The Centers for Medicare & Medicaid Services (CMS) has a web portal called the Medicare Secondary Payer Recovery Portal (MSPRP) used by settling parties or those with authorization, to investigate and confirm the dollar amount of injury related medicals paid by Medicare. When Medicare makes injury related payments for medical items and services prior to a judgment, settlement, award or other payment to a Medicare beneficiary, those payments are called conditional payments and need to be reimbursed to Medicare, or otherwise resolved via lien resolution. CMS uses its Benefits Coordination and Recovery Center (BCRC) contractor to both gather information about claims and their pending resolutions from beneficiaries and carriers and to most often pursue collection of the Medicare beneficiaries for recovery of conditional payments contemplated to be paid back pursuant to the Medicare Secondary Payer Act (MSP). CMS uses its Commercial Repayment Center (CRC) to develop recovery cases against commercial entities that are primary to Medicare under the MSP including both Group Health Plans (GHPs) and Non Group Health Plans (NGHPs). An entity classified under the NGHP designation would include any liability insurance plan including an auto-insurer or a self-insured entity, a workers’ compensation plan, or a no fault insurer.
Therefore, parties involved in resolving liability, workers’ compensation or no fault claims should continue to focus their attention on and use the MSPRP. This July, CMS released an updated version of the MSPRP User Guide (Version 4.2) after increasing the functionality of the portal to help provide a more efficient process for both beneficiaries and insurers (and respective representatives/recovery agents) to obtain updated conditional payment information. Changes to the MSPRP, discussed in a CMS webinar on August 16, 2018, included allowing authorized persons/entities access to view correspondence sent and received on files in chronological order, to request electronic or paper copies of conditional payment correspondence, to confirm primary diagnosis codes on payment summary forms, and to even request a waiver for lien resolution (only after a recovery demand has been issued) and/or file a first level appeal concerning a determination of the conditional payment amounts to be reimbursed to Medicare. Future enhancements to the MSPRP may include a more convenient way for Medicare beneficiaries or authorized agents to notify the BCRC of pending cases and a way to make conditional payment reimbursements via the portal.
For cases that arose prior to October 1, 2015 and anytime that a backlog may exist, the BCRC also may pursue collections from commercial entities for recovery of conditional payments. For example, the BCRC is currently helping the CRC contractor, Performant Recovery, Inc. with a backlog it inherited when it took over the CRC contract from CGI in February of 2018. While slightly confusing, case numbers are based on what entity sends the letter instead of based on the type of case. Therefore, the BCRC uses its traditional numbering system for all of its cases regardless of whether it is pursuing a beneficiary or a commercial entity, so it is important to pay attention to who sends the letter and what the letter is requesting, instead of concentrating on the case number. The entity that sends the letter is the entity to which you should address responses and follow up correspondence. The CRC on the other hand, is solely focused on commercial collections. When the CRC initiates a NGHP collection, the MSPRP is the web portal to access to check on the conditional payment reimbursement.
CMS recently announced that it will host a webinar providing an overview of the functions of a currently existing web portal called the Commercial Repayment Center Portal (CRCP) that involves claims outside the NGHP scope. While the CRCP involves the CRC, this upcoming CMS webinar (September 19, 2018) only pertains to CRC’s recoveries in the Group Health realm. There has been no indication from CMS that the CRCP functions would or even might be expanded to accommodate CRC collections for NGHP matters that will instead remain with the MSPRP.
In addition to the authorization backlogs referenced above, there seems to have been a delay in obtaining conditional payment amounts in writing from the new CRC contractor via phone communication or traditional written correspondence. Hopefully, the updates to the MSPRP web portal will begin to help alleviate some of the delays that have been experienced by prospective settling parties by allowing for timely electronic confirmation of receipt of authorizations and access to updated conditional payment information.
 All authorizations are forwarded to the BCRC. Authorization for a Medicare beneficiary will typically require a Proof of Representation form signed by the Medicare beneficiary (or someone legally authorized to act on their behalf if they are incapacitated) in favor of the representative along with written documentation from the attorney for the Claimant/Applicant/Plaintiff documenting the chain of representation and intent for the representative to be able to transmit and receive information and act on behalf of the beneficiary for CMS purposes. Authorization for a commercial entity will typically require a Consent to Release form signed by the Medicare beneficiary and a Letter of Authority from the commercial entity/carrier demonstrating the intent for the representative to be able to openly communicate and act on the commercial entity’s behalf with CMS via a “two-way street”.
 42 U.S.C. § 1395y(b)(2) et. seq.
 Jacqueline Cipa, Department Director, Division of Medicare Secondary Payer (MSP) Program Operations for CMS, explained in a presentation at the Workers’ Compensation Institute (WCI) annual conference in Orlando in August 2018 that there is a backlog for confirmations of receipt of authorization documents at the CRC of up to 45 days.