Tag: medicare-set-aside

What’s Included in a Medicare Set-Aside (MSA)?

May 13, 2025

Tower MSA Partners presents What’s included in an MSA with a button that says find out.

Fourth Installment in our Tower MSA Partners Series

In our previous posts, we introduced the fundamentals of Medicare Set-Asides (MSAs), explained how they work, and outlined when an MSA is necessary. Now, we turn to the next important question: what exactly is included in an MSA?

At Tower MSA Partners, we ensure that every MSA is carefully developed to provide for the injured worker’s future medical care needs while protecting Medicare’s interests. In this article, we break down the typical components of an MSA allocation.

Future Medical Costs

The core of any MSA is the projection of future medical expenses related to the work injury or illness that Medicare would otherwise cover. These expenses include, but are not limited to:

  • Physician visits (primary care and specialists)
  • Hospitalizations
  • Physical therapy
  • Diagnostic testing (X-rays, MRIs, CT scans)
  • Durable Medical Equipment (DME), such as wheelchairs or prosthetics
  • Home health care services, if related to the injury
  • Surgical procedures

Each projected cost is based on the injured worker’s medical history, current treatment plan, and anticipated future needs as determined through a comprehensive medical record review.

It is important to remember that CMS relies on the notes and opinions of the treating physician(s). Examining physicians, such as IMEs, PQMEs, AMEs, and the like, do not carry weight with CMS. Furthermore, statements from injured workers indicating that they do not plan to pursue a certain course of treatment, such as a spinal cord stimulator, will not be considered by CMS if a treating physician continues to recommend it as a treatment option.

Prescription Medications

In addition to medical services, the MSA must also allocate funds for prescription medications related to the injury. These include:

  • Ongoing maintenance drugs (such as pain management medications)
  • Antibiotics for recurring infections tied to the injury
  • Future prescriptions based on ongoing treatment needs

It’s important that the medications included in the MSA are tied directly to the work-related condition and are likely to be needed based on current and reasonably foreseeable medical standards.

Treatment Trends and Cost Mitigation

Accurately projecting future care is essential to ensuring that the MSA is sufficient but not overinflated. This means factoring in:

  • Discontinuation of treatments that are no longer medically necessary
  • Weaning off medications (such as opioids) where clinically appropriate
  • Updates or clarifications from treating physicians to mitigate outdated or unnecessary ongoing care assumptions

At Tower, we work closely with treating providers to clarify treatment plans and identify opportunities to right-size the MSA appropriately.

CMS Submission Documentation Requirements

If the MSA is submitted to the Centers for Medicare & Medicaid Services (CMS) for review and approval, there are specific documentation requirements:

  • Submission of all relevant medical and pharmacy records for the most recent two years for each settling body part or condition
  • The Medicare Set-Aside Report
  • Claim payment history
  • Claim prescription drug history
  • Claimant executed Consent to Release form
  • Clear explanation of how the MSA will be funded (lump sum vs. annuity) and administered (self-administered or professionally administered)
  • If applicable, court orders, denial letters and depositions

Tower strives to provide a straightforward allocation for future medical care supported by the necessary treatment records and pharmacy history.  In doing so, we avoid CMS development letters and expedite the settlement process for the parties.

Conclusion

A properly developed Medicare Set-Aside includes a detailed projection of future medical costs, related prescription medications, and compliance with CMS submission requirements. Ensuring these elements are accurately captured is critical to protecting Medicare’s interests and the injured worker’s access to necessary care.

At Tower MSA Partners, our expert team builds MSAs that are precise, defensible, and compliant, helping you navigate settlements with confidence.

Stay tuned for our next blog in the series, where we will explore “What are Some Common MSA Challenges? “

Need assistance with your Medicare Set-Aside allocations? Contact Tower MSA Partners today.

 

How Do I Know If I Need a Medicare Set-Aside?

April 22, 2025

Tower MSA Partners banner with copy that reads “How do I know if I need an MSA” with a button that says find out with papers, medication, money, a magnifying glass, and EKG results.

