Q&A: MOON Notice for CAHs

July 5, 2016
Medicare Web

Q. When issuing a MOON in a critical access hospital (CAH), how do we explain the patient financial responsibility since we are not paid the observation set amount?

A. CMS requires a 20% percent coinsurance amount due from the patient (or supplemental insurance) plus self-administered drugs when receiving Observation services from a CAH.  Also, remember that critical access is capped at 48 hours of observation. You cannot go beyond that. You might just want to give the patient an estimate based upon 24 hours, 36 hours, and 48 hours of what his or her copay would be at 20%. 

Deborah Hale, CCS, CCDS, president and CEO of Administrative Consultant Service, LLC, in Shawnee, Oklahoma, answered this question.

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