(Medicare Claims Processing Manual)

COMBINED MSNs   In some instances, multiple claim types may be combined on a single MSN.  This most commonly occurs with Part A Inpatient and B of A claims, with Part B assigned and unassigned claims, and with DME assigned and unassigned claims.  Instructions related to combined MSNs will be found below in any section or subsection that is affected.   PAY MSNs   From time to time, beneficiaries may receive an MSN that includes a check, refunding an overpayment made (most often) for Part B services, either assigne d or unassigned.  Instructions related to Pay MSNs will be found below in any section or subsection that is affected.  Instructions for the check cover sheet are located near the rear of this chapter.  Instructions for Pay MSN envelopes are located in the Envelopes section. In addition, there are examples of complete Pay MSNs in the Exhibits section.   EFFECT OF CLAIM TYPES   In the specifications below, layout and content instructions can be assumed to be global -  that is, they apply to all MSNs, regardless of what types of claims appear on the notice.   However, there are particular sections and subsections of the MSN where the type of claims on the MSN determines not only what specific claim data is printed, but also affects the inclusion of other content and language across the notice.   If a given subsection is affected by the claim type(s) on the notice, specifications for that subsection will be split -  into global specifications and specifications for each member of the extended family.   10.3.2 - Format C onventions for the MSN  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  This information describes the overall format conventions for the MSN.   MSNs are a combination of fixed and variable length sections, using a range of dif ferent 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. MACs should establish page layout and page breaks as specified by these instructions and exhibits.   A. Printing Requirements   MSN MACs 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 MACs 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 pa ge 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 subsections content runs within one column in a two- column layout.   C. Type & Graphic Styles   The MSN uses two t ypefaces, 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 ma jority 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 th in 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 i n 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 uni t 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 Eur ope, 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 ot her 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 benefi ciary -specific and dynamic information. Minion is typically used for instructional body text.   MSN MACs should:    Use the exact type point sizes and leading in the specifications.    Use uppercase and lowercase letters, as well as bold printing, throughout t he 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  Code  Name  Font  Point Size Leading  TH 1.1  Notice Title  Myriad Bold  25 pt  25 pt  TH 1.2 Notice Subtitle  Myriad Regular  22 pt  25 pt  TH 1.3  Notice Subtitle Alternate  Myriad Regular  18 pt  25 pt  TH 1.4  Notice Subtitle Alternate 2  Myriad Regular  17 pt  25 pt  TH 2  Section Name  Myriad Bold  21 pt  22 pt  TH 3  Body Header  Myriad Bold  14 pt  16 pt  TH 4  Claim Date  Myriad Bold  16 pt  18 pt  TH 5.1  Claim Column Title  Myriad Semibold  10 pt  10 pt  TH 5.2  Claim Column Maximum  Myriad Bold  10 pt  10 pt   TYPE BODY STYLES  Code  Name  Font  Point Size Leading  TB 1.1  Body Text  Minion Regular  12 pt  15 pt  TB 1.2  Body Highlight  Minion Bold  12 pt  15 pt  TB 1.3  Alternate Address Text 1  Minion Bold  11 pt  12 pt  TB 1.4  Alternate Address Text 2  Minion Bold  10 pt  11 pt  TB 2.1  Bene Data Text  Myriad Regular  12 pt  15 pt  TB 2.2  Bene Data Highlight  Myriad Bold  12 pt  15 pt  TB 3  Notice Title Tagline  Minion Regular  11 pt  25 pt   GRAPHIC STYLES AND SPACING  Code  Name  Graphic Style  Space Before  Space After  GR 1  Gray Fill  15% tint of black  N/A N/A GR 2.1  Black Rule  2 pt black line  0 points  6 points  GR 2.2  Black Rule only  2 pt black line  N/A N/A GR 3.1  Dotted Rule  1 pt dotted line  7 points  6 points  GR 3.2  Dotted Rule 2  1 pt dotted line  0 points  7 points  GR 3.3  Dotted Rule 3  1 pt dotted line  5 points  7 points  GR 4.1  Space after header  No rule  14 points  0 points  GR 4.2  Space after icon  No rule  10 points  0 points  GR 5  Space after text  No rule  7 points  0 points  GR 6  Space between paragraphs  No rule  12 points  0 points    D. Glyphs & Static Print Elements  There are several locations on the MSN that require the insertion of graphic elements.   FLASH IMAGE  Code  Name  Location  Size Sample  GL 1  HHS Seal  Page 1  72 pt x 72 pt   GL 2  Foreign -Language Footer  Page 1  540 pt x 27 pt  See section 10.3.3.J  GL 3  Check logo  Pay MSN  540 pt x 27 pt  See section 10.3.9.C  GL 4  Notice Title, Part A  Pay MSN  540 pt x 27 pt  See section 10.3.9.D  GL 5  Notice Title, Part B  Pay MSN  540 pt x 27 pt  See section 10.3.9.D  GL 6  Notice Title, Part A and Part B  Pay MSN  540 pt x 27 pt  See section 10.3.9.D  GL 7  HHS Seal for envelope  Envelope  57.5 pt x 57.5 pt  GL 8  Envelope Liner  Envelope   See section 10.3.10.D  GL 9  RRB Logo  Page 1 of RRB Part B MSNs  70 pt  x 70 pt