When planning a settlement with a Medicare beneficiary injured worker or someone close to becoming a Medicare beneficiary, ensuring that the burden of future medical care is not shifted to Medicare is paramount. In our previous posts, we introduced the fundamentals of Medicare Set-Asides (MSAs) and detailed how they work within workers’ compensation claims. Now, we take a closer look at the key factors, such as projected medical costs, specific monetary thresholds, and special circumstances, that determine whether an MSA is required.

Refining the Decision: Beyond the Basics

While earlier blogs explained the overall structure and regulatory importance of MSAs, this post focuses on the critical evaluation of each case. Determining whether an MSA is necessary hinges on two primary considerations: Medicare eligibility and settlement size. At the same time, there are instances where, after a thorough review, a $0 MSA is both appropriate and legally supported.

Medicare Eligibility: Immediate vs. Imminent

A starting point to determine the need for an MSA is whether the injured worker is or is not Medicare eligible.

  • Immediate Eligibility:
    For injured workers who are already covered by Medicare, any settlement must include an MSA (CMS now requires the payer to report the MSA amount at the time of settlement), whether that is a $0 allocation or an earmark of funds exclusively for care that Medicare would otherwise cover.
  • Imminent Eligibility:
    When a claimant is not Medicare eligible but is expected to qualify for Medicare within the next 30 months due to being 62 ½ or older or having applied for or receiving Social Security Disability Insurance (SSDI) benefits, an MSA should also be a consideration – especially when there is a clear need for long-term future medical care.

Settlement Size: Monetary Thresholds as a Trigger

For many years, CMS has had in place monetary thresholds for when they will review and approve an MSA:

  • For Medicare-eligible individuals, settlements exceeding $25,000 allow for a CMS-approved MSA.
  • For those approaching Medicare eligibility, settlements where anticipated future healthcare costs exceed $250,000 allow for a CMS-approved MSA.

Whether an MSA is submitted to CMS or not, most settling parties will include an MSA in the settlement if these triggers are met. The situation becomes more complicated when the monetary thresholds are not met.

For example, consider a Medicare-eligible claimant where the settlement will be $15,000.  As noted earlier, CMS requires you to report an MSA amount. As such, either a $0 or a specific MSA dollar amount will need to be included in the settlement.

Now say you have a $100,000 settlement involving a 63-year-old claimant who is not a Medicare beneficiary, the injured worker’s specific medical history and need for long-term medical care should be considered in determining whether an MSA is appropriate.

$0 MSA

In many cases, reserving funds for future medical care is necessary, yet thorough medical and legal evaluations sometimes support a $0 MSA. Recent policy changes have further clarified this area. We will cover this in more detail in a future post.

MSA Decision Best Practices

Here are some targeted best practices for determining whether an MSA is necessary:

  1. Identify the Medicare status of the claimant.
  • If you are a payer, then you have access to the Section 111 reporting information on whether the claimant is a Medicare beneficiary. If not a payer, then make an inquiry to the claimant as to their Medicare status.  If not a Medicare beneficiary, then are Medicare’s interests nonetheless implicated based on their age or having applied for SSDI benefits?
  • Follow Tower’s “Do I Need a Workers’ Compensation Medicare Set-Aside (WCMSA)” decision tree to determine whether an MSA is appropriate.
  1. Settlement Value and the MSA
  • CMS MSA Submission Approval:
    While an MSA may be a consideration in any settlement involving a Medicare beneficiary claimant or one close to Medicare eligibility, depending on settlement value, CMS approval of the MSA can be obtained.
  • Non-CMS Approved MSAs:
    An MSA should still be considered when CMS MSA approval cannot obtained. This is especially true when the claimant is a Medicare beneficiary, even when the settlement is $25K or less and where the claimant has applied for or is receiving SSDI, even when the settlement is $250K or less.
  1. Engage Specialized Expertise
  • Consult Compliance Experts:
    Collaborate with attorneys, or experts like Tower MSA Partners, specializing in Medicare Set-Asides to ensure that every decision is compliant with CMS and state guidelines.
  • Stay Updated:
    Keep abreast of any regulatory changes, such as the recent CMS update eliminating $0 MSA reviews, to ensure ongoing compliance.
  1. Enhance Stakeholder Communication
  • Internal Alignment:
    Ensure that all team members, from legal advisors to claims adjusters, understand the criteria for establishing an MSA.
  • Client Transparency:
    Clearly explain to injured workers how their settlement is structured and the rationale behind inclusion of an MSA in settlement, ensuring they understand the implications for their future care.

