Posted on September 1, 2020 by Tower MSA Partners
Tower MSA Partners has created an intuitive, easy-to-use 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 dashboard provides 24/7 access to your claims data and reporting oversight for all aspects of the reporting process. It will even remind you to update ORM Term Dates when claims settle. You can run all kinds of reports and correct errors on the fly.
Posted on September 1, 2020 by Tower MSA Partners
During the Q & A portion of the recent Section 111 NGHP Webinar, CMS finally clarified a reporting question that had long plagued/confused workers’ compensation payers. Payers do not need to report indemnity only (no release of medicals) settlements through Section 111 Mandatory Reporting because they are not considered a Total Payment Obligation to Client (TPOC).
Since the initiation of Section 111 reporting, Responsible Reporting Entities (RREs) have been uncertain whether indemnity only settlements are reportable and have made their own decisions about reporting these settlements. Part of the confusion arose from the definition of TPOC in Section 6.4 of the Section 111 User Guide which states TPOC:
refers to the dollar amount of a settlement, judgment, award, or other payment in addition to or apart from ORM [Ongoing Responsibility for Medicals]. A TPOC generally reflects a “one-time” or “lump sum” settlement, judgment, award, or other payment intended to resolve or partially resolve a claim. It is the dollar amount of the total payment obligation to, or on behalf of the injured party in connection with the settlement, judgment, award, or other payment.
There is nothing in this definition of TPOC which refers to a release of medicals. If anything, the references to “apart from ORM” and “partially resolve a claim” imply that indemnity only settlements are reportable. It seems if CMS added the words, “released medicals or has the effect of releasing medicals” to the definition, it would clarify any remaining uncertainty as to the types of settlements reportable to CMS.
Other Webinar Topics
While the above was the most notable takeaway from the webinar, CMS also:
- Highlighted the RREs responsibilities when changing reporting or recovery agents.
- Reminded reporting entities of the importance of accurate reporting of diagnosis codes.
- Reiterated the requirements for reporting the code ‘NOINJ’ in liability insurance. This is used when the settlement, judgment, award, or other payment releases medical or has the effect of releasing medicals, but the type of alleged incident typically has no associated medical care.
- Indicated that while an RRE may submit multiple claim input files during the quarter, it is limited to one file submission every 14 days and not until the prior file is completely processed. This type of multiple file reporting would most commonly be done to report TPOC termination that cannot wait until the next quarterly reporting cycle.
- Noted that the reporting thresholds remain at $750 for physical trauma-based injuries. The thresholds do not apply to claims involving implantation, ingestion or exposure.
- Provided threshold errors, such as delete transactions for more than 5% of the total records submitted, and the top reporting errors.
- Another reminder on the correct reporting of Med Pay and Personal Injury Protection (PIP) coverage.
Full details on the above can be found in the CMS slides and presentation notes here.
While most of CMS’s presentation were reminders of reporting rules which have been in place for quite some time, the statement regarding indemnity only settlements will hopefully clarify for RREs that a release of medicals is necessary to trigger TPOC reporting. Additionally, we hope that CMS’s webinar statement results in an update to the definition of TPOC in the Section 111 User Guide.
If you have any questions, please contact Dan Anders, Chief Compliance Officer, at Daniel.email@example.com or 888.331.4941.
Posted on August 21, 2020 by Tower MSA Partners
Tower MSA Partners has completed its SOC 2 Type I audit. Performed by Kirkpatrick Price, 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 audit provides an independent, third-party validation that a service organization’s information security practices meet industry standards stipulated by the AICPA. During the audit, an organization’s non-financial reporting controls as they relate to security, availability, processing integrity, confidentiality, and privacy of a system are tested. The SOC 2 report delivered by KirkpatrickPrice verifies the suitability of the design of Tower’s controls to meet the standards for these criteria.
“Tower’s processes have been technology driven from its beginning with the privacy and security of client data at the forefront of internal policy and procedure development,” said Tower CEO Rita Wilson. “We are pleased to receive this affirmation from an independent analysis.”
