The following is a question and answer form created by Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at R1 Physician Advisory Services in Chicago, to help outline some basics regarding the complex rules surrounding the three-day qualifying stay required, which Medicare requires in order for patients to qualify for the skilled nursing facility (SNF) benefit.You can use this as a starting point to create your own physician and provider training materials on this topic. Ensuring that providers are well-trained on this topic can help ensure patients get accurate information, which can make these discussions less difficult.
CMS released eight frequently asked questions related to the Medicare Outpatient Observation Notice March 8, the date by which all hospitals and critical access hospitals were required to begin delivering the new patient notice.
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?
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.
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.
On February 2, CMS Revised its Medicare Outpatient Observation Notice (MOON) instructions in MLN Matters 9935, but the document provided little new information, primarily reiterating much of what was already said in the 2017 IPPS final rule.
“CMS went into great detail on delivery of the MOON when the patient is not competent, but completely ignored providing details on the amount of specificity needed in completing the box specifying ‘the reason the patient is outpatient,’ ” says Ronald Hirsch, MD, FACP, CHCQM, vice president of the Regulations and Education Group at R1 Physician Advisory Services in Chicago. “This was one of the least helpful publications I have seen from CMS.”
For case management professionals, keeping up with the MOON revisions has been a challenge.
Whether writing a note, completing a flow sheet, or entering information in an electronic record, a discharge planner is capturing data: facts related to actions, reactions, and decisions. For the purposes of this example, a discharge planner is writing the story about the planning that occurs to prepare for a patient’s transition to the next level of care.