Conclusion

Determining whether a Medicare Set-Aside is necessary involves a careful analysis of Medicare eligibility and settlement value. An MSA may be needed in both situations where CMS approval and can and cannot be obtained.  In either case, the goal for the settling parties is to close out medical with the reasonable assurance that they have not shifted the burden of future medical care to the Medicare program.  In most cases this will involve some type of allocation for future medical care while in some a $0 MSA may be the right solution.

For personalized guidance on evaluating your case or determining the most appropriate MSA strategy, Tower MSA Partners is here to help. Contact our team to navigate the complexities of Medicare Set-Asides with confidence.

Stay tuned for the next article in our series on “What is Included in an MSA?”

MSA 101: What is an Medicare Set-Aside?

March 5, 2025

What Is an MSA?

This is the first in a series of articles on the basics of Medicare Set-Asides (MSA) that Tower will be releasing in the coming weeks. For those familiar with MSAs, think of this as a refresher on what an MSA is, how it operates, what it contains, and when you should use one. If you are new to MSAs or have limited experience with them, consider this as your MSA 101 course.  Enjoy!

In the world of workers’ compensation, ensuring that Medicare’s interests are protected is a critical component of settlement negotiations. This is where an MSA comes into play. If you’ve ever wondered what an MSA is, why it’s necessary, and how it impacts claim settlements, this article will provide you with a foundational understanding.

What is a Medicare Set-Aside (MSA)?

A Medicare Set-Aside (MSA) is an arrangement that allocates a portion of a workers’ compensation settlement to cover future medical expenses related to the work-related injury, ensuring that Medicare does not pay for treatment that should be covered by the settlement. This amount is “set aside” in a designated account and is used exclusively for Medicare-covered medical expenses associated with the injury.

Think of an MSA as a financial reserve specifically designated for medical costs, helping claimants maintain Medicare eligibility while ensuring compliance with the Medicare Secondary Payer (MSP) Act.

Why are MSAs Necessary?

  1. Compliance with the Medicare Secondary Payer (MSP) Act

The MSP Act prevents Medicare from paying for medical expenses when another entity (such as a workers’ compensation insurer) is responsible. If an injured worker is eligible for Medicare (or expected to be soon), an MSA helps ensure that Medicare is not burdened with costs that should be covered by the settlement.

  1. Protecting the Injured Worker’s Medicare Benefits

If a settlement does not properly account for future medical costs, Medicare could deny payments for treatment related to the injury. This could leave the injured worker responsible for medical expenses that should have been accounted for in the settlement.

  1. Avoiding Legal and Financial Risks

Failure to properly allocate funds for future medical expenses can lead to compliance issues with the Centers for Medicare & Medicaid Services (CMS). In some cases, CMS may pursue recovery from both the claimant and the insurer, leading to unnecessary legal and financial complications.

How Does an MSA Work?

  1. Case Evaluation
    • A review is conducted to determine if an MSA is necessary, typically for claimants who are Medicare-eligible or expected to become eligible within 30 months.
    • Medical history and projected future treatment costs are assessed.
  2. MSA Allocation Report
    • A professional allocation report is developed to estimate the future medical costs that Medicare would typically cover over someone’s lifetime.
  3. CMS Submission (Optional but Recommended)
    • If certain review thresholds are met, the MSA proposal can be submitted to CMS for approval to ensure compliance. While not always required, CMS approval provides protection against future disputes.
  4. Funding and Administration
    • The MSA can be funded as a lump sum or through structured payments.
    • The funds must be used exclusively for medical expenses related to the work injury.
    • The MSA account can be self-administered by the claimant or managed by a professional administrator to ensure proper usage and record-keeping.
  5. Exhaustion and Medicare Coverage
    • Once the MSA funds are properly spent and exhausted, Medicare assumes responsibility for injury-related medical expenses.

