the purpose of allowing settling parties an easy method to identify if a claimant is enrolled in a Part C or D plan or Medicaid.  The bill, H.R. 5881, sponsored by U.S. … Continue reading Proposed PAID Act Intends to ID Medicare Part C, Part D and Medicaid Enrollees for Insurers

Tower MSA Partners Hany Abdelsayed looks forward to seeing you at the upcoming Montana State Fund’s 18th Annual Medical Conference (May 31st & June 1st). Reach out to Hany at hany.abdelsayed@towermsa.com or 916-878-8062 to learn more about Tower’s Technology Driven MSP Compliance.

Please join us June 10 – 13! We are pleased to be a Silver Sponsor and Exhibitor at the NCSI annual Meeting and Vendor Showcase. Tower’s CEO, Rita Wilson, will be presenting on Tuesday, June 12 @ 9:30am as part of the NAMSAP Panel.

Tower MSA Partners’ Chief Compliance Officer, Dan Anders, is featured this month in the WorkCompWire Leaders Speak series with two articles. In the first article, Don’t Get Taken Advantage of by Medicare Advantage, Dan provides an easy to understand explanation as to why Medicare Advantage plans can seek reimbursement in workers’ … Continue reading Tower MSA Chief Compliance Officer featured in WorkCompWire Leaders Speak Series

Please join us June 10 – 13! We are pleased to be a Silver Sponsor and Exhibitor at the NCSI annual Meeting and Vendor Showcase. Tower’s CEO, Rita Wilson, will be presenting on Tuesday, June 12 @ 9:30am as part of the NAMSAP Panel.

Tower MSA Partners Hany Abdelsayed looks forward to seeing you at the upcoming Montana State Fund’s 18th Annual Medical Conference (May 31st & June 1st). Reach out to Hany at hany.abdelsayed@towermsa.com or 916-878-8062 to learn more about Tower’s Technology Driven MSP Compliance.

Tower MSA Partners Kathleen Losada looks forward to seeing you at the upcoming Louisiana Claims Association 2018 Annual Convention & EXP0 June 6-8, 2018 in New Orleans. Reach out to Kathleen at Kathleen.losada@towermsa.com or 561-609-9313 to learn more about Tower’s Technology Driven MSP Compliance. https://lca37.wildapricot.org/event-2778126

Tower MSA Partners Kathleen Losada looks forward to seeing you at the upcoming 43rd Annual Florida RIMS Educational Conference, June 19-23, 2018 at the RITZ-Carlton in Naples, Florida. Reach out to Kathleen at Kathleen.losada@towermsa.com or 561-609-9313 to learn more about Tower’s Technology Driven MSP Compliance.

Tower MSA Partners is proud to be an Exhibitor and Sponsor at the 27th Claims Management & Leadership Conference, June 10th-13th, 2018 at the beautiful Hyatt Regency Coconut Point, Bonita Springs, FL. Stop by our booth to meet Kathleen Losada, V.P. of Strategic Services and learn about Tower MSA Partners Technology … Continue reading Tower MSA Partners is proud to be an Exhibitor and Sponsor at the 27th Claims Management & Leadership Conference

Tower MSA Partners Kathleen Losada looks forward to seeing you at the upcoming Louisiana Claims Association 2018 Annual Convention & EXP0 June 6-8, 2018 in New Orleans. Reach out to Kathleen at Kathleen.losada@towermsa.com or 561-609-9313 to learn more about Tower’s Technology Driven MSP Compliance. https://lca37.wildapricot.org/event-2778126

Tower MSA Partners Kathleen Losada looks forward to seeing you at the upcoming 43rd Annual Florida RIMS Educational Conference, June 19-23, 2018 at the RITZ-Carlton in Naples, Florida. Reach out to Kathleen at Kathleen.losada@towermsa.com or 561-609-9313 to learn more about Tower’s Technology Driven MSP Compliance.

