March 30, 2022 General Interest
How and Why to Read a Medicare Summary Notice (MSN)
As you may know, our mission at Wisconsin Senior Medicare Patrol is to help Medicare beneficiaries and their advocates prevent, detect, and report health care fraud, abuse, and errors. One way you can assist us in the detection phase is to read your Medicare Summary Notice (MSN) when you receive it in the mail every three months to ensure it is accurate. It is also available for you to read online 24 hours a day in your free and secure Medicare.gov account, where you can also review all bills processed in the last 36 months.
What Is An MSN?
An MSN states in large print that it is not a bill. It’s a report of any doctor visits, services, or supplies that have been billed to Medicare in your name (if you’re enrolled in Part A and/or Part B). The MSN will explain which charges will be paid by Medicare and which will be paid either by you or other insurance like Medigap or employer insurance.
Using a Health Care Tracker
One way you can be sure the information on your MSN is accurate is by keeping a detailed record of all medical visits you’ve had, including dates, providers seen, medical equipment or tests you received, and receipts for those services. You can document this in a calendar or notebook, or you can order a Health Care Tracker from Wisconsin SMP to keep track of everything.
How Do I Read An MSN?
First, you’ll want to review all the claims listed to ensure the service date, provider name, and procedure codes are accurate for the services you received.
You should also check whether your Part A or Part B deductibles have been met (this will be on the front page of the MSN).
Then, look at each claim to make sure proper payment was made. Here are some things to ask yourself:
- Did Medicare pay towards each claim?
- Was the payment breakdown correct?
- Was the number of benefit days used correct?
- Were the daily copays for skilled nursing facility or hospital claims correct?
- If it was a Part B claim, was it paid at 80/20%?
You can visit Medicare.gov to download sample MSN’s with a breakdown of each section of the MSN. The SMP National Resource Center also has an excellent 12-minute tutorial about how to read an MSN on their YouTube channel. For a shorter video on what to look for in your MSN, visit the Milwaukee County Department on Aging’s YouTube channel.
What If a Claim Was Denied?
If you see any denied claims on your MSN, you can look at the following things to try to determine why it was denied:
- There are footnotes at the bottom of the MSN that may refer you to a local or national coverage determination number explaining the coverage criteria for the related procedure.
- The “You May Be Billed” column will say if Medicare determined the provider is liable for the cost of the service received (then you owe nothing).
- Confirm with the provider’s billing office that they used the correct billing codes for the services received. You can also ask them if they have any other information on the claim’s denial.
The last page of the MSN includes an appeal date and address if you wish to appeal the denial after taking the steps above. Keep in mind, your appeal must be received by the date listed.
What Should I Do After I Read My MSN?
Once you have confirmed that all the information is accurate, you can dispose of this paperwork, but always make sure to shred it instead of just throwing it away. If you shred important medical documents like your MSN, you will keep your private information away from any potential identity thieves. If there are ever questions about past statements, you can contact Medicare to request copies.
If you have any questions about the MSN or notice any mistakes, call your provider to report them immediately. If you still have questions after talking to your provider, please feel free to contact Wisconsin SMP for additional help. We can be reached via email at firstname.lastname@example.org or on our toll-free helpline 888-818-2611.
Note: Please do not include any sensitive personal information such as Medicare or Social Security numbers in your messages to us.