We create MSAs that you – and CMS – can approve. Our mantra is to not allocate one dollar more than CMS will require. With a thorough understanding of CMS WCMSA guidelines and Medicare coverage criteria, Tower’s team of clinical and legal professionals carefully examines claims and aggressively removes costs and other barriers to closure before producing an MSA.  We continually incorporate CMS’s responses into our data and when CMS is wrong, we challenge them. We stay involved through the submission and approval stages and consult with you every step of the way. We will even assemble a settlement team to steer the claim to closure.  All this is included in the price of the MSA.

When you are evaluating whether to settle a claim, Tower’s Pre-MSA Triage identifies obstacles that may impact an MSA. This trigger-driven review of medical and pharmacy records pinpoints potential exposure and recommends interventions we can implement to reduce costs and optimize the MSA before a full MSA for CMS submission is written. The cost of a Pre-MSA Triage is half that of a full MSA, and if Tower ultimately prepares the full MSA we only charge for the other half.

A Non-Submit Medicare Set-Aside (MSA) may be used when the settlement does not meet CMS review thresholds or when settling parties decide not to participate in the voluntary CMS approval process.  In general, a Non-Submit MSA uses evidence-based medicine, IMEs, PQMEs and other examining physician reports, state statutes and regulations, along with claimant statements and agreements to determine future medical care.  As a result, it may have a lower allocation than a CMS-approved MSA.

Tower is the only MSP compliance company that embeds prescription drug triggers and physician peer review workflow into its MSA technology. When issues are identified, we arrange for a physician to analyze the treatment and prescription drug regimen and compare it against state specific, evidence-based guidelines, and propose changes to the treating physician.  These changes are incorporated into an MSA which meets the parties’ expectations for settlement. While Tower includes its PPR work in the cost of the MSA, there is a separate fee for physician.

When a Physician Peer Review secures a treating physician’s written agreement to change inappropriate pharmacy treatment, the agreement does not automatically produce a new, appropriate drug regimen. The injured worker needs to be stabilized on the new medications before CMS can approve the MSA. That’s where our Pharmaceutical Clinical Oversight comes in.  Clinical Oversight engages registered nurses to confirm that medication changes have occurred and the MSA reflects current/ongoing care.

In drafting the MSA we often find opportunities to reduce the MSA or mitigate potential increases from CMS review. Vague references in medical records to potential future procedures and discontinued medications mean these costs will be included in the MSA. CMS’s exacting review process requires clear confirmation of the last dates of service and ongoing treatment and medications.  At no extra charge to the MSA, Tower contacts physicians, clarifies treatment, drafts physician statements and obtains medical providers’ signatures to document dates of treatment and ongoing and future medical care.  This service paves the way to quick CMS MSA approval and mitigates the potential for unexpected increases.

The purpose of an MSA is to get the parties to settlement.  If you have an MSA that seems unreasonably high or otherwise prevents settlement, Tower will review it free of charge.  Our MSA 2nd Opinion recommends how the MSA can be modified or updated to a cost point that enables CMS MSA approval, if needed, and to optimize it for settlement.

A Liability Medicare Set-Aside (LMSA) allows the settling parties to identify a portion of the liability settlement for Medicare-covered future medical care.  Based on recent medical records and pharmacy history, the clinically prepared report reasonably allocates future medical care.  Depending on the settlement circumstances and amount, consideration can also be given to a proportional reduction of the proposed MSA amount.