MSP Compliance Archives

Workers’ Compensation MSP Outcomes & Regulatory Insights Report

June 16, 2026

2022-2025 Performance Analysis

One of the most comprehensive multi-year MSP outcome analyses available in the workers’ compensation industry.

Executive Summary

Tower MSA Partners is pleased to provide this first-of-its-kind report, offering one of the most comprehensive multi-year MSP outcome analyses available in the industry. The report provides wide-ranging data points and key metrics across MSA services, conditional payment programs, and CMS-published benchmarks.

These outcomes reflect an integrated model that combines clinical engagement, disciplined allocation methodology, CMS alignment controls, pharmacy mitigation strategies, and aggressive conditional payment resolution.

This report presents aggregated, anonymized performance metrics from 2022 through 2025 to serve as directional benchmarks for workers’ compensation stakeholders evaluating their Medicare Secondary Payer strategy.

Key Findings

Between 2022 and 2025, Tower MSA Partners delivered measurable, repeatable reductions in Medicare-related settlement exposure while maintaining disciplined alignment with CMS expectations.

Across this four-year period:

33% to 64% annual reduction in projected MSA amounts through clinical intervention
$9 million to $12 million in annual MSA-related savings generated through physician and pharmacy optimization
23% lower CMS-approved MSAs compared to CMS national averages
84% to 90% of submissions avoided development letters
82% of conditional payment demands reduced to $0 in 2025
Three-day average turnaround time once documentation is complete

In 2025 alone:

Average CMS-approved Tower WCMSA: $67,692
CMS national average WCMSA: $86,169
Average savings differential per file: $18,477

Why This Matters

Medicare Secondary Payer strategy is no longer simply a compliance requirement. It directly impacts settlement velocity, reserve accuracy, pharmacy exposure, and overall financial predictability.

The outcomes presented in this report demonstrate that a disciplined MSP framework can materially improve both operational and financial performance. Organizations that combine clinical oversight, pharmacy management, documentation discipline, and regulatory expertise are better positioned to achieve compliant and cost-effective settlement outcomes.

What’s Included in the Report

Multi-year MSP performance benchmarks
Medicare Set-Aside outcome analysis
CMS approval and development metrics
Pharmacy and opioid mitigation outcomes
Conditional payment resolution trends
Regulatory developments impacting workers’ compensation
Settlement optimization insights
Industry benchmark data from 2022-2025

Access detailed benchmarks, regulatory developments, CMS trends, and performance metrics from 2022 through 2025.

Navigating Medicare Secondary Payer Compliance in Denied Workers’ Comp Claims

November 13, 2024

compass representing navigating MSP compliance

We’re excited to share that our Chief Compliance Officer, Dan Anders, is featured in WorkCompWire in an insightful article titled “Handling Medicare Secondary Payer Compliance in Denied Workers’ Compensation Claims.”

In this article, Dan explores:

The complexities of managing Medicare Secondary Payer (MSP) compliance when a workers’ compensation claim is denied.
Best practices to ensure compliance, minimize risks, and keep claim processes moving smoothly.

This is a must-read for anyone involved in claims management, compliance, or risk mitigation.

Read the full article on WorkCompWire: Handling Medicare Secondary Payer Compliance in Denied WC Claims.

At Tower MSA Partners, we’re committed to sharing valuable insights that help our clients navigate the intricacies of MSP compliance. Dan’s expertise provides practical advice on handling denied claims while remaining compliant with Medicare guidelines, and we’re thrilled to bring this knowledge to the broader industry.

For more insights and resources on MSA compliance, check out our blog regularly and follow us on LinkedIn.

Section 111 Reporting Penalties Rule Released

October 10, 2023

Tower MSA Partners analyzes CMS final Section 111 penalties rule and compliance requirements for RREs.

