If your client is a Medicare beneficiary and Medicare paid for any injury-related care, Medicare must be repaid from the recovery. Those payments are called conditional payments. Getting this wrong can delay disbursement for months and add interest. This guide maps the process PI staff manage day to day, with the deadlines CMS publishes.
1. Who handles what: BCRC, CRC and the old "MSPRC"
Many firm templates still say "MSPRC" (Medicare Secondary Payer Recovery Contractor). Recovery work for cases where Medicare pursues the beneficiary is now handled by the BCRC. Update your letter templates and contact sheets. When Medicare pursues the insurer or workers' compensation entity directly, the Commercial Repayment Center (CRC) sends the correspondence and copies the beneficiary and attorney.
BCRC customer service: 1-855-798-2627 (TTY 1-855-797-2627), Monday–Friday, 8 a.m.–8 p.m. Eastern, per CMS's contacts page.
2. Reporting the case
CMS says beneficiaries, through their attorney or otherwise, must notify Medicare when a claim is made against a liability insurer (including self-insurance), no-fault insurer or workers' compensation. Report through the MSPRP or by contacting the BCRC. Have this ready:
- Beneficiary: full name, Medicare number, gender and date of birth, address and phone
- Case: date of injury, description of the alleged injury, claim type, insurer name and address
- Attorney: firm name, address and phone, plus proof of representation
The BCRC then issues a Rights and Responsibilities letter to all parties on the case.
3. The letters, in order
| Letter | What it means | Staff action |
|---|---|---|
| Rights & Responsibilities | The case is set up at the BCRC. | Confirm proof of representation is on file. Calendar the CPL follow-up. |
| Conditional Payment Letter (CPL) | Interim itemized list of claims Medicare paid. | Compare each line to the injuries, and dispute unrelated claims. |
| Conditional Payment Notice (CPN) | Issued instead of the usual CPL in some cases, such as when the BCRC learns of a settlement first. | Respond within 30 days with proof of representation, settlement documents, any unrelated-care proof, and procurement costs. |
| Final Demand | Issued after the BCRC gets settlement information. It reflects the procurement-cost reduction. | Pay within 60 days of the letter date, or appeal or request a waiver in time. |
Interest: per CMS, interest accrues from the demand letter date but is assessed only if the debt is not resolved within 60 days. It is charged for each full 30-day period, and payments are applied to interest first. Interest is assessed even while an appeal or waiver request is pending. Paying on time and seeking a refund if you win is the only way to avoid it.
4. Demand-calculation options for liability cases
Final Conditional Payment process (MSPRP only)
- Notify the BCRC on the MSPRP that the case is within 120 days of settlement. This can be started only once per case.
- Disputes submitted on the MSPRP are addressed within 11 business days, and only one dispute is allowed per claim or line item.
- Request the final conditional payment amount within 120 calendar days of starting the process, then settle within 3 business days of requesting it.
- Submit settlement information on the MSPRP within 30 calendar days of requesting the final amount. Missing any step voids the process.
Self-Calculated Conditional Payment Amount
- The injury must be caused by physical trauma, not exposure, ingestion or implant.
- Treatment must be complete, with no further care expected and none for at least 90 days before submission. A physician's or beneficiary's written confirmation is required.
- The total settlement must be $25,000 or less, and the incident at least six months before submission.
- You give up the right to appeal the amount or existence of the debt, but keep the right to seek a waiver.
Fixed Percentage Option
- Medicare is repaid a flat 25% of the gross liability settlement, which is not reduced for attorney's fees and costs.
- Requirements: a physical-trauma injury, a total settlement of $10,000 or less, no Medicare demand already issued, and no other related settlements received or expected.
- Elect it before or when settlement documents are submitted. If a CPN was issued, elect it by the CPN response date (30 days).
5. Procurement costs
Medicare's recovery is generally reduced to share the procurement costs (attorney's fees and costs) the beneficiary paid to obtain the settlement. The rule is in 42 CFR 411.37, and the reduction appears on the final demand. Send a fee and cost breakdown with the settlement information.
6. Medicare checklist for PI staff
- Ask every client at intake whether they have Medicare (Part A/B or a Medicare Advantage plan), and copy the card
- Report the case on the MSPRP or to the BCRC, and save confirmation
- Upload proof of representation
- Calendar a follow-up if no CPL arrives
- Line-by-line relatedness review before the demand goes out, with disputes filed on the MSPRP
- Choose a calculation option with the attorney before settlement
- Send settlement documents and the fee/cost breakdown promptly after settlement
- Hold the final demand amount in trust and pay within 60 days
- Medicare Advantage (Part C) plans pursue recovery separately. Request their lien directly.
Sources
Official sources reviewed October 28, 2026. Always check the current version before relying on it.