Medicare Summary Notice (MSN)

A Medicare Summary Notice (MSN) is sent to Medicare beneficiaries for each claim that is processed. On nonassigned claims, the MSNs are issued as the claims are processed. On assigned claims, the MSN is mailed in 90-day cycles. Even though the supplier may have received notification of payment, the beneficiary may not have received his/her MSN.

The MSN explains what claim is involved, the types of service(s), the supplier and other identifying information that explain the payment and/or denial. It also includes information that can affect future reimbursement, such as explaining that a Certificate of Medical Necessity (CMN) has expired. Suppliers should remind clients to review each MSN carefully and report any suspected errors as soon as possible.

The following field descriptions may be helpful when viewing the sample MSN:

  • Your Medicare Number should match the number on the beneficiary's Medicare card.
  • Name and Address. If the beneficiary's name and address are incorrect on the MSN, they should contact 1-800-MEDICARE and the Social Security Administration immediately.
  • Dates of Service shows when the supplier provided the service(s) listed. These dates should compare with the dates shown on the supplier's bill.
  • Each claim is assigned a Claim Number, which the beneficiary may provide when calling Medicare about the MSN.
  • Services Provided is a brief description of the item, the number of items provided, and service code.
  • Amount Charged is the charge submitted to Medicare by the supplier.
  • Medicare Approved is the amount Medicare approved for the items received.
  • Medicare Paid Provider. In most situations, Medicare pays 80 percent of the approved amount after subtracting any unmet portion of the annual deductible. For unassigned service(s), this column is titled Medicare Paid You.
  • You May Be Billed. This is the total amount the supplier is allowed to bill the beneficiary. It combines the deductible, coinsurance, and any non-covered charges. If the beneficiary has supplemental insurance, it may pay all or part of this amount.
  • See Notes Section. If a letter appears in this column, the beneficiary should refer to the Notes Section for more detailed information about the claim.
  • The Supplier's Name and Address is the billing address, which may be different than where the services were received.
  • Deductible Information shows how much of the beneficiary's annual Medicare deductible has been met.
  • General Information provides important Medicare news and information.
  • Appeals Information such as how and when to request an appeal, is shown here.

Last Updated Mon, 07 Nov 2016 12:12:40 +0000