CMS MSA approval Archives

Tower MSA Partners Saves $175K With Optimized MSA

June 15, 2022

Tower MSA Partners optimized MSA savings for complex workers’ comp settlement

Challenge

Tower was engaged to prepare an MSA for a 54-year-old partial quadriplegic. Several issues made it difficult to prepare an accurate allocation. These included limited current medical records, erratic patient behavior, inconsistent provider treatment coding, and unknown treatment outside the workers’ compensation plan.

The preliminary MSA amount was $424,528.

Solution

Tower’s medical experts reviewed the treatment records and identified several areas where Medicare-covered expenses could be reduced through Tower’s Optimized MSA process.

At Tower’s request, the client obtained current medical records. Tower’s clinical team then reviewed those records along with the billing codes used for each treatment.

The team compared the provider’s treatment methods against Medicare reimbursement requirements. This review showed that some items could be priced more accurately with alternative codes.

For example, Tower determined that catheterization code A4353 had been used incorrectly. By using the correct billing code and applying other cost-saving strategies, Tower significantly reduced the MSA allocation.

To support CMS review, Tower explained why the original billing code was incorrect. Tower also provided the corrected coding for consideration.

Results: $175,867 in Savings

After the optimized MSA was finalized, Tower submitted a total allocation amount of $248,661 to CMS for review and approval.

CMS accepted the proposed MSA amount and issued a Full Approval.

Using Tower’s proprietary processes and technology, the client carrier reduced the Medicare exposure of the settlement. The final result was $175,867 in total savings.

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!

Tower’s Dan Anders Reviews MSP Policies and Predicts 2022 Actions

January 20, 2022

Dan Anders reviews MSP policy updates and Medicare Set-Aside trends in this article

WorkersCompensation.com’s Nancy Grover captured the thoughts of Tower MSA Partners Chief Compliance Officer Dan Anders on a variety of Medicare Secondary Payer and Medicare Set-Aside issues from 2021 and 2022 in a recent article.

WorkersCompensation.com Features Dan Anders on MSP Policy Updates

The article reviews several important MSP and MSA developments. MSAs cost less than many stakeholders think, opioid allocations are down, and the PAID Act makes obtaining Medicare Advantage Plan data easier.

Key Medicare Secondary Payer and MSA Issues Reviewed

The article also notes that the Centers for Medicare & Medicaid Services said MSAs that are not approved by CMS could be viewed as “a potential attempt to shift financial burden” to Medicare.

Read the Full WorkersCompensation.com Article

The article, “MSA Policy Updates, Changes Likely in Store for 2022, Expert Predicts,” can be read here. Remember it’s just a one-time process of subscribing to this free section of Workerscompensation.com.