Tag: Amended Review MSA

Premier Webinar: Amended Review MSA Provides Second Bite at the Apple

CMS now allows any previously approved MSA to have a one-time Amended Review.  This means that CMS will consider a new MSA submission that may be lower or higher than the previously approved MSA. Essentially, it is a second bite at the apple for old MSAs that, for whatever reason–they were too high, or the injured worker was not ready to settle–weren’t utilized for settlement.

Tower is pleased to feature our Chief Compliance Officer, Dan Anders, who on Wednesday, October 4, at 2:00 PM ET, will address the following topics:

  • Criteria for an Amended Review MSA
  • Is an Amended Review MSA required?
  • Documentation to support an Amended Review MSA
  • Examples of Amended Review MSA submissions

Besides Amended Review MSAs, the webinar will also consider how MSA Re-Reviews can reduce MSA amount resulting from CMS counter-highers.

A Q&A session will follow the presentation, and you can provide questions when you register. Please click the link below and register today!

Please note there is no CEU credit offered for this webinar.

Register Here

Amended Review MSA Case Study

May 26, 2022

CHALLENGE:

CMS approved an MSA on 5/7/2015 for $147,483. The parties were unable to settle the workers’ compensation case at the time.  Nearly four years later, the parties were again ready to consider settlement, but the 2015 MSA no longer reflected the injured worker’s current course of medical care.

SOLUTION:

CMS’s Amended Review process provides for submitting a new MSA, but such submission must take place within one to four years after the original CMS MSA approval. Upon receipt of the referral, Tower had left less than two months to meet the 5/7/2019 deadline to submit a new MSA.

A review of recent medical records caused Tower to suspect that a supplemental oxygen delivery system was no longer used and that the injured worker could switch from brand-name Crestor to generic. Tower’s Physician Follow-Up service obtained a signed statement from the treating physician confirming the oxygen system was discontinued and that the injured worker now used the generic.

Based on this physician’s statement, Tower revised the MSA down to $46,171 and submitted shortly before the Amended Review deadline. CMS approved the new MSA amount on 5/13/2019.

RESULTS:  $101,312 in Savings

While CMS’s Amended Review process is a valuable tool to facilitate settlement where a prior MSA approval does not reflect current care, it is Tower’s Physicians Follow-Up solution that obtains the necessary documentation to substantiate the requested changes to the previously approved MSA. Tower’s Physician Follow-Up is provided at no charge when initiated as part of the MSA and CMS submission process.

More Tower Success Stories can be found here!