June 2020 - Tower MSA

PREMIER WEBINAR: Avoiding the Medicare Mandatory Reporting Penalty

June 29, 2020

Avoiding the Medicare Mandatory Penalty webinar banner

Regulations for Medicare Mandatory Reporting Penalty are in the process of being formalized!

Under the threat of up to a $1,000 per-day, per-claim penalty, most insurers and self-insurers have implemented processes to ensure Medicare beneficiary claimants are reported to Medicare per Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA).

Penalties have never been imposed as the SMART Act specified that the Centers for Medicare and Medicaid Services (CMS) must formalize regulations prior to issuing them. This past February, CMS released proposed regulations, which we detailed in this article: CMS Issues Proposed Rule for Mandatory Insurer Reporting Penalties. Comments on the proposal were due in April and now we await a final regulation.

In a timely webinar, a full analysis of CMS’s penalties proposal will be provided by Tower’s Chief Compliance Officer, Daniel Anders, Esq. Joining Dan will be Jesse Shade, Tower’s VP of Information Technology, who will break down new user-friendly enhancements to Tower’s Mandatory Insurer Reporting platform that are designed specifically to avoid the penalties CMS seeks to impose.

A Q&A session will follow the presentation. Plan to attend the webinar on Wednesday, July 22, at 2 pm ET.

Thank you,

Dan Anders
Chief Compliance Officer

Forbes Technology Council Welcomes Tower’s Jesse Shade

June 24, 2020

Tower’s Vice President of Technology Jesse Shade has joined Forbes Technology Council, a prestigious invitation-only forum of senior CIOs, CTOs, and technology execs. Members collaborate to help solve daily business challenges—like cybersecurity threats—and share insights in Forbes.com articles. Read the related release: Tower MSA Partners’ Vice President of IT, Jesse Shade Accepted into Forbes Technology Council

We know Jesse will be a major asset to the Council because he delivers such high value to Tower. Possessing an unusual blend of interpersonal skills as well as hands-on technical expertise, he is responsible for strategic planning and serves on Tower’s executive team.

Tower designed and built its own technology based on best practices in MSP compliance and MSA preparation. The seamless system drives all compliance processes from Section 111 Mandatory Insurer Reporting, conditional payment resolution, MSA triage, and clinical interventions all the way through MSA preparation, CMS submission, and claim closure.

To be simple for clients to use, technology has to be quite complex behind the scenes. That’s where Jesse’s 35+ years of IT experience in numerous industries, including banking, defense and aviation, comes into play. He leads development efforts for our proprietary technology and its network infrastructure all within a cybersecurity framework that protects Tower and its clients and business partners. (To learn more about cybersecurity threats, especially during COVID-19, check out Jesse’s two Leaders Speak articles on WorkCompWire.)

We’re proud that Jesse will be participating in Forbes’ exclusive Technology Council and look forward to seeing his articles in Forbes.com.

Related information

Jesse Shade

Forbes business communities

CMS Provides Notices on Section 111 Reporting and Conditional Payment Processes

June 17, 2020

People using laptop and mobile phones to update Section 111 Reporting

CMS has recently issued two notices, one pertaining to mandatory Section 111 reporting and one relevant to Medicare conditional payment recovery.

First, in a “teaser” notice, CMS announced that on July 13, 2020 the Medicare Secondary Payer Recovery Portal (MSPRP) is scheduled to be enhanced to allow authorized users to view and print correspondence.

According to the notice,

MSPRP users who log in using Multi Factor Authentication will be able to view and print CMS mailed correspondence that is displayed on the Letter Activity tab. Additional information on how to use this new functionality will be available in Section 14.1.1.4 of the July version of the MSPRP User Guide.

Second, in an alert entitled “Reporting No-Fault Insurance Limit on Non-Group Health Plan (NGHP) Claim Input Files,” CMS reminds Responsible Reporting Entities (RREs) that they must combine both Med Pay and Personal Injury Protection (PIP) coverage limits for Section 111 reporting purposes. This would be under circumstances where separate Med Pay and PIP coverages are being paid out on claims for the same injured party and incident under a single policy.