The long-awaited Section 111 Mandatory Insurer Reporting Civil Monetary Penalties (CMPs) rule has been released. Recall that the purpose of the rule is to set out specific criteria for when CMS may impose penalties for what it considers a failure to report or improper reporting. The rule is unpublished but will be considered published tomorrow, October 11.

In conjunction with its release, the Centers for Medicare and Medicaid Services issued the following Alert:

Effective Dates

Please note that this rule is effective as of 60 days following the date of publication (December 11, 2023), but is only applicable one year after publication (October 10, 2024). RREs are expected to be compliant with their Section 111 Mandatory Insurer Reporting requirements no later than October 10, 2024, or they may be eligible for a CMP.

Additional Information

RREs should review the published rule and take time to evaluate their reporting processes to ensure the RRE is compliant with all reporting requirements before the rule goes into effect. If RREs have any questions or concerns about their reporting, they should contact their EDI representative.

We know that CMPs are of great interest to RREs, and CMS is in the process of developing and publishing additional written guidance related to CMPs. Questions should be directed to the new CMS Section 111 Civil Money Penalties mailbox at Sec111CMP@cms.hhs.gov. Please be aware that responses should not be anticipated at this time; CMS will use these questions and comments to help inform outreach and educational materials (including webinar presentations). RREs should continue to monitor the Mandatory Insurer Reporting pages on CMS.gov where additional guidance and updates, including information about CMP-related webinars, will be posted.

Key Takeaway

The initial key takeaway from this announcement is the rule will be enforced against RREs starting on October 10, 2024, one year from today. Further, as noted by CMS, there will be additional guidance before that date.

We are in the process of reviewing the regulation and will provide a complete analysis shortly. This will be followed by an invitation to a special Tower webinar to explain the rule and its implications for RREs and answer your questions.

If you have any immediate questions, please reach out to Tower’s Chief Compliance Officer, Dan Anders at daniel.anders@towermsa.com.

Fixed Percentage Option Now Available for Liability Settlements up to $10,000

September 29, 2023

Tower MSA Partners explains CMS Fixed Percentage Option for liability settlements up to $10,000.

The Centers for Medicare and Medicaid Services recently announced that the maximum settlement amount for use of the Fixed Percentage Option will increase from $5,000 to $10,000, effective 10/2/2023. The Fixed Percentage Option is available to the claimant in a liability settlement and allows them to agree to pay 25% of the total settlement amount to resolve Medicare’s recovery claim for conditional payments. The criteria for selecting this option are:

Your liability insurance (including self-insurance) settlement, judgment, award or other payment is related to an alleged physical trauma-based incident and;
The total settlement is for $5,000 (Note this amount will be raised to $10,000, effective October 2, 2023) or less.
You elect the option within the required timeframe and Medicare has not issued a demand letter or other request for reimbursement related to the incident.
You have not received and do not expect to receive any other settlements, judgments, awards, or other payments related to the incident.

This option benefits the injured person when Medicare conditional payments exceed 25% of the total settlement amount. For example, if Medicare has made conditional payments of $8,000 on a $10,000 total settlement, the claimant would pay only $2,500 to resolve them with the Fixed Percentage Option. On the other hand, if conditional payments are $800 on a $10,000 settlement, it is better to use the traditional repayment method with a proportional reduction for attorney’s fees and costs, if any.

Accordingly, it is essential for claimants and their attorneys to investigate Medicare conditional payments prior to settlement so that they can choose the best method for resolving Medicare’s interests.

More information on the Fixed Percentage Option can be found on the CMS website here.

Please contact Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com with any questions.

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 12^th 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.

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

May 25, 2023

Learn what CMS shared about non submit MSAs, WCMSA policy updates, Medicare obligations, & key guidance for workers' comp settlements.

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.

CMS to Provide RREs with Response File on ORM Record Changes

Automation has its place, but it can’t replace people in MSP compliance

October 3, 2022

Automation in MSP compliance cannot replace human expertise in complex claims

Technology isn’t everything. It may seem hard to believe that I have said this because most of my career was steeped in technology.