Who Needs an MSA?

Not every workers’ compensation claim requires an MSA. However, they are generally recommended when:

  • The claimant is Medicare-eligible (65+ or receiving SSDI) or expected to be Medicare eligible in the next 30 months.
  • The settlement includes funds for future medical treatment related to the work injury.
  • The claim involves significant ongoing medical expenses that would typically be covered by Medicare.

If these conditions apply, it is crucial to evaluate whether an MSA is needed to avoid compliance risks and ensure the claimant’s continued access to care.

Final Thoughts

A Medicare Set-Aside is an essential tool for protecting Medicare’s interests, ensuring compliance with federal regulations, and securing long-term medical coverage for injured workers. By understanding what an MSA is and why it matters, all parties involved in a workers’ compensation claim—insurers, employers, attorneys, and injured workers—can make informed decisions that align with best practices and regulatory requirements.

If you’re navigating a workers’ compensation settlement and unsure whether an MSA is necessary, Tower MSA Partners is here to help. Our team specializes in developing compliant and cost-effective MSAs, ensuring that your settlement is both strategic and Medicare-compliant.

Stay tuned for our next blog in this series: “How Does an MSA Work?” where we’ll dive deeper into the MSA components.

Want to discuss your MSA needs? Contact Tower MSA Partners today.

CMS 2024 WCMSA Metrics: Key Trends in Medication and Treatment Costs

December 4, 2024

stethoscope and pill bottle on representing WCMSA trends

CMS 2024 WCMSA Metrics: Key Insights into Costs and Trends

The Centers for Medicare and Medicaid Services (CMS) has released its 2024 data on Workers’ Compensation Medicare Set-Aside (WCMSA) reviews. This year’s metrics highlight two significant trends: declining prescription drug costs and rising medical treatment costs.

For employers, insurers, and other stakeholders, understanding these trends is crucial for effective planning and cost management. Here’s a breakdown of the key findings and how Tower MSA stands out in the industry.

CMS WCMSA Metrics Overview: 2020–2024

CMS’s fiscal year 2024 data provides a five-year perspective on MSA reviews, comparing proposed amounts to CMS-recommended (approved) amounts. Here are the major takeaways:

  • Consistency in Review Numbers:
    CMS completed 14,862 MSA recommendations in 2024, closely aligning with the five-year average of 15,138.
  • Decrease in Recommendations:
    After a 9% rise in recommended amounts between 2022 and 2023, 2024 saw a 6% drop.
  • Stable Average MSA Amounts:
    The average approved MSA decreased slightly to $85,927 in 2024 from $86,453 in 2023. However, this remains above the five-year average of $83,851.
  • Variance Between Proposed and Approved Amounts:
    The variance, which increased to 22% in 2023, remained steady at 21% in 2024.

Key Trends in Costs

  1. Prescription Drug Costs Continue to Decline

CMS data reveals a notable 33% decrease in average prescription drug costs over five years, from $26,574 in 2020 to $17,807 in 2024. This decline reflects:

  • Reduced opioid use in workers’ compensation cases.
  • Increased allocation of generic medications over brand-name drugs.
  1. Treatment Costs Are Rising

While prescription costs have fallen, the average treatment costs have increased by 15% since 2020, signaling a shift in the cost structure for MSAs.

How Tower MSA Partners Compares to Industry Averages

Tower MSA Partners has consistently achieved lower costs for its clients, significantly outperforming industry averages in both total MSA and prescription drug components.

  • Average Approved MSA (2020-2023):
    • CMS: $82,332
    • Tower: $63,005 (23% lower)
  • Prescription Drug Component (2020-2023):
    • CMS: $22,048
    • Tower: $14,286 (35% lower)

Through targeted interventions like our Physician Follow-up service, Tower mitigates costs while ensuring compliance with CMS requirements.

