Tag: cost containment

$231K in Savings from Free Physician Follow-Up

March 4, 2026

Image of Tower MSA Partners Why Case Studies Matter series, Blog 6 $231K in Savings from Free Physicians Follow-Up.

In Tower MSA Partners’ previous post, Trimming the Fat, $175K in Savings Through MSA Optimization, we explained how MSA optimization removed $175,000 in unnecessary projected costs. In this case, a payer asked Tower to validate the treatment plan for a complex claim through physician follow-up. By engaging the treating provider, confirming current medical needs, and obtaining a physician attestation, Tower reduced the projected Medicare Set Aside (MSA) lifetime cost by $231,487 and secured CMS acceptance without development.

Identifying the Problem

The claimant’s original MSA had been created more than two years earlier. Since that time:

  • Multiple prescriptions were listed without up-to-date clinical context
  • Treatment frequency and diagnoses were not validated
  • The projected costs reflected outdated assumptions

Without direct clinical confirmation, the allocation risked inflating projected future costs and faced potential CMS scrutiny. The payer needed a defensible allocation grounded in current medical reality.

The Physician Follow-Up Solution

Tower’s clinical team initiated physician follow-up, adhering to jurisdictional rules for secure outreach. The process included:

  • Reviewing the full set of updated medical records
  • Confirming active medications, dosages, and indications
  • Discussing current therapy frequency with the treating physician
  • Validating the absence or tapering of unnecessary prescriptions

The physician confirmed that the only active prescription was Oxycodone/APAP 5/325 mg and that certain therapies were no longer needed. Armed with this clinical confirmation and a signed attestation, Tower updated the allocation.

The result was a $231,487 reduction in projected MSA costs — fully documented, fully supported, and defensible.

Collaboration and Communication

Tower MSA Partners didn’t just update numbers in a spreadsheet. Every correction was explained clearly to the claims professional and documented. The physician’s signed attestation — verifying current care and confirming that outdated items were no longer clinically necessary — was included in the CMS submission.

Because the revised MSA included accurate current clinical information and a valid attestation, CMS approved the allocation quickly and without development requests.

Why Physician Follow-Up Makes the Difference

Treatment plans evolve, medications change, and assumptions in an early allocation can become outdated. Without direct validation from the treating physician:

  • Medications may be mischaracterized
  • Frequencies may be overstated
  • Lifetime projections may overestimate future care

Physician follow-up ensures the MSA reflects actual current need, which:

  • Controls costs
  • Enhances compliance
  • Strengthens defensibility in CMS review

This case shows that physician engagement isn’t a luxury — it’s a strategic lever for both accuracy and savings.

Lessons Learned

  1. Physician engagement validates clinical need and clarifies current care.
  2. Signed attestations give CMS confidence in the accuracy of the allocation.
  3. Outdated medications and therapies can be confidently removed when confirmed to be clinically unnecessary.
  4. Defensible projections protect payers from excess costs and speed CMS review.

Results That Reflect Expertise

With targeted physician follow-up and attestation:

  • The payer realized $231,487 in reduced lifetime MSA costs
  • The updated allocation aligned with clinical reality
  • CMS approved the allocation without development requests

Tower MSA Partners delivered transparent documentation, accurate projections, and a cost-conscious, defensible settlement outcome.

FAQs

What is physician follow-up?

Physician follow-up is direct communication by Tower with the treating provider to confirm current medical treatment, active medications, and therapy needs. It ensures MSAs reflect accurate, individualized clinical information.

How does physician follow-up create savings?

By validating care with the treating physician, unnecessary treatments and medications can be removed or corrected in the lifetime projection, reducing projected future costs.

Is physician follow-up accepted by CMS?

Yes. When physician follow-up includes clear clinical documentation and, if required, a signed statement, CMS will accept updated MSAs and often approves them without development requests.

When should physician follow-up be used?

Physician follow-up can be used anytime there is open-ended medical care, outdated treatment recommendations or inconsistent or contradictory medication history.

Trimming the Fat, $175K in Savings Through MSA Optimization

February 3, 2026

Image of Tower MSA Partners Why Case Studies Matter series, Blog 5 Trimming the Fat with MSA Optimization

In Tower MSA Partners’ previous post, we showed how a MSA second opinion review helped a payer avoid ninety-eight thousand dollars in unnecessary allocation. This month, we look at a case study on how targeted MSA optimization can uncover even larger savings. Tower MSA Partners reviewed a complex claim with significant pharmacy exposure and identified an opportunity to reduce projected costs by $175,000. This case shows how structured review protocols and clinical oversight create precise and defensible MSAs.

