Posted: 08/03/15, 11:31 AM EDT | Updated: 4 weeks ago
The Chester County Department of Aging, through its APPRISE program of trained Medicare counselors, helps Medicare beneficiaries to understand the health care options specific to their health needs and financial resources. This is one, in a series of articles, prepared by APPRISE volunteers to help Medicare beneficiaries navigate this complex system.
If you have original Medicare, have received any medical services and had the claims paid in the last quarter, you will receive information in the mail from the Centers for Medicare and Medicaid Services (CMS). The form is headed Medicare Summary Notice (also called an MSN) and is generally mailed out quarterly, usually the first month of the following quarter. This is not a bill but it does contain important information about what services were provided and how any claims have been paid. There are separate MSNs for Part A (inpatient stays) and Part B (physician visits) but the basic format is the same.
Page 1 will always be a summary of the content enclosed. Included will be the date of the notice, the range of dates for services processed, the status of your portion of the deductible, the number of services not approved and the total amount that may be your responsibility. Note, that while CMS will send your claims on to a supplement plan for processing, this notice does not take into consideration any payments that might be made by that plan. You will receive a separate notice of benefits from your supplemental insurance explaining claims they have processed and the amount, if any, that may be billed to you.
Page 2 explains how to review the claims information to determine that it reflects the providers you used and the services you received from those providers. Contact information tells how to call Medicare for any questions and how to report suspected fraud. There may also be general messages about Medicare coverage or new covered benefits.
Page 3 and any following pages provide additional information about the services processed during the period. It is important to check that each claim is accurate and includes only services you received and providers/facilities that you recognize. For Part A claims, there will only be a summary of the charges and dates of stay for each facility. If you suspect the charges are not correct, you can ask the facility for an itemized bill. Part B claims will provide detail of each service billed and the date of that service as well as the name of the medical provider of the service. You should review each line to be sure that you agree with the claim detail. Is it accurate? Are there services that you do not think you received? Do you recognize the name of the person/facility providing the service? Again, you can call 1-800-MEDICARE with questions or to report suspected fraud.
The last page contains information on how to appeal the claim if you believe services were denied inappropriately. There is a time limit for appeals of 120 days after receipt of the notice, so be sure to review the MSN promptly.
There is a lot of information contained in the MSN so spend some time reviewing the content before filing it away in a drawer. The Medicare Rights Center recommends that you try to save your MSNs for about seven years. You might need them in the future to prove that payment was made if a provider’s billing department makes a mistake. If you lose an MSN or you need a duplicate copy, you can call Medicare or go to your account on www.mymedicare.gov.
Contact the APPRISE program if you have any questions about services described on your Medicare Summary Notice. Call 610-344-5004 and leave your name, your phone number and a brief message describing your situation. A volunteer will return your call within 24 hours. You can also email us with questions at email@example.com.