Why CMS Metrics Matter

These annual metrics provide invaluable insights for stakeholders managing workers’ compensation cases. They not only reflect trends in CMS review processes but also offer benchmarks to evaluate cost-saving strategies.

Tower MSA’s cost-effective approach demonstrates that significant savings are possible with a robust review and allocation methodology.

Have Questions? Let’s Connect

If you want to learn more about how CMS metrics impact your workers’ compensation program—or explore cost-saving opportunities—contact Dan Anders, Chief Compliance Officer, at Daniel.anders@towermsa.com or call 888.331.4941.

Top 5 Most Listened to Podcast Episode: Medicare Set Asides

November 20, 2024

image of microphone representing medicare set aside podcast

Medicare Set Aside Podcast Featured

We are delighted to announce that our very own Dan Anders, Chief Compliance Officer at Tower MSA Partners, has been featured in the Top 5 Most Listened to Episodes of Berkley Industrial Comp’s Adjusted Podcast!

The Adjusted Podcast recently reached its milestone 100th episode and is celebrating by highlighting its top episodes. Dan’s insightful discussion on Medicare Set Asides has made the list.

Listen to Dan’s episode here: Medicare Set Asides with Dan Anders

In this popular episode, Dan dives deep into the complexities of Medicare Set Asides, offering valuable guidance and expertise that have resonated with professionals across the workers’ compensation industry.

We are incredibly proud of Dan’s contribution and grateful to all the listeners who have made this recognition possible. Your support helps us continue our mission to provide clarity and solutions in the ever-evolving world of Medicare compliance.

Join us in congratulating Dan and the Adjusted Podcast team on this remarkable achievement! Let’s continue to engage, learn, and grow together in the workers’ compensation community.

Subscribe to our blog for more insights and updates from Tower MSA Partners.

MSA Amended Reviews – Key to Settlements of Old Dog Legacy Claims

October 26, 2023

Tower MSA Partners covering CMS expanded Amended Review availability for Medicare Set-Aside arrangements.

Tower MSA Partners’ Chief Compliance Officer Dan Anders’ enthusiasm for Amended Reviews kept the audience engaged during our recent Premier Webinar: Amended Review MSA Provides Second Bite at the Apple.

Several criteria dictate whether payers can submit an Amended Review, including the fact CMS needed to have approved the first MSA more than 12 months earlier. In addition, there must be a $10,000 or 10% (whichever is higher) difference between the first MSA allocation and the Amended Review MSA.

Our earlier post discussed CMS’s decision to remove the lookback period for Amended Reviews. Previously, we could only use this process if the original MSA had been approved during the last six years.  The removal of the lookback period opened the door for insurers and employers to examine their unsettled legacy claims that had any approved MSA and try to settle the claims.

Dan cautioned attendees not to submit an Amended Review MSA unless the injured worker seemed open to settlement.  “CMS’s change gave payers a second bite at the apple,” Dan said, “But it’s just one more bite, only one opportunity to obtain a new MSA.  You don’t get to eat the whole apple.”

The webinar shared facts and advice about Amended Reviews and highlighted several real case studies, including one where the second MSA amount was much higher than the first.  Some takeaways:

  • Request an MSA report to decide if an Amended Review MSA submission makes sense.
  • An Amended Review is not available until 12 months after CMS approved the first MSAA.
  • There’s no requirement to submit an Amended Review MSA for settlement purposes even if the CMS-approved MSA does not reflect current or future course of care.
  • Make sure all parties are at a stage where settlement is feasible.
  • Obtain medical documentation to support all medical and medication changes from the original MSA.
  • Unlike a regular MSA submission, where CMS requests more information and we can supplement and support the proposal in our response, the Amended Review MSA process offers no opportunity to provide documentation after submission. CMS will review what is provided and make its determination.

Attendees asked great questions:

  • Must the vendor who submitted the original MSA also submit the Amended Review MSA?

No. Tower can handle the Amended Review MSA even if a different vendor handled the original submission.

  • If an MSA was previously submitted for a Re-review, can it be submitted for an Amended Review MSA?

Yes.

  • Does the undertaking of an Amended Review make the previously submitted MSA null and void?

