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Provider Manual

Medicare Outpatient Observation Notice (MOON)

Last Updated on November 16, 2018

Important Information Regarding the 42 CFR 489.20 and 405.926 Medicare Outpatient Observation NOTICE (NOTICE Act)

  • Security Health Plan is required to ensure its contracted hospitals and critical access hospitals (CAHs) implement the provisions of the NOTICE Act.  Under the NOTICE Act, hospitals and CAHs must deliver the Medicare Outpatient Observation Notice (MOON) to any Medicare beneficiary (including any Medicare Advantage enrollee) who receives observation services as an outpatient for more than 24 hours. The MOON requires hospitals and critical access hospitals (CAHs) to provide written and oral notification to individuals receiving observation services as outpatients for more than 24 hours.  The written notice must be delivered no later than 36 hours after observation services are initiated, must include the reason the individual is receiving observation services, and must explain the implications of receiving outpatient observation services, such as cost sharing and post-hospitalization eligibility for Medicare coverage of skilled nursing facility (SNF) services. The hospital or CAH must obtain the signature of the individual or an individual acting on behalf of the patient.
  • 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. The MOON contains all of the informational elements listed above as required by statute.
  • MOONs are not given every time items and services are furnished in a hospital or CAH. Hospitals are only required to deliver the MOON to individuals receiving observation services as outpatients for more than 24 hours.
  • Hospitals must deliver a hard copy of the MOON to beneficiaries and enrollees. Hospitals must retain a copy of the signed MOON and may store the MOON electronically if electronic medical records are maintained. If a hospital elects to issue a MOON that is viewed on an electronic screen before signing, the beneficiary must be given the option of requesting paper rather than electronic issuance if that is what the beneficiary prefers. Regardless of whether a paper or electronic version is issued, and whether the signature is digitally captured or manually penned, the beneficiary must be given a paper copy of the signed MOON.
  • In cases where the beneficiary has a representative who is not physically present, hospitals are permitted to give the MOON by telephone as long as a hard copy is delivered to the representative.
  • Click here to view the English MOON form Medicare Outpatient Observation Notice
  • Click here to view the Spanish MOON form Medicare Outpatient Observation Notice
  • Click here to view Notice Instructions CMS-10611: Medicare Outpatient Observation Notice
  • Click here to view the Supporting Statement for the Medicare Outpatient Observation Notice CMS-10611