Medicare pays out nearly $57 billion a year in “improper payments,” or payments that should never have gone out but did because of fraud, abuse, incorrect coding on medical bills, or overpayments to providers.
It’s easy to ignore your out-of-pocket costs when your Medigap Plan G pays for them, and your balance is $0 — but it doesn’t mean your medical bills are correct, and ignoring them could mean you miss billing errors. Your Medicare Summary Notice (MSN) Plan G is a detailed list of your Part A- and Part B-covered services. Taking just a few minutes to look over your MSN will help you eliminate improper payments to healthcare providers, track progress you’ve made toward your Part B deductible, and prepare for tax season.
How to read your MSN statement
Your MSN isn’t a bill. It’s a notice that details everything Medicare has paid for, including healthcare services and supplies. The MSN tells you what Medicare paid and any balance you owe the provider.
You should get an MSN at least twice a year, if not more often. The document includes:
- Your Medicare number,
- Providers who filed claims,
- When claims were processed,
- Your deductible status,
- Which claims were approved and denied,
- What your provider charged,
- The Medicare-approved amount (what Medicare negotiated, which is often way less than the amount charged) for services,
- What Medicare paid (usually 80% of the negotiated rate after you’ve met your deductible),
- Any outstanding balance you may be billed,
- Notes on the services provided, including whether Medicare sent your claim to your Medigap provider,
- How to file an appeal if a claim is denied.
The notices are sent by mail, or you can sign up to get access to your MSN monthly online at Medicare.gov/go-digital.
Preventing fraud and abuse with your MSN
Looking over your MSN regularly can help you avoid being part of billions of dollars paid out by Medicare improperly each year. Treat your MSN like your checking account or a credit card statement and reconcile it with your doctor’s visits.
To do this, get out your personal planner or health log. Cross-reference the dates on the MSN with the ones you have noted on your planner. Ensure the services on the notice are ones you received from your healthcare provider. You’ll see if any bills you received from your doctor were correct by checking the Maximum You May Be Billed column. Your doctor can’t bill you more for any services than what this column lists.
Note: When you get rid of the summary, it’s best to shred it to prevent identity theft. There is a lot of important personal information on the MSN, including your Medicare number, that criminals can use to perpetrate Medicare fraud.
Tracking your Part B deductible on your MSN
Each year, you pay a deductible toward your healthcare services before Medicare begins to pay. Your MSN has a section that tells you what your annual deductible is and what you have paid toward your deductible (you can also check this online at Medicare.gov). This is a handy tool for tracking your costs and budgeting what out-of-pocket expenses are left for the year.
How to check coverage denials and miscoding
An important area that may go unnoticed on your MSN is the Notes section. This space (at the bottom of your page) explains why Medicare did or didn’t pay a bill. Your insurer may deny a claim because they don’t think it’s medically necessary, paperwork is missing, they don’t cover the treatment, or it wasn’t coded correctly.
Medical billing codes are alphanumeric codes your doctor uses to bill your insurance company for the care they provide. The billing code is listed after each service you received from each provider. If a claim is denied or a service doesn’t match the care from that provider, you can look up the codes online using the CMS ICD-10 Lookup Tool to see if you believe they are correct.
Note: Keep your MSNs for at least three months or until the claims are completely processed through Medicare and your Medigap plan. If you have questions about your MSN, you can call Medicare and speak to an agent at 1-800-633-4227. You can also reach out to your State Health Insurance Program, the organization that offers assistance and guidance to Medicare enrollees and their caregivers.
How your MSN helps prep for tax season
If you itemize the deductions on your federal income taxes, your MSN acts as documentation for your medical spending. The document is a simple and effective way to track your deductibles, copays, and other out-of-pocket costs over the year. It’s especially useful for condensing a lot of different bills from various providers because all visits from the MSN coverage period are in one place. If you itemize your deductions, you should keep digital or paper copies of your MSNs for at least three years in case you are audited by the Internal Revenue Service.
Spending just a few minutes each time you receive your MSN can help you track your healthcare spending and ensure you, and Medicare, aren’t overpaying for healthcare. Becoming familiar with your MSN now can help you sort out Medicare denials or other payment issues that may pop up down the road. If you find errors, don’t panic. You can reach out to your healthcare provider or contact Medicare to discuss issues with any claims on your MSN.
