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to CMS, Tower’s clinical and compliance teams perform an in-depth review that identifies unnecessary treatments, outdated medications, and questionable recommendations that inflate costs.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- Outdated medical regimens that no longer reflect the claimant’s current condition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:
- 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. - 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. - Claimant & Provider Communication
Tower facilitates direct communication with physicians to update treatment plans, discontinue unnecessary therapies, or substitute safer, more cost-effective options. - 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.
