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Educate Medicare Patients Using MSN

The Medicare Summary Notice (MSN) is a summary of health care services and items patients have received during the previous three months. MSN is not a bill. This document is intended to help patients remember the physicians, specialties, supplies, and services involved in their care. The contractor that processes claims for Medicare will send the MSN, so it may have the name and address of a private company on it. For patients enrolled in original Medicare, an MSN is mailed out every three months (if any claims were submitted to Medicare during that period). Medicare also makes this notice available online at Medicare.gov.

The MSN is similar to the explanation of benefits (EOB) statement, which itemizes everything billed to Medicare, including what services were charged, what Medicare paid for, and what the patient still may owe their providers. There are separate notices for Part A, Part B, and DME, but each notice provides the same type of information. This document is intended to help patients remember the physicians, specialties, supplies, and services involved in their care. Understanding the information contained in an MSN can minimize the frustration often felt by both patients and providers trying to grasp benefit coverage. In many instances, Medicare forwards your MSN to your secondary insurer, which may help with some or all of the remaining costs.

Medicare patients can get MSNs electronically. If they choose eMSNs, they’ll get a monthly email with a link to claims information. With eMSNs, they won’t have to wait 3 months for a paper copy in the mail. In addition to the health care services you received in a given quarter, your MSN lists:

  • The amount providers billed Medicare for those services (Note: The “Amount Charged” field does not show your costs.)
  • The amount Medicare paid providers for each service
  • The amount you may need to pay directly to providers (indicated in the “You May Be Billed” field). Note that you will receive a bill from providers and do not need to pay anything until you have received a bill.
  • Any non-covered charges. This field shows the portion of charges for services that are denied or excluded (never covered) by Medicare. $0.00 in this field means that there were no denied or excluded services. A charge in this field means you are responsible for paying it. If you disagree with a non-covered charge, you should file an appeal.

Medicare encourages beneficiaries to compare claim details on their MSNs with the bills they receive from their providers, including verifying provider name, date of service, billing code(s), and descriptions. Patients often call questioning a service that shows up on their MSN when they do not recognize it or remember receiving it. While the charges are usually accurate and fair, patients do not always have a clear understanding of the services they received and the coverage parameters for those services. Although these calls can be daunting and quite tedious in a busy office, consider the call an opportunity to educate the patient and, sometimes, the physician, too.

MSN and Medicare Patients

  • If Medicare patients have other insurance, they can check if it covers anything that Medicare didn’t.
  • They can keep receipts and bills, and compare them to MSN and can be sure of getting all the services, supplies, or equipment listed.
  • They can compare you with the bill to make sure you paid the right amount for your services if they paid a bill before receiving MSN.
  • If an item or service is denied, they can call your office to make sure that the correct information is submitted. If they disagree with any decision made, they can file an appeal. The last page of the MSN gives you step-by-step directions on when and how to file an appeal.

For providers, MSN is an opportunity to educate patients. Patients will call about a procedure they don’t recall receiving. Chances are they are not aware of the formal medical terminology of the procedure they received. For example, perhaps the patient sees on the MSN CPT® 20610 Arthrocentesis, aspiration, and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance and does not believe they had such a complicated-sounding procedure performed during their visit. A quick explanation that this is the cortisone shot they received will ease their concern about any fraud or abuse, and now they know the name of the procedure for cortisone injections.

Reference:

Use Medicare Summary Notices as an Opportunity to Educate Patients

“Medicare Summary Notice” (MSN)

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