Get the free Medicare Outpatient Observation Notice (MOON) Instructions

Patient Name: MRU #: Green Bay, WisconsinPhysician: Date:MEDICARE OUTPATIENT OBSERVATION NOTICE (MOON)Time:You're a hospital outpatient receiving observation services. You are not an inpatient because:

How to fill out medicare outpatient observation notice

How to fill out medicare outpatient observation notice

1. Review the Medicare Outpatient Observation Notice (MOON) form provided by the hospital or healthcare provider.
2. Fill out your personal information including name, address, date of birth, and Medicare number.
3. Review the information provided on the form about why you are being placed under outpatient observation status.
4. Sign and date the form to acknowledge that you have received and understand the information provided.
5. Keep a copy of the completed form for your records.

Who needs medicare outpatient observation notice?

1. Patients who are admitted to a hospital under outpatient observation status by the healthcare provider.

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What is medicare outpatient observation notice?

The Medicare Outpatient Observation Notice (MOON) is a notification provided to Medicare beneficiaries when they are receiving observation services as outpatients. It informs them that they are under observation rather than being admitted as inpatients.

Who is required to file medicare outpatient observation notice?

Healthcare providers, such as hospitals and outpatient facilities, are required to issue the Medicare Outpatient Observation Notice to patients receiving observation services.

How to fill out medicare outpatient observation notice?

To fill out the MOON, providers must include the patient’s information, details of the observation services provided, the reason for the observation status, and inform the patient about their rights under Medicare.

What is the purpose of medicare outpatient observation notice?

The purpose of the MOON is to ensure that patients are aware of their outpatient observation status, which impacts their coverage for services, financial liability, and eligibility for skilled nursing facility care.

What information must be reported on medicare outpatient observation notice?

The MOON must report the patient's name, Medicare number, observation start date, reason for observation status, and a statement explaining the implications of the observation status.