In this month's article we discuss the Notice of Observation Treatment and Implication for Eligibility Act that was adopted in August, 2016. We hear from many professionals impacted by the NOTICE Act that adoption of the new rules and process has come with the standard set of growing pains and additional controversies. In this article, we'll discuss some of the most common controversies and points of confusion for both patients and professionals alike.
The Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) was adopted in August, 2016. The NOTICE Act established a standardized method of informing patients of their admission status. On March 8th, 2017, hospitals began issuing a form, Medicare Outpatient Observation Notice (MOON), to their patients.
This was a significant change, as previously patients were told upon admission if their status was observation or inpatient. Few patients understood the implication of that status. Each facility had their own process and procedure for informing patients and, in addition, their own timetable. There was little uniformity throughout the industry. Patients given verbal notice complained of not understanding their status and, specifically, the financial implications. The MOON form was in response to this scenario and was adopted in attempt to address patient confusion.
As we approach a year since the MOON form was adopted, certain challenges and controversies have been raised.
One concern brought forward by The Center for Medicare Advocacy, a national non-profit advocacy group focused on Medicare-related issues, was that the rule does not require hospitals to explain the MOON form or provide the specific reason the patient is being considered an outpatient. This decision is different than most Medicare notices.
The most challenging section to be completed on the MOON form is the following:
"You're a hospital outpatient receiving observation services. You are not an inpatient because: _____________________________."
When looking at the Medicare Benefit Policy Manual, observation care is "a well-defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital."
In light of that guidance, a common answer will frequently be something along the lines of "you require ongoing short term treatment or assessment before a decision can be made whether you will require treatment as a hospital inpatient." This response often leads to patient confusion.
Another aspect of the MOON form creating controversy is the lack of a process of appeal. Most Medicare notices of coverage determination will provide the beneficiaries an opportunity to appeal to Medicare. Only the MOON form defines the coverage issue as non-appealable. Just as beneficiaries can challenge a premature discharge or contest a host of other coverage determinations in the Medicare program, it is felt that they should be able to appeal their placement on Observation Status.