Protect yourself from fraud by understanding how to read yours.
For those not in-the-know, a Medicare Summary Notice (MSN) is a document that you receive in the mail every three months that shows all of the claims and deductibles connected to your specific Medicare number. It is not a bill, but does include amounts that you may be billed.
In an effort to protect yourself from Medicare fraud and scams, it is vitally important that you carefully review this information every three months to make sure it is correct.
Here is how to read each of the four pages you are receive in the mail.
Overview
Only those that are enrolled in Original Medicare will received a MSN. If you have chosen to go the Advantage Plan route, and for those with Pard D Prescription Drug coverage, you will instead (or also) receive an Explanation of Benefits (EOB) each month from the private company that sold you your coverage.
The MSN is sent through the mail every three months IF you received any services or medical supplies during that 3-month period. If you did not get any services or medical supplies during that period, you will not get an MSN.
You can choose to instead receive your MSN electronically here. This will allow you to an MSN each month instead of every three months.
Up to three different notices will be sent; one for Part A, one for Part B, and one for durable medical equipment. Each part will show all of the services or supplies that were billed to Medicare, how much Medicare paid, and how much you may owe to the provider.
What to do if you receive an Medicare Summary Notice?
First and foremost, read through the document thoroughly. You are looking to compare all of your receipts and bills that you have to the MSN to be sure that you actually received all of the services, supplies, and equipment listed. A common tactic among con artist is to bill things to your Medicare number so that they can receive payment from Medicare, even though you did not receive care; matching what you Medicare says you received to what you actually received will protect against this threat.
Look at any of the other insurance you have (a Medigap plan for instance) and check to see if it covers anything Medicare does not.
If you did pay a bill before you received your notice, compare the MSN with the bill to make sure that you paid the correct amount (the Medicare approved amount) for that service.
If your MSN shows that a service is denied, call the doctor’s office to make sure that they submitted the correct information. If they did not, they can resubmit. If you disagree with the decision made by Medicare, you can file an appeal using the form found here. Your MSN walks through the details on how to file this appeal. Appeals do have a deadline by which they must be filed, so don’t wait if you feel something is not right.
Finally, make sure to keep these documents for your records later. They should be kept at least until provider sends you a bill, which can be reconciled to the MSN. If you are claiming a deduction on your taxes, then keep the MSN for at least three years after the tax-filing deadline.
Page 1- Your Dashboard
Regardless of which part this covers, the first page will look pretty similar. Make sure that your name, address, and Medicare number are correct. Ensure that they logo is correct (the current MSN documents use the logo for Health and Human Resources, not the CMS logo).
This page is just a brief overview of the notice. It will show your deductible status, quickly show if all claims were approved, and list which facilities or providers submitted claims during this period.
Page 2- Helpful Tips
Page two is the same for all 3 types of notices, and list a few helpful tips on how to review the MSN.
Page 3- Claims Informations
Page three list all of the different claims that were submitted during the specific time period.
For each service, you will see if it was approved or denied and how much you may owe depending on how much Medicare paid minus any relevant deductibles and coinsurance amounts.
If plans were denied, it will list a lettered code which will be explained at the bottom of the page. Additionally, all the codes used by CMS can be found here.
Last Page- Handling Claims
The last page is always the same and it walks you through how to file a claim for any dispute you may have.
You have 120 days to file a claim, and the date by which the claim must be received is shown on the MSN.
Things to Keep in Mind
These documents are specific to Original Medicare. Your Medicare supplement plan, your Advantage plan, or your Part D drug plan will all send you something different called a EOB, or explanation of benefits, that shows what was charged to that specific insurance plan.
Make sure to compare the two documents together to ensure that they match.
Takeaways
Of all of the Medicare-related documents you’ll receive each year, these are one of the easier ones to get through, but it is still important to take your time and read through them thoroughly to make sure they are accurate.
While having Medicare cover a service you didn’t actually receive may seem like it doesn’t affect you, when you do need coverage for that specific service down the road, issues may come as Medicare thinks they already paid.
If you need a hand understanding your MSN or with anything else, feel free to give us a call and we can talk.
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