CMS Pub. 100-04, ch. 29, § 270.3

Requirements with Respect to the Appointment of Representatives

(Rev. 4278, Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19)

The following instructions/rules apply with respect to MSP recovery claims, not withstanding any language

to the contrary in other subsections of “Section 270 Appointment of Representative.”

For a MSP recovery claim involving a beneficiary debtor, the representative relationship typically arises in

the context of the beneficiary’s claim against a workers’ compensation plan, liability insurance (including

self-insurance), or no-fault insurance. The representative is not hired solely to represent the beneficiary with

respect to the recovery demand letter/debt at issue on appeal; the representative is routinely hired in

connection with an underlying liability, no-fault or workers' compensation claim.

For MSP recovery claims involving a debtor other than a beneficiary or a provider/supplier, follow the

instructions in the MSP IOM, Pub. 100-05, Chapter 7, section 10, regarding authorization to represent a

debtor. For MSP recovery claims involving a provider/supplier debtor, follow the instructions for non-MSP.

The instructions below contain exceptions or additions to the non-MSP rules for MSP recovery claims

involving a beneficiary debtor.

A. Appointment of Representative

For MSP recovery claims involving a beneficiary debtor, the representative relationship may be established

in the following ways (the document must always include the beneficiary’s Medicare number as well as

his/her name):

1. If the representative is an attorney, by:

• A copy of the fee agreement between the beneficiary and the attorney, signed by the beneficiary

and signed/countersigned by the attorney,

• A statement on the attorney’s letterhead accompanied by a release signed by the beneficiary, or

• A document compliant with the non-MSP rules.

2. If the representative is a non-attorney, follow the non-MSP rules. However, note that information

may be released to a non-representative regardless of whether or not there is a proper appointment of

representative if the individual or entity has a proper HIPAA compliant release from the beneficiary.

B. Duration of Appointment

The duration of the appointment lasts until revoked by the beneficiary absent specific language in the

appointment document limiting the duration of appointment. This is true regardless of whether or not an

appeal has been filed within 1 year of the date of the appointment.

C. Correspondence

Both the beneficiary and the representative shall receive copies of all correspondence (including all appeals

determinations).

D. Death of a Beneficiary

The death of the beneficiary terminates the authority of any representative appointed by the beneficiary.

The representative must obtain a new appointment from the beneficiary’s estate or the individual assuming

responsibility for the estate if there is no formally appointed executor.