Tower MSA Partners Archives

Tower’s Cybersecurity Measures Go the Extra Mile to Protect Your Data

April 3, 2024

Tower MSA Partners Cybersecurity Measures Go the Extra Mile to Protect Your Data

Navigating cybersecurity landscape: Insights from CTOs on cybercrime trends

Cybercrime continues to mount, threatening organizations of all sizes and types. The right cybersecurity measures matter. And which cyber risks worry Chief Technology Officers the most? That would be the danger of an employee accidentally opening the door to an attack.

A recent survey of CTOs showed that 59% considered human error a significant security threat. Highlighted in a March 12 Risk & Insurance brief, the survey was conducted by STX Next with results reported in Technology Magazine.

The phenomenal increase in the sales of cyber insurance underscores the growth of cybercrimes and corporations’ concerns about their impact. Cyber insurance sales, which were $1 billion in 2013, soared to $16 billion in 2023.

Still, only half the companies surveyed had a cybersecurity insurance policy. Tower, of course, has had cybersecurity insurance for years. It’s necessary, but we hope we never have to use it. Our focus is on detecting and preventing attacks in the first place.

Cybercrime spotlight: Cybercriminals zeroing in on users

Cybercriminals are becoming more sophisticated. Forget the lone hacker in his basement; now there are large “professionalized” cybercrime operations. They know most companies that hold sensitive personal health or financial data have reinforced their networks and systems, and now criminals have their sights on soft targets, the people.

One wrong click can launch a devastating breach. Without the right kind of education and ongoing awareness of new viruses and scams, employees can easily fall prey to phishing, vishing, smishing, and social engineering issues.

Fortifying remote workforce: Tower’s cybersecurity education to combat cybercrime

Cybersecurity education is essential for a remote workforce, where an employee can’t quickly turn to a teammate for a second opinion on an email. Tower’s employees receive extensive cybersecurity training and understand how to do their part to prevent breaches.

Tower equips our remote workforce with virtual desktop infrastructure (VDI), including VPNs, anti-virus software, and software that analyzes and downloads electronic email attachments before they can be accessed by any of our devices. We also conduct monthly training sessions that cover topics such as how to detect phishing attacks and procedures for reporting suspicious email and malware, and how to handle email attachments that may contain them.

Enhancing cybersecurity protocols: Tower’s robust defense system against cybercrime

We don’t stop there, though. We conduct annual penetration testing, also called pentesting, where a third-party security expert tries to find and exploit vulnerabilities. Ntierty, our cloud provider, keeps us up to date on the latest viruses and scans our network every week. Tower’s IT department also conducts its own weekly scans using different software as an extra precaution.

And the Tower management team engages in annual cybersecurity tabletop exercises to simulate real-world attacks on Tower’s systems. These simulations probe for known vulnerabilities, which allows us to develop new strategies and procedures to secure our systems.

We also review our controls, processes and procedures to assess their effectiveness every year in a formal SOC 2, Type 2 audit. All this is done to continually identify potential vulnerabilities so we can proactively fortify our defenses.

Tower invests significant amounts of time and money to ensure business continuity and the protection and privacy of data. This may sound like overkill, but we understand the risks, and we’re not willing to take chances on our security and the protection of our clients’ data.

To learn more about Tower’s security suite, please contact Chief Technology Officer Jesse Shade at jesse.shade@towermsa.com.

Links

Human Error is Biggest Cybersecurity Threat, CTOs Say | Technology Magazine

5 things business leaders must know to combat the cybercrime menace – Liberty Mutual Business Insurance

https://towermsa.com/your-settlement-partner/security-confidentiality/

CMS Sets April 16 for Webinar on Section 111 Reporting of WCMSAs

March 27, 2024

Prepare for Change: CMS Webinar on Expanding Section 111 NGHP TPOC Reporting to Include WCMSA Information

The Centers for Medicare and Medicaid Services has scheduled a webinar for April 16, 2024, at 2 PM ET to provide updates on the implementation of Section 111 reporting of Workers Compensation Medicare Set-Asides (WCMSAs). Per the March 25, 2024 announcement:

CMS will be hosting a second webinar regarding the expansion of Section 111 Non-Group Health Plan (NGHP) Total Payment Obligation to Claimant (TPOC) reporting to include Workers’ Compensation Medicare Set-Aside (WCMSA) information. After the first webinar in November, CMS received additional questions and feedback from the industry. The intent of this webinar is to ensure that RREs will be prepared for the change once implemented. With that in mind, this webinar will include a background recap, summary of technical details, updated timelines and CMP impacts. The presentation will be followed by a question and answer session. Because this expansion impacts reporting of WCMSAs, it is strongly recommended that Responsible Reporting Entities (RREs) that report Workers’ Compensation settlements attend.

