1

How to Read a Medicare Summary Notice

2

What We Will Cover Today• The SMP Program

• The New Medicare Summary Notice (MSN)

• How to Read your MSN

• Fraud Prevention

3

The SMP Programwww.illinoissmp.org

4

• Senior Medicare Patrol (SMP) Program

• Goals of SMP:

– Recruit local volunteers to provide outreach and educate consumers about health care fraud and abuse

– Help consumers with questions about billing mistakes and how to report fraud

The SMP Program

5

• Report of medical services or supplies billed to Medicare in your name (doctor/hospital visits, procedures, tests, equipment, etc.)

• Mailed every three months when Medicare has been billed

• Explains the payments made by Medicare to your health care providers and those that will be paid by you or your other insurance

Medicare Summary Notice

6

• Larger text size

• Easier to understand

• Shows how much of your Part A or Part B deductible you’ve paid

• Lists providers you saw and brief descriptions of medical procedures you received

• Shows whether Medicare approved your claims

Recent Updates to the MSN (2013)

7

• Make sure your name and address are correct

• Verify your deductible status

• Check your claims and costs • Compare providers listed on your MSN with your

records of doctor appointments/services received

Just the Basics

8

9

• Check this Notice

• Get Help with Your Questions

• Messages from Medicare

Making the Most of Your Medicare

10

11

• This the most a provider can bill you

• This amount is usually 20% of the Medicare approved amount after your annual deductible is met for Part B covered services

• This amount may include deductibles, coinsurance and non-covered charges

Maximum You May Be Billed

12

13

• Make sure the service description is appropriate for the service you received

• Check to see that the service dates are correct• Read the notes at the bottom of the page

• Remember that the MSN is not a bill; therefore, do not pay the provider until you receive a final bill

• If you have supplemental or other insurance, do not pay the provider until all other payments have been made and you receive a final bill

What Else to Check

14

15

• Call the provider first with questions about denied claims

• You have the right to appeal any denial

• Act before the appeal date

• Follow the steps listed for an appeal

Denials and Appeals

16

17

• Billing for services or supplies not provided

• Billing for services or supplies that are different than what was actually provided

• Billing for services or supplies that you do not need

What is Health Care Fraud?

The SMP Message:

Protect!

Detect!

Report!

18

19

PROTECT Yourself From Fraud!

20

PROTECT Yourself From Fraud!

• Do NOT give personal information (like your Medicare number) to people you do not know in person or on the phone

• Do NOT carry your Medicare card in your wallet

• Shred documents BEFORE you throw them away

21

DETECT Fraud!

22

• It shows what was charged to your Medicare account

• When you review your MSN look for:– billing for services or supplies not provided or

different than what you actually received– names of providers or suppliers you do not

recognize

How does your MSN help you detect fraud?

23

REPORT Fraud!

24

If you notice a mistake:

1. Call the provider. If it is just a mistake, they may be able to fix the problem.

2. If this does not work or you suspect fraud, contact AgeOptions at (800)699-9043.

Report Fraud!

25

Why Report Fraud?

People who commit fraud are

STEALING

from you, not helping you!

26

Why Report Fraud?

• When things are not ordered by your doctor, they may not fit or work properly

• When someone gives you something that you do not need your health may get worse

• Health care fraud puts you at risk for identity theft

2727

• Last year Medicare saved taxpayers over $4 billion from fraud tips

• Reducing fraud, waste and abuse extends the life of Medicare

• IT IS OUR MONEY!

Reporting Fraud Matters!

28

Volunteers are the key to stopping fraud

We need YOUR help!

29

Thank you!

If you have questions, contact:

AgeOptions

(800)699-9043

TTY: (708)524-1653

This project is supported in part by grant numbers 90MP0163 and 90SP0015 from the U.S. Administration on Aging, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.