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Medicare Terminology and Forms to Know For Coders

Medicare terminology can take some getting used to for most people. Terms get abbreviated to save time. Two common abbreviated terms that you should be aware of are the MSN and RA.

Medicare summary notice (MSN) deals directly with the beneficiary or the person covered  under Medicare. The MSN replaced the Explanation of Medicare Benefits form in 2001.

[1] This is an easy to read document sent to the Medicare holder every month that allows them to see their Part A and Part B claims. The MSN also holds the deductible status. Basically it is an information sheet. Often when a patient receives the MSN they think it is a bill. It is important to understand that this is not a bill but rather an explanation of what has transpired the previous month under their Medicare coverage.

The Medicare Remittance Advice (RA) unlike the MSN is for the provider. It explains how the claims sent were adjudicated or how the decision was made for payment. Included is a list of all claims paid, rejected or denied during a certain time period. The RA is extremely important to the provider as it keeps them informed of errors in coding or billing and amount of funds to be expected. Claim Adjustment Reason Codes and Remittance Remark codes are used to paint a clear picture for the provider. Reason codes reveal why adjustments were made by the payer. Remark codes give non-financial information regarding a claim. Each are needed for a Medicare provider to obtain reimbursement for claims.

It is important to be familiar with both the MSN and RA. Often the beneficiary will not understand the MSN and you will be called to explain it. Without a working knowledge of the RA form a practice can get back logged with denied claims and not be able to establish a comprehensive budget. It is significant in the life of a medical coder or biller to know these terms and get comfortable with the forms.

Medicare Terminology and Forms to Know for Coders

 


[1] Beik, J., Health Insurance Today A Practical Approach 3rd Ed. 2011, Elsevier Saunders, St. Louis, MO.

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