January 26, 2017
In October, the Centers for Medicare and Medicaid Services (CMS) issued a new ruling regarding new notification procedures for Medicare patients receiving outpatient observation services for more than 24 hours. Hospitals and critical access hospitals had 90 calendar days to fully implement the final ruling.
The new rule requires hospitals and critical access hospitals to provide notice (known as a Medicare Outpatient Observation Notice, or MOON) to patients classified as observation and not inpatient. Outpatient Observation Services are provided in a hospital, but without the patient being admitted as an inpatient.
Why?
The new rule helps Medicare patients understand their care and related costs. Medicare Part A covers inpatient costs, while Medicare Part B covers outpatient observation care. As a result, Medicare patients receiving outpatient observation care could be responsible for higher out-of-pocket costs.
How?
The notice must be delivered to the patient or their representative within 36 hours after observation services are initiated. While the patient may read the notice on an electronic screen, CMS requires that hospitals give patients the option of reading the information on paper.
If the patient has a representative who is not physically present, CMS allows hospital staff to give the notice by telephone, but they must deliver a hard copy to the representative.
MOON notification instructions and written templates are available on the CMS website at CMS.gov.
This link from CMS provides patient-friendly information on inpatient vs. outpatient care.