-
Technology
-
Industry
-
Solutions
-
- ASSET MANAGEMENT
- CUSTOMER EXPERIENCE MANAGEMENT
- CYBER SECURITY
- DATA CENTER
- DOCUMENT MANAGEMENT
- ELECTRONIC DATA INTERCHANGE
- ENTERPRISE DATA MANAGEMENT
- ENTERPRISE RESOURCE PLANNING
- ENTERPRISE RISK MANAGEMENT
- ENTERPRISE-GRADE WEB DATA SOLUTIONS
- FACILITY MANAGEMENT
- FIELD SERVICE
- IDENTITY AND ACCESS MANAGEMENT
- INFRASTRUCTURE
- IT SERVICE MANAGEMENT
- MANAGED IT SERVICES
- PAYMENT AND CARD
- PROJECT MANAGEMENT
- SOFTWARE TESTING
- STORAGE
- VIDEO SOLUTIONS
- WORKFLOW
-
-
Platforms
-
Functions
- Leadership Perspectives
- Innovation Insights
- Research
- Magazines
- News
- CXO Awards
Kristine Dudley, Esq., COO and co-founder and Rita M. Wilson, CEO and co-founderThe Centers for Medicare and Medicaid Services (CMS), which oversees the Medicare program, has a three-part compliance program for primary payers. First, it requires primary payers to report Medicare beneficiary individuals who file workers’ compensation, no-fault or liability claims, a process called Section 111 Mandatory Insurer reporting.
Second, CMS requires both the primary payers and the Medicare beneficiary claimants to reimburse Medicare for medical payments related to the claims; this is known as Medicare conditional payments. Third, it has a review program where an allocation, called a Medicare Set-Aside (MSA), to fund a portion of a workers’ compensation settlement for future medical expenses is reviewed and approved by CMS.
When investigating the MSP compliance provider landscape before starting Tower in 2010, Rita Wilson, Chief Executive Officer, and Kristine Dudley, Chief Operating Officer, found an industry dependent on a manual, very paper-intensive process of MSP compliance. For the most part, these companies also made little effort to mitigate costs of MSA allocations, and this prevented many workers’ compensation claims from settling.
Pairing Dudley’s legal background and understanding of MSP compliance with Wilson’s IT expertise, the women created an integrated technology platform to drive MSP compliance and MSA preparation processes. The platform provided clients end-to-end visibility from Section 111 reporting, through conditional payment resolution, and through Medicare Set-Aside and claim settlement- -something payers had never had before.
Tower’s MSP Automation Suite captures, stores and manages all data points and tracks and drives MSP compliance from the moment a Medicare beneficiary is identified. Easy integration with ANY claims system, including proprietary ones, allows Tower to smoothly onboard all types of clients and empowers these payers to overlay their custom business rules onto Tower’s operating protocols.
Every aspect of a claim, such as past, present, or future treatment, is taken into consideration to calculate the amount for an MSA, and the platform’s rules-based triggers escalate medical and pharmacy issues for review and interventions and prevent over-allocation of the MSA. In short, Tower’s MSP Automation Suite leverages automation until technology intersects with the need for expertise.
“Tower identifies all the treatment and legal barriers to settlement,” said Wilson. “With the payer’s authorization, we proactively apply interventions to resolve pharmaceutical, medical, legal, and jurisdictional issues before we prepare an MSA. This yields appropriate future care for workers’ comp patients, complies with CMS review policies, and facilitates closure.”
A common instance of MSA overallocation is for prescription medication that has been discontinued. The issue is fixed by contacting the treating physician to confirm if the drugs are still required as part of a beneficiary’s care. Tying up these loose ends, Tower identifies the smallest factors that can cause over-estimation of the MSA and mitigates or eliminates them prior to submission to CMS for MSA approval.
“In addition to monitoring external changes, our automated system also benchmarks every CMS MSA response against our internal best practices in MSA allocation,” said Tower COO Kristine Dudley. “This is done by reconciling every line item in every CMS response. Through this software module, we know exactly how we perform against CMS in pricing, frequency, life expectancy, etc. and can avoid overfunding when we initially draft the MSA.”
Tower identifies all the treatment and legal barriers to settlement,” said Tower CEO Rita Wilson. “With the payer’s authorization, we proactively apply interventions to resolve pharmaceutical, medical, legal, and jurisdictional issues before we prepare an MSA.
With a clear understanding of the importance of systems, software, and data to Tower’s business functions and a keen awareness of the reality of cyber threats in today’s digital environment, Tower has also taken major steps to develop its enterprise-wide security infrastructure to guard against, detect and mitigate cyberattacks. This includes partnering with a data security firm that monitors data traffic 24/7, responds to threats in real time, provides direction to keep client data secure, and gives Tower unlimited access to incident response resources if attacks occur.
