Posted on October 24, 2012 by Rita Wilson
Fight Against Prescription drugs
Another state takes up the fight against Prescription Drug Abuse….
“Kentucky House Bill 1, sponsored by House Speaker Greg Stumbo, passed in a special legislative session this spring and went into effect July 20. The bill included multiple elements to prevent the abuse and diversion of prescription drugs and to enhance law enforcement’s tools to investigate illegal prescribing practices. Since its implementation, 10 pain management clinics have closed, prescriptions for some of the most-abused controlled substances are dropping, and a record number of investigations are under way into suspicious prescribing practices,
For workers’ compensation carriers and employers, this is a tremendous victory in the fight to prevent prescription drug abuse by injured workers. We believe more states should follow Kentucky’s lead.
Posted on October 24, 2012 by Tower MSA Partners
She taught me a LOT!
My mother taught me TO APPRECIATE A JOB WELL DONE.
³If you¹re going to kill each other, do it outside. I just finished cleaning.²
My mother taught me RELIGION.
³You better pray that will come out of the carpet.²
My mother taught me about TIME TRAVEL.
³If you don¹t straighten up, I¹m going to knock you into the middle of next week!²
My mother taught me LOGIC.
³Because I said so, that¹s why.²
My mother taught me MORE LOGIC.³If you fall out of that swing and break your neck, you¹re not going to the store with me.²
My mother taught me FORESIGHT.
³Make sure you wear clean underwear in case you¹re in an accident.²
My mother taught me IRONY.
³Keep crying, and I¹ll give you something to cry about!²
My mother taught me about the science of OSMOSIS.
³Shut your mouth and eat your supper.²
My mother taught me about CONTORTIONISTS.
³Will you look at that dirt on the back of your neck!²
My mother taught me about STAMINA.
³You¹ll sit there until all that spinach is gone.²
My mother taught me about WEATHER.
³This room of yours looks as if a tornado went through it.²
My mother taught me about HYPOCRISY.³If I told you once, I¹ve told you a million times, don¹t exaggerate!²
My mother taught me the CIRCLE OF LIFE.
³I brought you into this world, and I can take you out..²
My mother taught me about BEHAVIOR MODIFICATION.
³Stop acting like your father!²
My mother taught me about ENVY.
³There are millions of less fortunate children in this world who don¹t have wonderful parents like you do.²
My mother taught me about ANTICIPATION.
³Just wait until we get home.²
My mother taught me about RECEIVING.
³You are going to get it when you get home!²
My mother taught me MEDICAL SCIENCE.
³If you don¹t stop crossing your eyes, they are going to get stuck that way.²
My mother taught me ESP.
³Put your sweater on; don¹t you think I know when you are cold?²
My mother taught me HUMOR.³When that lawn mower cuts off your toes, don¹t come running to me.²
My mother taught me HOW TO BECOME AN ADULT.
³If you don¹t eat your vegetables, you¹ll never grow up.²
My mother taught me GENETICS.
³You¹re just like your father.²
My mother taught me about my ROOTS.
³Shut that door behind you. Do you think you were born in a barn?²
My mother taught me WISDOM.
³When you get to be my age, you¹ll understand.²
My mother taught me about JUSTICE.³One day you¹ll have kids, and I hope they turn out just like you!²
Posted on October 24, 2012 by Tower MSA Partners
Court Urges Change in Florida Workers¹ Compensation Law. An appellate court is urging the Florida Legislature to reconsider a state law that makes injured employees pay employers¹ legal costs if they lose good faith workers¹ compensation appeals.
A three-judge panel of the 1st District Court of Appeal in Tallahassee made that recommendation in upholding such an order. It requires Gina Frederick to pay the Monroe County School District $11,834.
There¹s no dispute Frederick was hurt on the job, but two doctors disagreed on whether she had a permanent total injury. A medical adviser appointed by a compensation claims judge, though, offered the opinion she¹s not totally and permanently injured.
Frederick then withdrew her claim but still was ordered to pay the district¹s costs. The court noted the law on the other hand limits fees for workers¹ lawyers.
Copyright 2012 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Posted on October 18, 2012 by Tower MSA Partners
Tower MSA Partners will be a sponsor of the Annual WCCP Holiday Conference! The event will be held at the Intercontinental Hotel in Tampa, FL on November 30, 2012. Registration begins at 7:30 a.m., with the conference starting at 8:30 a.m. After a full day of education, be sure to join us for our Sponsored Holiday Reception. This year we will be partnering with the Rough Riders for our 1st Annual Teddy Bear Drive. While this is the end of our educational season, it is one of the Rough Riders first events of the year, so let’s make it memorable! Challenge your peers to see who can donate the greatest number of bears while increasing your chance to win the WCCP Holiday Door Prize. Teddy bears must be between 12″ and 16″.
