medicare moon notice what can be done

Under CMS

’ final NOTICE Act regulation, published August 2, 2016, hospitals and CAHs may deliver the MOON to individuals receiving observation services as an outpatient before such individuals have received more than 24 hours of observation services.

Full Answer

What is a Medicare outpatient observation notice (Moon)?

You may get a Medicare Outpatient Observation Notice (MOON) that lets you know you’re an outpatient in a hospital or critical access hospital. You must get this notice if you're getting outpatient observation services for more than 24 hours. The MOON will tell you why you’re an outpatient getting observation services, instead of an inpatient.

Does the Moon need to be delivered to every Medicare patient?

The MOON does not need to be delivered to every Medicare patient who receives outpatient services — only those receiving at least 24 hours of observation services.

When do I need to get a moon notice?

You must get this notice if you're getting outpatient observation services for more than 24 hours. The MOON will tell you why you’re an outpatient getting observation services, instead of an inpatient.

When can a hospital deliver the Moon?

Under CMS’ final NOTICE Act regulation, published August 2, 2016, hospitals and CAHs may deliver the MOON to individuals receiving observation services as an outpatient before such individuals have received more than 24 hours of observation services.

What is the purpose of the moon form for Medicare?

Issued to inform Medicare beneficiaries (including health plan enrollees) that they are outpatients receiving observation services and are not inpatients of a hospital or critical access hospital (CAH).

Can you appeal a MOON?

[22] Only the MOON defines the coverage issue as non-appealable. Just as beneficiaries can challenge a premature discharge or contest a host of other coverage determinations in the Medicare program, they should be able to appeal their placement on Observation Status.

What benefit is the Notice of Medicare outpatient observation Notice MOON billed under?

The MOON will serve as the standardized notice used to notify persons entitled to Medicare benefits under Title XVIII of the Act who receive more than 24 hours of observation services that their hospital stay is outpatient and not inpatient, and the implications of being an outpatient.

When must the moon form be given to the patient?

The MOON must be delivered before 36 hours following initiation of observation services if the beneficiary is transferred, discharged, or admitted. The MOON may be delivered before a beneficiary receives 24 hours of observation services as an outpatient.

What is the purpose of Moon letter?

The MOON is a standardized notice to inform beneficiaries (including Medicare health plan enrollees) that they are an outpatient receiving observation services and are not an inpatient of the hospital or CAH.

What can Medicare beneficiaries appeal?

An appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan. For example, you can appeal if Medicare or your plan denies: A request for a health care service, supply, item, or drug you think Medicare should cover.

What is explained in a Medicare outpatient observation notice?

The “Medicare Outpatient Observation Notice”, or “MOON,” is a standardized document that Medicare developed for hospitals to use to explain observation status. All Medicare patients receiving observation services for more than 24 hours must receive a MOON.

How do you avoid observation status?

The best way to avoid being blindsided is to be informed. When you are told that you are being admitted to the hospital, ask the doctor if you will be an inpatient or in observation status.

Which requires hospitals to provide the Medicare outpatient observation notice to Medicare patients who receive observation services as outpatients for more than 24 hours?

Since March 8, 2017, hospitals have been required to give patients the Medicare Outpatient Observation Notice (MOON) within 36 hours if the patients are receiving “observation services as an outpatient” for 24 hours. Hospitals must also orally explain observation status and its financial consequences for patients.

What is IMM and MOON?

These include the Important Message from Medicare (IM), the Medical Outpatient Observation Notice (MOON), the Advance Beneficiary Notice of Noncoverage (ABN), the Emergency Medical Treatment & Labor Act (EMTALA) requirements, Medicare Secondary Payer (MSP) and Centers for Medicare & Medicaid Services (CMS) ...

What is the 2 midnight rule?

The Two-Midnight rule, adopted in October 2013 by the Centers for Medicare and Medicaid Services, states that more highly reimbursed inpatient payment is appropriate if care is expected to last at least two midnights; otherwise, observation stays should be used.

What does code 44 mean in a hospital?

A Condition Code 44 is a billing code used when it is determined that a traditional Medicare patient does not meet medical necessity for an inpatient admission.

What is the MOON section?

The MOON "additional information" section may be used to add information to meet any state law observation notification requirements that differ from the MOON federal requirements but the MOON may not be used for non-Medicare/Medicare Advantage patients. 6. The MOON is required for any Medicare/Medicare Advantage patient who receives 24 hours ...

How many hours of observation is required for a MOON?

The MOON is required for any Medicare/Medicare Advantage patient who receives 24 hours of observation and must be given by 36 hours but CMS allows the MOON be given to any Medicare/MA patient who receives observation services.

How long can you use an old moon?

The old MOON cannot be used. 3. Because the new MOON must go through the approval process, use of the MOON will not be required for at least 120 days (the 30-day comment period and unknown time for comment review and release of the final MOON then a 90-day implementation period.)

Is a moon required for Medicare?

The MOON is required for patients in whom Medicare is a second payer and for all patients with Medicare Advantage plans even though the copay ments and SNF requirements for those patients may differ from those described on the MOON.

