CMS Releases Instructions for Using MOON

PUBLISHED: Jan 25, 2017

The Centers for Medicare and Medicaid Services has published instructions for implementing the updated version of the Medicare Outpatient Observation Notice (MOON). The MOON is a standardized notice to inform Medicare beneficiaries that they are an outpatient receiving observation services and are not an inpatient of the hospital or critical access hospital.

The MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), passed on August 6, 2015. The NOTICE Act requires hospitals and CAHs to provide notification to individuals receiving observation services as outpatients for more than 24 hours explaining the status of the individual as an outpatient, not an inpatient, and the implications of such status.

Interpretive Guidance:

  • The MOON must be delivered to beneficiaries in Original Medicare (fee-for-service) and Medicare Advantage enrollees who receive observation services as outpatients for more than 24 hours. The hospital or CAH must provide the MOON no later than 36 hours after observation services as an outpatient begin.
  • The statute expressly provides that the MOON be delivered to beneficiaries who receive observation services as an outpatient for more than 24 hours. In other words, the statute does not require hospitals to deliver the MOON to all beneficiaries receiving outpatient services.
  • The MOON is intended to inform beneficiaries who receive observation services for more than 24 hours that they are outpatients receiving observation services and not inpatients, and the reasons for such status, and must be delivered no later than 36 hours after observation services begin.
  • Hospitals and CAHs may deliver the MOON to an individual receiving observation services as an outpatient before the 24 hour mark has been reached.
  • An oral explanation of the MOON must be provided, ideally in conjunction with the delivery of the notice, and a signature must be obtained from the individual, or a person acting on such individual’s behalf, to acknowledge receipt. In cases where such individual or person refuses to sign the MOON, the staff member of the hospital or CAH providing the notice must sign the notice to certify that notification was presented.
  • Electronic issuance of the MOON is permitted.
  • The MOON may be delivered to a beneficiaries’ representative.

Hospitals and CAHs are required to provide the MOON beginning no later than March 8, 2017. Included with today’s notice is an example policy outlining specific instructions for delivery of the MOON.

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