CMS also reminded RREs that ORM cannot be terminated until both Med Pay and PIP coverage limits are exhausted. Further, that when providing the dollar amount for the policy limit, that it must accurately reflect two decimal places. For example, a policy limits of $5,000 should be reported as 500000.

Practical Implications

In regard to the MSPRP enhancement to print documents, while we will have to see the specific guidance in the July update, this may prove quite useful in not having to wait for correspondence to come in the mail, print letters that were not received via the mail or reprint letters.

As for the alert to remind No-Fault carriers to report Med Pay and PIP coverage limits as a combined amount, while this guidance is already included in the NGHP User Guide, there was apparently some confusion that led CMS to provide this alert as a reminder of how such coverage must be reported.

If you have any questions, please contact Dan Anders, Chief Compliance Officer at daniel.anders@towermsa.com or 888.331.4941.

Dan Anders Weighs in on Legacy Comp Claim Closures

June 8, 2020

Stethescope and an insurance claim form illustrating legacy comp claim post

Business Insurance’s Louise Esola wrote an interesting More legacy comp claim closures anticipated with pandemic on an unexpected side effect of the coronavirus. Injured workers who previously rejected settlement offers are rethinking their decisions.

When researching the story, Esola contacted our Chief Compliance Officer, Dan Anders, who noted that insurers have long focused on legacy comp claim closures, especially those with high prescription drug costs. He said they have, “become a little more proactive in looking at older legacy comp claims to see if this may be an opportunity to take a first or second look at settling those claims.”

At the same time, injured workers find themselves in financial conditions where a settlement would be critical.

Tower’s Legacy Claims Settlement Initiative analyzes a payer’s portfolio of claims to detect those that could settle with or without clinical intervention. When future pharmacy costs inhibit settlement, Tower teams with myMatrixx to review drug regimens and find opportunities to reduce costs while protecting injured worker safety. Our recent Tower Premier Webinar: A Prescription for Settling Legacy Claims describes the program in detail.

After triaging the claim, Tower recommends interventions to optimize the MSA, identifies settlement partners, executes interventions, and helps move the claims to closure.

June 1, 2020

“The older the claim, the higher the costs—especially for prescription drugs,” wrote WorkersCompensation.com’s Nancy Grover, in this excellent recap of A Prescription for Settling Legacy Claims webinar.

The May 19 webinar was presented by Dan Anders, Tower MSA Partners’ Chief Compliance Officer, and Phil Walls, Chief Clinical and Compliance Officer of myMatrixx.

They said that aging claims increase the likelihood that the injured worker may become a Medicare beneficiary. “That means those higher drug costs must be included in a Medicare Set-Aside,” she wrote.

The fast-paced webinar explains how and why prescription drug costs increase during the life of a claim. Brand name drugs, compounds (yes, still), and “prescription cascade” (prescribing new meds to address the side effects of other meds) top the list of cost-drivers.

To gain CMS approval of an MSA, medications that may not be needed or even being used must be allocated in the MSA. What’s more, they are priced at Redbook’s lowest average wholesale price (AWP), eliminating discounts the pharmacy benefit manager (PBM) once provided. Side note: Phil describes issues with AWP in detail during the Q&A at the end of the webinar.

Dan and Phil discussed ways an MSA provider and PBM can partner to identify and address unnecessary costs—without negatively impacting the injured worker’s treatment. “We reach out to the treating physician for last dates of service to see what’s going on,” Dan said. “We also do drug reviews to see if there are alternatives that can be implemented.”

Presenters cited a case where an intervention reduced the total morphine equivalent dosage from a dangerous 480 mg per day to 120 mg per day. The changes produced a savings of about $1 million.

“Our goal is never to keep the injured worker from obtaining the therapy they need, but not to expose them to unnecessary prescribing,” Phil said.

To download the recording of this valuable webinar, please go to: https://register.gotowebinar.com/recording/7163259288372148492

Tower MSA

Month: June 2020