Identifying the Problem

The claimant had a long-term injury that included frequent therapy, diagnostics, and multiple ongoing prescriptions. The initial MSA prepared by another vendor included duplicate entries, outdated treatments, and medications that had been replaced with safer and more cost-effective alternatives. Therapy frequency was also projected far beyond what the medical records supported. These inaccuracies created an inflated allocation that did not reflect current treatment patterns.

The MSA Optimization Solution

Tower MSA Partners completed a full optimization review and reconciled every projection with the latest medical records. Our clinical team verified treatment frequency, evaluated pharmacy histories, and confirmed whether each medication remained clinically appropriate. Outdated therapy, legacy prescriptions, and inaccurate frequency projections were removed or corrected. Each modification included detailed clinical reasoning and clear documentation. After optimization, the MSA decreased by $175,000 and remained fully aligned with CMS expectations. The updated allocation represented the claimant’s true medical needs without unnecessary inflation.

Collaboration and Communication

As with all Tower reviews, collaboration played a significant role. The clinical team walked the claims professional through each correction and clarified why the original allocation overstated ongoing care. Defense counsel and treating providers were updated as needed to confirm accuracy and alignment with the medical record. The optimized MSA was submitted to CMS with strong supporting documentation and was approved without development requests.

Why Oversight Makes the Difference

MSA optimization is not simply cost-cutting. It is a structured validation process that ensures every projected service is clinically necessary and supported by current documentation. Removing outdated items protects payers and claimants from unnecessary costs and strengthens the defensibility of every file. This case demonstrates how careful review drives savings.

Lessons Learned

  1. MSA optimization identifies inaccurate or outdated projections that inflate lifetime medical costs.
  2. Clinical oversight ensures medications and treatments reflect current best practice.
  3. Documentation clarity leads to predictable CMS approval.
  4. Savings come from precision. The $175,000 reduction resulted from accurate alignment with the medical record.

Results That Reflect Expertise

The optimized MSA saved the payer settlement monies and produced a compliant, defensible allocation supported by current documentation. Tower MSA Partners continues to demonstrate how clinical accuracy, alignment with CMS, and detail-oriented review generate meaningful and measurable results. Optimization is an essential tool in responsible claims management.

FAQs

What is MSA optimization

MSA optimization is a detailed clinical review that removes outdated treatments, corrects inaccurate projections, and ensures the allocation reflects current medical necessity.

How does optimization reduce allocation amounts

Optimization aligns treatment and pharmacy projections with the actual medical record, which eliminates unnecessary costs and outdated services.

When should an MSA be optimized

It is recommended for claims with long-term treatment, complex pharmacy needs, or significant changes in care since the initial projection.

Does CMS accept optimized MSAs

Yes. CMS accepts optimized MSAs when the updated allocation includes clear clinical documentation and accurate reasoning for the projected future medical.

A $98K Mistake Avoided, The Value of Second Opinion MSA Reviews

January 12, 2026

Image of Tower MSA Partners Why Case Studies Matter series, Blog 4 A $98K Mistake Avoided with a Second Opinion MSA Review

In Tower MSA Partners’ previous post, we explained how Physician Peer Review generated more than one million dollars in savings while strengthening CMS compliance. This month, we shift focus to the importance of accuracy. Tower MSA Partners was asked to review a Medicare Set Aside allocation prepared by another company, and the findings revealed a significant error that would have cost the payer ninety eight thousand dollars. This case illustrates why a second opinion is a valuable safeguard in every MSA strategy.

Identifying the Problem

The claim involved ongoing treatment, therapy, and pharmacy exposure. The original MSA prepared by another vendor appeared complete, and the projected costs seemed typical for this type of injury. Once Tower MSA Partners reviewed the file, the clinical team found inconsistencies that required deeper investigation. Several treatment projections did not align with the documented medical record. The file also listed duplicate items and outdated medications that had already been removed from the claimant’s regimen. The largest issue involved a discontinued high-cost prescription that remained in the allocation. This error inflated the MSA by nearly one hundred thousand dollars and created unnecessary CMS risk. If submitted as written, the payer would have funded care that no longer existed and faced questions about clinical justification.

The Second Opinion Solution

Tower MSA Partners completed a complete second opinion MSA review. Analysts verified each treatment recommendation and cross-referenced records with the most current documentation. Pharmacy history was compared to recent physician notes to ensure accuracy. The discontinued medication was the key discrepancy. The treating physician had replaced it with a lower cost, safer alternative, and the original reviewer failed to revise the allocation. Tower updated the MSA to reflect the correct medication plan and documented the clinical reasoning in clear, concise terms. With the correction in place, the projected cost of the MSA decreased by ninety-eight thousand dollars while maintaining complete alignment with CMS guidance.