There is no pre-registration for the webinar. Full details can be found here.

As of April 4, 2025, TPOC reporting must include Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs). (See CMS Sets Date for Start of Section 111 WCMSA Reporting).

The WCMSA reporting requirement applies to both CMS-approved and non-approved MSAs. This information must be reported if the insurance type is workers’ compensation and the TPOC amount is greater than $0. The rule will be prospective only, meaning it applies to TPOC dates of April 4, 2025 and later.

To collect this data, CMS is adding new fields to the Section 111 Claim Input File.

Tower will provide a post-webinar summary. If you have any questions, please contact Dan Anders at daniel.anders@towermsa.com or 888.331.4941.

Tower Webinar Shared the Best Ways to Manage Conditional Payments

February 29, 2024

Man with magnifying glass and calculator adding up Conditional Payments.

What are conditional payments? How and when should payers respond to Conditional Payment Letters, Notices and Demands? What happens if you don’t? Our Chief Compliance Officer Dan Anders and Director of MSP Compliance Services Ada Lopez covered these topics and much more in our February 7 webinar. Here’s a quick recap.

How does Medicare know who the primary payer is … or that a case has settled?

The Medicare Secondary Payer Act was written to protect the Medicare Trust Fund. And the Centers for Medicare and Medicaid Services developed Coordination of Benefits (COB) rules and processes to keep Medicare from paying for treatment that is covered by a primary payer (workers’ compensation, liability, no-fault). If Medicare has made a payment for which a primary payer exists, then such a payment is considered conditional, meaning it is conditioned upon reimbursement to the Medicare Trust Fund.

Most commonly, CMS learns that a primary payer for a Medicare beneficiary’s claim exists through these Section 111 reporting triggers:

Acceptance of Ongoing Responsibility for Medical (ORM), usually in a WC or no-fault claim
Total Payment Obligation to Claimant (TPOC), typically a settlement

Timeliness and accuracy are keys to protecting the payers who are the Responsible Reporting Entities (RREs)

ORM and TPOC should be reported via Section 111 every quarter.
As of Oct. 11, 2024, RREs will be subject to penalties if ORM or TPOC are reported more than 365 days late. (Link to Penalty blog)
Report valid ICD-10 codes:
- For ORM, report only diagnosis codes that are accepted on the claim.
- For TPOC, only report diagnosis codes that are released as part of the settlement.
- Be careful to report only codes that apply to the claim. (Medical bills and records often contain non-claim-related ICD-10 codes.)

Conditional payment recovery

The webinar took a deep dive into the processes and communications the Benefits Coordination & Recovery Center (BCRC) and Commercial Repayment Center (CRC) deploy to obtain reimbursements. Dan and Ada also discussed ways to dispute conditional payment notices and demands. It’s worth requesting a recording of the session from Dan (daniel.anders@towermsa.com) just to get this information.

Some best practices for conditional payments

Make sure claims are accurately and timely reported for ORM and TPOC.
Update ICD-10 codes when additional body parts are accepted or denied or they need correction.
Terminate ORM when appropriate, e.g., settlement.
Identify your Medicare-eligible claimants.
Immediately review and act on conditional payment correspondence and meet the deadlines!
Make sure settlement terms specify who is responsible for conditional payments post-settlement.
When a Demand is received, either pay or appeal. Pay attention to Conditional Payment Letters (CPLs) and Conditional Payment Notices (CPNs) and take action on them, but do not pay before the Demand.
Be sure to respond to the Demand on time. Otherwise, the debt will eventually be transferred to the U.S. Treasury.
Follow-up with the CRC or BCRC to ensure payment was received and applied to the debt and that no debt remains.

