More News & Resources

Hospitals must provide MOON

 

Hospitals and critical access hospitals (CAHs) must provide the Medicare Outpatient Observation Notice (MOON), or CMS-10611, to patients with Original Medicare who are receiving outpatient observation services for more than 24 hours, effective Feb. 21, 2017. The purpose of this change request (CR) is to update Chapter 30 of Pub. 100-04 to include the Medicare Outpatient Observation Notice (MOON), CMS-10611, form instructions.

 

Hospitals must provide MOON

The MOON was developed to inform all Medicare beneficiaries when they are an outpatient receiving observation services, and are not an inpatient of the hospital or critical access hospitals (CAH). The form instructions to be included in Chapter 30 provide guidance for proper issuance of the MOON.

For purposes of these instructions, the term “beneficiary,” means either beneficiary or representative, when a representative is acting for a beneficiary.

 

This also includes beneficiaries in the following circumstances: • Beneficiaries who do not have Part B coverage • Beneficiaries who are subsequently admitted as an inpatient prior to the required delivery of the MOON • Beneficiaries for whom Medicare is either the primary or secondary payer The statute expressly provides that the MOON be delivered to beneficiaries receiving observation services as an outpatient for more than 24 hours. In other words, the MOON should not be delivered 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.

However, hospitals and CAHs may deliver the MOON to an individual receiving observation services as an outpatient before such individual has received more than 24 hours of observation services. Allowing delivery of the MOON before an individual has received 24 hours of observation services affords hospitals and CAHs the flexibility to deliver the MOON consistent with any applicable State law that requires notice to outpatients receiving observation services within 24 hours after observation services begin. The flexibility to deliver the MOON any time up to, but no later than, 36 hours after observation services begin also allows hospitals and CAHs to spread out the delivery of the notice and other hospital paperwork in an effort to avoid overwhelming and confusing beneficiaries.

The MOON must be delivered to applicable patients no later than 36 hours after outpatient observation services begin, but may be given prior to the 24-hour mark, per the Centers for Medicare & Medicaid Services (CMS).

The official instructions for using the MOON will appear in the Medicare Claims Processing Manual, Chapter 30, Section 400. Until then, you may refer to the chapter updates attached to CMS Transmittal 3698, Change Request 9935.