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METRICS, MSAS & SETTLEMENT STRATEGIES AT WCI2019

Posted on July 26, 2019 by Tower MSA Partners

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 to evaluate and improve your MSA program. The session will be moderated by Michael Stack, CEO of AMAXX, and Kris and Dan will also describe how clinical interventions produce MSAs that balance care, cost, and compliance. Then at 10:15, “Allaying the MSA Fear at Time of Settlement” Ametros CEO Marques Torbert and Structured Settlement Consultant Joe Bornstein join the panel to examine reasons employers and injured workers avoid settling claims.

For more information, see Tower MSA Partners’ Dan Anders to Discuss Metrics for MSAs and Claims Settlement Strategies at WCI 2019.

WCI2019 will be held August 11-14, 2019.

Business Insurance Article on CAT Claims Features Dan Anders

Posted on May 8, 2019 by Tower MSA Partners

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 beginning, he advises. Read more here. (registration or subscription will be required.)

Tower’s Average MSA Amount Dropped by 13%

Posted on May 3, 2019 by Tower MSA Partners

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 the average CMS-approved MSA. This is mainly due to reductions in prescription drugs, Anders said. And, although 66% of Tower’s MSAs were approved with no pharmacy allocation, Tower has not seen an increased allocation for non-pharmacy treatment. See more (subscription required) here.

Tower’s Dan Anders says “It’s Still OK to Submit an MSA” in WorkCompWire article

Posted on April 26, 2019 by Tower MSA Partners

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.

 

The article can be found here.

Tower CEO Rita Wilson Talks MSAs and Metrics in WorkCompWire’s Leaders Speak

Posted on April 18, 2019 by Tower MSA Partners

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 brief excerpt:

“When issues are detected, the same clinical interventions (pharmacist-to-physician contact or physician peer review) used in the MSA process can be used to ensure the injured worker receives appropriate treatment and reduce costs to the claim. Payers can mitigate their eventual MSA exposure by managing the claim for settlement, and the PBM can help, but only if they know what will happen downstream.

Some payers tend to isolate MSP compliance, but it’s actually a continuation of claims management and critical to pre-settlement analysis. If payers have a high drug spend throughout the life of the claim, they are accepting a lifetime of spend at settlement. If they implement clinical interventions to reduce pharmacy usage early in the claim, they reduce its overall costs.”

Read the full article:Rita Wilson: Applying Settlement Strategies to Improve Ongoing Claims Management

Related:

What Gets Measured Gets Managed…. What’s Your Number?

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.

For Media Inquires, Contact:

Helen King Patterson
813.690.4787
helen@kingknight.com

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