Collaboration and Communication

Tower MSA Partners emphasizes transparency in every step of the review. The clinical team explained each correction and helped the claims professional understand why the original allocation was inaccurate. This clarity supported confident decision making and prepared the file for CMS submission. Tower also communicated updates with the defense attorney and treating provider, so all parties understood the medical basis for the revisions. When submitted to CMS, the revised MSA was approved without development requests. Accurate documentation and clinical alignment created a predictable approval process.

Why Oversight Makes the Difference

Accuracy is essential in Medicare Set Aside management. Even a small oversight can inflate lifetime medical projections and expose the payer to avoidable costs. A second opinion MSA review provides an essential layer of validation that confirms medical necessity, eliminates outdated information, and protects the overall integrity of the claim. This case demonstrates that clinical oversight and cost savings work together. Correcting the allocation not only protected the payer from unnecessary spending but also ensured that the file met CMS expectations with confidence.

Lessons Learned

  1. A second opinion review prevents costly mistakes and confirms accuracy before submission.
  2. Outdated information leads to inflated costs, especially in pharmacy heavy claims.
  3. Strong clinical documentation makes CMS approval predictable and efficient.
  4. Precision drives savings. The ninety-eight-thousand-dollar reduction resulted from careful review and experienced analysis.

Results That Reflect Expertise

By requesting a second opinion, the payer avoided a ninety-eight thousand-dollar over allocation and gained a compliant, defensible Medicare Set Aside. The corrected review reflected actual medical necessity and prevented unnecessary long-term funding. This case highlights Tower MSA Partners’ continued commitment to accuracy, clinical alignment, and cost containment. A second opinion review is more than a quality check. It is an essential safeguard for payers, claimants, and settlements.

FAQs

What is a second opinion MSA review?
A second opinion review evaluates an MSA prepared by another company to confirm accuracy, clinical validity, and compliance with CMS guidelines.

How do second opinions create savings?
They uncover outdated treatments, discontinued prescriptions, and projection errors that inflate total costs.

When should a second opinion be considered?
Any claim with complex medical history, high pharmacy exposure, or uncertainty about the accuracy of an existing MSA benefits from a second opinion.

What is a second opinion MSA review?

A second opinion review evaluates an MSA prepared by another company to confirm accuracy, clinical validity, and compliance with CMS guidelines.

How do second opinions create savings?

They uncover outdated treatments, discontinued prescriptions, and projection errors that inflate total costs.

When should a second opinion be considered?

Any claim with complex medical history, high pharmacy exposure, or uncertainty about the accuracy of an existing MSA benefits from a second opinion.

 

$1 Million Saved with Physician Peer Review

December 4, 2025

Image of Tower MSA Partners Why Case Studies Matter series: Blog 3 $1 Million Saved with Physician Peer Review

In Tower MSA Partners’ previous post, we explored “How Pre-MSA Triage Prevented $774k In Unnecessary Costs” by diagnosing issues before submission. This month, we move from prevention to precision. Through a comprehensive Physician Peer Review, Tower MSA Partners helped a client reduce projected MSA costs by more than $1 million, reinforcing how clinical oversight transforms both financial and compliance outcomes.

Identifying the Problem

The claim involved a long-term pain management case where the claimant had been prescribed multiple overlapping therapies and high-cost medications for years. On paper, everything appeared compliant, but Tower’s experienced analysts recognized red flags. The medications had not been re-evaluated for clinical necessity, and several treatments were duplicative or no longer consistent with current medical standards.

Left unchecked, the proposed MSA would have locked the payer into unnecessary costs for the claimant’s lifetime medical care. Beyond the financial impact, the payer also faced potential CMS scrutiny for including treatments without supporting clinical documentation. This is where Tower MSA Partners’ layered review process stepped in.

The Physician Peer Review Solution

Tower’s team initiated an independent Physician Peer Review, assigning the case to a licensed physician with expertise in pain management. The reviewer conducted a full analysis of the medical history, treatment progress, and prescription patterns. This deep clinical evaluation uncovered that several medications could be tapered or replaced with safer and lower-cost alternatives.

For example, the claimant was taking a combination of opioid medications that exceeded current best practice guidelines. The reviewing physician documented a detailed rationale for modification, providing evidence-based recommendations that were not only medically sound but also compliant with CMS expectations.

