DELRAY BEACH, Fla.--(BUSINESS WIRE)--Workers’ compensation payers using Tower MSA Partners’ Pre-MSA Triage have seen their Medicare Set-Aside allocations dramatically reduced.
Tower’s Pre-MSA Triage analyzes medical and pharmacy records, identifies unnecessary, inappropriate, cost-driving treatment and recommends interventions to improve patient and financial outcomes. The service ensures that MSAs include only accurate and appropriate medical and pharmaceutical allocations.
“Triage projects the cost of a potential MSA and gives clients ways to reduce the costs before preparing the actual MSA,” said Tower CEO Rita Wilson.
Inappropriate prescription drug use is among MSA cost drivers. In one case, Tower’s Pre-MSA Triage projected an initial MSA cost of $1,300,000. It showed that long- and short-acting opioids extended over the 46-year-old’s lifetime accounted for more than $1,000,000. Tower’s physician peer review secured the treating physician’s agreement to wean the patient, and its clinical oversight program monitored the weaning and obtained written confirmation of the discontinuation of opioids. CMS approved the MSA for $210,641.
Tower’s Pre-MSA-Triage saved $179,000 by confirming that the drug, Lyrica, was being prescribed off-label and should not be included in the MSA. “Although the carrier had been paying for Lyrica, this off-label use did not meet the criteria for a Medicare-covered diagnosis,” Wilson said. The MSA was prepared, submitted and approved for $83,000.
In another case, more than $210,000 of a $239,006 projected MSA was due to medication costs, including prescriptions no longer being filled. “We believed the medications were no longer necessary and should be discontinued,” Wilson said, “but without proper documentation and the correct MSA language, they would have been included in future treatment and costs.”
About Tower MSA Partners
Headquartered in Delray Beach, Fla., Tower MSA Partners’ services include pre-MSA Triage, MSAs, physician peer reviews, conditional payments, Section 111 reporting, CMS submissions, MSA administration, medical cost projections, and life care plans. With more than 50 years combined experience in pharmacy, legal oversight and medical care, Tower proactively stages claims, working collaboratively with clients to identify issues and intervene to modify outcomes. Tower remains involved in the claims, through final resolution, MSA and/or other settlement. This model enables Tower’s clients to provide better care to injured workers, reduce claim and MSA costs, and obtain CMS acceptance of the MSA. For more information, visit www.towermsa.com and www.mspcomplianceblog.com.