In my past life, I developed automation systems for pharmacies and workers’ comp pharmacy benefit management (PBM) models. Rules-based adjudication platform allowed for automatic Rx fills for many prescriptions, but also supported trigger-based escalation for the outliers to request authorization or have an expert take a closer look. The time saved and convenience provided were astounding.

When we started Tower, Kristine Dudley and I automated much of the paper-intensive world of Medicare Set-Asides, and also integrated the 3 major components of Medicare Secondary Payer compliance, Section 111 Mandatory Insurer Reporting, Conditional Payments and Medicare Set Asides, into a single platform. I believe we were the first to do that.

Our platform, Tower’s MSP Automation Suite, was built based on state workers’ compensation statutes overlayed with WCMSA guidance, metrics-based KPI tracking and intervention / escalation triggers that supported MSP best practices. By seamlessly integrating Section 111 reporting, conditional payment resolution, and MSA preparation into a single, all-encompassing system, our MSP Automation Suite ensures that nothing drops through the cracks, no field goes unpopulated, problem cases can be identified, and deadlines are met.

Tower’s MSP Automation Suite captures, stores and manages all data points, integrates with ANY claims system, enables clients’ business rules to be overlaid onto ours, and gives our clients end-to-end visibility into Medicare and claim information. Our system also leverages embedded triggers to escalate medical and pharmacy issues, prompting a review for intervention. In short, Tower’s MSP Automation Suite leverages the best of automation until technology intersects with the need for expertise. This allows our team to manage, track and drive MSP compliance from the moment a Medicare beneficiary is identified through the claim’s closure.

Do we love automation? You bet we do.

But we realize automation can’t do everything. MSP compliance has always – and will always – require a high degree of consultative expertise. You can’t just capture and populate data fields, and automatically “pop” out an MSA that supports aggressive cost mitigation that is both CMS-approvable and facilitates settlement.

While many workers’ compensation claims move through the system seamlessly, others are “messy”. Body parts may be denied, additional claims may exist, co-morbid conditions may complicate treatment, surgeries, medical treatment and medications may be prescribed inappropriately or ICD10 codes may be too general or inconsistent with the treatment being paid by the carrier. These are just a subset of the rules-based triggers built into our system so that claims warranting attention are automatically escalated to a human expert to dig through files, examine causation questions, and probe open-ended medical care and contradictory medical records.

Clients need their calls, emails and questions answered by real people, and quickly. Complex conditional payment matters call for conversations … with a knowledgeable partner who shares your goals.

Our automated system escalates medical and pharmacy issues, but then you need a professional with specialized knowledge and experience to recommend the best intervention. And to implement it.

One of our most effective interventions created by Tower is our Physician Follow-up. Guess what? This is performed by people, people who have the patience and commitment to keep trying to talk to the provider. If you’ve tried to call and talk to your own doctor lately, you know what a challenge this can be.

These professionals have the knowledge and soft skills needed to delicately point out vague notes and open-ended recommendations in medical records. And they must be able to persuade the provider to clarify their treatment and prescriptions. Drafting a jurisdiction-specific statement for the provider to sign requires yet another human skill set.

If I had to name the one aspect that drives Tower’s success, I’d have to say service. Our technology enables us to respond quickly, anticipate issues, and proactively address them, but it’s the people, their attitudes, and their expertise our clients value the most.

The common thread in our client testimonies are service and partnership. Clients are “very impressed with [Tower’s] level of communication and availability to help answer questions,” and they say, “they truly listen; listen to understand and not just to respond.”

Perhaps this person sums things best: “They have advanced technology and certified specialists to ensure no stone is unturned.”

Insurance carriers, self-insureds and TPAs are dealing with shortfalls in staffing. There’s more pressure on the experienced adjusters, and the new hires need all kinds of support to get up to speed on MSP matters. Tower MSA Partners is here to help. That’s what the Partners part of our name means.

