What is the CMS (and why is it so important to seniors)?

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If you are a Medicare beneficiary, the CMS is a very important agency in your life.  Those initials stand for the “Centers for Medicare and Medicaid Services.” This agency was once known as the Health Care Financing Administration (HCFA). It is the CMS that administers the Medicare program, making it one of the most important agencies of the federal government as far as seniors are concerned.
One of the most important functions of the CMS is to keep seniors informed about their own Medicare records. This is done through a document called a, “Medicare Summary Notice” or the “MSN.” For Medicare patients, health care providers send their bills for your care directly to Medicare, not to the senior. The Medicare Summary Notice is a statement (not a bill) showing all of the hospital costs, doctor’s fees and medical services or supplies billed to Medicare on your account (Medicare Parts A,B, and C). Prescription drug expenses are summarized in a separate document known as the Part D Explanation of Benefits (EOB).
Your MSN tells you:

  • The Medicare approved amount for the hospital services, doctors’ fees and service or supplies provided.
  • How much of the bill Medicare paid.
  • How much you (or your private insurance company) still owe the provider or supplier.

The Medicare Summary Notice is also used to notify beneficiaries of decisions on claims for Medicare benefits. Obviously, this is an important document that should not be ignored. The CMS generates a new Medicare Summary Notice every quarter (every three months) for all seniors who had any claim activity in that period. If the senior had no expenses billed to Medicare in the quarter, no MSN is sent.
Seniors should look for and recognize mailings from the Centers for Medicare and Medicaid Services. These communications are not advertisements or throwaways. On the contrary, they contain information directly concerning how much a senior may be billed for out-of-pocket medical expenses. Most seniors probably continue to get the MSN by mail. Look for this logo on the envelope and be aware that it is an important document –
Centers for Medicare and Medicaid Services
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