When you’re navigating Medicare and trying to figure out how Medicare paperwork works, it can be hard to find a starting point. Two terms you’ll often find thrown around are EOBs and MSNs.
But what exactly are EOBs and MSNs? Read on to find out and understand what they are and how they affect you. Every month, when you refill a prescription, Medicare sends you a notice called an Explanation of Benefits or EOB. This notice outlines your prescription drug costs and claims.
You receive this notice each month. It is sent by the provider of your plan, and there are several things you should do when you receive it. You should hang on to your EOB until you get your “final bill” from your health care provider or doctor.
Next, look at the bill amount on both your bill and EOB. The amount due on both documents should be the same. Of course, it helps to understand the process that takes place before you receive an EOB. You first visit your doctor. He or she will send a bill or claim to your insurance company.
Once this happens, your insurance company decides how much of the bill they will cover. As a result, you receive an EOB. Your insurance plan sends its portion of payment to your doctor or health care provider. Your doctor will then send you a bill for the remaining balance. This is the amount you must pay for your provider to be paid in full.
Because an EOB is not a bill, you are not required to pay it, at least not right away. The EOB itself is simply a document stating how much your insurance company will pay for it. However, this amount will depend on your individual plan. You should examine the EOB to see the date services were rendered and the type of treatment you received.
What must you do when you receive an EOB? According to experts, there may be times when you receive more than one EOB. This happens when you receive more than one service from health providers. If you received two different services on the same day, you may also receive two EOBs.
This may also happen if you receive two different kinds of treatments. This EOB should provide a detailed list of services you received. Examine this list to see how much you have been billed and how much your insurance company paid for these services and treatments.
Be sure not to pay your bill until you receive an EOB detailing what services you received. By doing this, you can verify that your insurance company paid its share of the bill, and you will not pay more than the amount you’re responsible for.
If you have questions about an EOB, you can call your insurance company’s member services to get the information you need.
Although several states govern how long medical records should be kept, rules outlined by HIPPA state that Medicare Fee-For-Service providers must retain documentation for six years after the document’s creation or the day the document was last used or referenced for services. The latest version of the document is the one most likely to be referenced.
When you pay your bill, make sure you do not pay more than the amount you owe. There are a few other things you should check when you receive an EOB. Experts recommend making sure the information about you is correct. If you find mistakes, this may indicate that someone has stolen your identity.
Also, ascertain that you are not “billed twice for the same service.” If you find this to be the case, contact your insurance company as soon as possible. Your insurance company may have paid the claim, but being billed twice indicates a problem.
Figure out which service provider sent you the bill. Over-billing is technically fraud, and this can lead to even more expenses. Make sure you know what doctor sent you the bill. The bill can list the name of the doctor, lab, clinic, or billing facility. If you find that your insurance company did not pay its share of the bill, it could be because you have not yet met your yearly deductible.
If you are trying to keep track of your monthly medical expenses, it helps to understand Medicare Summary Notices or MSNs. According to Medicare.gov, an MSN is a notice individuals with Original Medicare receive every three months. This notice is for services covered by Medicare Part A and Medicare Part B.
But what does an MSN tell you? An MSN details all services and supplies providers billed you for within a period of three months. An MSN also tells you how much Medicare paid for your services and the highest amount you may owe a provider.
Since an MSN is sent quarterly, you will not be billed for months in which you did not receive services. MSNs are sent by Medicare.
You should know a few things about what an MSN envelope looks like. The upper left-hand corner of the envelope should bear the name, “Centers for Medicare & Medicaid Services.” The return address should read as follows:
Centers For Medicare & Medicaid Services
c/o National Government Services
Street Address
City, State, and zip code
On the back of the envelope, it should read “To be opened by addressee only.”
If you know you are about to get an MSN, you should do a few things to prepare. If you have insurance with another company, you may want to check and see if that company covers expenses that Medicare did not. You may also want to keep track of your bills and any receipts you receive from service providers.
“Compare these bills and receipts to the MSN you received. Make sure that you pay the right amount. Also ensure that you received the services that you paid for. If you did not get the services you paid for, your doctor’s office may need to “resubmit.” If you disagree with any decisions your doctor has made, you have the right to file an appeal.
If you decide to file an appeal, the last page of your MSN provides instructions on how and when to file an appeal. Your MSN provides information about the charges you have been billed for tests and services. You might receive another MSN if you receive reimbursement for a bill you have already paid.
If you receive medical services but do not receive an MSN, call MSN right away at 1-800-MEDICARE. You may also access MSN online. All you have to do is create an account or log in to your Medicare account. However, it will also help to request a paper copy.
Your MSN lists several other things other than your charges for services. It lists the amount each provider charged, the amount Medicare paid to each provider, and indicates the amount you are obligated to pay each of your providers. An MSN also lists charges that are not covered by insurance. It lists charges that are excluded or denied by Medicare.
If a field lists $0, this means that no charges were denied or excluded. If a charge is listed in this field, you are required to pay it. However, if you disagree with a charge, you have the right to submit an appeal. There may be cases where Medicare sends your MSN to a secondary insurance provider. This may help pay for any outstanding balance you have.
It is advisable to keep your MSNs. This will help you prove that you have paid a bill if there is a discrepancy. This can happen if a billing department makes a mistake. Having a paper trail like this helps cover you. Problems can sometimes arise if you claim a medical deduction on your taxes.
It is important to understand your MSN. Be aware that sometimes providers make mistakes, and sometimes a provider may bill you directly, instead of billing your provider. It is important to wait for your Medicare statement, because it allows you to make certain Medicare receives a bill directly from your provider. If you find that the numbers don’t correspond, you must report it.
Although this may have been an honest mistake, it can be indicative of something more serious, like illegal activity. There may also be medical coding errors. If you think this may be the case, it may be a good idea to investigate.
If you want to understand MSNs and EOBs, it is first important to educate yourself on how they work and how they affect you as a patient and customer.
7 Sources
MedigapCoverage has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.
https://www.healthpartners.com/blog/explanation-of-benefits-vs-bill/
https://www.strongdm.com/blog/what-are-the-three-rules-of-hipaa
https://www.cms.gov/files/document/mlnpodcastmedicalrecordretentionandmediaformatpdf
https://www.tdi.texas.gov/tips/explanation-of-benefits.html