Format Conventions for the MSN (Rev. 3210, 04-16-15)

by  Jared Staheli
June 19th, 2015

This information describes the overall format conventions for the MSN.

MSNs are a combination of fixed and variable length sections, using a range of different typefaces and type styles, as well as a number of static graphic elements. For discussion of the display in specific areas of the notice, see the technical specifications beginning in section 10.3.3. Contractors should establish page layout and page breaks as specified by these instructions and exhibits.

A. Printing Requirements

MSN contractors must follow these instructions:

• Generate all MSN forms by a laser printer.

• Ensure that the MSN is printed on 8.5 by 11 inch paper, exclusive of perforated marginal pin-feed tabs.

• Print duplex.

• Use black ink only on white paper.

• Use shading as required by the instructions and exhibits.

• Allow for coding necessary for mail sorting equipment (e.g., bar coding, aims marks).

• Ensure any contractor’s notations placed on the MSN do not affect the design of the MSN.

• Refer to the specifications and exhibits for placement of information on the MSN.

B. Page Margins and Layout

Use 0.5-inch outer margins on the notice with exceptions when noted in the instructions. Alternate approved margins, 0.75-inch left and 0.25-inch right, may also be used when extra space is needed for bar code placement.

The MSN pages use two different column layouts, full page and two-column. Full-page layouts are 7.5 inches or 540 points wide with 0.5-inch margins on each side, as stated above. The Notice title, Foreign Language Footer, Section Title, and Claims section use this layout. This layout may be used on just a portion of a page, with the remainder of the page content split across two columns.

Two-column layouts have two separate 259 point columns with a 22 point gutter between, also with 0.5-inch margins on each side. The Summary section, Making the Most of Your Medicare section, Claims definitions, and Appeals section use this layout. In the specifications below, a given subsection may be described as being one-column wide; this means that the subsection’s content runs within one column in a two-column layout.

C. Type & Graphic Styles

The MSN uses two typefaces, Minion (serif) and CMS Myriad (sans serif) in Opentype format. Minion is a standard system font. The CMS Myriad font is customized for CMS use; the font file contains additional glyphs to be used in the MSN. (Font files may be requested from CMS, or may be included with Chapter 21 on an enclosed CD.)

Type & Graphics Glossary:

Alignment: The positioning of text within the page margins. Alignment can be flush left, flush right, justified, or centered. Flush left and flush right are sometimes referred to as left justified and right justified.

Baseline: The imaginary line on which the majority of the characters in a typeface rest.

Body Text: The paragraphs in a document that make up the bulk of its content. The body text should be set in an appropriate and easy-to-read face, typically at 10- or 12-point size.

Glyph: The word glyph is used differently in different contexts. In the context of modern computer operating systems, it is often defined as a shape in a font that is used to represent a character code on screen or paper. The most common example of a glyph is a letter, but the symbols and shapes in a font like ITC Zapf Dingbats are also glyphs.

Header: The short lines of emphasized text that introduce detail information in the body text that follows. Also the category of faces that are designed to work best in headline text.

Italic: A slanting or script-like version of a face. The upright faces are often referred to as Roman.

Leading (pronounced: ledding): The amount of space added between lines of text to make the document legible. The term originally referred to the thin lead spacers that printers used to physically increase space between lines of metal type. Most applications automatically apply standard leading based on the point size of the font. Closer leading fits more text on the page, but decreases legibility. Looser leading spreads text out to fill a page and makes the document easier to read. Leading can also be negative, in which case the lines of text are so close that they overlap or touch.

Letterspacing: Adjusting the average distance between letters in a block of text to fit more or less text into the given space or to improve legibility. Kerning allows adjustments between individual letters; letterspacing is applied to a block of text as a whole. Letterspacing is sometimes referred to as tracking or track kerning.

Margin: The white spaces around text blocks. Margins typically need to be created on the edges of a page, since most printers can't print to the very edge. White space also makes a document look better and easier to read.

Point: A unit of measure in typography. There are approximately 72 points to the inch. A pica is 12 points.

Point Size: The common method of measuring type. The distance from the top of the highest ascender to the bottom of the lowest descender in points. In Europe, type is often measured by the cap-height in millimeters.

Rule: A solid or dashed graphic line in documents used to separate the elements of a page. Rules and other graphic devices should be used sparingly, and only for clarifying the function of other elements on the page.

Sans Serif: A type face that does not have serifs generally a low-contrast design. Sans serif faces lend a clean, simple appearance to documents.

Serif: Small decorative strokes that are added to the end of a letter's main strokes. Serifs improve readability by leading the eye along the line of type.

Style: One of the variations in appearance, such as italic and bold, that make up the faces in a type family.

In most instances, Myriad is used for headers and for beneficiary-specific and dynamic information. Minion is typically used for instructional body text.

MSN contractors should:

• Use the exact type point sizes and leading in the specifications.

• Use uppercase and lowercase letters, as well as bold printing, throughout the form, except as specifically noted in the specifications.

• Not print text in italic type. In instances where italic is typically used, as in document titles, quotes are used instead (e.g., “Medicare & You” handbook).

See below for a list of the different type styles used in printing the MSN. The styles described below will be referenced throughout the detailed section and subsection specifications that follow. All elements can be assumed to be printed in 100% black, unless otherwise noted.

The naming convention of the different style groups are based on usage. Type Header is abbreviated to TH, Type Body to TB, Graphic style to GR, and Glyph to GL.

TYPE HEADER STYLES

TYPE BODY STYLES

GRAPHIC STYLES AND SPACING

D. Glyphs & Static Print Elements

There are several locations on the MSN that require the insertion of graphic elements.

FLASH IMAGE

GLYPHS

Smaller icons used in headers can be found in CMS Myriad font file as glyphs.

E. Language & Style Conventions

The MSN generally follows CMS conventions for style and language use. One MSNspecific convention is noted below:

facility vs. provider vs. supplier

When describing the provider of the claimed services on an MSN, different terms are used for the different ‘extended family’ members: Part A Inpatient and ‘B of A’ use “facility,” Part B (assigned and unassigned) use “provider,” and DME notices (assigned and unassigned) use “supplier.”

F. Organizing Principles for Specifications

The specifications that follow can be assumed to apply globally; when specifications vary by extended family member, the specifications will indicate which instructions apply globally and which relate to a particular member or members of the extended family.

The specifications are organized into chunks that relate to the individual subsections of the notice. Each unit of specifications will typically contain:

POSITION

• Instructions relating to the position of the subsection and its elements. The position coordinates are based on top and left edge of margin set as (0˝, 0˝). Adjust measurement according to margins used.

• Dimensions of content area and spacing between subsections.

• Specifications per section, listed by page position: top, left column, then right column.

FORMATTING

• All figures are style and layout examples. Any magenta guides are for layout reference only and are not to be printed. Refer to exhibits for accurate printed examples.

• Graphic example of subsection with type formats, graphic style and spacing used, and the content to which those formats are applied.

• Line by line code containing type, graphic, and spacing styles.

DYNAMIC RULES

• Description of any dynamically generated content within the section, and what rules should be applied to generate the content.

CONTENT

• Language and other specific content that should appear.

• General specifications are presented in Roman text. Type formats are indicated by bracketed codes (e.g., [TH 1.1]). Content that should be replicated on the MSN is presented in italic type; dynamic elements within the content are surrounded by curly brackets, {like this}.

In addition to figures for each subsection, exhibits are available for full MSNs for the base design family and worst-case scenarios. Reference will be made to corresponding files as needed.

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 21