TOWER MSA PARTNERS WAS CREATED BY TWO ENTREPRENEURS:  The company was founded in 2011 by Rita M. Wilson, who had an extensive pharmacy and technology background, and Kristine M. Dudley Esq, who had several years of experience practicing workers’ compensation law. Daniel Anders joined their company in 2016 and is their Chief Compliance Officer. He was previously an attorney who worked for a law firm specializing in workers’ compensation. He was very impressed by their company and their ongoing pursuit of improving the Medicare process. The purpose was to help their clients comply with Medicare Secondary Payer (MSP) compliance and provide Medicare Set-Aside (MSA) services while simultaneously being cost-effective. The MSA process can be very complicated and can delay claim settlements.

MEDICARE SET-ASIDE COMPANIES SATURATED THE MARKET WHEN TOWER MSA PARTNERS WAS FOUNDED: What made them different from other companies was that they implemented technology into the MSA process, along with pharmacy benefit management experience. They recognized that the MSA process was labor intensive. By introducing technology into the mix, they created a company that made the MSA process more efficient and accurate for their clients.

WHEN DO YOU NEED AN MSA? The first step in determining if a MSA is needed is if you require a settlement. A settlement for MSA purposes means that medical is going to be closed out. If medical is not going to be closed, then a MSA is not needed. The second step is to determine if the medical care has stability. If an injured worker just had surgery, they are not medically stable. Their pharmacy needs and medical care cannot be determined accurately. Once the injured worker’s care has leveled off or is determined to be at Medical Maximum Improvement (MMI), that is the optimal time to look at a MSA. If a MSA is completed too early, the allocation for the MSA could be excessive, which could negatively affect the injured worker’s settlement.

THE DIFFERENCE BETWEEN A SUBMIT AND A NON-SUBMIT MSA:  The decision to submit or non-submit a MSA is a voluntary process. A non-submit MSA is when the allocation is done without Medicare’s approval. Medicare only allows a MSA submission if the injured worker meets certain criteria: an injured worker that is a Medicare beneficiary, and the total settlement exceeds $25,000.00, or someone who has a reasonable expectation of Medicare eligibility in the next 30 months, and the total settlement exceeds $250,000.00. Other circumstances would make an injured worker Medicare eligible, and all documentation must be presented to avoid rejection on a MSA submission to Medicare. Tower MSA Partners makes the process of submitting and non-submit MSA accurate and easier for their clients. When all medical records, pharmacy history, and information are correct, a MSA submission is usually approved in about two weeks.

IF YOU HAVE QUESTIONS, THEY WANT YOU TO REACH OUT: The best part is that questions are free! They recognize that the process can be very confusing, and they love making the process a smooth one. They offer other services, such as their Physician Follow-Up Service, when they will look at the medical records and review to see if the injured worker still needs the listed medications or suggested surgeries in the MSA. If the injured worker has changed medications or no longer requires the recommended surgery, they will request a statement from their treating physician listing the amended treatment plan and will send it to Medicare for approval. For further information or to ask a question, go to www.towermsa.com.