We are proud of our technology, and we recognize when to leverage it and when automation must give way to consultative expertise. There is a need for partnership with real people who care about your claim closure and settlement and can ensure that happens with the right balance of care, cost and compliance.

If you have any questions or just want to talk about partnership opportunities, the expertise of our people, or our technological capabilities contact me at rita.wilson@towermsa.com.

Tower MSA Partners’ WCI-TV Interviews Reveal How Workers’ Compensation Companies Use Claims Data

August 19, 2022

The workers’ compensation industry has extolled the promises of data analytics and automation for years.

But how are organizations really using claims data? What strategies have worked best? And what have they learned? Several executives will share their experiences during WCI-TV interviews sponsored by Tower MSA Partners.

Guests include Dave Strange, the Yellow Corporation’s Workers’ Compensation Manager and Greg Hamlin, Senior Vice President, Resolution with Berkley Industrial Comp. Ametros CEO Porter Leslie and Alisa Hofman, Vice President of Workers’ Compensation and Medicare Practices for Arcadia will discuss the use of data during and after settlement.

In addition, Tower’s Chief Compliance Officer Dan Anders and Chief Operations Officer Kristine Dudley will share how the technology driven company uses data to streamline Medicare Secondary Payer compliance, protect clients from penalties, and optimize Medicare Set-Asides.

Tower has been the exclusive sponsor of WCI-TV since it first aired in 2015. WCI-TV airs throughout the convention center, in hotel guest rooms and shuttles, on You Tube and CI’s website. Tower’s interviews will also be shared on the company’s LinkedIn page.

The 76^th Annual WCI Conference will be held August 21-24 at the Orlando World Center Marriott. For more information, please see https://www.wci360.com/conference/.

Is a CMS-approved $0 MSA Still Possible?

July 26, 2022

WCI TV interviews on workers compensation claims data analytics and insights

A common question we receive is whether a CMS-approved $0 MSA is still possible. The answer is, yes– if it meets the criteria.

There are three different ways a $0 MSA can be obtained, each with its own criteria and documentation requirements.

Denied Claim $0 MSA

This is a $0 MSA based on a completely denied workers’ comp claim when no payments have been made for medical treatment or indemnity. In certain jurisdictions, such as California, some medical payments can have been made during a statutory investigating period. Payments for non-treatment purposes such as IMEs, case management and medical records copies do not impact the ability to obtain a $0 MSA approval.

This type of $0 MSA has significant documentation requirements:

1. Claim Payment History

A claim payment history printout, even if blank, representing payments since the inception of the claim. All payments must be itemized.
Printout must be divided into categories for medical, indemnity and expenses with subtotals for each category and a grand total listed. This printout needs to include the print or run date.
If the claim payment history does not meet the above requirements, then Tower will work with you to identify alternative documentation that meets CMS requirements.

2. Draft or final settlement documents and court orders or rulings or a statement that no such documents exist (see below Financial Detail and Denial Letter). CMS recently added a requirement that there must be a proposed or agreed-to settlement. Importantly, while CMS requires a proposed settlement, it will reject the $0 MSA if the settlement is finalized, for example with court or commission approval, before CMS’s review and approval of the $0 MSA.

3. First Report of Injury or a statement that no such document exists (See below Financial Detail and Denial Letter).

4. Financial Detail and Denial Letter – At the time of submission Tower will draft a letter for the client to sign that confirms the denial of the claim and any other necessary explanations, such as why no First Report of Injury is available.

5. Medical Records: As with a regular MSA, medical records for the past two years must be provided with the submission.

6. CMS Consent to Release form executed by the claimant.

Accepted Claim $0 MSA

This is a $0 MSA based on medical documentation supporting no further need for injury-related treatment. In the WCMSA Reference Guide, CMS provides as follows:

The individual’s treating physicians conclude (in writing) that to a reasonable degree of medical certainty the individual will no longer require any Medicare-covered treatments related to the WC injury.