Only if the Amended Review MSA is submitted and approved.  The beauty of CMS-approved MSAs is that they never die.  If you can get the injured person and their attorney to agree, you can use it to settle, regardless of how outdated it is.

Like just about everything else CMS touches, the Amended Review process is complicated, and you can easily blow your one and only chance. Do not try this at home.

Dan is always happy to discuss cases and explore Amended Review and other options with you. Don’t hesitate to email him at Daniel.Anders@TowerMSA.com.

Remember, Tower can create MSA reports to help you decide if you want to pursue an Amended Review MSA. In addition, we’ll review your open claims with high CMS-approved MSAs and select those that could settle with an Amended Review MSA. We can also provide clinical recommendations to determine whether a physician statement, additional medical records or other intervention can result in a lower MSA.

Tower MSA Partners.  Don’t Settle with Anyone Else.

Tower MSA Partners Launches New Website and Celebrates 12th Anniversary

September 26, 2023

Tower MSA Partners celebrates its 12th anniversary and launches its new website.

Tower MSA Partners recently marked our 12 years in business with the rollout of a new, streamlined website that emphasizes our focus on your settlements.  We facilitate claim closure by aggressively seeking savings and making Medicare Secondary Payer (MSP) compliance and Medicare Set-Aside (MSA) prep better, faster and easier.

Working on the new site allowed us to reflect on our differentiators. We don’t try to be all things to all people.  We are singularly focused on MSP compliance, MSA preparation, and going above and beyond to serve our clients.  It’s you, our client partners, and your need to close claims and continually improve your workers’ comp programs that drives us.

This includes our built-for-this-industry MSP Automation Suite, which integrates Section 111 reporting with conditional payment resolution and MSA preparation processes.  Automation saves significant time, reduces errors and allows our client partners to focus on matters other than MSP compliance. And our annual SOC 2 Type II audit confirms the efficiency and effectiveness of our systems and processes.

As great as our tech is, however, at some point, it must give way to human expertise. It’s our legal and clinical specialists who apply their knowledge and experiences to remove barriers to settlement. Our clients appreciate our intuitive technology, but they love the personal service we provide.

As our name says, Tower is your partner. We actively listen to our clients’ goals and desires and make them our own.  Our specialists respond quickly to your questions with clear answers. We consult, advise and stay involved through claim closure and (when appropriate) approval from the Centers for Medicare and Medicaid Services (CMS).

We know that an MSA allocation can determine if a claim can close and we fight for every dollar of savings while we maintain 100% compliance with CMS and state regulations. Tower will also assemble and lead a settlement team to work with injured workers and their attorneys to bring claims to closure.

As we celebrate our 12th anniversary and the launch of a new website, we thank our clients – our partners – for your trust and support.  Many of you have been with us for all 12 years.  We look forward to many more years of innovation and successful settlements.

Please visit our new website, still www.TowerMSA.com, and tell us what you think.

 

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

CMS News Roundup: New Conditional Payment Appeals Guide & Webinar on Section 111 Reporting

May 25, 2023

Tower MSA Partners covers CMS new guide on Medicare conditional payment appeals and the upcoming Section 111 reporting webinar.

The Centers for Medicare and Medicaid Services (CMS) recently released a how-to guide for appealing Medicare conditional payment demands. The Non-Group Health Plan (NGHP) Applicable Plan Appeals Reference Guide consolidates conditional payment rules and best practices that the agency has issued through webinars, slides and its website.

Section 2.0 gives a breakdown of the appeals levels and explains how to submit an appeal and authorization/letter of authority requirements.  Section 3.0 details what can be appealed and supporting documentation.  Section 4.0 lists additional resources.  Finally, an appendix provides sample letters and model language for applicable plans to appoint recovery agents.

It is important to note that this guide does not cover Conditional Payment Notices (CPNs), which are issued before demand letters to allow the recipient 30 days to dispute the charges.  However, the bases for CPN disputes are the same as those found in Section 3.0.  When the dispute fails or is not timely, a demand letter is issued and the demand letter can be appealed, even with the same arguments used to dispute the CPN.