Once incorporated into the revised MSA, these adjustments reduced projected costs by more than $1 million while maintaining patient safety and treatment continuity.

Collaboration and Communication

One of Tower MSA Partners’ key strengths lies in its ability to bridge communication between medical reviewers, claims professionals, and legal teams. Rather than simply returning a report, Tower’s clinical experts walked the client through each recommendation, explaining how and why changes were appropriate. This transparency ensured that the payer, the defense attorney, and the treating physician were aligned before submission.

The final MSA reflected current medical necessity and included detailed documentation supporting each change. When presented to CMS, the submission received prompt approval with no development requests — a testament to the thoroughness of Tower’s process.

Why Oversight Makes the Difference

In MSA management, accuracy is everything. A single unchecked treatment plan can inflate costs by hundreds of thousands of dollars. Physician peer review adds a layer of expert validation that standard file reviews simply cannot provide. By ensuring that each projected medical service is both necessary and properly justified, Tower protects clients from avoidable financial and compliance risks.

This case demonstrates the tangible value of pairing clinical and administrative expertise. It also reinforces a key truth in the MSA industry: compliance and savings are not competing goals. When handled correctly, one strengthens the other.

Lessons Learned

  1. Medical oversight pays off. Involving a physician reviewer early or mid-process can uncover inefficiencies that purely administrative reviews miss.
  2. Documentation drives approval. Every modification included detailed clinical support, making CMS approval faster and more predictable.
  3. Collaboration builds trust. Transparent communication between Tower, the client, and treating providers eliminated resistance and ensured everyone understood the reasoning behind the changes.
  4. Savings reflect strategy. The $1 million reduction was not luck,  it was the result of structured review protocols, experienced medical oversight, and Tower’s culture of precision.

Results That Reflect Expertise

Beyond the financial win, this case underscored Tower MSA Partners’ reputation for pairing clinical insight with regulatory mastery. The client achieved measurable ROI, CMS compliance, and peace of mind knowing that future medical allocations were realistic, defensible, and supported by clinical data.

Each peer review conducted by Tower is more than a medical check — it is a safeguard for payers, claimants, and settlements. This case serves as another example of how Tower delivers consistent, evidence-based results that protect both cost and care quality.

FAQs

What is a Physician Peer Review in MSA?

It is an independent medical evaluation that confirms treatment plans and medications in an MSA are clinically justified and aligned with CMS guidelines.

How does Peer Review reduce MSA costs?

By identifying unnecessary or outdated treatments and offering safer, evidence-based alternatives, peer review reduces total medical cost projections without compromising care.

Does CMS recognize Peer Reviews?

It’s important to combine the peer review with clinical oversight to document the changes to the treatment plan and medication regimen, which CMS will recognize.

When should an MSA include a Peer Review?

Any time a claim involves long-term treatment or high medication costs, a peer review should be performed before submission.

 

 

 

 

How Pre-MSA Triage Prevented $774K in Unnecessary Costs

November 4, 2025

Image of Tower MSA Partners Why Case Studies Matter series: Blog 2 How Pre-MSA Triage Prevented $774K in Unnecessary Costs

In Tower MSA Partners’ recent blog post, “Why Case Studies Matter: Real-World Proof of MSA Savings,” we introduced this 12-month series demonstrating how Tower MSA Partners turns complex Medicare Set-Aside challenges into measurable savings and compliance wins.

Now, we’re diving into one of the most overlooked, and powerful, steps in the process: Pre-MSA Triage.

Before an MSA is ever submitted to CMS, Tower’s clinical and compliance teams perform an in-depth review that identifies unnecessary treatments, outdated medications, and questionable recommendations that inflate costs.

This early intervention isn’t just smart, it’s transformative. In one recent case, it prevented $774,000 in unnecessary costs before an MSA ever reached submission.

The Challenge: When “Wait and See” Becomes Expensive

For many payers, MSA management doesn’t begin until after a settlement is nearly complete. By then, most treatment plans and prescriptions have been in place for years, leaving little room to make meaningful changes.

Unfortunately, waiting too long can cause costs to spiral. We often see:

  • Outdated medical regimens that no longer reflect the claimant’s current condition
  • Duplicate or overlapping treatments prescribed by multiple providers
  • Inconsistent medical documentation that increases CMS scrutiny
  • Unnecessary or long-term opioid use that drives future cost projections

When these red flags go unaddressed, the resulting MSA can balloon to unrealistic levels, delaying settlements and unnecessarily tying up reserves.

Pre-MSA Triage changes that narrative.

