Tower News

Stay up to date on Tower MSA Partners news and events

Coming Soon: CMS Portal for Full or Partial Demand Payments

Posted on March 20, 2019 by Tower MSA Partners

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 the 21st Century,” he notes.
Read it Here

Medicare for All – WorkCompCentral Story Featuring Dan Anders

Posted on March 11, 2019 by Tower MSA Partners

“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.

Tower MSA Partners’ Dan Anders Elected Treasurer of NAMSAP

Posted on February 27, 2019 by Tower MSA Partners

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 Certified and Certified Medicare Secondary Payer Professional credentials, Anders also co-chairs NAMSAP’s Policy and Legislative Committee.

 

Anders and Tower have been active in the organization for several years; Tower’s CEO Rita Wilson is the immediate past president, and Wilson and Anders frequently speak at its conferences and webinars.

 

“We’re dedicated to continuing our work with NAMSAP,” Wilson said. “It provides timely and comprehensive education and is the leading advocate for Medicare Secondary Payer compliance policies and practices that serve all stakeholders.”

Tower MSA Partners Launches Quarterly Webinar Series

Posted on January 18, 2019 by Tower MSA Partners

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 Cost Savings with a Structured MSA.”

Please see the News Release for full information:  https://www.businesswire.com/news/home/20190115005194/en/Tower-MSA-Partners-Launches-Quarterly-Webinar-Series

New Year Brings New Enhancements to the MSPRP

Posted on January 11, 2019 by Tower MSA Partners

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 reporting a Medicare Secondary Payer case through the portal versus via phone or written correspondence to the BCRC. CMS has also updated its Multi Factor Authentication (MFA) process which ensures only authorized users can view information in the portal.Self-Reporting Functionality Added to MSPRP

The new functionality allows for self-reporting by a Medicare beneficiary or their representative or an insurer or an insurer representative in a liability, no-fault insurance or a workers’ compensation claim to CMS (Known as an MSP lead). Important, MSPRP self-reporting does not replace Section 111 reporting. Accordingly, if Ongoing Responsibility for Medicals (ORM) has been reported through the Section 111 reporting process, then MSPRP self-reporting cannot be used. Similarly, if a Total Payment Obligation to the Claimant (TPOC), typically a settlement, has been reported through the Section 111 process, then MSPRP self-reporting cannot be utilized.

Practically speaking, self-reporting would most often be used for the initiation of a conditional payment search stemming from a liability claim or a denied workers’ compensation claim. Prior to the introduction of self-reporting, reporting these types of claims to the BCRC required a phone call or written correspondence to the BCRC (Self-Reporting will remain available via phone and written correspondence).

The information to be submitted through the portal to self-report a claim is that which has been required to self-report a claim by phone or written correspondence, namely:

  • Beneficiary Information: Full Name, Medicare ID, Gender and Date of Birth and complete Address and Phone Number
  • Case Information: Date of Injury/Accident, date of first exposure, ingestion or, implant, Description of alleged injury or illness or harm, Type of Claim (Liability, No-Fault or Workers’ Compensation Insurance) and the Insurer/Workers’ Compensation entity name and address
  • Representative Information: Attorney or other representative name, Law firm name if representative is an attorney and complete address and phone number
  • Related Diagnosis Code(s): At least one diagnosis code. The system provides for a diagnosis code search function and allows for up to 25 ICD-9 or ICD-10 diagnosis codes to be entered

Upon submitting the report through the portal, if ORM or TPOC has already been reported, then the user will be advised that the self-reporting cannot be completed. If the claim has not been previously reported with ORM or TPOC, then the following will occur:

  • The information will be developed into a beneficiary-debtor case.
  • The Rights and Responsibilities (RAR) letter will be generated and sent.
  • The basic case information will be immediately accessible in MSPRP
  • Claims history will be retrieved and claims filtering will be completed per current functionality.
  • Beneficiary users will be able to immediately upload settlement information from the “Case Information” page.
  • Beneficiary representatives will be able to upload settlement information after first uploading a Proof of Representation document.
  • If settlement information is uploaded prior to claims history being retrieved and the claims filtering process being completed, a Conditional Payment Notice (CPN) will be systematically generated, otherwise a Conditional Payment Letter (CPL) or No Claims Paid (NCP) will be generated.