Tower MSA Partners is proud to be an Exhibitor and Sponsor at the 27th Claims Management & Leadership Conference, June 10th-13th, 2018 at the beautiful Hyatt Regency Coconut Point, Bonita Springs, FL. Stop by our booth to meet Kathleen Losada, V.P. of Strategic Services and learn about Tower MSA Partners Technology … Continue reading Tower MSA Partners is proud to be an Exhibitor and Sponsor at the 27th Claims Management & Leadership Conference

On March 16, 2018, Capitol Bridge took over responsibility from Provider Resources as the Centers for Medicare and Medicaid Services’ (CMS) Workers Compensation Review Contractor (WCRC) (See New CMS MSA Review Contractor: Different Name, Same Policy and Procedures). The WCRC is responsible for reviewing all Workers’ Compensation Medicare Set-Asides (WCMSAs) … Continue reading Transition From Provider Resources to Capitol Bridge: 45 Day Update

Case law supporting Medicare Advantage Plans (MAPs) reimbursement rights against primary plans (WC, Liability, No-Fault) continues to accumulate with a recent decision from the United States District Court for the District of Connecticut in Aetna Life Insurance Company vs. Nellina Guerrera, et al., Civil Action No. 3:17-cv-621 (3/13/2018). Consistent with … Continue reading Medicare Advantage Plan Hits Speed Bump in Effort to Recover Against Medicare Beneficiary and Her Attorneys

While the review contractor is changing, the Workers’ Compensation Medicare Set-Aside (WCMSA) review policies and procedures remain the same. This was the message related to attendees of the Workers Compensation Review Contractor (WCRC) transition webinar held by CMS, yesterday, March 7, 2018. The purpose of the webinar was to introduce … Continue reading New CMS MSA Review Contractor: Different Name, Same Policy and Procedures

For those who have raised children, or are in the process of doing so, one of our biggest challenges is to instill in our children some sort of positive decision-making paradigm in our children.  You can call it religious values, moral absolutes, grounding, or just plain common sense, but as … Continue reading What Do Medicare Part D, Medicare Set-Asides and Parenting Have in Common?

Effective March 19, 2018, Capitol Bridge, LLC will be taking over responsibilities from Provider Resources as CMS’s Workers Compensation Review Contractor (WCRC). CMS has now announced a webinar set for Wednesday, March 7, 2018 at 1:00 PM ET to introduce the new MSA review contractor. See CMS Notice which includes … Continue reading CMS Webinar to Introduce New MSA Review Contractor

On Thursday, January 18, 2018, the Centers for Medicare and Medicaid Services (CMS) held a webinar to introduce the new Commercial Repayment Center (CRC) contractor, Performant Recovery, and Performant’s management team. This transition to a new contractor is important to insurers and employers as the CRC is responsible for the … Continue reading CRC Contractor Change Brings New Team to Medicare Conditional Payment Recovery Efforts

On Thursday, January 18, 2018, at 1:00 PM ET, the Centers for Medicare and Medicaid Services (CMS) will host a webinar for the purpose of introducing the new Commercial Repayment Center (CRC) contractor to Non-Group Health Plans. The CRC is responsible for recovery of Medicare conditional payments from liability insurers … Continue reading CMS to Host Webinar on Transition to New CRC Contractor

Pursuant to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, CMS is required to transition all Medicare beneficiaries from the Social Security Number based Health Insurance Claim Numbers (HICNs) to a new identification number called a Medicare Beneficiary Identifier (MBI). The primary purpose of this initiative is to … Continue reading Updated Section 111 User Guide Provides for Transition to MBIs, ORM Termination Defined

In a recent post on its website, the Centers for Medicare and Medicaid Services (CMS) acknowledged the opioid crisis in this country, but provided little clarity as to how it intends to address this crisis in its review and approval of Workers’ Compensation Medicare Set-Asides (WCMSAs). The 12/14/2017 statement provides … Continue reading CMS Statement on Opioids and WCMSAs Provides Little Clarity as to Future Review Practices

As 2017 winds down, it seems like an appropriate time to feature some of the top content that has been provided by Leaders from the industry for our Leaders Speak section. So, as we close out the year and prep to bring you more great thought leadership in 2017, check … Continue reading Leaders Speak: 2017 Year in Review (Part One)

“I start to think we are making progress and we are getting somewhere and opioid use in comp is down, and then you come across something like this,” said Alex Swedlow, president of the Oakland-based California Workers’ Compensation Institute, which conducted a study that found 70% of federally mandated and … Continue reading Medicare settlements feature lifetime opioid guarantees

It’s the week of our industry’s biggest conference of the year. There will be a lot of great content, but be sure not to miss these 5 sessions: The Norstrom Way: Boosting Injured-Worker Engagement Steal These Ideas! Teddy Award-Winning Employers Showcase Their Successful Strategies The Intersection of Medicine and Disability … Continue reading 5 Sessions Not to Miss at National Workers’ Comp & Disability

