Explaining the Medicare Summary Notice
When you are enrolled in Medicare, and you receive health services, the health care provider directly bills Medicare. The Medicare program pays your health care provider for her services. You then receive a Medicare Summary Notice (MSN), describing the services and cost of service. The MSN is a not a bill to you, but you should spend some time reviewing the information, nonetheless.
The MSN statement can provide you with the information to track your out-of-pocket charges for health services. Additionally, you can help combat fraud and catch errors by carefully reviewing your MSN.
What is a Medicare Summary Notice?
The Medicare Summary Notice contains a summary of your benefits for Medicare, including Part A, Part B and Part C. In mid-2013, the federal government redesigned the Medicare Summary Notice. Based on the results of a study of Medicare recipients, several changes were made that make the MSN easier to read and understand. Your prescription drug coverage is summarized in a separate document known as the Part D Explanation of Benefits (EOB).
The following image will illustrate what the newer Medicare Summary Notices look like as compared to the older versions. Click on the image to enlarge it:
If you would like to be able to download the full document provided by the Centers for Medicare and Medicaid Services (CMS), you can do that by clicking on Medicare Summary Notice Download at Medicare.gov.
The Medicare Summary Notice is a clear, summarized snapshot of recent claims to your Medicare account. Each notice includes your deductible status, a list of health care provider visits for the quarter, as well as the status for each claim. The MSN also includes a section describing how to spot and report potential fraud and a section providing instructions for appealing a claim. And, MSN statements include definitions and clear instructions for procedures and descriptions; they’re provided in large type, as well.
Reviewing your Medicare Summary Notice
You will receive your Medicare Summary Notice four times per year, once each quarter in which you receive health care services. This means that about every three months, you will receive your MSN, if you have received service during that quarter. If you do not receive medical services during a particular quarter, you will not receive an MSN statement for that quarter.
You can also view an up-to-date, digital version of your MSN at MyMedicare.gov. Your information is available approximately 24 hours after the claim is processed to your account. Use your statement to verify the charges to your Medicare account. You can also use the site to request a paper copy of your statement.
Verify your Medicare statement
To review your MSN, first, gather all receipts and paperwork from any healthcare services you have recently received. Next, sit down with the paperwork and the MSN and compare codes and charges. The charges and codes, though they may not be identical, should be similar enough to understand if the charge is valid. A quick conversation with your provider should clarify any questions you may have.
Follow up on unfamiliar charges
With Medicare, honest billing errors sometimes do occur. So, do not be surprised if you find a line item that looks a bit suspicious. Unfortunately, fraud also occurs, so be sure to highlight any charges that appear on your statement that may be questionable. In some cases, your MSN will include services that were billed after a care visit, or your summary may include charges you were unaware of at the time of service. Follow up with your provider to discover the reason for the charge, and request copies of paperwork for the charged services.
Follow up on items not covered
If there are charges that are not covered by Medicare listed on the MSN, and you believe these charges should be covered, contact your healthcare provider’s office. Billing personnel can assist you with your questions about qualified charges.
If Medicare has denied a claim that you believe should be covered, you can appeal the decision if your case falls into one of three categories:
1.) If you received a service from your healthcare provider, and the claim was denied by Medicare as an unnecessary service, you can appeal this decision.
2.) If you or your doctor has made a specific request for a healthcare service or product, you can appeal this decision. For example, if your doctor recommends a certain wheelchair for your lifestyle, but Medicare denies the charge for the equipment because the chair was deemed unnecessary, you can appeal.
3.) If you or your doctor has made the request to Medicare to change the price you pay for a particular medication, and your request was denied, you can appeal this decision.
Medicare Summary Notice disposal
Though you may keep your MSNs throughout the year, eventually, you will need to dispose of your MSNs. Remember that the MSN form contains sensitive information and should not be handled lightly. This means you should never toss your MSN statements in the garbage with the rest of the trash. Instead, shred your forms to ensure your privacy.
Medicare and Medicaid fraud is often made possible when an identity thief acquires information from forms, such as the MSN. Identity thieves scour through garbage, steal from mailboxes and use public Wi-Fi networks to acquire the personal information of unsuspecting victims. Make sure your information is safe by keeping all of your personal information, including your MSN statements, away from view of visitors, friends and family members. If you access your MSN online, do so only from a secured network, preferably only from your home.
Additionally, watch for your MSN to arrive in the mail during quarters when you receive healthcare services. Make sure your statement is in your possession, and do not leave the paperwork in a place where the document might be stolen or copied. Protect your Medicare account number, just like you would protect your Social Security number or a credit card number.
Reporting Medicare fraud
If you suspect a charge you find on your MSN to be in error or fraudulent, first, report the error to your medical service provider. If the issue is not resolved by contacting your provider, contact a member of the Medicare support staff at (800) MEDICARE (633-4227). The federal government offers a reward of up to $1,000 for tips about fraud.
Use your MSN to determine the current status of your Medicare account. Though the document is not a bill, you should still reconcile the charges to find and resolve errors and identify potential fraud. If you have any questions about the information included on your MSN, contact your healthcare provider’s office. If you have additional questions that cannot be answered by your provider, visit the Medicare website at medicare.gov or call the support line at (800) MEDICARE.
Medicare Part D Explanation of Benefits
If you receive Medicare Part D prescription drug benefits, you will get a monthly statement describing the charges to your account. This monthly statement is known as the Explanation of Benefits (EOB). You will also receive an EOB if the status of the drug has changed in the context of your plan or if the cost of the medication has changed. Note that, in most cases, you will not receive an EOB in months that you did not have any prescriptions filled or refilled.
Like the MSN, the EOB is not a bill. This document is a summary of your benefits under the Part D plan. The EOB is sent directly from the administrators of your plan, and you will receive the EOB for the prescriptions filled in the current month, during the following month.
The contents of the EOB include:
– A statement of the drug purchases, or claims, processed to your Medicare account, since your previous statement
– Your year-to-date charges and costs for your Part D plan
– Your out-of-pocket costs to date for your plan
– Updates and adjustments to your coverage
– Additional resources to help you find the best price for your prescription medications
If you have questions about your EOB, contact your Part D plan administrator. The status of prescription drug coverage can change on plans. Be sure to examine your EOB each month when it arrives and note any changes that will affect the medications you currently receive.
Review your explanation of Medicare benefits
Though the EOB is not a bill, you should review the document just like you review your MSN. Reconcile your statement with your pharmacy receipts for the month. If you find errors, contact your plan administrator and report the inaccuracies. If you suspect a charge is fraudulent, you can report the incident to (877) 7SAFERX (772-3379). Remember to keep your prescriptions and medications in a safe, secure location at all times. Successfully preventing identity theft and minimizing fraud depends on you.