Awareness : Frequently Asked Questions

Medicare Outpatient Observation Notice

What is MOON?

The Medicare Outpatient Observation Notice (MOON) is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (Notice Act), passed on August 6, 2015. This law amended hospitals and critical access hospitals (CAH) to provide written notification and oral explanations of such notification to individuals receiving observation services as outpatients for more than twenty-four hours at a hospital or CAH’s. Hospitals and CAH’s must provide the MOON to patients who receive observation services as outpatients for more than 24 hours.

When is MOON Delivered?

All patients receiving services in hospitals or CAH’s must receive a MOON no later than 36 hours after observation services as an outpatient begin. The MOON should not be delivered to all patients receiving outpatient services. The Medicare Outpatient Observation Notice is intended only for patients who receive services for more than 24 hours.

Hospitals may deliver the MOON to an individual receiving observation services as an outpatient before such individual has received more than 24 hours of observation services. Allowing delivery of the MOON before the individual has received 24 hours of observation services affords hospitals and CAH’s the flexibility to deliver the MOON (consistent with any applicable State Law that requires notice to outpatients receiving observation services within 24 hours after observation begins.) The flexibility to deliver MOON any time up to, but no later than, 36 hours after observation services begin also allows hospitals and CAH’s to spread out delivery of the notice and other hospital paper work in an effort to avoid overwhelming and confusing patients.


Ensuring Beneficiary Comprehension

As well as providing the standardized written MOON, hospitals and CAH’s must also orally notify the patient. The oral notification must consist of an explanation of the standardized written MOON. The hospital and CAH’s must ensure that the patient or representative’s signs and dates the MOON to demonstrate that the patient or representative’s received the notice and understands its contents. NOTE: There is an exception to the in-person notice delivery requirement. If the MOON must be delivered to a representative who is not physically present to receive deliver of the notice, the hospital and CAH’s is not required to make an off-site delivery to the representative.


Refusal to Sign MOON

If the patient refuses to sign the MOON, and there is no representative to sign on behalf of the patient, the notice must be signed by the staff member of the hospital or CAH who presented the written notification. The staff member’s signature must include the name and title of the staff member, a certification that the notification was presented, and the date and time the notification was presented. The date and time of refusal is considered to be the date of notice receipt.

Moon Delivery to Representatives

The MOON may also be delivered to an authorized representative. Generally an authorized representative is an individual who, under State or other applicable law, may make health care decisions on a patient’s behalf. If the representative is not present at the time of delivery of the notice the hospital must complete the MOON as required and telephone the representative. The information provided telephonically should include all contents of the MOON. Note: the date and time the hospital or CAH communicates this information telephonically to the representative is considered the receipt date of the MOON, annotate the “additional information” section to reflect that all of the information indicated above was communicated to the representative. Annotate the “additional information” section with the name of the staff person initiating the contact, the name of the representative contacted by phone, the date and time of the telephone contact, and the telephone number called.


Notice Retention for the MOON

The hospital or CAH must retain the original signed MOON in the patient’s medical record. The patient should receive a paper copy of the MOON that includes all of the required information.