If seeing the word opioids one more time doesn’t trigger some sort of reaction, whether sadness, anger, desperation, or possibly hope at what appears to be traction to ‘Turn the Tide’ of addiction, then I can only surmise that you must live under a rock! That certainly isn’t the case … Continue reading Opioids in the MSA… Challenges and Strategies

CMS issued the following brief statement on their website this week: The Centers for Medicare and Medicaid Services (CMS) continues to consider expanding its voluntary Medicare Set-Aside Arrangements (MSA) review process to include liability insurance (including self-insurance) and no-fault insurance MSA amounts. CMS will work closely with the stakeholder community … Continue reading CMS Releases Statement Regarding Stakeholder Input in Liability MSA Review Process

Benjamin Franklin must have been contemplating Medicare Advantage Plan reimbursement when he uttered one of his famous lines: “If you fail to plan, you are planning to fail.” Over the past few years Medicare Advantage plans have increasingly been seeking reimbursement for payments made stemming from workers’ compensation, liability and … Continue reading Don’t Plan to Fail: Best Practices for Addressing Medicare Advantage Plan Reimbursement

The Centers for Medicare and Medicaid Services has chosen Performant Financial Corp. as its Commercial Repayment Center contractor to replace CGI Federal. The announcement of a new CRC contractor comes after CMS said in an August report that the CRC had recovered $106 million in fiscal year 2016 out of … Continue reading Dan Anders, Tower’s Chief Compliance Officer, interviewed by WorkCompCentral to Discuss CMS’s Move To New Partner for NGHP Medicare Recovery

A recent press release from the Performant Financial Corporation announced it has been awarded the Commercial Repayment Center (CRC) contract by the Centers for Medicare and Medicaid Services (CMS). Barring a bid protest, we expect a transition to the new CRC contractor over the next few months (CGI Federal’s contract, … Continue reading New Commercial Repayment Center Contractor on the Horizon; WCRC Contract Protested

The NAMSAP Annual Conference – MSP Policy Palooza 2017  – takes place September 27-29 in Baltimore. Tower MSA Partners’ CEO Rita Wilson and Chief Compliance Officer Daniel Anders, MSCC will participate in two sessions at the National Alliance of Medicare Set Asides Professionals (NAMSAP) Annual Conference this month. New rules, … Continue reading Tower MSA Partners Rita Wilson and Dan Anders to Speak at NAMSAP Annual Conference

Tower MSA Partners will host a free webinar on Medicare Advantage and Part D Plan Recovery Rights on October 4 at 12:00 PM EDT. Tower MSA Partners is pleased to have Brian Bargender, of Humana, as the guest presenter for the Webinar. Humana is the second largest Medicare Advantage Plan … Continue reading Tower MSA to Host Free Webinar on Medicare Advantage, Part D Plan Recovery Recovery Rights

On September 1, 2017, the Centers for Medicare and Medicaid Services (CMS) announced the awarding of the contract for the Workers Compensation Review Contractor (WCRC) to Capitol Bridge, LLC. The $60 million contract is for one-year with the option of renewing for an additional four years. Since 2003, CMS has … Continue reading CMS to Transition to New MSA Review Contractor

As the safety of Tower MSA Partners employees and their families is our utmost concern, Tower MSA’s office in Delray Beach, FL, may be closed on Monday, September 11, 2017, and longer depending upon the impact of Hurricane Irma on South Florida. In anticipation of this closure, we have implemented … Continue reading Statement Regarding Hurricane Irma’s Impact on Tower MSA Partners Services

On 8/30/2017 the Centers for Medicare and Medicaid Services released its annual report on the Commercial Repayment Center’s (CRC) Medicare conditional payment collections for the 2016 fiscal year (10/1/2015 through 9/30/2016). In short, the report documents the CRC identified $243.68 million in conditional payments, collected a net of $106.29 million … Continue reading CMS Releases Annual Report on CRC Conditional Payment Recovery

Earlier this month the Centers for Medicare and Medicaid Services (CMS) released a revised Workers’ Compensation MSA Reference Guide (WCMSA) (find Version 2.6 here) with several notable changes and additions impacting its review of MSAs in workers’ compensation cases. The Tower MSA compliance team has taken some time to review … Continue reading Practical Implications of the Revised CMS WCMSA Reference Guide