“Tower completes an annual SOC 2 audit which again was unqualified in 2022,” 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.”
Carisk® Partners, Tower MSA Partners, and Ametros to Provide Patient-Centered Case Closure and Settlement Solution in Workers’ Compensation: Improves Quality of Life and Patient Engagement
Monday, October 30, 2023
MIAMI - Carisk® Partners, a specialty risk transfer and care coordination company, Tower MSA Partners, a settlement-focused MSP compliance company, and Ametros, a post-settlement medical administration company, are launching a novel, patient-centered case closure and settlement solution. The integrated program provides continuity in care and accurate medical cost projections while improving the settlement process for injured patients and workers’ compensation payers.
“We’re excited to partner with industry leaders Tower and Ametros on this innovative program that extends the trusted relationship built with the patient in our Pathways™ 2 Recovery program,” says Carisk CEO Joseph Berardo, Jr. “This bundled program benefits all parties by ensuring an accurate, fair and acceptable settlement and post-settlement experience for the patients we are entrusted to serve.”
As the patient approaches achievement of their care plan outcomes and goals, the Case Closure and Settlement Program introduces patient settlement resources delivered by Tower and Ametros into the Carisk Pathways™ 2 Recovery (P2R) process.
“Tower identifies all the treatment and legal barriers to settlement,” said Tower CEO Rita Wilson. “With the payer’s authorization, we proactively apply interventions to resolve pharmaceutical, medical, legal, and jurisdictional issues before we prepare a Medicare Set-Aside. This yields appropriate future care for workers’ comp patients, complies with the Centers for Medicare and Medicaid’s review policies, and facilitates closure. We are thrilled to overlay our settlement-focused workflow with Carisk and Ametros to create win-win outcomes for both payers and patients.”
Ametros advocates for Carisk patients during and after the settlement process, educating them about the multiple benefits available through professional administration of their MSA.
“Our mission is to help the injured person live a better life after they accept a settlement with an MSA. In addition to paying bills from their MSA, providing discounts on their treatments, and completing required CMS reporting, we have a Member Care Team to help them navigate the health care system after settlement every step along the way,” said Ametros CEO Porter Leslie.
This comprehensive solution extends patient advocacy for workers’ compensation patients whose cases Carisk manages during and after their claims settlements by ensuring that their future medical expenses are accurately covered and that the patients receive on-going support post-settlement. Working together, our Case Closure and Settlement Program accelerates claims closure, reducing payers’ claims portfolios, adjuster burdens, along with their medical, pharmacy, and indemnity costs.
Tower MSA Partners Announces Section 111 Reporting Audit Service to Help Workers’ Comp Payers Correct Systemic Issues and Avoid Penalties
Wednesday, May 15, 2024
DELRAY BEACH - Workers’ compensation payers have approximately six months to get their Section 111 reporting houses in order. Tower MSA Partners has introduced a Section 111 reporting audit service to help them do just that.
Starting October 11, 2024, workers’ compensation plans, liability insurance (including self-insurance, no-fault insurance), and Responsible Reporting Entities (RREs), and will be held accountable for the timely reporting of Medicare beneficiary claimants where ongoing responsibility for medicals (ORM) has been accepted, or where a Total Payment Obligation to the Claimant (TPOC) has occurred. Civil Monetary Penalties (CMPs) for untimely reporting of ORM acceptance or TPOC can be thousands of dollars on a single claim.
Tower’s Section 111 reporting audit service detects problems or potential problems in the RRE’s reporting processes that could lead to CMPs due to untimely reporting. It also addresses the issuance of unnecessary Conditional Payment Demands by Medicare’s recovery contractor that occur when ORM Term Dates are not reported as part of TPOC reporting.
“Our compliance experts examine a set of claim input and response and query response files over a set time period and review the organization’s reporting policies and procedures,” said Chief Compliance Officer Daniel Anders. “The audit detects the types of errors, inconsistencies and omissions that hinder compliance and could trigger a reporting penalty.”
Tower goes beyond just identifying problematic processes. Experts collaborate with the RRE to take corrective actions and implement changes to ensure compliance. “It’s not just a snapshot in time,” Anders said. “Changing processes fixes issues for the long term.”
Company
Tower MSA Partners
Management
Kristine Dudley, Esq., COO and co-founder and Rita M. Wilson, CEO and co-founder
Description
Tower MSA Partners works with employers, insurance carriers and third-party administrators to facilitate MSP compliance with all regulations, legislation and recommendations issued by CMS. Concurrently, the company supports client business objectives to close and settle claims in ways that balance care, cost and compliance. Tower provides services nationally and is a certified Women’s Business Enterprise (WBENC) that has successfully completed annual SOC 2 Type 2 audits.
