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.
What do we do when families want their loved one admitted as a hospital inpatient so he or she can qualify for a transfer to a skilled nursing facility?
No later than Wednesday of this week—March 8, 2017—hospitals (including critical access hospitals [CAH]) are required to meet the newest of Medicare’s numerous hospital notification requirements. Under the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, hospitals must provide both written and oral notice regarding the outpatient nature of observation and the resulting implications to all Medicare beneficiaries who receive observation services for more than 24 hours. This notice must be provided in a prescribed form (the Medicare Outpatient Observation Notice [MOON]) within 36 hours of when observation care began and must meet certain additional requirements with respect to delivery, documentation, etc.
Q: We have seen a decrease in payment for our CT scans this year. It is only affecting the scans that we report with modifier –CT, so it isn’t all of them, but it is enough that our CFO has asked about it.
In several recent reports, the Office of Inspector General (OIG) determined that providers are, on average, variant from expected volumes on both short stay inpatient and long stay observation cases. What was not made clear in the OIG report is the reason why it believes such variances exist. The answer to this question likely rests within the details of how hospitals have adjusted (or not adjusted) to the use and application of “new criteria” in their daily and ongoing Medicare billing compliance processes.
The American Case Management Association (ACMA) is now offering the Accredited Case Manager (ACM™) certification exam at more than 300 testing sites, according to a press release. Previously, ACMA offered the exam at 185 testing sites.
