Medicare Summary Notices: Are Those Charges Mine?

— Written By Kim Reid and last updated by Cindy Nance

In an effort to protect the Medicare beneficiaries of North Carolina from fraud, waste and abuse, the Seniors’ Health Insurance Information Program and the North Carolina Senior Medicare Patrol are encouraging all Medicare beneficiaries to read their Medicare Summary Notices. MSNs are mailed to beneficiaries every three months for services covered by Medicare Part A and Part B. MSNs are not bills; they are a record of the services and supplies that providers and suppliers billed to Medicare, the amounts that Medicare paid and the amounts the beneficiary may owe the provider. It is vital that beneficiaries read and understand their MSNs to recognize possible Medicare fraud, billing errors and discrepancies.

The Centers for Medicare & Medicaid Services recently redesigned the MSN so that it is more user-friendly. The new design still contains the same important information for review. Two areas to check for accuracy include:

  • Name and Address: Are these correct and current?
  • Medicare Claim Number: Does it match the number and suffix letter on your Medicare Card?

The Part A MSN will provide information about inpatient hospital stays, skilled nursing facility rehab stays and home health visits following inpatient hospital stays and/or skilled nursing facility rehab stays. This information will include dates of service, the name and address of the facility and the name of the referring physician. It also will show the number of covered benefit days and if Medicare covered those stays, non-covered charges, the amount Medicare paid the facility, and the maximum amount the provider can bill you or your secondary insurance for deductibles, coinsurance or non-covered charges.

The Part B MSN will provide information about claims from doctor services, diagnostic tests, equipment, and ambulance and other medical services. Each claim will have dates of service, the supplies received, and the name and address of the provider (which may be the billing address rather than the address where services were received). The information will include if Medicare covered the service, the provider’s fee for the service, the amount a provider can be paid for the service, the amount paid to the provider by Medicare and the maximum amount you may be billed.

When reviewing your MSN, ask yourself the following questions:

  • Do you recognize the name of each doctor or provider?
  • Did you have an appointment or service rendered on the dates shown?
  • Did you receive the services or supplies listed?
  • If you already paid the bill, did you pay the correct amount?
  • Did you keep a health care journal and receipts or bills regarding the service(s)?

If you believe that you may have been a victim of fraud, waste or abuse, please contact the North Carolina Senior Medicare Patrol at 1-877-996-2767.

For more information, contact Kim Reid, Extension Agent with the North Carolina Cooperative Extension Service at (910) 592-7161.