Medicare Summary Notices: Understanding claims and catching waste
May 1, 2018
Medicare Summary Notices (MSNs) are a great tool for beneficiaries and I highly recommend learning how to read them. They may appear a bit intimidating at the outset, but once you learn how to review them, they can be very helpful in understanding how your medical claims have been processed and how much you may owe after your insurance has paid their part. Additionally, these documents are invaluable in helping beneficiaries catch any errors, abuse or fraud. Let’s walk through the MSN together (feel free to use your most recent MSN to refer to while reading this article).
First of all, a Medicare Summary Notice (MSN) is not a bill. It is a statement that you will receive if you have Original Medicare (Part A; Hospital and/or Part B; Medical) coverage. It is a summary of all of the services and products that you have received during the past three months and provides you with information on how those claims were paid. You will receive these statements quarterly and you will get separate MSNs for Part A and Part B if you have had claims filed under both. They will show you how much was billed to Medicare, how much Medicare paid and the amount for which you may be responsible.
The name of the company that processes your claims for Medicare may be on the envelope of your MSN. In Alaska, that company is Noridian Healthcare Solutions.
If you have not received healthcare within the three months covered by the MSN, you will not receive one. If you have received healthcare services or products, but have not received an MSN, call 1-800-MEDICARE and request one be mailed to you. You can also check your claims online at your own confidential website at http://www.mymedicare.gov. The online site has the capability to download the claim information so that you can print it.
Page one of the MSN is referred to as the “Dashboard” and offers several pieces of information. First, verify that the MSN has the Department of Health & Human Services (DHHS) logo displayed. Check your name for accuracy and correct spelling. The notice will show the last four digits of your Medicare claim number, the date your MSN was printed and the dates covered by this statement. You will be able to see your current Part B deductible status on Part B MSNs. Displayed will be the total of how many claims have been processed for you and if Medicare approved all of the claims. It will display the total amount that you may be billed along with a list of all of the providers that billed Medicare on your behalf.
Page two has six sections that help make the most of reading your MSN. These include reminders on how to review the notice, how to report fraud if you suspect it, how to get help with questions, a reminder about preventive services offered by Medicare and messages from Medicare to you.
Page three begins the breakdown of how each claim was processed and paid. It will provide each provider’s name, address, phone number, date of service, service or product being billed, if the service was approved, the amount the provider charged, the Medicare approved amount (that is the amount that Medicare has agreed to pay for that service or product), the amount Medicare paid, and the maximum amount you may be billed.
The final column is very helpful. Titled “See Notes Below”, you may notice letters A, B, C etc. that will direct you to a key at the bottom of the page. Here you will find information that provides further details about the claim. This is where you find explanations as to why Medicare may have denied a claim, if the claim was sent to a secondary payer and the name of that insurance, and so forth.
The final page of the MSN gives you details on how to handle denied claims and the steps in how to file an appeal. If you would have questions about reading your Medicare Summary Notice or about a claim that was processed, you can call 1-800-MEDICARE or the Medicare Information Office for the State of Alaska at 1-800-478-6065.
You can catch fraud
The Centers for Medicare & Medicaid Services (CMS) estimates that the Medicare system loses approximately $60 billion to errors, abuse and fraud each year. Medicare beneficiaries are uniquely positioned to catch much of this waste. The Senior Medicare Patrol (SMP), the volunteer-based program focused on educating Medicare beneficiaries about fraud, recommends keeping a Personal Healthcare Journal – essentially a list of all provider appointments. Document the date, the provider seen, the type of treatment received, and if you paid any amount up front.
When your MSN arrives, carefully check to see if the information on it aligns with your journal. If there is an inconsistency or you have questions about a claim, first contact the provider. If after speaking with the provider, you feel the issue is unresolved, contact 1-800-MEDICARE or in Alaska, the Medicare Information Office at 1-800-478-6065. There is a reward system in place if a beneficiary reports a fraudulent billing that results in a conviction.
Understanding how to read the Medicare Summary Notice is a valuable skill in helping you get the most out of your Medicare benefits and protecting the Medicare system.
Nila Morgan is a Certified Medicare Specialist who works at the Anchorage Senior Activity Center.