New Medicare Summary Notice Designed to Help Fight Fraud

CMS has begun issuing a redesigned Medicare Summary Notice (MSN) that will be easier to read and does more to help beneficiaries identify potential fraud.  The MSN informs Medicare beneficiaries about their claims for Medicare services and benefits. 

The redesign of the MSN includes several features not currently available on the current MSN.  Those features are:

  • a clear notice on how to check the form for potential fraud;
  • an easy-to-understand snapshot of the beneficiary’s deductible status, a list of providers they saw, and whether their claims for Medicare services were approved;
  • clearer language, including consumer-friendly descriptions for medical procedures;
  • definitions of all terms used in the form;
  • larger fonts throughout to make it easier to read;
  • information on preventive services available to Medicare beneficiaries.

 There are several new informational boxes on page 2 of the MSN including one that describe how to report fraud and some examples of fraud including offers for free medical services, or billing for medical services that were not received.  There is a phone number beneficiaries can call to report fraud and a statement that they might be eligible for a reward if their tip leads to uncovering of fraud.  The statement also says that last year taxpayers saved close to $4 billion in a large part to people who reported suspicious activity.

There is also a box reminding beneficiaries about covered preventive services and a box that has messages that look like they will change from time to time.  In this instance, there is a reminder to get a covered pneumococcal shot, a mammogram, and information about annual coverage limits for therapy services.

The new MSN also highlights the maximum amount of copayment a beneficiary may be billed by a provider for each service.  That information is in a larger type font and is surrounded by a box to bring it to the attention of the beneficiary.  If a claim for a service is denied there is a step-by-step form describing how the appeal the claim with a date highlighted in a box that the appeal must be received.

The redesigned MSN will be available to beneficiaries on mymedicare.gov, Medicare’s secure online service for personalized information regarding Medicare benefits and services; and, in early 2013, paper copies of the redesigned MSN will start to replace the current version.

“Consumer protection starts with making sure consumers not only get timely and accurate information, but that they understand what services they’re receiving from Medicare,” said Acting Administrator Marilyn Tavenner.  “The new Medicare Summary Notice empowers Medicare’s seniors and people with disabilities.  The statement is easier to understand and navigate, and makes clear what information to check and how to report potential fraud.  The new MSN also makes it easier for people with Medicare to understand their benefits and file appeals if a claim is denied.”

The MSN redesign is part of a new initiative, “Your Medicare Information: Clearer, Simpler, At Your Fingertips,” stated Tavenner. CMS said it will take additional actions this year to make information about benefits, providers, and claims more accessible and easier to understand for seniors and people with disabilities who have Medicare.