If you don’t work with conditional payments on a daily basis, consider partnering with Tower for conditional payment identification, resolutions and appeals. And, if you have any questions about conditional payments, even on specific claims, or any other MSP compliance issues, Dan Anders is happy to answer them. Email daniel.anders@towermsa.com.

Also, let us know what areas of MSP compliance you would like us to cover in future Premier Webinars. We want to help you.

Section 111 Mandatory Insurer Reporting Updates

February 22, 2024

The Centers for Medicare and Medicaid Services (CMS) issued a series of updates over the past month, which include an updated NGHP Section 111 User Guide, the latest Top 10 Section 111 Reporting errors, and its 2024 conditional payment recovery threshold. We have summarized these for you below.

Updated NGHP Section 111 User Guide

CMS released NGHP User Guide Version 7.4, which incorporates the Section 111 civil monetary penalties rule into Section 5.1 of Chapter III: Policy Guidance of the guide. See our most recent update on Section 111 penalties in Recap of CMS Section Penalties Webinar. CMS includes the following in the guide:

The occurrences to be audited will include both Section 111 submissions and records from sources outside of the Section 111 reporting process, to ensure that CMS does not miss those situations where an RRE has entirely failed to report the occurrence. RREs will only be informed when there is a potential instance of non-compliance.

In short, CMS will be auditing untimely reporting through Section 111 and reviewing reports outside of Section 111 to determine if there was a failure to report at all.

Top 10 List of Section 111 Reporting Errors

CMS released a chart of the Top 10 Section 111 Non-Group Health Plan Reporting Error Codes from 7/1/2023 to 12/15/2023. The top three reporting errors were:

TN – 99: No matching, valid TIN Reference File Detail Record was found for the TIN/Office Code combination on the Claim Input File Detail Record.
CI05 – Invalid Diagnosis Code 1.
SP49 – No previously accepted record can be matched to the submitted delete. Delete failed.

These issues are what CMS calls “hard errors,” meaning the record will be rejected. Remember that if a record is rejected and not timely corrected, it could be subject to Section 111 civil monetary penalties for untimely reporting.

$750 Threshold Kept for Reporting and Conditional Payment Recovery

In a February 14, 2024 alert, CMS announced that the 2024 conditional payment recovery threshold for liability, no-fault and workers’ compensation settlements will remain at $750. Accordingly, Total Payment Obligations to the Claimant (TPOCs) in the amount of $750 or less do not need to be reported to CMS through the Section 111 Mandatory Reporting process. Nor will CMS attempt to recover conditional payments for TPOCs of $750 or less (The threshold does not apply to liability settlements for alleged ingestion, implantation or exposure cases.)

By way of background, pursuant to the SMART Act of 2012, CMS must determine a threshold amount each year to ensure the collection cost stays within the amount recovered through such efforts.

Please get in touch with Tower’s Chief Compliance Officer, Dan Anders, with any questions at (888) 331-4941 or daniel.anders@towermsa.com

Medicare Conditional Payment Tune-up, a Tower MSA Partners Webinar

January 25, 2024

Tune-up your conditional payment resolution processes with Tower’s Feb. 7 webinar!

Medicare conditional payment resolution should be a standard practice when settling workers’ compensation or liability claims that involve an injured worker or claimant who is a Medicare beneficiary. While most settling parties recognize this obligation, many have questions about Medicare Secondary Payer (MSP) Medicare conditional payment requirements, conditional payment policies, the practices of CMS recovery contractors, and the role of the Treasury Department in debt recovery.

For the answers, join Tower for a complimentary webinar on Wednesday, February 7, at 2:00 PM ET. Dan Anders, Tower’s Chief Compliance Officer, and Ada Lopez, Director of Medicare Secondary Payer Compliance Services will tell you when and how to:

Communicate with the Commercial Repayment Center (CRC) instead of the Benefits Coordination and Recovery Center (BCRC).
Investigate conditional payments.
Respond to Medicare conditional payment recovery correspondence.
Dispute and appeal conditional payment demands- What works, what doesn’t work, and what sometimes works.
Resolve Treasury Department debt recovery actions.
Work with Tower to investigate, dispute and resolve conditional payments.

A Q&A session will follow the presentation and you can submit questions now.

Please click the link below and register today!

Note there is no CEU credit offered for this webinar.