“The SOC 2 audit is based on the Trust Services Criteria. Tower MSA Partners has selected the security and confidentiality criteria for the basis of their audit,” said Kirkpatrick Price President Joseph Kirkpatrick. “Tower delivers trust-based services to its clients and by communicating the results of this audit, its clients can be assured of their reliance on this company’s controls.”
Posted on August 5, 2020 by Tower MSA Partners
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 of the Forbes Technology Council, brings more than 35 years of IT experience to the panel. He oversees all aspects of Tower’s technologies, including data security.
Joining Shade in the information-packed session is the George State Board of Workers’ Compensation’s Director of Information Technology Bobby Allen and WorkersCompensation.com’s Media Director Nancy Grover.
Among the topics are:
- Misconceptions about cybersecurity
- Should organizations outsource cybersecurity efforts?
- How can you guard against internet attack?
The webinar will be moderated by WorkersCompensation.com President and CEO Bob Wilson and Judge David Langham. There is no charge for the webinar, and registration information can be found at https://tinyurl.com/y4qst7oq
Posted on August 3, 2020 by Tower MSA Partners
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 recording the wrong diagnostic code.
The webinar highlighted various penalties for inaccurate or late reporting and demonstrated the new dashboard Tower built to help its clients find and fix reporting errors faster and easier. The dashboard identifies claims with errors and the remedy to correct them. It also enables users to produce instant reports, such as a one showing claims with reported medical closure settlements or Total Payment Obligation to Claimants (TPOCs) where Ongoing Responsibility for Medicals (ORM) has not been terminated, a common reporting error.
Posted on July 29, 2020 by Tower MSA Partners
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 of changes [in the final rule],” said Tower’s Chief Compliance Officer Dan Anders, who presented the webinar with Jesse Shade, VP of Information Technology.
Penalties could be imposed on organizations for not reporting a claim closure at all, exceeding error tolerance, or reporting contradictory information at different times. The article quoted Anders’ “contradictory information” example of a Medicare beneficiary with work-related injury on his right shoulder and a diagnoses code indicating the injury was on the right knee.
“CMS would have conflicting information. Even if the error is subsequently corrected, CMS could still impose a penalty of up to $365,000 [for a year],” he said.
To avoid penalties from even minor mistakes, Anders recommended that attendees note the omission of data, confirm the correct use of diagnosis codes, be sure to promptly report termination of ongoing responsibility for medicals or ORM.
“And ensure you have a reporting platform that is identifying potential errors and is working with you … to resolve errors and avoid penalties,” he said.
Tower is well positioned to serve as your reporting agent partner. The company proactively developed its own Section 111 Mandatory Reporting dashboard, which Shade demonstrated on the webinar. He showed the many ways the platform helps users identify possible mistakes, address missing data points, confirm ICD9 and ICD10 codes, and run reports to direct their efforts. Incorporating all the elements CMS examines, the dashboard simplifies and automates the process for users.
The dashboard is ready to roll as soon as CMS publishes the final regs. As usual, Tower is ahead of the game — meeting clients’ needs before they know they have them.
Posted on July 8, 2020 by Tower MSA Partners
Michael Stack’s recent article in www.reduceyourworkerscomp.com points out that not every claim with a CMS-approved MSA settles on the first attempt. The piece describes one of CMS’s rare do-over opportunities, the Amended Review process.
In the past, once an MSA had been approved by CMS, that was it. If the claim didn’t close and subsequent changes in medical treatment reduced the MSA’s allocated costs, that was too bad.
Fortunately, the agency changed its stance in 2017 and now allows the submission of revised MSAs to reflect changes in medical treatment and costs. Naturally, the claims need to meet certain criteria, which the article clearly outlines.
Stack, a highly regarded expert in workers’ compensation cost containment, illustrates his points with one of Tower’s Amended Review case studies, which resulted in savings of over $100,000.
