CMS Proof of Representation and Consent to Release
Guidance for Proof of Representation required for the Benefits Coordination and Recovery Center (BCRC) to communicate with and provide information to an attorney that represents a Medicare beneficiary.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 16, 2019
Proof of Representation is required for the Benefits Coordination & Recovery Center (BCRC) to communicate with and provide information to an attorney that represents a Medicare beneficiary. Once the BCRC has the appropriate documentation, it can communicate with the attorney and act upon requests made by the attorney on behalf of the beneficiary. This includes furnishing conditional payment information and/or a recovery demand letter as well as addressing questions regarding the specific claims included in the conditional payment information, appeal requests, or waiver of recovery of overpayment requests. Note: A Subpoena Duces Tecum is not needed to obtain these documents when a valid Proof of Representation and or a Consent to Release is on file.
A “Consent to Release” document is used by an individual or entity that does not represent the beneficiary but is requesting information regarding the beneficiary’s conditional payment information. “Consent to Release” does not authorize the individual or entity to act on behalf of the beneficiary or make decisions on behalf of the beneficiary.
Additional information, including a Proof of Representation vs. Consent to Release (POR vs. CTR) presentation, may be obtained by clicking the Medicare’s Recovery Process link. Proof of Representation Model Language and Consent to Release Model Language prepared by CMS may also be accessed by clicking the Medicare’s Recovery Process link.
Deceased Beneficiary
If a resolution of the Medicare Secondary Payer recovery claim is not reached before the death of a beneficiary, new Proof of Representation on behalf of the beneficiary’s estate must be submitted. If there is no will or formal estate, the document or documents must be signed by an individual who is entitled under state law to pursue the applicable claim. For additional details, please refer to the Proof of Representation vs. Consent to Release (POR vs. CTR) presentation which can be accessed by clicking the Medicare’s Recovery Process link.
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