We appreciate CMS taking the time to draft and release this guide.  It joins the WCMSA Reference Guide and the Section 111 User Guide as critical reference tools for anyone impacted by Medicare Secondary Payer compliance.

CMS Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File Webinar

The Centers for Medicare and Medicaid Services (CMS) recently published a Section 111 reporting webinar notice for a webinar on June 6, 2023 at 1:00 PM ET and states:

CMS will be hosting a webinar regarding the upcoming implementation of the Section 111 NGHP
Unsolicited Response File option. The format will be opening remarks by CMS, a presentation that will include background as well as how to opt in and what to expect, followed by a question and answer session. For questions regarding this topic, prior to the webinar, please utilize the Section 111 Resource Mailbox PL110- 173SEC111-comments@cms.hhs.gov

As of July 2023, Responsible Reporting Entities (RREs) can opt-in to receive a monthly “NGHP Unsolicited Response File” via the Section 111 secure website. Per CMS, the file “will provide critical information about updates to ORM records originally submitted in the last 12 months and allow RREs to either update their internal data or contact the Benefits Coordination & Recovery Center (BCRC) for a correction.”

It is important for an RRE to review and confirm that the changes made by the BCRC and listed in this report are correct.  If not, then the BCRC must be contacted to advise them that the RRE disagrees with the change made by the BCRC.  We encourage anyone involved in managing Section 111 reporting to tune in.  Please note that there is no pre-registration; the link and call-in numbers are on the notice.  You log in shortly before the webinar’s start time.

Related Articles

CMS to Provide RREs with Response File on ORM Record Changes

Premier Webinar: Easy MSA Cost Savings Through Structured Settlements

May 18, 2023

Tower MSA Partners webinar on structured settlements for Medicare Set-Asides cost savings and compliance.

One of the easiest ways to lower the settlement cost is through a structured Medicare Set-Aside. Not only does this reduce the payer’s cost of funding the MSA, but it also provides the injured worker a consistent stream of funds for injury-related medical care over their lifetime.

 On June 7 at 2 pm (EDT) Tower will present an informative session on structured settlements for MSAs. Tower’s Chief Compliance Officer will moderate a special guest panel from Arcadia: Alisa Hofmann, Vice President – Workers’ Compensation and Medicare Practices and Lori Vaughn, Director of Arcadia Client Programs. This hour-long webinar will show how structured MSAs can benefit all stakeholders in a settlement – the injured party, Medicare and the insurance carrier or employer.

Attendees will learn:

  • How to work with a structured settlement provider to incorporate an MSA structure into settlement.
  • The methodology CMS uses to calculate a structured MSA.
  • Rules around converting a CMS-approved lump sum MSA into a structured MSA.
  • The role of a structured settlement broker pre-settlement, during settlement negotiations and post-settlement.

A Q&A session will follow the presentation, and you can provide questions you’d like to have answered when you register. Please click the link below and register today!

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

Register here.

About Alisa Hofmann:

Alisa is the Vice President of Workers’ Compensation and Medicare Practices at Arcadia Settlements Group and currently works on the Business Development team. She has been handling and overseeing Workers’ Compensation claims for almost three decades with various national carriers.  Alisa obtained her BA in Organizational Communication at Otterbein University. She maintains her adjuster licensing in many states, also holds Life, Health, and Accident Licensing, and many Insurance Accreditations. Alisa has been an active member of the National Structured Settlement Trade Association since 2019, and a member of The MSP Network where she serves on the Professional Administration and Structure-Education Committee.

About Lori Vaughn:

Lori Vaughn has 15+ years of experience in the structured settlement industry and currently oversees structured settlement programs for multiple workers’ compensation and private insurance carrier clients. She leads teams of consultants, case managers, and corporate employees, and is the primary point of contact for the corporate management team for each client. Lori obtained her BS in Kinesiology from California State University, Fresno, and her MS in Kinesiology from California Baptist University. She holds her Life, Health, and Accident licenses in many states and is a member of the National Structured Settlements Trade Association.