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CMS’ new “MOON” (Medicare Outpatient Observation Notice) draft is out, and Ron Iverson over at NAMSMAP is calling it “probably the most important event of the year in news from CMS.”
Iverson believes the new draft (see attachment) is a good document – far less confusing than earlier attempts. He also notes it has received very little fanfare for the potential big impact it can have.
Some excerpts of Ron’s observations, from today’s edition (with Ron’s permission) of his NAMSMAP newsletter:
People who have been patients in a hospital have no idea why they were coded as being under “observation”—and what it means. It means a lot. Being coded as observational means that it becomes a Part B (outpatient) claim, and the costs are higher to the patient or their insurance company.
Then, there’s a loss of Extended Care (skilled care) benefits in a skilled care facility, which means greater expense for those who have to go to a facility for rehabilitation and pay for it themselves. We’ve complained about this for years, considering the fact that it happens to about two million people a year…
So, now with the MOON notice, patients must be notified of any stay (longer than 24 hours) why they have been coded as “receiving observation services.” The hospitals didn’t have to notify them of this coding, but now they will have to.
He’s advising agents use the simple MOON form to explain the “admitted” vs. “observational” problem to prospects and clients, because they likely won’t hear it from anybody else.
He goes into much more detail in his newsletter to NAMSMAP members, but here’s one final comment from Ron:
It will take some time, but when people start complaining about the MOON Notice, or that they are being coded as an outpatient Part B claim, rather than an inpatient Part A claim, the stories will start coming out, and the major media will start to shout about it—even though they have been oblivious to the matter at this point.
Iverson believes the new draft (see attachment) is a good document – far less confusing than earlier attempts. He also notes it has received very little fanfare for the potential big impact it can have.
Some excerpts of Ron’s observations, from today’s edition (with Ron’s permission) of his NAMSMAP newsletter:
People who have been patients in a hospital have no idea why they were coded as being under “observation”—and what it means. It means a lot. Being coded as observational means that it becomes a Part B (outpatient) claim, and the costs are higher to the patient or their insurance company.
Then, there’s a loss of Extended Care (skilled care) benefits in a skilled care facility, which means greater expense for those who have to go to a facility for rehabilitation and pay for it themselves. We’ve complained about this for years, considering the fact that it happens to about two million people a year…
So, now with the MOON notice, patients must be notified of any stay (longer than 24 hours) why they have been coded as “receiving observation services.” The hospitals didn’t have to notify them of this coding, but now they will have to.
He’s advising agents use the simple MOON form to explain the “admitted” vs. “observational” problem to prospects and clients, because they likely won’t hear it from anybody else.
He goes into much more detail in his newsletter to NAMSMAP members, but here’s one final comment from Ron:
It will take some time, but when people start complaining about the MOON Notice, or that they are being coded as an outpatient Part B claim, rather than an inpatient Part A claim, the stories will start coming out, and the major media will start to shout about it—even though they have been oblivious to the matter at this point.