In practice, CMS accepts treating physician statements that say the injury-related treatment has resolved or returned to baseline (when there was a pre-existing condition) and that no further injury-related treatment will be necessary as sufficient to support the $0 MSA.

Keep in mind that CMS will not accept the physician’s statement unless it is consistent with the treatment records/notes. For example, if the physician states the injury-related has resolved, but treatment notes document ongoing pain to the relevant body part, CMS is unlikely to approve a $0 MSA. Also, if the injured worker will require a revision or replacement to a body part, e.g., a knee replacement, a $0 MSA will not be approved.

In addition to the physician statement, a claim payment history, medical treatment records and an executed Consent to Release are required.

Judicial Decision $0 MSA

CMS will accept a judicial decision after a hearing on the merits of the case as a basis for a $0 MSA. This can be on a completely denied claim where the judge upholds the denial of the claim or an accepted claim where the judge finds future medical treatment, if any, is unrelated to the work injury. The key here is the decision is “on the merits.” If it in any way looks like an agreement between the parties and the judge just stamped their approval, CMS will not accept it.

In addition to the judicial decision, a claim payment history, medical treatment records and an executed Consent to Release are required.

While there are strict documentation requirements, these $0 MSA approvals remain available for workers’ compensation cases meeting the applicable criteria. Please contact Tower MSA Partners at referrals@towermsa.com or (888) 331-4941 to refer a claim meeting these requirements or for further consultation.

Tower MSA Partners Receives 2022 SOC 2 Type II Attestation

May 3, 2022

Independent Audit Verifies Tower MSA Partners’ Internal Controls and Processes

Delray Beach, FL – Tower MSA Partners, a Medicare Secondary Payer compliance services company, today announced that it has completed its annual SOC 2 Type II audit, performed by KirkpatrickPrice. This attestation provides evidence that Tower has a strong commitment to security and to delivering high-quality services to its clients by demonstrating that they have the necessary internal controls and processes in place.

A SOC 2 audit provides an independent, third-party validation that a service organization’s information security practices meet industry standards stipulated by the AICPA. During the audit, a service organization’s non-financial reporting controls as they relate to security, availability, processing integrity, confidentiality, and privacy of a system are reviewed, examined and reported on. The SOC 2 report delivered by KirkpatrickPrice verifies the suitability of the design and operating effectiveness of Tower MSA Partners’s controls to consistently meet the standards for these criteria throughout the full audit period.

“The SOC 2 audit is based on the Trust Services Criteria,” said Joseph Kirkpatrick, President of KirkpatrickPrice. “Tower delivers trust-based services to their clients, and by communicating the results of this audit, their clients can be assured of their reliance on Tower’s controls.”

“It’s an honor to again earn an unqualified 2022 SOC 2 Type II outcome” said Wilson. “It’s an attestation that Tower’s systems, policies and procedures meet the trust services criteria of security, availability, processing integrity, confidentiality, and privacy.”

What does this mean for you?

Peace of mind.
If you partner with Tower, you can be assured that
- Our human processes and our highly automated system– have been validated by third-party auditors after a stringent analysis.
- Your data is transferred safely, used appropriately, stored securely, and is accessible for the required amount of time.
- You can partner with a best-in-class MSP services provider and superior technology.
Cybersecurity assurance. Auditors recognized Tower’s commitment to keep up with cyber threats, patching, monitoring methods and cybersecurity technology. They saw that we monitor all internal systems for patching cadence and antivirus/antimalware activity, we regularly train staff on how to avoid the latest scams, and we execute multi-factor authentication and password changes to prevent breaches. In addition, we partner with reliable and well-respected cloud storage, monitoring, and security companies.

While the complete report is confidential and proprietary, a redacted synopsis of the report, SOC 3, can be downloaded here. I’m happy to answer questions and discuss the value of partnering with Tower for your MSP compliance and MSA needs. Please contact me at Rita.Wilson@TowerMSA.com to arrange for a conversation.