medicare outpatient observation notice (moon) update
TRANSCRIPT
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MOON Update E
DICARE
UTPATIENT
BSERVATION
OTICE
Presented by:
Laura Legg RHIT, CCS, CDIP, AHIMA approved ICD-10 CM/PCS
Trainer HRG Executive
Director of Revenue Integrity and Compliance
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DisclaimerThis PowerPoint presentation is an education tool to provide basic information for coding. The information is the sole view of the author and was put together based on experience, research and expertise in the coding profession. It is not intended to be an exhaustive review and should not be considered a substitution for Coding Guidelines. The presenter does not accept any responsibility or liability with regard to errors, omissions misinterpretations or misuse by the audience.
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Medicare Outpatient Observation Notice
(MOON)Who should explain MOON to the patient?When should notice be given?What documentation must be included?How can we help the patient understand possible reimbursement consequences?
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Why Do We Need the MOON?
Medicare beneficiary thinks:
“I spent the night in the
hospital, therefore, I must
be an inpatient!”
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CMS Says:A patient must be cared for in the most appropriate setting. If a patient does not need inpatient care, they must be cared for as an outpatient. Hence, we must have outpatient observation status. Only the physician can decide whether the patient needs inpatient care or outpatient observation care.
This is called Hospital Status.
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Hospital Status Effects How Much Medicare Beneficiaries Pay for
Hospital ServicesKnow Your Hospital Stays?
Formal Admission of Observation?
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Medicare Outpatient Observation Status
Last year, President Obama signed the Notice of Observation Treatment and Implication for Care Eligibility ActRequires hospitals to give patient specific details about their hospital status and educate them about what services are usually covered by MedicareEvery patient who receives observation services as an outpatient for more than 24 hours must receive an official notice
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Official Notice Called the MOONMedicare Part A does not cover outpatient servicesMedicare Part B may require copays for certain outpatient hospital and physician services after the deductiblePatients will likely be charged extra for any self-administered drugs they’ve been taking for chronic conditionsOutpatient observation services don’t count toward the three-day inpatient stay requirement for Part A coverage for post-discharge care in a skill nursing facility
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What Documentation Should be Included?
The MOON is a standardized form created by Centers for Medicare and Medicaid Services (CMS)The form has blank areas where providers must fill in the name of the patient’s attending physician for the hospital stay and both the date and time when observation services first begin for the patientDeadline: March 8, 2017
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When Should the Patient Receive the MOON?
Patients must get a MOON no later than 36 hours after observation services beginThe patient or the patient’s representative must acknowledge receiving the form with a signatureThe form can be printed out or signed electronicallyPatients must receive a physical copy of the signed form
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It’s Not Just a Form - It’s a Conversation
Hospital staff must verbally inform patients about how Medicare may handle their observation statusIt should only take a few minutes, but remember to anticipate time for questions
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Patient Will Likely be Concerned:MOON is designed to let patients know about their potential out-of-pocket costsMedicare beneficiaries may have further questions about their own costsHave pricing information available for patients to review as they read over the MOON
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Who Should Explain MOON to the Patient?
Every facility must decide who can best explain the MOON
- Case Manager- Financial Counselor- Access staff
It’s YOUR Decision!
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There ARE Some Risks Involved: Medicare beneficiaries may opt out of the observation services entirely, leaving the hospital against medical adviceBe sure they know it is the physician who determines the need for observationIt’s a good idea to establish a follow-up process for these patients making sure they at least understand their discharge instructions and visit their primary care provider after leaving the hospitalThere may be patient complaints
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What if the Patient Refuses to Sign?
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What Documentation is Required?
The MOON will require a narrative of why the patient is being placed in outpatient status with observation servicesCMS says that in the future it will consider model language for use in this section
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Is MOON Required if Medicare is the Secondary Payer?
The MOON is required for patients for whom Medicare is the second payerThe MOON is required for all patients with Medicare Advantage plans, but note that copayments and SNF requirements may differ for those patients
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MOON Form Part 1
Presenting the long-awaited…
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MOON FormPart 2
From the makers of MOON Form Part 1…
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MOON Form Part 3
Just when you thought it was safe to go back in the file room, the makers of MOON Form Part 1 & 2 bring you…
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Questions?Laura Legg, RHIT, CCS, CDIPExecutive Director of Revenue Integrity & [email protected]
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Referenceshttps://www.cms.gov/Medicare/Medicare-General-Information/BNI/index.htmlhttps://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/CMS-10611-MOON.ziphttps://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/CR9935-MOON-Instructions.pdf