What does the moon mean in Medicare?

MOON is the catchy acronym for the Medicare Outpatient Observation Notice which goes into effect tomorrow (August 6, 2016)*. This was created to fulfill the requirements of the Notice Act passed one year ago, requiring hospitals to provide written notification (the MOON) and a verbal explanation to individuals receiving observation services as ...

How long does a hospital have to give notice of observation?

Effective August 6th, the NOTICE Act requires that hospitals provide written and oral notice, within 36 hours, to patients who are under observation/outpatient status for more than 24 hours. The notice must explain the reason that the patient is an outpatient (though there has been some criticism that it does not require specific enough information and this is one of the few Medicare notices which cannot be appealed) and describe the implications both for cost-sharing in the hospital and for subsequent “eligibility for coverage” in a SNF.

What is observation status?

Observation status is typically used as a way for a physician to decide if a patient needs to be admitted to the hospital or discharged, but for many patients and families this has been unclear and has been happening for longer periods of time (it is usually done for 48 hours or less but even at 48 hours many patients would be surprised to know they haven’t been “admitted” to the hospital). You can read more in our article, Think You’ve Been Admitted to the Hospital? Beware of Observation Status.

Does Medicare cover skilled nursing?

If you need a skilled nursing facility (SNF) after you leave the hospital, Medicare Part A will only cover it if you have a prior qualifying inpatient hospital stay. A qualifying inpatient hospital stay means you’ve been a hospital inpatient for at least 3 days in a row (not counting the day of discharge). If you were in the hospital three days but under observations status some or all of that time, you could not get your SNF care covered. Rehabilitation and skilled nursing in a SNF costs hundreds of dollars/day so this difference could quickly cost you thousands of dollars.

Does Medicare cover outpatient hospital services?

Medicare Part B covers outpatient hospital services (observation services are considered outpatient). Generally, if you have Medicare Part B, you pay: a copay for each individual outpatient hospital service that you receive and 20% of the Medicare-approved amount for most doctor’s services, after the Part B deductible. Part B copayments may vary by type of service. In most cases, your copayment for a single outpatient hospital service won’t be more than your inpatient hospital deductible. However, your total copayment for all outpatient services may be more than the inpatient hospital deductible. In other words, the costs you incur during “observation status” in the hospital may be greater than if you received similar services as an inpatient. If you’re enrolled in a Medicare Advantage plan, your costs and coverage are determined by your plan.

Where can I find the Medicare Outpatient Observation Notice?

This form and its instructions can be accessed on the webpage " Medicare Outpatient Observation Notice (MOON)" at: /Medicare/Medicare-General-Information/BNI/MOON

What is a CMS model notice?

CMS model notices contain all of the elements CMS requires for proper notification to enrollees or non-contract providers, if applicable. Plans may modify the model notices and submit them to the appropriate CMS regional office for review and approval. Plans may use these notices at their discretion.

What is an advance notice for a nursing facility?

A provider must issue advance written notice to enrollees before termination of services in a Skilled Nursing Facility (SNF), Home Health Agency (HHA), or Comprehensive Outpatient Rehabilitation Facility (CORF). If an enrollee files an appeal, then the plan must deliver a detailed explanation of why services should end. The two notices used for this purpose are:

What are the different types of notices?

The following model notices are available in both Microsoft Word and PDF formats in the "Downloads" section below: 1 Notice of Right to an Expedited Grievance 2 Waiver of Liability Statement 3 Notice of Appeal Status 4 Notice of Dismissal of Appeal

How long does a hospital have to issue a notice to enrollees?

As under original Medicare, a hospital must issue to plan enrollees, within two days of admission, a notice describing their rights in an inpatient hospital setting, including the right to an expedited Quality Improvement Organization (QIO) review at their discharge. (In most cases, a hospital also issues a follow-up copy of this notice a day or two before discharge.) If an enrollee files an appeal, then the plan must deliver a detailed notice stating why services should end. The two notices used for this purpose are:

What is NDMCP form?

Notice of Denial of Medical Coverage or Payment (NDMCP), Form CMS-10003-NDMCP, also known as the Integrated Denial Notice (IDN)

Do hospitals have to provide a moon to Medicare?

Hospitals and CAHs are required to provide a MOON to Medicare beneficiaries (including Medicare Advantage health plan enrollees) informing them that they are outpatients receiving observation services and are not inpatients of a hospital or critical access hospital (CAH).

What does observation only mean in Medicare?

The “observation only” status, when applied to a Medicare Beneficiary means that the Hospital will access the patient’s Part B benefits, which results in a SIGNIFICANTLY higher “out of pocket cost” for the patient [including for things like “diagnostic” tests, any type of treatments (think “Breathing” treatments here) and medications given to the patient, while in the hospital] which is WHY we should ALWAYS ask for an “itemized bill” after a hospital stay.

Can you remember your status after 24 hours in a hospital?