Posted on October 18, 2012 by Tower MSA Partners
Tower MSA Partners will be sponsoring an After Hours CEU at the new Buca di Beppo in the Governor’s Square Mall in Tallahassee this Thursday, October 18, 2012, starting at 5:30 P.M. We will be presenting “Important Deadlines” for a 1hr Law credit and “Tips For Employers On How To Save On WC Cost”. Heavy hor d’oeuvres and drinks provided to make sure no one goes hungry.
Posted on October 10, 2012 by Rita Wilson
The Pennsylvania Commonwealth Court, in a decision published late last month, seized upon Fentanyl (ACTIQ), a highly addictive opioid, 100 times more powerful than morphine, when it ruled specifically that Fentanyl lozenges were not appropriate as treatment for a workers’ compensation low back injury. According to defense counsel, Ronald A. Varga, the decision of the Court “could be significant” as it provides carriers with “a mechanism to cut of this medication and switch to something else”.
The original dispute occurred after Utilization Review findings concluded that the Fentanyl lozenge was not appropriate and necessary treatment for a low back injury because of its highly addictive nature and because its only approved use is listed as end stage cancer pain. The original decision, made by the Workers’ Compensation Board, found that the risk of addictive and potential danger to the patient is a valid and reasonable basis for the determination of the appropriateness and necessity of a treatment regimen. Upon appeal, however, divided Workers’ Compensation Appeals Board (WCAB) overturned the decision, noting that the availability of alternative treatment options “does not, in and of itself, render claimant’s current pain management unreasonable or unnecessary”.
The Commonwealth Court, in its reinstatement of the original ruling, noted the following:
1. The utilization review process is the sole method for determining if a disputed treatment is reasonable and necessary.
2. In making its determination of reasonableness and necessity, it is entirely appropriate for UR reviewer to consider the risk to the patient.
3. The reviewer in this case was within his rights to “consider whether it is reasonable and necessary for a provider to expose his patient to the level of risk presented by a medication”.
4. The weight and credibility of a utilization reviewer’s findings is for the workers’ compensation judge to decide.
As a resource for other employers, it is likely that we’ll see this decision cited as justification to contest the use of this very dangerous opioid. If an employer or insurance company can obtain objective medical opinion that the treatment the patient is receiving is highly addictive and there are alternatives to the use of narcotics, this case will certainly support an effort to challenge the prescription.
For more information on the decision and its implications, see https://ww3.workcompcentral.com/news/story/id/b8df217867f36a5641fbd85e9bcb5dd7s (subscription required).
Posted on July 18, 2012 by Rita Wilson
A native of Atlanta, Georgia, Christy will be responsible for both southeast regional and national accounts for Medicare Set Aside and Medicare Secondary Payer compliance services. Christy has more than 15 years experience in providing cost containment services in the workers’ compensation and disability market.
Christy served the industry in various capacities, beginning her career as a registered nurse and case manager, and transitioning into sales more than 10 years ago. Prior to joining Tower MSA Partners, Christy served the workers’ compensation market in local and regional roles involving both management and sales specific to Medicare Set Aside, Pharmacy Benefit, and Case Management Services.
Christy received her nursing degree from Dekalb College School of Nursing and maintains her license as a registered nurse in the state of Georgia.
Tower is pleased to have someone with Christy’s solid reputation for professionalism, sales and service as part of our organization, and we look forward to participating in her many successes. Christy can be reached via email at firstname.lastname@example.org, or via phone at 678-787-9412.
Posted on May 17, 2012 by Tower MSA Partners
A new online Self-Service Tool to help manage your Medicare recovery case.
The Centers for Medicare & Medicaid Services (CMS) is in the process of implementing a new web-based tool designed to assist in and accelerate the resolution of Liability Insurance, No-Fault Insurance, and Workers’ Compensation Medicare recovery cases. The new tool is called, The Medicare Secondary Payer Recovery Portal (MSPRP).
The MSPRP will give users (attorneys, insurers, beneficiaries, and TPAs) the ability to access and update certain case specific information online. Activities that currently require written communication or telephone calls to the Medicare Secondary Payer Recovery Contractor will soon be able to be done through the portal.
