Medicare Summary Notice

As a Medicare recipient of any kind, your Medicare Summary Notice is one of the most important documents you will have to become familiar with. You will review it on a regular basis and may have to use it in the event you have a problem receiving covered medical care or need to settle a dispute in your coverage.

What is a Medicare Summary Notice?

A Medicare Summary Notice, called MSN for short, is a simple summary of everything that has been charged to your Medicare policy over the past three months. This includes valuable information about the services you've received, their cost and the facility or provider associated with your treatment. It represents the basic information that Medicare has on file based on Medicare claims received on your behalf.

When Will I Receive a Medicare Summary Notice?

You will receive a Medicare Summary Notice automatically for each three month period, assuming any items are charged within ninety days of your previous notice. You will only receive these notices every ninety days, no matter how much activity takes place on your account.

Likewise, you will never receive fewer than four Medicare Summary Notices each and every year. If you have not received a scheduled MSN after about one hundred days, you should inquire with Medicare. While there may be ordinary delays associated with postal mail, there are almost never any delays related to Medicare itself.

How is a Medicare Summary Notice Related to a Medicare Claim?

A Medicare "claim" is a packet of information that is sent by your healthcare provider to Medicare to request benefit money that will cover a medical service you received. Every time you receive any medical service, your doctor or hospital is required by law to issue a Medicare claim to Medicare, based on the strict standards of the federal government.

A Medicare Summary Notice is a brief summary of information that Medicare has pulled from the claims filed on your behalf over the last ninety days. It allows you to look over the claims that have been made in your name in recent history. This helps protect you by preventing fraud and ensuring your healthcare providers are meeting their obligations.

What Should I Look For in a Medicare Summary Notice?

When you receive a Medicare Summary Notice, you should read it and compare it to the information that you received directly from your caregiver or treatment center. It is very important that you ensure two things:

  1. That nothing has been claimed that you did not receive. This is a sign of Medicare fraud and may happen in cases of identity theft. It means a claim for Medicare benefits has been registered on your behalf for services others may have received. It can also indicate a clerical mistake. Either way, it needs to be corrected immediately!
  2. That everything you did receive has been claimed. Although hospitals and other medical organizations are responsible for making Medicare claims, there are cases where a provider might fail to do so promptly. If they fail to do so within thirty days, you should contact them immediately. If they fail to do so by the time of your next Medicare Summary Notice, you should file the claim on your own behalf. If you wait beyond this time, you may exhaust the time limit for filing a Medicare claim.

How is a Medicare Summary Notice Used in Disputes?

The Medicare Summary Notice should allow you to notice many kinds of disputes before they become serious. For example: as above, if a healthcare provider has failed to file a claim on your behalf, you can file it yourself.

This is also important if, due to a clerical error, you are charged more than expected for a covered service. Here are the items you should keep together in the event of a dispute:

  1. The Medicare Summary Notice is the most important piece of "evidence" that you'll use in the event of any dispute. You should react immediately to any problem that you perceive with your Medicare Summary notice.
  2. The second most important paperwork will be copies of prescriptions you received. Prescriptions are made not only for medicinal drugs, but also for items like medical equipment and prosthetics you might need.
  3. You should also maintain copies of "Certificates of Medical Necessity" -- these are documents your physician must fill out so you can claim benefits for certain kinds of home medical equipment and prosthetics.

If you maintain a file of this paperwork separate from the ones maintained by Medicare and your doctor, you will be well prepared to represent yourself in the event of any confusion regarding your Medicare coverage. As a Medicare recipient, you will be more likely to receive your full legal entitlement if you get into the good habit of reviewing your MSN regularly.