Hospitals are very good at getting lots of signatures, and of course “orally” informing you of your “status” after being in a Hospital over 24 hours could happen, and I suppose you could remember it, and maybe even understand what it is that they are telling you. Yes, it could happen, sure.

Does SNF accept Medicare?

Based on information received from the acute care facility (The Hospital) the SNF will accept, or admit the patient to the SNF believing that when they submit the claim to Medicare for payment , they will be reimbursed for those long-term care charges.

Can a physician make a decision about a patient's status?

Your Physician can make professional, and medically necessary decisions about your patient status, however CMS continues to have claims reviewed by the same standards as before: short inpatient decisions are prioritized for review by Quality Improvement Organizations, and the specter of audits by Recovery Auditors (still known as RACs) remains. Should a RAC’s determination after review of a claim be that a “patient has been incorrectly classified as an inpatient” they will issue a denial and require that the hospital return most of the Medicare money for the patient’s Hospitalization, despite the fact that the services were medically necessary and covered by Medicare.

Does Medicare reduce patient rights?

In a move announced to improve patient rights, Medicare actually reduces patient rights, improves Hospital profits and leaves patient’s on the hook for huge medical bills!#N#Our in house expert on all things Medicare explains;

Is an outpatient hospital covered by Medicare?

Let me start by explaining that “outpatient” hospital stays are not covered under the “Part A” benefit like an inpatient Hospital stay would be. The “outpatient” or “observation” status patient will be accessing their “Part B” Medicare coverage, and this can be quite expensive.

Does CMS require you to sign the moon?

CMS does require that you get the “MOON” both “orally and in writing” so why isn’t this Law, or rule not really having the affect that it was intended to have ?

What is a MOON in Medicare?

The Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) requires all hospitals and critical access hospitals to provide a written and oral notification to patients who are placed in observation status. The notice informs the patient of specific details about their status, and educates them regarding what Medicare typically covers.

Why does Medicare advise hospitals to have pricing information available for patients to review as they read the MOON form?

Because patients may have questions, Medicare advises hospitals to have pricing information available for patients to review as they read the MOON form. CMS says a patient must be cared for in the most appropriate setting; if a patient does not need inpatient care, they must be cared for as an outpatient.

What is a moon in CMS?

The MOON is a standard CMS form with blanks for: Patient name and number. Attending physician name. Date and time observation services begin. A description of why the patient is being placed in outpatient observation status. Additional patient-specific information, which may be added by the hospital.

How many hours of observation is required for a moon?

Time Factors into MOON Rules. The MOON does not need to be delivered to every Medicare patient who receives outpatient services — only those receiving at least 24 hours of observation services. Per the Centers for Medicare & Medicaid Services (CMS), the observation clock begins when “observation services are initiated (furnished to the patient), ...

Why is a moon necessary?

Why the MOON Is Necessary. The MOON was created because of inconsistency in status assignment and ongoing patient confusion. The purpose of the MOON is to tell patients up front about potential out-of-pocket expenses. The MOON informs patients: Part A does not cover outpatient services.

How long does it take to receive a MOON?

Patients must receive the MOON no later than 36 hours after the start of observation services, and the patient or representative must acknowledge receipt by signing and dating the form.

What to say in a moon conversation?

Be aware that the MOON conversation may raise questions and complaints from patients, who may decide to leave the hospital against medical advice. In the conversation with the patient, explain that the provider determines observation status, not the hospital. Establish a follow-up process for patients who leave against medical advice, so they (at minimum) visit their primary care physician after leaving the hospital.

What does the moon tell you?

The MOON will tell you why you’re an outpatient getting observation services, instead of an inpatient. It will also let you know how this may affect what you pay while in the hospital, and for care you get after leaving the hospital.

How does hospital status affect Medicare?

Inpatient or outpatient hospital status affects your costs. Your hospital status—whether you're an inpatient or an outpatient—affects how much you pay for hospital services (like X-rays, drugs, and lab tests ). Your hospital status may also affect whether Medicare will cover care you get in a skilled nursing facility ...

What is deductible in Medicare?

deductible. The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay. , coinsurance. An amount you may be required to pay as your share of the cost for services after you pay any deductibles.

Is observation an outpatient?

In these cases, you're an outpatient even if you spend the night in the hospital. Observation services are hospital outpatient services you get while your doctor decides whether to admit you as an inpatient or discharge you. You can get observation services in the emergency department or another area of the hospital.

Can a doctor change your hospital status?

Your doctor writes an order for you to be admitted as an inpatient, and the hospital later tells you it's changing your hospital status to outpatient. Your doctor must agree, and the hospital must tell you in writing—while you're still a hospital patient before you're discharged—that your hospital status changed from inpatient to outpatient.

Does Medicare cover skilled nursing?

Your hospital status may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay. You're an inpatient starting when you're formally admitted to the hospital with a doctor's order. The day before you're discharged is your last inpatient day. You're an outpatient if you're getting ...

Can you deduct outpatient hospital copayments?

The copayment for a single outpatient hospital service can’t be more than the inpatient hospital deductible. However, your total copayment for all outpatient services may be more than the inpatient hospital deductible.