Register Here

Happy Holidays From Your Friends at Tower MSA Partners

December 20, 2023

Tower wishes you a happy holiday season filled with peace, joy and laughter! We hope you can connect with loved ones and have time to relax and recharge.

This is a time to reflect on the past and prepare for new opportunities in the upcoming year. As we do this, we are filled with gratitude for our clients and other partners. We cherish these strong relationships and deeply appreciate the opportunity to work closely with you.

May your holidays be merry, your New Year prosperous … and your settlements smooth!

The DEA Finally Decides To Reschedule Hydrocodone

August 27, 2014

Last week the DEA released a final rule on the rescheduling of hydrocodone removing it from the schedule III controlled substances list in favor of a schedule II designation. To be clear, this decision specifically addresses hydrocodone combination products (i.e., hydrocodone-acetaminophen formulations such as Vicodin) as hydrocodone by itself has always been a schedule II drug.

The new parameters surrounding the prescribing of hydrocodone under the more restrictive schedule II classification will go into effect on October 6, but the decision by the DEA in conjunction with the Assistant Secretary for Health of the U.S. Department of Health and Human Services has been a long time coming. Hydrocodone combination products (HCP’s) have been schedule III since the Controlled Substances Act was passed in 1970 despite, as mentioned, the fact that hydrocodone itself has always been a schedule II drug. The thought initially was that by combining hydrocodone with another substance such as acetaminophen would diminish the abuse potential, but in the DEA’s final order they actually point to several different statistics that definitively portray just the opposite. Perhaps the most eye opening of these statistics tells us that high school aged children have actually abused Vicodin at twice the rate of Oxycontin, a more tightly controlled schedule II drug that has in the past, grabbed a lot more of the headlines.

Not surprisingly, there was a lot of pushback from the pharmaceutical community as well as some from the medical community throughout this process which has taken 15 years to come to fruition (the original petition was submitted by a physician in 1999). This dissent however, is misplaced and perhaps even irresponsible considering hydrocodone is the most prescribed drug in the United States. Last I checked, heart disease was the biggest killer in this country, not pain, yet hydrocodone is prescribed more than even ACE inhibitors (for hypertension) or statin drugs (to lower cholesterol). And if that is surprising to you try to wrap your head around this: the United States is comprised of about 4% of the world’s population yet we use 99% of the world’s hydrocodone.

The affect this will have on the workers compensation industry could prove to be significant. In terms of PBM’s who commonly push for mail order distribution, schedule II drugs have restrictive policies not conducive to this type of service. It would therefore be a good idea to check with your PBM to ensure that they are actively transitioning all applicable injured workers.

A second implication could be in regards to the widely utilized Official Disability Guidelines (ODG) which have long classified several HCP’s as Y drugs (recommended for first line treatment) within their workers compensation formulary. If changed to N drugs, those HCP’s would be subject to immediate utilization review in states such as Texas and Oklahoma that have instituted a closed formulary.

In my world of Medicare Secondary Payer compliance, it’s tough to say exactly where the effect of this rescheduling will be felt, but there are some trends that I hope we begin to see starting with less hydrocodone on MSA’s. It is easy to get caught up in cost drivers and how to mitigate unnecessary medical treatment in my line of work, and rightfully so when a prescription that was never meant to be maintained long term must be allocated for because it is part of the current treatment plan. But oftentimes, payers tend to overlook or not focus on HCP’s due to their relative low cost in comparison to some of their counterparts such as Oxycontin, Opana or Actiq. The result of that is we are consistently including long term use of hydrocodone-acetaminophen (for example) within MSA allocations in spite of the fact that no opioid has ever been recommended for long term use. This sort of tradeoff is unavoidable at times, but I will still hold out hope that the DEA’s most recent stance to reschedule hydrocodone combination products will prove to have a significant impact on the misuse and abuse of prescription painkillers, not just in our little world of work comp, but far reaching into our society as a whole.

How Will State Boards of Pharmacy Respond to Senate Committee’s Compounding Inquiry?

