CMS Discusses General MSP Recovery Issues on its “MSP Intro” Webinar

April 3, 2025 / 7 min read

On March 27, 2025, the Centers for Medicare and Medicaid Services (CMS) held an “Introduction to MSP for Beneficiary Representatives Webinar.” As part of its webinar announcement, CMS noted that the intent of this webinar was “to support the attorney and beneficiary representative communities and review the basics of MSP, Group Health vs. Non-Group Health Coordination of Benefits, and MSP recovery.”ⁱ

reviewing documents on a laptop

Overall, CMS focused primarily on Medicare conditional payment recovery issues from the claimant/beneficiary (and their representative) perspective regarding NGHP claims. As outlined below, CMS addressed such issues as how its conditional payment process works, how to dispute CMS’s recovery claim, and the use of the Medicare Secondary Payer Recovery Portal (MSPRP). Of note, CMS did not discuss MSP compliance issues or its recovery process from the insurer or primary payer perspective as part of this webinar session.

The authors attended this webinar and provide the following general overview of the key points discussed by CMS related to NGHP compliance matters as follows:

Conditional Payment Recovery

CMS began the webinar with a brief overview of common MSP terms and Medicare’s Coordination of Benefits (COB) processes but noted the webinar would be primarily focused on non-group health plan (NGHP) recovery (which, as noted above, is the focus of this summary).

In this regard, CMS noted that NGHPs include liability insurers (including self-insured entities), no-fault insurers, and workers’ compensation entities. CMS further noted that as the webinar was intended as an introduction for attorneys and other Medicare beneficiary representatives, the session would focus mainly on Medicare’s Benefits Coordination and Recovery Center (BCRC), which is the contractor that handles Medicare conditional payments when recovery is sought from the claimant/Medicare beneficiary. CMS indicated that while its other contractor, the Commercial Repayment Center (CRC), handles conditional payment recovery against group health plans (GHPs) and NGHP insurers, it is possible that CMS may also send correspondence to claimants/beneficiaries and their representatives, although, in general, these parties typically do not interact with the CRC.

CMS recommended that when a claimant/beneficiary suffers an injury or illness for which another primary payer may have responsibility for medical treatment, he/she, or their representative, should report the claim to Medicare to initiate the conditional payment process. Claims can be reported to the BCRC by phone, fax, mail, or the MSPRP and, once a case is created, a Rights and Responsibilities (RAR) letter would be issued to the claimant within 15 days. For a more detailed overview of the MSP recovery process, please see CMS’ website.

Authorizations

CMS discussed its various authorizations related to its recovery process and noted that neither CMS nor its contractors can share personally identifiable information (PII) or personal health information (PHI) without proper authorization. Accordingly, CMS noted that it recognizes two types of authorizations for BCRC recovery against the claimant/beneficiary as follows:

Consent to Release (CTR): This authorization allows an authorized party to receive copies of Medicare correspondence but does not allow the entity to make decisions on behalf of the claimant/beneficiary, such as filing a dispute.
Proof of Representation (POR): In contrast to the CTR, CMS explained that a POR allows an authorized party to receive copies of Medicare correspondence and to make decisions on behalf of the claimant/beneficiary, including filing disputes.

Further information on this topic can be found on CMS’ website.

Conditional Payment Correspondence Types

CMS then provided a general overview of the different types of conditional payment correspondence issued by the BCRC as part of its recovery activities as follows:

Conditional Payment Letter (CPL): CMS stated that a CPL is issued within 65 days once a BCRC recovery case is created if a settlement has not been reported. CMS explained that a CPL will be sent to all authorized parties and will include a list of medical treatment paid by Medicare, to date, which Medicare believes to be related to the incident. CMS also noted that a CPL is an interim statement rather than a bill, CPLs can be disputed, and that updated CPLs can be requested until a claim settles.
Conditional Payment Notice (CPN): CMS indicated that a CPN is issued when the BCRC is notified of settlement before a case is created. CMS explained that the CPN is similar to the CPL in that reimbursement is not being sought and a list of the treatment Medicare believes to be related to the incident is included. However, in contrast to a CPL, CMS noted that a CPN has a due date giving the claimant/beneficiary and their representative 30 days to respond with a dispute. If no dispute is received, a demand will be issued.
Demand: CMS indicated that upon notification of settlement, or if no response is received within 30 days of the issuance of a CPN, the BCRC will then issue a demand for reimbursement. This demand would: include a list of the medical treatment Medicare is seeking reimbursement for, indicate the amount of money owed to Medicare, include instructions for payment as well as the interest rate if interest accrues, and include information on the claimant/beneficiary’s appeal and waiver rights. CMS also noted that if not resolved, a demand could be referred to the Department of Treasury for collection.

Additional detail regarding BCRC recovery can be found on CMS’ website.

Challenges to CMS Recovery Claims

CMS noted that there may be instances where CMS’s recovery efforts can be challenged by the parties and that there are dispute and appeals processes that are available to claimants/beneficiaries and their authorized representatives. For example, CMS indicated that if a claimant/beneficiary or their representative believes that treatment listed on a CPL or CPN is unrelated to the claim, a dispute can be submitted by the parties outlining what treatment is being disputed and including any relevant supporting documentation. CMS also stated that the BCRC would provide a response within 45 days.

Once a demand is issued, CMS noted that there is a formal appeals process which allows claimants/beneficiaries and their representatives to appeal the existence of the debt and the amount of the debt. CMS stated that the parties must start at the first level of appeal and work their way through the various levels of appeals sequentially, ensuring they are meeting all filing requirements, including any applicable timeframes. For additional information regarding appeals, please see CMS’s website.

Waiver and Compromise Requests

CMS noted that, in addition to the formal appeals process, claimants/beneficiaries may request that CMS waive or compromise their recovery. On this point, CMS stated that if a request that Medicare waive recovery of the demand in full of in part is received, the BCRC would issue SSA form 632 to the claimant requesting additional information (such as the claimant assets, income, expenses, and reasons why the waiver should be granted) to allow review of the waiver. If the BCRC is unable to grant a request for a waiver, a decision will be issued including appeal options. In addition, CMS stated that compromise requests, where a party is requesting that Medicare accept less than the amount owed, are handled by CMS directly, potentially in consultation with the Department of Justice for higher-value debts. More detail about waiver requests can be found at CMS’s website.

Medicare Secondary Payer Recovery Portal (MSPRP)

Throughout the webinar, CMS made several references to the use and functionality of the MSPRP, CMS’s web-based tool designed to assist in the resolution of NGHP recovery cases. On this topic, CMS noted that Medicare beneficiaries can access the MSPRP through their medicare.gov account and that attorneys can register for access through the MSPRP directly. Depending on authorization and case status, users of the MSPRP may be able to take several different actions on a case, including:

Access and update certain case specific info online
Submit authorizations
Request conditional payment information
Dispute claims
Initiate demand letters
View the status of submitted correspondence
Submit settlement information
Submit waiver and compromise information
Self-report cases
Make electronic payments

Further information about the MSPRP can be found on CMS’s website.

Additional Resources

At the conclusion of the presentation, CMS indicated that additional resources regarding MSP, NGHP recovery, and the MSPRP can be found at CMS’s website. Additionally, CMS stated that the presentation would be posted to CMS’s website within the coming weeks. The reader should monitor CMS’s website to determine when CMS posts its presentation.

Questions?

Please do not hesitate to contact the authors if you have any questions regarding the above or how Verisk can help you address MSP compliance issues.