Wholesale MOON Claims Rejections No Longer Allowed

Hospitals present “MOON” forms to Medicare patients to inform them that they are outpatients receiving observation services rather than being inpatients of the hospital. Delivering the “Medicare Outpatient Observation Notice” to patients and having them confirm receipt is just another piece of the paperwork puzzle that is part of providing care in hospitals.
But over the past few months, National Government Services (NGS) – which is part of the Anthem health insurance company – has been conducting audits on use of the MOON form and, as a result, has been routinely denying hospital observation claims.
MHA, working with its member law firm Foley & Lardner investigated the issue, which resulted in the Centers for Medicare and Medicaid Services (CMS) instructing its vendor NGS to quit issuing claims denials based on MOON form delivery objections. Such objections are often related to not having the patient clearly write the date and time when they received the form, or the provider not being sufficiently descriptive when filling in the line explaining why the patient is not considered an inpatient.
MHA is encouraging its members to adhere closely to the form instructions and to be as descriptive as possible when filling out all lines, but not to accept wholesale rejections by the insurance company auditor CMS hired.