Highlights from the Benefits Coordination & Recovery Center (BCRC) NGHP Beneficiary Recovery Process Webinar

CMS, Conditional Payments, Medicare Secondary Payer Recovery Portal, Medicare Set-Aside Blog, MSP News on December 21, 2020
Posted by Shannon Flynn

On December 9, the Centers for Medicare & Medicaid Services (CMS) held a webinar focused on the Medicare Secondary Payer (MSP) recovery process when a Medicare beneficiary receives a settlement, judgment, award, or other payment. The Benefits Coordination & Recovery Center (BCRC) presented a refresher on the beneficiary recovery process, including what functions can be facilitated using the Medicare Secondary Payer Recovery Portal (MSPRP).

Key takeaways from the webinar:

  • Overview of MSPRP application
    • Using MSPRP to self-report, submit authorizations, dispute claims, submit settlements, initiate final conditional payment process, and more
    • Access to MSPRP for beneficiaries as well as for attorneys and representatives
  •    Self-Reporting via MSPRP
    • Beneficiaries/Representatives can use self-reporting option via the MSPRP, rather than via phone or in writing when a claim is made against liability insurance
    • Will result in the creation of a beneficiary debtor case
    • Specific information is required when reporting an incident pertaining to a liability, no-fault, or worker’s compensation claim including beneficiary info, case info, and representative info
    • If a self-report is submitted using the MSPRP, it should not also be reported to the BCRC via another method (call center, etc.) and vice versa
  • Authorizations
    • MSPRP prevents access to beneficiary’s info until they have provided authorization to CMS in writing. The two types of authorizations are:
      • Proof of Representation (POR) – gives another individual/entity authority to represent beneficiary (receive correspondence, dispute/appeal unrelated charges, submit waiver), allowed to receive all copies of correspondence
      • Consent to Release (CTR) – gives authority to receive and obtain info, but does not provide authority to act on beneficiary’s behalf
    • BCRC recommends uploading and submitting the proper authorizations via the MSPRP as soon as CMS is made aware of the case
  • Final Conditional Payment (CP)
    • Permits authorized users to obtain time and date stamped final conditional payment summary documents
    • Ensures that related disputes submitted through the MSPRP are addressed within 11 business days of receipt of dispute documentation (if settlement extends beyond timeframe of 120 days, then the case goes back to traditional process)
    • All final CP actions must be completed on the MSPRP
    • Final CP process can only be initiated once per case and disputes are limited to one per claim/line item (after one dispute, disputes can be submitted in writing, via traditional process)
    • Users are required to complete specific actions for the final CP process on the MSPRP
  • Demand Calculation Options (are subject to specific criteria, which is listed in the full presentation deck)
    • Self-Calculated Conditional Payment Amount – allows self-calculation of the demand amount before settlement in certain situations
    • Fixed Percentage Option – offers simple, straightforward process to obtain the amount due to Medicare (may be elected if certain eligibility criteria are met)
  • Electronic Payments
    • Authorized users of the MSPRP can make payments electronically on Non-Group Health plan debts to Medicare
  • View/Print Letters
    • Users who are logged in using the multifactor authentication option can view and print letters
    • Users can choose which correspondence, including all correspondence received and sent, just correspondence received, and/or just letters sent

Further details, specific presentation notes, and links to additional resources can be found in a PDF copy of the presentation slides on the CMS website.

For questions or concerns regarding the Conditional Payment process or Medicare Secondary Payer (MSP) recovery process, feel free to reach out to a member of our team at info@medval.com.