Use Medicare Summary Notices as an Opportunity to Educate Patients

Use Medicare Summary Notices as an Opportunity to Educate Patients

Use the MSN to inform patients of their benefits and clarify billing questions.

While calling Medicare to explain a patient’s benefits is sometimes better, this is not always the first phone call the patient makes. More likely, the patient calls the provider’s office with questions about their medical bills. Here’s how your practice can use the Medicare Summary Notice (MSN) to help educate all parties involved on Medicare benefits.

What is a Medicare Summary Notice (MSN)?

An MSN is a document that Medicare patients receive after visiting their physician or other healthcare provider for Part A or Part B services and durable medical equipment (DME). 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.

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.

Why Do Patients Call With Questions About Their MSN?

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.

For example, services like the hepatitis B vaccine may need to be explained to patients, or a friendly reminder may need to go out to the providers in your office, regarding coverage. This service is confusing because immunization is covered under Medicare Part B for medium- to high-risk patients, but for low-risk patients, it’s covered under Medicare Part D.

Use Phone Calls as an Opportunity to Educate Patients

Use the MSN to educate patients when they 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 (eg, 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.

Finally, although “This is not a bill” is printed on every MSN, patients sometimes mistake the MSN for a bill. Usually, this error can be cleared up by asking the patient to read the title of the first page of the document, which states “Medicare Summary Notice.”

Download an example of an MSN.


About the Author:

LeAndrea Mack, CPC, CRCS-I, NR-CMA, is a clinical coding investigator for UnitedHealthcare/Optum through Healthcare Support Staffing. She has a degree in healthcare and over 16 years of healthcare experience, starting as a medical assistant and moving into coding for multi-specialty practices in 2015. She is a member of the Overland Park, Kan., local chapter.

Resources:

https://www.medicare.gov/coverage/hepatitis-b-shots

Evaluation and Management – CEMC

https://www.medicare.gov/forms-help-resources/mail-you-get-about-medicare/medicare-summary-notice-msn

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