The MSPRP will allow users the ability to electronically perform the following activities:
•Submit Proof of Representation or Consent to Release documentation – Instead of mailing in an authorization, users will be able to upload authorizations through the portal.
•Request conditional payment information – Requesting an updated conditional payment amount or a copy of a current conditional payment letter will be as simple as clicking a few buttons.
•Dispute claims included in a conditional payment letter – Users will be able to view the claims listed on the conditional payment letter and dispute unrelated claims online.
•Submit case settlement information – Users will be able to input settlement information online and upload a copy of the settlement documentation through the portal.
The MSPRP is scheduled to go live in July 2012. Additional details regarding the MSPRP will be shared on this website in the coming months.
Tower MSA Partners will be part of the MSPRP rollout. More details will follow as to how to utilize this new electronic service.
Posted on January 30, 2012 by Tower MSA Partners
Just released from MSPRC (http://www.msprc.info/).
On February 21, 2012, the Centers for Medicare & Medicaid Services (CMS) will implement an option that allows certain Medicare beneficiaries to self-calculate Medicare’s final conditional payment amount prior to settlement. A full explanation, including instructions on how and when to elect this option can be found by clicking on the following link:
The information provided includes eligibility criteria for this process, instructions on how to self-calculate the final conditional payment amount, CMS’ review process, tips, and an illustrative example for completing this new process.
CMS will continue to improve and refine this process. Therefore, we welcome your input and comments at a future teleconference.
Posted on December 19, 2011 by Tower MSA Partners
The Centers for Medicare & Medicaid Services (CMS) will be implementing an option that will allow certain Medicare beneficiaries to obtain Medicare’s final conditional payment amount prior to settlement. This option will be available in February 2012, for certain settlements involving physical trauma based injuries where treatment has been completed.
Under this option, the beneficiary or his representative will calculate the amount of Medicare’s conditional payment amount using information received from the Medicare Secondary Payer Recovery Contractor (MSPRC), the MyMedicare website, or other claims information available to the beneficiary. The MSPRC will review this amount and, if finding the amount accurate, will respond with Medicare’s final conditional payment amount within 60 days. To secure the final conditional payment amount, the beneficiary must settle within 60 days after the date of Medicare’s response.
In order to use this option, ALL of the following criteria must be met:
- The liability insurance (including self-insurance) settlement will be for a physical trauma based injury (the settlement does not relate to ingestion, exposure, or medical implant);
- The total liability settlement, judgment, award, or other payment will be $25,000 or less;
- The Date of Incident occurred at least six months before the beneficiary or his representative submits his proposed conditional payment amount to Medicare;
- The beneficiary demonstrates that treatment has been completed and no further treatment is expected either through a written physician attestation or by certifying in writing that no medical treatment related to the case has occurred for at least 90 days prior to submitting the proposed conditional payment amount to Medicare.
Explicit instructions on how to use this process will be posted on the Medicare Secondary Payer Recovery Contractor’s website at www.msprc.info by January 15, 2012. CMS will leverage existing processes to the greatest extent possible. This is an initial step to provide beneficiaries and their representatives with Medicare’s conditional payment amount prior to settlement. CMS plans to expand this option as it gains experience with this process.
New Fixed Percentage Option For Medicare’s Recovery Claim
Effective November 7, 2011, the Centers for Medicare & Medicaid Services has implemented a new and simple fixed percentage option that is available to certain beneficiaries. This option is available to beneficiaries who receive certain types of liability insurance (including self-insurance) settlements of $5000 or less.
A full explanation, including instructions on how and when to elect this option, is available in the Fixed Percentage Option section of both the Attorney and Beneficiary Toolkits.
Beneficiary Alert: $300 Threshold on Liability Settlements
Medicare has implemented a $300 threshold for certain Liability Insurance cases. If all of Medicare’s criteria are met, the MSPRC will not recover against the beneficiary’s settlement, judgment, award or other payment.
We have posted a detailed explanation in the Attorney and Insurer Toolkits.
Alert: Liability Insurance (Including Self-Insurance) and December 5, 1980 (12/5/1980):
Additional policy details have been provided by the Centers for Medicare & Medicaid Services on liability insurance (including self-insurance) cases involving exposure, ingestion, and implantation. Click the link below to view the update. http://www.msprc.info/forms/Exposure-Ingestion-TDL.pdf.
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