One hospital or clinic visit can lead to more than one Medicare Summary Notice (MSN) and more than one bill. That's because Medicare has separate notices for Part A and Part B claims, and the hospital and the doctors who treat you there may bill on their own. Often it isn't a duplicate, but it's worth matching each bill to its own line before you pay.
Why does Medicare send more than one notice?
Medicare publishes separate sample notices for Part A and Part B. Part A covers things like inpatient hospital stays, skilled nursing, hospice, and home health. Part B covers doctors, outpatient care, and tests.
So an inpatient stay might show:
- The hospital's charges on a Part A notice.
- The doctors' charges on a Part B notice.
Medicare.gov says paper MSNs come every 6 months if you had services. If you choose electronic MSNs, you get an email for any month with a processed claim. Claims from one visit may also be processed at different times, so they can land on different notices.
For how to read each column, see how to read your Medicare Summary Notice.
Why do I get separate bills from the hospital and doctors?
Medicare's hospital benefits booklet lists doctor services separately from the hospital's own outpatient services, though Part B covers most of both. In practice, one ER visit can bring bills from:
- The hospital (sometimes called a facility fee). See emergency room facility fees.
- The ER doctor's group.
- Radiology, for the doctor who read your X-ray or scan.
- A lab, for blood work. See lab bills after a routine visit.
- Anesthesia, if you had a procedure.
Some of these groups have names you won't recognize. That alone doesn't mean a bill is wrong.
Does observation status change which notice I get?
Yes. Medicare.gov says observation services are outpatient care. So for an observation stay, the hospital's charges show up as Part B services, along with the doctors'. For an inpatient stay, the hospital's charges are under Part A. See observation status vs. inpatient.
How do I tell a real duplicate from separate charges?
For each bill, find:
- The provider's name.
- The date of service.
- The service and code.
- The amount.
Then find the matching line on your MSN.
Probably separate charges:
- Different provider names.
- One is a facility charge and the other is a doctor's charge.
- Different services on the same date.
Possibly a duplicate:
- Same provider, same date, same code, same amount, listed twice.
- A bill for a service the MSN shows was already paid, with nothing left owed.
- Two bills from the same provider for the same visit with different account numbers.
See duplicate charges on a medical bill.
What should I do if I can't match a bill?
Call the provider's billing office.
What to say:
"I got a bill from you for [patient name] for [date]. I can't find a matching line on my Medicare Summary Notice. Can you tell me what service this is, what code you billed, and whether Medicare has processed it yet?"
If Medicare hasn't processed it, ask them to hold the bill until it has.