CMS Reveals User-Friendly Medicare Summary Notices

CMS will soon be mailing Medicare recipients revised Medicare Summary Notices that are easier to understand and that, hopefully, will encourage recipients to report Medicare fraud. Beginning this summer, the agency will mail the notices every three months to recipients who received services or medical supplies in that three month period. Tech-savvy recipients can access claims data within 24 hours after processing at

New Envelopes

CMS advises that the summaries will arrive in redesigned envelopes sporting the DHS logo. They will include the phrase “OFFICIAL MEDICARE INFORMATION” on the front and will list contact numbers on the back. They will indicate that they are “TO BE OPENED BY ADDRESSEE ONLY.”

User-Friendly Summaries

The redesigned summaries will be issued for Part A, Part B, and Durable Medical Equipment (DME). They will consist of four pages, each of which includes page and subsection titles in larger print. Page 1, “Your Dashboard,” will include the total amount that the recipient may be billed, along with deductible information and a list of facilities, providers, or suppliers that the recipient saw. It also includes a phone number that speakers of languages other than English and Spanish may call for assistance. Page 2, “Making the Most of Your Medicare,” explains how beneficiaries should review the notice. It also includes information about how to report Medicare fraud and general messages about health care. Part A and Part B summaries include information about benefit periods and preventive services, respectively. Page 3, “Your Claims,” lists the type of claim, as well as definitions of terminology used on the page. It lists either the date of visit or the date that items or supplies were ordered, and includes either benefit periods or a description of services. It also lists the maximum amount that the beneficiary may be billed. Finally, Page 4, “How to Handle Denied Claims,” explains the appeals process and includes the date that the claim must be appealed. It also includes step-by-step instructions for filing a written appeal.

Accurate Review

CMS encourages recipients to determine whether outside insurance covered any claims that Medicare did not cover and to compare receipts and paid and unpaid bills to make sure that they are accurately reflected in the summary. It also advises recipients to ask providers to resubmit bills where appropriate. In addition to aiding beneficiaries in navigating their Medicare claims, CMS hopes that the new forms will empower recipients to report Medicare fraud.