The following is a question and answer form created by Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at R1 Physician Advisory Services in Chicago, to help outline some basics regarding the complex rules surrounding the three-day qualifying stay required, which Medicare requires in order for patients to qualify for the skilled nursing facility (SNF) benefit.You can use this as a starting point to create your own physician and provider training materials on this topic. Ensuring that providers are well-trained on this topic can help ensure patients get accurate information, which can make these discussions less difficult.
Organizations today are putting a lot of energy into getting ready to comply with the NOTICE Act and Medicare Outpatient Observation Notice (MOON) guidelines, which go into effect on March 8 (see related story on p. 1). But this new notification requirement is giving them a related headache to contend with as well: issues related to the three-day qualifying inpatient stay required for Medicare coverage of the SNF benefit. The NOTICE Act is intended to ensure patients are aware of their status and the financial implications it may have for them—in particular, how it might affect their postacute care options.
On February 2, CMS Revised its Medicare Outpatient Observation Notice (MOON) instructions in MLN Matters 9935, but the document provided little new information, primarily reiterating much of what was already said in the 2017 IPPS final rule.
“CMS went into great detail on delivery of the MOON when the patient is not competent, but completely ignored providing details on the amount of specificity needed in completing the box specifying ‘the reason the patient is outpatient,’ ” says Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at R1 Physician Advisory Services in Chicago. “This was one of the least helpful publications I have seen from CMS.”
For case management professionals, keeping up with the MOON revisions has been a challenge.
This week's note from the instructor discusses implementation of the Medicare Outpatient Observation Notice (MOON) and the implementation deadline, which is just a week away.
Ever since Pat became a nurse case manager three years ago, both family and friends have reached out to her for healthcare advice. She really doesn’t mind and almost expects it, especially since healthcare can be complex and challenging. By sharing her knowledge as a case manager, Pat can often help people navigate healthcare complexities.
Ever since Pat became a nurse case manager three years ago, both family and friends have reached out to her for healthcare advice. She really doesn’t mind and almost expects it, especially since healthcare can be complex and challenging. By sharing her knowledge as a case manager, Pat can often help people navigate healthcare complexities.