Multi Factor Authentication Verification Process Updated

MFA is a security process that verifies the user’s identity by requiring multiple credentials rather than solely asking for a username and password. Effective January 5, 2019, CMS is replacing the current MFA process via EIDM/Symantec with one provided by OKTA. The change will require users to utilize the new authentication method to view “unmasked” information in the MSPRP.

Practical Implications

As the self-reporting functionality is limited to cases where ORM or TPOC has not been reported, its use, while a welcome improvement, will not impact much of the work Tower completes on accepted workers’ compensation claims where ORM has been reported. Tower commends CMS for these continuing enhancements to the MSPRP and looks forward to additional functionalities to be added in 2019, including a function to directly pay Medicare through the portal.

CMS’s 12/18/2018 slide presentation, which details the above enhancements, may be found here.

The updated MSPRP User Guide, Version 4.4, which includes these enhancements, may be found here.

Simple Cost Savings with a Structured MSA Premier Webinar

Posted on December 27, 2018 by Tower MSA Partners

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 for injury-related medical care over his or her life expectancy. This hour-long webinar will show how structured MSAs help all the stakeholders involved in a settlement – the injured party, Medicare and the insurance carrier or employer.

On January 23rd Tower is pleased to host Kerri Poe of Atlas Settlement Group for an informative presentation on structured MSAs as part of settlement. This webinar is intended for anyone involved in the management or handling of workers’ compensation or liability claims and for plaintiff and defense attorneys. By attending this free webinar, you can expect to come away with the ability to:

 

  • Understand how structured MSAs work and recognize the benefits they provide to the injured worker/claimant, employer/insurer and Medicare
  • Explain the methodology by which CMS calculates a structured MSA
  • Convert a CMS-approved lump sum MSA to a structured MSA
  • Define the role of a structured settlement broker pre-settlement, during settlement negotiations and post-settlement.

Case Studies will be included, and attendees will have an opportunity to ask questions.

Hope to see you on January 23rd!

Dan Anders

Chief Compliance Officer

 

 

Background on Guest Presenter, Kerri Poe, CSSC:

Kerri Poe is head of Atlas Settlement Group’s Los Angeles office. Her experience spans Workers’ Compensation, Longshore and Harbor Workers’ Compensation Act, liability, and employment litigation nationwide. Kerri brings value to both sides of the negotiation by facilitating settlement and working as an advocate to the settlement process.

As part of the settlement team, Kerri assists with case evaluation, prepares settlement proposals, attends conferences and mediations and reviews legal documents to ensure the tax benefits of the structured settlement are preserved. Her extensive experience with Medicare Set-Asides and the integration of public benefits allow her to provide needs-based financial options for the injured party.

Her specialties include assisting with case evaluation, preparing settlement proposals, and attending settlement conferences and mediations. Kerri also performs file reviews and client trainings and has been a guest speaker at several claims associations, risk management groups, and settlement annuity seminars. In addition to being a member of the National Structured Settlement Trade Association, she is the Chairwoman of its Legislative Committee.

Kerri began her structured settlement career in 1997 as a Case Manager for a national structured settlement firm in Tampa, Florida and Houston, Texas. She also has experience as a Business Analyst and Project Manager for a prominent benefits administration firm and as the Regional Operations Manager for a large fund-raising company.

Optimize your MSAs for 2019

Posted on December 17, 2018 by Tower MSA Partners

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 Drivers, cites the metrics needed. Take some time to get a handle on your program, identify any unmet cost drivers and update your processes so that your MSAs comply with state and federal statutes, are adequately allocated, and that you do not pay any unnecessary costs.

