by Jared Staheli
June 18th, 2015
A. Intermediary/RHHI MSN
The MSN is used to notify Medicare beneficiaries of action taken on intermediary processed claims. MSNs are not used by RHHIs for RAPs, and RAP data are not included on the monthly MSN.
The MSN provides the beneficiary with a record of services received and the status of any deductibles. The MSN also informs the beneficiary of appeal rights. The Balanced Budget Act of 1997 requires all Part A benefit notices to include the amount of Medicare payment for each service. Intermediaries and carriers (including RHHIs and DME MACs) must furnish an MSN to all beneficiaries for whom claims are filed during the month unless the situation is specifically excluded by other manual instructions. Contractors shall issue No-Pay MSNs on a quarterly/90 day mailing cycle. MSNs with a payment check to the beneficiary shall continue to be mailed out as processed. No–pay MSNs are defined as those MSNs which do not require payment to the beneficiary for the respective claim(s).
The MSN replaced the following documents:
• Form CMS-1533, Part A Medicare Benefit Notice, also known as the Part A Notice of Utilization (NOU) sent for inpatient services;
• Form CMS-1954, Benefit Denial Letter (BDL), sent for partially denied claims; and
• Form CMS-1955, BDL sent for totally denied claims.
Since CMS eliminated BDLs, Medicare beneficiaries receive the information previously conveyed on BDLs through narrative messages contained on the MSN. Providers no longer receive a separate written notification or copy of the BDL. Providers must utilize the coding information (e.g., ANSI Reason Codes) conveyed on the financial remittance advice to ascertain reasons associated with Medicare claims determinations affecting payment and applicable appeal rights and/or appeals information.
B. Carrier/DME MAC MSN
The MSN is used to notify Medicare beneficiaries of action taken on their processed claims. The MSN provides the beneficiary with a record of services received and the status of any deductibles. The MSN also informs the beneficiary of appeal rights.