Frequently Asked Questions

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FAQ

How do I read my Part A Hospital Outpatient Claims based Electronic Medicare Summary Notice details?

The Part A Hospital Outpatient Claim based Electronic Medicare Summary Notice displays information on a selected Part A claim, from the Claim Results page.

 

Below are explanations for each field shown on the Claim Details page:

  • Claim Type - Type of claim (Hospital Insurance)
  • Disclaimer - Reminds the beneficiary that this eMSN is not the original MSN
  • Facility Name - The name of the facility where the service took place
  • Beneficiary Name - Name of beneficiary of the claim
  • Provider Billing Address - The billing address of the provider that performed the service
  • Provider Street Address - The billing address of the provider that performed the service
  • Medicare Number - Medicare number of beneficiary
  • Date Notice Printed - Date notice was printed
  • Date Claim Processed - Date claim was processed
  • Your Deductible Status - Status of the amount you must pay before Medicare begins to pay
  • Be Informed! - Notice to the beneficiary to register at www.MyMedicare.gov for direct access to all original claims
  • Your Cost for this Claim - Whether or not Medicare approved all claims, and the total you may be billed
  • Facility for this Claim - The date the service began and ended, and the name of the facility where the service took place

Making the Most of Your Medicare

  • How to Check This Notice?
    • Do you recognize the name of each facility?
    • Did you get the services listed?
    • If you already paid the bill, did you pay the right amount?
  • How to Report Fraud - Detailed explanation to report a fraudulent business or facility
  • How to Get Help With Your Questions - Phone numbers to ask any questions regarding the eMSN
  • Your Benefit Periods - The amount of days you spent in a hospital or skilled nursing facility (SNF)
  • Your Messages from Medicare - Important messages from Medicare to the beneficiary

Your Hopsital Outpatient Claim for Part A (Hospital Insurance)

  • Start Date - The date of that service for this claim started
  • End Date - The date that service for this claim ended
  • Facility Name - The name of the facility where the service took place
  • Provider Billing Address - The billing address of the provider that performed the service
  • Provider Street Address - The billing address of the provider that performed the service
  • Referred by - Name of physician who referred beneficiary for service
  • Benefit Days Used - The number of full inpatient coverage hospital days used during the coverage period
  • Claim Approved? - Whether or not the claim was approved by Medicare
  • Total Non-Covered Charges - The total charges not covered by Medicare
  • Amount Medicare Paid - Total amount Medicare paid your inpatient facility
  • Maximum you may be billed - The total dollar amount that the beneficiary is responsible for paying. This amount includes deductibles, co-insurance and/or charges for services or supplies that are not covered by Medicare.
  • See Notes Below - Any notes for this claim

How to Handle Denied Claim or File an Appeal

  • Get More Details - Gives phone number for any further details needed by beneficiary about their claim
  • If You Disagree with a Coverage Decision, Payment Decision, or Payment Amount on this Notice, You Can Appeal - Explanation of how to appeal
  • If You Need Help Filing Your Appeal - Medicare phone number listing along with other options to help the beneficiary in filing their appeal
  • Find Out More About Appeals - Refers beneficiary to "Medicare & You" handbook along with website www.medicare.gov/appeals, to learn more about appeals
  • File an Appeal in Writing - List of eight steps the beneficiary must follow in order to successfully file an appeal in writing

 

Please Note: The eMSN is not a bill, please visit MyMedicare.gov to access your original Medicare claims.



(FAQ6005)

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