During the economic fallout of COVID-19, some injured workers are re-thinking their earlier decisions to not settle their cases. This is a good time to pull out any unsettled claims with MSAs, consider the Amended Review process and reopen settlement talks.
For more information, please see our Chief Compliance Officer Dan Anders’ earlier posts on Amended Reviews. Contact Dan at Daniel.Anders@TowerMSA.com with any questions; he will be happy to help you determine if this program can help you close any of your claims.
Posted on June 24, 2020 by Tower MSA Partners
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 more here.
We know Jesse will be a major asset to the Council because he delivers such high value to Tower. Possessing an unusual blend of interpersonal skills as well as hands-on technical expertise, he is responsible for strategic planning and serves on Tower’s executive team.
Tower designed and built its own technology based on best practices in MSP compliance and MSA preparation. The seamless system drives all compliance processes from Section 111 Mandatory Insurer Reporting, conditional payment resolution, MSA triage, and clinical interventions all the way through MSA preparation, CMS submission, and claim closure.
To be simple for clients to use, technology has to be quite complex behind the scenes. That’s where Jesse’s 35+ years of IT experience in numerous industries, including banking, defense and aviation, comes into play. He leads development efforts for our proprietary technology and its network infrastructure all within a cybersecurity framework that protects Tower and its clients and business partners. (To learn more about cybersecurity threats, especially during COVID-19, check out Jesse’s two Leaders Speak articles on WorkCompWire.)
We’re proud that Jesse will be participating in Forbes’ exclusive Technology Council and look forward to seeing his articles in Forbes.com.
For information on Forbes business communities, please see https://councils.forbes.com/ .
Posted on June 8, 2020 by Tower MSA Partners
Business Insurance’s Louise Esola wrote an interesting article 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 have long focused on closing claims, especially those with high prescription drug costs. He said they have, “become a little more proactive in looking at older legacy claims to see if this may be an opportunity to take a first or second look at settling those claims.”
At the same time, injured workers find themselves in financial conditions where a settlement would be critical.
Tower’s Legacy Claims Settlement Initiative analyzes a payer’s portfolio of claims to detect those that could settle with or without clinical intervention. When future pharmacy costs inhibit settlement, Tower teams with myMatrixx to review drug regimens and find opportunities to reduce costs while protecting injured worker safety. Our recent webinar describes the program in detail.
After triaging the claim, Tower recommends interventions to optimize the MSA, identifies settlement partners, executes interventions, and helps move the claims to closure.
Posted on June 1, 2020 by Tower MSA Partners
“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 of myMatrixx.
They said that aging claims increase the likelihood that the injured worker may become a Medicare beneficiary. “That means those higher drug costs must be included in a Medicare Set-Aside,” she wrote.
The fast-paced webinar explains how and why prescription drug costs increase during the life of a claim. Brand name drugs, compounds (yes, still), and “prescription cascade” (prescribing new meds to address the side effects of other meds) top the list of cost-drivers.
To gain CMS approval of an MSA, medications that may not be needed or even being used must be allocated in the MSA. What’s more, they are priced at Redbook’s lowest average wholesale price (AWP), eliminating discounts the pharmacy benefit manager (PBM) once provided. Side note: Phil describes issues with AWP in detail during the Q&A at the end of the webinar.
Dan and Phil discussed ways an MSA provider and PBM can partner to identify and address unnecessary costs—without negatively impacting the injured worker’s treatment. “We reach out to the treating physician for last dates of service to see what’s going on,” Dan said. “We also do drug reviews to see if there are alternatives that can be implemented.”
Presenters cited a case where an intervention reduced the total morphine equivalent dosage from a dangerous 480 mg per day to 120 mg per day. The changes produced a savings of about $1 million.
“Our goal is never to keep the injured worker from obtaining the therapy they need, but not to expose them to unnecessary prescribing,” Phil said.
To download the recording of this valuable webinar, please go to: https://register.gotowebinar.com/recording/7163259288372148492
For Media Inquires, Contact:
Helen King Patterson
Search our blog:
Contact Us for a FREE Consultation