December 13, 2012

On November 19th, Chairman Tom Harkin (D-IA), Ranking Member Mike Enzi (R-WY) and members of the Senate Health, Education, Labor and Pensions Committee sent letters to all fifty state boards of pharmacy, the entities responsible for maintaining registries of pharmacies operating within their state. The HELP Committee is investigating the New England Compounding Center (NECC) for its production of tainted drugs that caused the recent outbreak of fungal meningitis, which has resulted in 33 deaths and more than 480 illnesses.

The letters were sent as a follow up to a hearing on November 15th in which Senators heard a very troubling account of NECC’s oversight record, which highlighted the gaps and grey areas that complicate the law establishing regulatory authority over such companies. In the course of the investigation, committee staff found that compounding pharmacies like NECC are required to register with their state of residence, and not with the U.S. Food and Drug Administration. This inquiry will help lawmakers to assess the scope of these companies nationwide. Today’s letters will also assist the committee as it determines what changes need to be made to ensure that compounded drugs are safe and available for patients and hospitals who need them.

“The outbreak raises serious questions about the level of oversight that a large-scale compounding pharmacy was subject to, both by state and federal regulators, and what if any additional steps need to be taken to prevent such a tragedy in the future. Therefore, as part of our investigation, we write to request information regarding general oversight of compounding pharmacies in your state and what actions you have taken to address this meningitis outbreak,” the Senators wrote.

Key Points Made in the Inquiry
As foundation for its request for information, HELP noted that the Centers for Disease Control and Prevention (CDCP) linked the recent meningitis outbreak to three lots of preservative-free methylprednisolone acetate produced by the New England Compounding Center (NECC) — a compounding pharmacy in Massachusetts. According to the CDCP, the three lots consisted of 17,676 products distributed to 23 states, exposing approximately 14,000 patients since May 21, 2012. As of November 16, 2012, at least 480 patients have become ill throughout the country, of which 33 have died as a result of the contamination.
In order to better understand how states address the potential issue of compounding pharmacies distributing large quantities of drugs throughout the country and whether additional federal oversight may be necessary, HELP requested that each state’s board of pharmacy provide information responsive to its requests as noted below:

Does your agency require compounding pharmacies to identify if they produce large volumes of drugs, if they compound sterile injectable products and/or ship their products across state lines? Do your inspection procedures vary based upon the production of sterile drugs, or large quantities of drugs, or drugs shipped across state lines?
Does your state require that pharmacies engaged in sterile compounding comply with USP and if so what is your procedure for ensuring compliance with the standard?Are compounding pharmacies in your state required to have a patient-specific prescription prior to producing a compounded drug or are they able to produce batches of products without a prescription?
Please provide the name and address of all pharmacies in your state that hold licenses or waivers or other exceptions that permit the pharmacy to operate in the absence of providing a full service retail pharmacy and meet all of the following three criteria (to the extent that you have information that allows you to identify pharmacies this way):
- engage in sterile compounding;
- hold licenses in other states; and
- engage in compounding as opposed to dispensing.

Assuming the states responded, information should have been available no later than Friday, December 7, 2012. Unfortunately, no responses have been published at this point, but it will be interesting to see how each state views its responsibilities to oversee compounding pharmacies at the state level.

Join Us In Vegas… Ask How Tower Triage Can Save Millions

October 29, 2012

Wednesday, Nov 7-9 Las Vegas Convention Center.

For 20 years, the National Workers’ Compensation and Disability Conference® & Expo has been the industry’s leading training event. And this year’s event is taking it to the next level – making it the best ever!

Key NWCD presentation tracks include the following:

A new full set of sessions will explore and deliver tangible, actionable solutions to the opioid crisis in workers compensation.
New ‘Regional Differences Sessions’ will each tackle the most challenging issues in a particular area of the country and provide you with practical strategies to overcome them.
New interactive ‘Think Tanks’ give attendees an opportunity to exchange innovative ideas with industry peers and leaders.
Enhanced legal track for attorneys and non-attorneys via partnership with LexisNexis.

Click here for more info on NWCD.

And for those who seek the latest in optimized settlement and Pre-MSA intervention strategies, stop by Booth #936 to learn more about the challenges of the current CMS review model and what Tower MSA Partners is doing to save clients millions.

Tower Triage enables employers and carriers to:

Mitigate CMS exposure
Optimize patient care
Expedite settlement

For more information , or to request a meeting with one of our executive team members, email us at info@towermsa.com.