Tower MSA Partners Chief Compliance Officer, Dan Anders, spoke with WCI-TV’s Ed Heiland about Tower MSA’s theme this year at WCI 2017 Conference. Tower MSA’s theme this year is a discussion on opioids that delves on intervention strategies, claim techniques, PBM tools, MSA impact, and public policy. Dan’s interview with … Continue reading Tower MSA Partners Chief Comliance Officer, Dan Anders, WCI-TV interview on Tower’s Opioid Discussion at WCI 2017 Conference

Tower MSA Partners is sponsoring WCI-TV, the televised coverage of Workers’ Compensation Institute’s Workers’ Compensation Education Conference, and is dedicating its TV segments to examining opioids. “Tower is pleased to partner with WCI to sponsor WCI-TV for the 3rd consecutive year and participate in the interview process throughout the conference. … Continue reading Tower MSA Partners to Sponsor Workers’ Compensation Institute (WCI) – TV

While the Commercial Repayment Center (CRC) has faced some valid criticism over the course of the past year and half in relation to its recovery efforts on behalf of the Centers for Medicare and Medicaid Services’ (CMS), not all problems start with the CRC. CRC’s recovery efforts are driven by … Continue reading Accuracy in Section 111 Reporting of ORM Vital to Avoiding Unnecessary Repayment Demands from Medicare

While there may be no second chances in life, there is now a second chance for CMS review and approval of an MSA. On July 10, 2017, the Centers for Medicare and Medicaid Services (CMS) quietly rolled out a new policy allowing for a re-review of a previously approved Medicare … Continue reading Second Chance with MSA Approval!: New CMS Policy Allows for Review of a New MSA Post a Prior Approval

It’s no secret quick and successful Medicare Set-Aside submissions to the Centers for Medicare and Medicaid Services (CMS) are driven by medical records which meet CMS requirements for review and approval of the MSA. At Tower MSA Partners we strive to work with our customers to prepare and submit to … Continue reading Not So Secret Tips for Quick and Successful MSA Submissions

Earlier this year, Tower MSA summarized the California Insurance Guarantee Association’s (CIGA) case challenging the Centers for Medicare and Medicaid Service’s (CMS) practice of claiming conditional payment reimbursement on a charge which includes mixed diagnosis codes.  Mixed diagnosis codes result in the charge including both treatment related and unrelated to … Continue reading U.S. District Court Declares CMS Practice of Over-Inclusive Reimbursement Demands to be Unlawful, but Withholds Injunction

In October 2016, CMS made an unannounced policy change which effectively eliminated the ability to obtain a Zero MSA approval from CMS based upon a complete denial of the claim, without a supporting judicial decision. After only a couple weeks, CMS withdrew this policy change and again allowed for approval … Continue reading Denied Claim Zero MSAs: Still Available, but Put Through the Wringer by CMS

Tower MSA understands the frustration when following submission of a Workers’ Compensation Medicare Set-Aside (WCMSA) to the Centers for Medicare and Medicaid Services (CMS) shortly thereafter you receive a request for additional medical records and prescription history which you thought was already provided! Indeed, in most cases you have provided … Continue reading Why is CMS Requesting Medical Records Which Are Not in My File and How Do I Respond?

Learn why MSAs and professional administration offers stability in an otherwise volatile and partisan political environment in this joint article between Ametros Financial and Tower MSA Partners These first few of months of 2017 have been, to put it mildly, volatile in national politics. The incoming Trump Administration and a … Continue reading In a Volatile Political Climate MSAs & Professional Administration Provide Much Needed Assurances

The Centers for Medicare and Medicaid Services (CMS) announced on 3/8/2017 that it “will begin referencing the CDC’s Table 1: Life Table for the total population: United States, 2012, for workers’ compensation medicare set aside (WCMSA) life expectancy calculations on April 1, 2017.” CMS presently uses the 2011 table, thus … Continue reading CMS to Begin Referencing 2012 Life Expectancy Table on April 1

While the Centers for Medicare and Medicaid Services (CMS) has yet to formally issue a policy regarding review of Liability Medicare Set-Asides (LMSAs), since a June 2016 announcement that it was considering expanding the WC MSA review process to liability and no-fault, CMS has nonetheless provided pieces of the puzzle … Continue reading CMS Provides Another Piece of the Puzzle on Future LMSA Policy

