Print

Medicare Outpatient Observation Notice (MOON) Requirement

December 13, 2017

The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act requires hospitals and Critical Access Hospitals (CAH) to provide the Medicare Outpatient Observation Notice or “MOON” to Medicare beneficiaries verbally and in writing. Per CMS guidance, all hospitals and CAHs were required to provide the MOON beginning no later than March 8, 2017. BCBSNM therefore expects its Network Providers to provide the MOON to its Blue Cross Medicare Advantage (PPO)SM, Blue Cross Medicare Advantage (HMO/HMO POS)SM and Blue Cross Medicare Advantage (HMO/HMO SNP)SM members receiving observation services as outpatients for more than 24 hours. The MOON explains the status of the individual as an outpatient as opposed to an inpatient, along with the implications of observation services on cost sharing and coverage for post-hospitalization skilled nursing facility (SNF) services.

An oral explanation of the MOON must be provided, ideally in conjunction with the delivery of the notice, no later than 36 hours after observation services are initiated or, if sooner, upon release. In addition, a signature must be obtained from the individual, or an individual qualified to act on their behalf, to acknowledge receipt and understanding of the notice. In cases where the 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.

The MOON and instructions can be found
at cms.gov/bni/ Learn more about third-party links or cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-12-08-3.html. Learn more about third-party links

The information provided here briefly summarizes the referenced law and neither exhaustively describes the law nor constitutes a legal opinion of such law. Compliance with this summary in no way infers or guarantees compliance with the referenced law. Furthermore, nothing herein constitutes legal advice. Providers are required to independently understand and fully comply with all laws applicable to their operations. If you have any questions regarding the law mentioned here you should consult the law and your legal advisor.