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NAMSAP Bulletin Highlights Meeting with CMS on Liability MSA Reviews

Posted on August 16, 2018 by Daniel Anders

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 with stakeholder organizations.

Your writer was one of the NAMSAP representatives who had the privilege of meeting with CMS to hear and discuss how such a Liability MSA Reviews may work.   Mr. Tom Stanley, the Co-Chair of NAMSAP’s Liability Committee provided a summary of the following meeting highlights in the bulletin:

  • CMS stated they have an 18-month timeframe (from April 2018) before it rolls out a LMSA Review program.
  • The program would be voluntary.
  • CMS has indicated that their enforcement mechanism is the denial of services.
  • CMS felt strongly that the injured party must receive something (free and clear) through settlement.
  • CMS would not review an LMSA until Settlement has been reached.
  • CMS feels a LMSA is exclusively the responsibility of the plaintiff.
  • Regarding LMSA’s, CMS made it clear that the defendant(s), and their insurers, are not a target.
  • Medicare pricing of services was discussed.
  • CMS does not feel it can mandate professional administration.
  • CMS would publish a LMSA Reference Guide.
  • Eligibility remains the same as the current WCMSA system – Medicare beneficiaries or injured parties who have a reasonable expectation of Medicare eligibility within 30 months. Per statute, Medicare’s interest must be considered in every claim.
  • A workload threshold of $250,000 is anticipated – “NO SAFE HARBOR”. This level mirrors the $25,000 workload threshold for WCMSA’s.
  • For settlements between $250,000 and $750,000 threshold, CMS approval is available and encouraged by CMS. CMS would apply “a formula” to determine the LMSA amount. Starting with the total settlement amount, CMS would subtract certain expenses and apply the discount factor to total settlement.
  • Above $750,000 level is a full commutation. A traditional MSA would be prepared and, if submitted to CMS, evaluated by CMS for adequacy.

As Mr. Stanley advised, “everything discussed in the meeting was subject to change and related to liability Medicare Set-Asides only.”  I would like to emphasize that point as well.  You should not in anyway take the above points as final, rather they are points of discussion as CMS continues to listen to stakeholders and assess the best method for protecting Medicare’s interests in post-liability settlement injury-related medical.

Importantly, CMS realizes that in protecting those interests an eventual voluntary LMSA review process must continue to provide an incentive for the parties to settle their case.   Consequently, some type of apportionment to ensure the plaintiff receives a portion of the settlement monies is expected in any final review process.

NAMSAP will to continue to dialogue with CMS and also discuss with its membership, both through a webinar and at the annual conference, the points presented by CMS.  Given the launch of a CMS LMSA review process is not expected for some time, Tower MSA Partners will shortly be releasing a white paper on best practices for addressing future medicals in liability settlements.

If you have any questions or would like to discuss the topic of LMSAs further, please contact Dan Anders, Chief Compliance Officer, at 888.331.4941 or Daniel.anders@towermsa.com.

Related:

Liability Settlement Solutions

CWC & Risk Conference

Posted on August 15, 2018 by Tower MSA Partners

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 to settling claims. Please stop by our booth or contact Hany at hany.abdelsayed@towermsa.com & 916-878-8062 to learn more.

Montana Governor’s Conference

Posted on August 15, 2018 by Tower MSA Partners

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.

Tower MSA Partners Sponsors WCI-TV

Posted on August 14, 2018 by Tower MSA Partners

Tower MSAFor 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 possible future surgeries, and jurisdictional challenges pose some of the common obstacles to settling claims.

Read it here

 

Case Study: $951,189 in Savings Through MSA Optimization

Posted on July 19, 2018 by Tower MSA Partners

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 into account only the expenses related to the specific injury. Also, it needs to include things such as durable medical equipment that, while not needed presently, may be necessary in the future. Surgeries and other recommended medical treatments should also be included.

At the same time, the MSA should not include treatments or medications that are either not related to the injury or are not currently being used, or expected to be used by the injured worker. Unfortunately, when treatment recommendations are not clearly stated in the medical records, the concern that CMS may return a ‘counter higher’ response can lead many to overfund MSAs — especially, in the case of medications. – Michael Stack

 

Check out Tower MSA’s case study showing how  MSA optimization can save companies thousands of dollars.

Read it here.

Tower MSA Partners Names Jesse Shade Director of Information Technology.

Posted on June 29, 2018 by Tower MSA Partners

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 manage and constantly improve it. So, we are delighted to announce that Jesse Shade has joined Tower to do just that. For more information, click here Tower MSA Partners Names Jesse Shade Director of Information Technology.

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.

Posted on June 22, 2018 by Tower MSA Partners

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

2018 Annual Meeting and Vendor Showcase

Posted on May 30, 2018 by Tower MSA Partners

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.

For Media Inquires, Contact:

Helen King Patterson
813.690.4787
helen@kingknight.com

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