News: Delayed implementation of the NOTICE act

by Richard D. Pinson, MD, FACP, CCS

With the release of the 2017 Inpatient Prospective Payment System final rule on August 2, 2016, CMS announced a delay in implementation of the NOTICE act.  CMS is submitting a revised version of the Medicare Outpatient Observation Notice (MOON) for a 30-day public comment period followed by final approval after review.  Implementation of the NOTICE act provisions for all Medicare beneficiaries using the MOON must take place within 90 days of final approval.

In response to public comment CMS reduced the number of required fields on the MOON including physician name and the date and time observation services began, and removed the field for the hospital name.  Hospitals will be permitted to pre-print the MOON to include their hospital name and logo at the top of it. CMS also removed the QIO contact section from the MOON over concerns it might unnecessarily prompt a flood of complaints about the nature and quality of care provided.

In response to public comment that the MOON language regarding coverage of post-hospital SNF care and Part B coverage should be more clearly stated and prominent, CMS has simplified it and moved it near the top of the notice. In addition, CMS has added a free text field where the specific reason for receiving observation services as an outpatient must be completed by the hospital

CMS noted that, while not required until 24 hours of observation have been provided, the NOTICE act does permit a hospital to voluntarily deliver notice sooner than 24 hours of observation services have been provided to ensure compliance. CMS does not recommend providing notice at the time of initiating observation services citing concerns that patients may be preoccupied with their healthcare needs and other paperwork.

Some States independently require notice of outpatient status for all outpatients, regardless of the payer and irrespective of whether the patient has received observation services, and some require notice within 24 hours. The MOON satisfies the written NOTICE Act requirements for a designated population of Medicare beneficiaries receiving observation services only. CMS notes that, in some cases, delivering the MOON may also fulfill State notice requirements for the Medicare population, but hospitals will need to make that determination on a state-by-state basis.

The revised MOON (Form CMS-10611) and notice instructions can be accessed at: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10611.html.

Editor’s note: Richard Pinson, MD, FACP, CCS, principal of Pinson & Tang LLC, wrote this article. Pinson has more than 12 years of experience improving coding and clinical documentation practices and educating thousands of coders, documentation specialists, and physicians. He is a recognized CDI authority who co-authored the CDI Pocket Guide published by ACDIS, co-developed ACDIS’ CDI for the Clinician eLearning program for hospitals, and has written the monthly Coding Corner of the ACP Hospitalist magazine for over four years.