Tower’s Approach: The Power of Early Insight

At Tower MSA Partners, Pre-MSA Triage is a strategic intervention process led by clinicians, compliance specialists, and pharmacists working collaboratively.

Here’s how it works:

  1. Early Case Identification
    As soon as a claim is identified as a settlement candidate, Tower’s team reviews the medical and pharmacy history to identify risk factors likely to inflate MSA costs.  This includes duplicative and open-ended medications.
  2. Clinical Analysis & Pre-MSA Triage Report
    A clinical expert examines treatment appropriateness, drug utilization, and long-term projections and provides a Pre-MSA Triage report.
  3. Claimant & Provider Communication
    Tower facilitates direct communication with physicians to update treatment plans, discontinue unnecessary therapies, or substitute safer, more cost-effective options.
  4. Final MSA Report
    These clinical changes are incorporated into the full MSA report.   The report gives adjusters and settlement teams actionable insights, providing a roadmap for CMS MSA submission and approval and settlement.

This proactive approach ensures that MSA allocations reflect actual, reasonable future medical needs, not inflated or outdated care plans.

Real-World Results: $774,000 Saved Before Submission

In one case, Tower MSA Partners was engaged to evaluate a complex workers’ compensation claim that had been open for years.

The initial Pre-MSA projection exceeded $900,000 due to:

  • High-cost brand-name medications
  • Redundant pain management treatments
  • Ongoing prescriptions that no longer matched clinical reality

Through Pre-MSA Triage, Tower’s team:

  • Identified outdated prescriptions no longer medically necessary
  • Coordinated with the treating physician to adjust the regimen
  • Applied evidence-based medical guidelines to revalidate care
  • Recalculated the MSA using corrected medical data

The result? A $774,000 reduction in projected future medical costs — achieved before the MSA was ever submitted.

The claim settled smoothly, with full CMS compliance and no delays.

This outcome demonstrates the power of collaboration, early action, and data-driven oversight. It also illustrates why Pre-MSA Triage is one of the most effective tools for balancing cost containment with patient care.

Lessons for Claims Professionals

The takeaway for insurers, TPAs, and self-insured employers is clear:
the earlier you intervene, the more control you have, both financially and clinically.

Key lessons include:

  • Start early. Integrating Pre-MSA Triage into claims workflows helps identify and correct costly issues before they compound.
  • Use clinical expertise. Medical professionals provide the insight needed to align treatment with guidelines and compliance requirements.
  • Collaborate often. Open communication among payers, providers, and Tower’s team ensures settlements move forward efficiently.
  • Document everything. A clear, defensible record of intervention builds confidence with CMS reviewers and reduces the risk of rejections or delays.

By applying these principles, payers gain greater control over outcomes, not just cost savings, but also improved accuracy, defensibility, and claimant satisfaction.

What’s Next: The Power of Peer Review

Pre-MSA Triage sets the stage for the next layer of cost containment, Physician Peer Review.

In our upcoming blog, “$1 Million Saved with Physician Peer Review: Here’s How,” we’ll explore how Tower’s network of medical specialists helped identify excessive treatment recommendations and achieve over $1 million in verified savings while maintaining full CMS compliance.

Stay tuned to see how medical oversight continues to transform outcomes for complex claims.

The Takeaway

Pre-MSA Triage isn’t just an optional step, it’s the foundation of effective MSA management.

By identifying risks early, Tower MSA Partners helps clients avoid inflated settlements, streamline CMS submissions, and achieve measurable cost reductions.

Each case tells a story of strategic collaboration and clinical excellence, and this $774K success is just the beginning.

Frequently Asked Questions

What is Pre-MSA Triage?

An early review that identifies outdated treatments and medications before an MSA is created.

Why does timing matter?

Starting early prevents inflated projections and costly surprises at settlement.

How does Pre-MSA Triage lower costs?

By removing unnecessary therapies and correcting medical or pharmacy issues that drive MSA totals up.

Do you contact treating physicians?

Yes, Tower works with providers to update treatment plans and discontinue unnecessary care.

Does this improve CMS approval?

Yes, cleaner medical records and updated care plans lead to smoother CMS submissions.

Is this only for big claims?

No, both routine and complex claims benefit from early clinical review.

How much can it save?

Savings vary, but reductions like the recent $774,000 example are common when outdated care is corrected.

Is this the same as Physician Peer Review?

No, Peer Review is the next level of clinical oversight used when specialty input is needed.

Why is Pre-MSA Triage important?

It sets the foundation for accurate, defensible, and cost-effective MSA outcomes.