Recap: CMS Intro to Medicare Secondary Payer for Beneficiary Representatives Webinar

by M. Heberling

Updated: 04/07/25

– CMS provided a link to slides from their Introduction to Medicare Secondary Payer for Beneficiary Representatives webinar on March 27 on the What’s New page of the Coordination of Benefits & Recovery area of CMS.gov.

On March 27, 2025, The Centers for Medicare & Medicaid Services (CMS) hosted a webinar for beneficiary representatives. CMS defined beneficiary representatives as those individuals who help beneficiaries address Medicare’s interests, primarily Medicare’s recovery interests. CMS presenters included Jacqueline Cipa, Brian Broznowicz, Kaisha Graves, Meagan Bradley, and Angel Pagan.

CMS began by defining basic Medicare Secondary Payer (MSP) terminology, such as primary payer, secondary payer, and coordination of benefits, with the goal being to acquire information necessary to determine which entity pays first. These entities could include group health plans, self-insured employers, liability insurance, no fault insurance, and workers’ compensation insurance. CMS has the right to recover Medicare payments made mistakenly, or conditionally, when payment was the responsibility of one of these entities as primary payer.

CMS noted that MSP provisions are federal law, whereas many health insurance products and non-group health plans are based on state law. Where conflict exists between federal and state law, federal law takes precedence.

CMS identified the two contractors responsible for coordination of benefits and recovery efforts – the Benefits Coordination and Recovery Center (BCRC) and the Commercial Repayment Center (CRC). Beneficiary representatives most likely interact with the BCRC, while insurance entities typically see recovery efforts being made through the CRC.

CMS discussed the process that occurs after an accident, illness, or injury. Notably, the fact that a medical provider is required by law to determine the primary payer before they can submit a bill to Medicare. If this is not determined promptly, then it is possible for the provider to bill Medicare, who will make a payment on the condition that Medicare will eventually be reimbursed by the primary payer (once identified).

In our industry, we often focus on reporting and conditional payment negotiation efforts being made through the insurer. However, beneficiaries can also report injury/accident-related information directly to the BCRC to help facilitate the coordination of benefits. If a beneficiary reports this information, a case will be created and a rights and responsibilities letter issued to the beneficiary. Beneficiaries are required to submit one of two forms – either a Proof of Representation or Consent to Release form that authorizes their attorney or representative to speak with the BCRC on their behalf or the Proof of Representation form, which is a more comprehensive authorization, allowing for the beneficiary’s representative to speak on their behalf AND make decisions on the file.

During the webinar, CMS spent significant time reviewing the conditional payment recovery process, including how they inform beneficiaries and their representatives about possible conditional payments, as well as dispute and appeal processes and timeframes. They indicated that detailed information on the levels of appeal and information/determinations subject to appeal are available in the NGHP MSP beneficiary reference guide.

Of note, beneficiaries also have the option of requesting that Medicare waive their recovery due to fraudulent activity if repaying the money would cause financial hardship or otherwise be unfair. Beneficiaries can also make a separate compromise request, asking Medicare to accept less than the amount owed. However, the BCRC does not have the authority to approve or deny compromise requests, so they are forwarded to CMS for review.

CMS concluded the session by encouraging beneficiaries and their representatives to make use of the Medicare Secondary Payer Recovery Portal (MSPRP) to submit authorization documents, request conditional payment information, dispute claims, initiate demand letters, submit case information, make waiver and compromise requests, self-report cas7es, and make payments.

If you have any questions about the topics covered during the webinar, please contact our Settlement Consulting team at [email protected].