Tower MSA Partners can help you define, measure and manage the metrics that yield the best balance of care, cost and compliance to continuously improve your MSA outcomes. For more on our data-driven philosophy, see Tower CEO Rita Wilson’s article, What Gets Measured Gets Managed . . . What’s Your Number?

For questions, or to learn more about Tower’s MSP compliance solutions, please email us at info@towermsa.com or call us directly at 888.331.4941.

Connect with Tower at NWCDC 2018

Posted on December 4, 2018 by Tower MSA Partners

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 are opioids included in your MSAs?

What percentage of counter-higher MSAs are submitted for a re-review to CMS and how successful are those re-reviews?

What is the success rate for appealing Medicare conditional payment demands?

Without such benchmark analytics, it is difficult to measure the cost-effectiveness of your MSP compliance program and ways to better optimize your program.  Tower constantly defines, measures and manages the metrics that yield the best balance in care, cost, and compliance.

We have a variety of interventions that will optimize your claims outcomes — many at no additional charge. If the numbers above don’t convince you, then perhaps you need another number that will — 5420.

Visit us at Booth 5420 to learn more about what Tower MSA Partners can do for you. 

CMS to Keep $750 Recovery Threshold & Announces Upcoming Webinar on MSPRP Enhancement

Posted on November 29, 2018 by Daniel Anders

$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 be reported to CMS through the Section 111 Mandatory Reporting process, nor will CMS attempt to recover conditional payments for TPOCs of this amount.

By way of background, pursuant to the SMART Act of 2012, CMS is required to annually determine a threshold amount such that the cost of collection does not outstrip the amount recovered through such collection efforts. CMS’s calculations, which can be found here, resulted in the $750 threshold being maintained.

Upcoming Webinar on MSPRP Self-Reporting Enhancement

CMS also recently announced it will hold a webinar on 12/18/2018 at 1 p.m. ET to provide an overview of the self-reporting functionality that will be added to the Medicare Secondary Payer Recovery Portal (MSPRP) as of 1/7/2019. The webinar invite can be found here.

Self-reporting refers to reporting a no-fault, workers’ compensation or liability claim to CMS’s Benefits Coordination and Recovery Center (BCRC) which is typically the first step in identifying whether conditional payments have been made by Medicare in the claim. Presently, reporting can be done via phone, fax, mail or through the Section 111 mandatory insurer reporting process.

The so-called “lead” which results from this reporting is utilized by CMS’s recovery contractors, the BCRC or the Commercial Repayment Center (CRC) to investigate payments made by Medicare for the reported diagnosis and seek recovery for conditional payments made for the diagnosis. It is anticipated the expansion of self-reporting to the MSPRP will assist in expediting the Medicare conditional payment investigation process and perhaps improve the accuracy of charges identified as conditional payments.

Practical Implications

As CMS is keeping the $750 threshold for mandatory reporting and conditional payment recovery there are no changes to the reporting processes or determinations as to when conditional payment should be investigated or resolved.

In regard to the self-reporting enhancement to the MSPRP, as noted above, we believe this may improve the speed and accuracy of the Medicare conditional payment process. We will provide further information following the December 18 webinar.

Connect with Tower at NWCDC 2018

Posted on November 27, 2018 by Daniel Anders

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 are opioids included in your MSAs?

What percentage of counter-higher MSAs are submitted for a re-review to CMS and how successful are those re-reviews?

What is the success rate for appealing Medicare conditional payment demands?

Without such benchmark analytics, it is difficult to measure the cost-effectiveness of your MSP compliance program and ways to better optimize your program.  Tower constantly defines, measures and manages the metrics that yield the best balance in care, cost, and compliance.

We have a variety of interventions that will optimize your claims outcomes — many at no additional charge. If the numbers above don’t convince you, then perhaps you need another number that will — 5420.

Visit us at Booth 5420 to learn more about what Tower MSA Partners can do for you. 

 

For Media Inquires, Contact:

Helen King Patterson
813.690.4787
helen@kingknight.com

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