Patricia Smith, RN, BSN, MSCC, CDMS, CLCP has joined Tower MSA Partners as executive vice president of Clinical Operations. In this role, Smith reviews and monitors clinical trends related to Medicare coverage criteria within the confines of Medicare Secondary Payer compliance, develops clinical strategies to support company’s pre- and post-Medicare … Continue reading Tower MSA Partners Selects Patricia Smith as EVP, Clinical Operations

Tower MSA Partners CEO, Rita Wilson, who is a board member of the National Alliance of Medicare Set-Aside Professionals (NAMSAP), has been elected Treasurer of the organization. Full details on her election as well as the election of other board members to leadership positions is detailed in the following NAMSAP … Continue reading Tower MSA Partners CEO, Rita Wilson, Elected NAMSAP Treasurer

As part of its Leaders Speak series, WorkCompWire recently published a two-part article by Tower MSA Partners’ Chief Compliance Officer, Dan Anders, describing how clinically driven settlement initiatives on legacy or “old dog” workers’ compensation claims yield significant cost savings and become the foundation for best practices on new workers’ … Continue reading Successful Legacy Claim Settlement Initiatives Featured in WorkCompWire Article

The California Insurance Guarantee Association (CIGA) has prevailed in its lawsuit (Cali. Ins. Guar. Ass’n v. Burwell, No. 2:15-cv-01113-ODW (FFMx), 2017 U.S. Dist. Ct. LEXIS 1681) against the Centers for Medicare and Medicaid Service (CMS) challenging the practice of over-inclusive reimbursement demands by CMS. As a consequence of this ruling … Continue reading Federal Court Holds Against Medicare Practice of Over-Inclusive Reimbursement Demands

Tower MSA Partners CEO, Rita Wilson, was recently interviewed by WorkersCompensation.com following her participation in a January 24, 2017 “State of MSP” webinar presented by the National Alliance of Medicare Set-Aside Professionals (NAMSAP). Workerscompensation.com asked Rita to comment on CMS’s December 21, 2016 announcement regarding its plans to update its … Continue reading WorkersCompensation.com: Tower MSA Partners’ Rita Wilson Predicts CMS Re-Review Changes Will Help Payers

On January 17, 2017, the Centers for Medicare and Medicaid Services (CMS) held a Special Open Door Forum to detail how the Social Security Number Removal Initiative (SSNRI) impacts the Medicare Secondary Payer (MSP) community. CMS’s explanation is summarized below with Tower MSA’s thoughts on the practical implications of this … Continue reading Removal of SSN from Medicare IDs Detailed in CMS Open Door Forum

We are not even a week into 2017, but already have news to share regarding Medicare’s planned expansion of its Workers’ Compensation MSA review process to liability in 2018. In its recently released Request for Proposal for the Workers Compensation Review Contractor (WCRC), the Centers for Medicare and Medicaid Services … Continue reading CMS MSA Review Expansion to Liability Planned for 2018

For those of us who deal with MSAs, it’s all too common to see claims at settlement time that started out as basic and simple, then spiraled downward as a result of bad prescribing habits, increased drug use and opioid addiction.  We hope for a different ending, but can  miracles really … Continue reading Christmas Miracles Can Happen in Workers’ Compensation

Employers, carriers and claimants frustrated by the inability to obtain a revised CMS MSA approval after a substantial change in the claimant’s pre-settlement medical condition may find relief from CMS in 2017. Also in 2017, CMS will be issuing a policy regarding use of utilization reviews in MSA submissions. These … Continue reading CMS Announces Plans for 2017 Expansion of MSA Re-Review Process & New Policy Regarding URs in MSAs

Tower MSA Partners CEO, Rita Wilson, is the subject of a recent Workcompcentral article, Focus on Tech Has Guided MSP Compliance Co. CEOs Career, highlighting how Rita’s career in building better pharmaceutical and worker’s compensation technology systems led her to develop a Medicare Secondary Payer (MSP) technology platform which electronically … Continue reading Workcompcentral Highlights Tower MSA CEO Rita Wilson’s “Edge” in MSP Compliance Technology

In a 12/12/2016 Technical Alert, the Centers for Medicare and Medicaid Services (CMS) confirmed their prior policy announcements concerning the implementation of a $750 threshold for the reporting of Total Payment Obligation to the Claimant (TPOC) through the Section 111 Mandatory Insurer Reporting process. The $750 threshold for TPOC reporting … Continue reading CMS Technical Alert Confirms $750 Threshold for Liability, WC and No-Fault TPOC Reporting