Q&A: MOON delivery in outpatient surgeries

Q: I am writing to ask about the CMS Medicare Outpatient Observation Notice (MOON) form. If a patient receives less than 24 hours of observation care, do you still have to provide the patient with the MOON form? We often have surgical outpatients who will need observation for six to 12 hours for pain control, IV antibiotics, or other services. After treatment, we will discharge them home, but we need to put them on our surgical floor to provide this care and consequently have been putting them on observation status. Only recently have we started to accept Medicare, so I'm sorry to say we have little experience with all the regulations. How should we proceed?

A: This is a great question. The writer is correct; the MOON is not required by law until the patient has passed 24 hours from the time of the observation order, unless your state has a more restrictive law. For an outpatient surgery patient, the standard recovery period, as defined by the surgeon, is not classified as observation and observation should not be ordered. But if the patient requires additional hospital care when the end of routine recovery occurs, and that care is not expected to take the patient past the second midnight where inpatient admission would be ordered, then an order for observation is appropriate.

It would be extremely rare for such a patient to end up with more than 24 hours of observation, so routinely giving the MOON would not be advised. It should also be noted that providing observation services to the postoperative patient is extremely unlikely to increase their coinsurance, so the MOON notification may actually confuse them. However, if that rare Medicare or Medicare Advantage patient does pass 24 hours, be sure to provide that patient with a MOON form. Failure to provide the form would be viewed as a violation of the Medicare Conditions of Participation.

Editor’s note: This question was answered by Ronald Hirsch, MD, FACP, CHCQM, of R1 Physician Advisory Services in Chicago.