top of page

What is the MOON notice?

By Martine G. Brousse (not AI!)

"The Medical Bill Whisperer"

Patient Advocate, Certified Mediator



June 5, 2024


Original Medicare and Medicare Advantage beneficiaries should be aware of the MOON notice, as it impacts their status while in a hospital, which in turn determines their ultimate share of cost. If they must be transferred to a Skilled Nursing facility (“SNF”) after a hospital stay, it is even more imperative they get familiar with this notice and what it means.


One of the great things about Medicare, is the many rights its beneficiaries enjoy. And even better are the protections they are entitled to. This translates into a number of notices, which medical providers – individuals and facilities – must give out to warn patients when their health and their wallet are about to be impacted.


One of those notices is called the “Medicare Outpatient Observation Notice” or “MOON”.


A.   What is “Observation”?


1.     It is a status of limbo, not quite “Inpatient” not quite “Outpatient

2.     You have been in the hospital at least 24 hours but (usually) less than 2-3 midnights

3.     You are not sick enough to be admitted, but are not well or stable enough to be discharged

4.     The supervising physician needs more time to determine what your diagnosis and/or course of treatment should be, whether you can be released from the hospital (“outpatient”), or must be admitted (“inpatient”)

5.     Your present condition does not warrant – at least now – a hospital stay of at least 2 midnights (or more), which would label you as “inpatient”

6.     You are here for reasons which do not require a lot of time or high level of medical care:

·      Short-term treatment or procedure (i.e. radiation treatment or colonoscopy)

·      Health or symptom assessment

·      Monitoring of symptoms or waiting for test results (heart attack or indigestion?)

·      Imaging services (i.e MRI), testing, labs

·      ER visit that does not involve trauma or a life-threatening situation

7.     If you need transfer to a Skilled Nursing Facility (“SNF”), those services will NOT be covered by Medicare, as Observation does NOT qualify as the 3 midnights required in order for Medicare part A to pay SNF claims


B.    What is this MOON notice?


1.     It indicates that while services rendered by a hospital are paid under Medicare Part A, and Part B covers Doctors and other “professional” services, “Observation”, even if you remain in the hospital for 2-3 days, is covered under part B NOT part A

2.     It aims at reducing confusion and potential negative financial surprises down the line

3.     It notifies a patient that may have been originally admitted (and therefore Inpatient) that their status has be changed to “Observation” as a better diagnosis has been established, and the health risk downgraded.

4.     It gives patients notification that Part B will be billed, NOT part A

5.     It must provide:

·      Contact info for the person at the hospital who can answer insurance and payment-related questions

·      The medical reasons why you are under “Observation”

·      Cost-sharing details

·      A place for your signature, that indicates you understand the financial ramifications

6.     The MOON notice also allows patients to:

·      Understand how this status determines the rate of payment, and their final liability

·      Understand they will be responsible for the 20% copay per Medicare Part B, and that if they don’t have a secondary plan – or a good enough one – the cost could be prohibitive

·      Discuss their situation with their doctor: what is the diagnosis, treatment or action plan, length of expected stay at the facility, or discharge considerations

·      Ask to be Admitted if they don’t have part B and have been in the hospital for a fair amount of time, or if a transfer to a SNF is considered


C.    Some Tips


1.     When in a hospital, try and confirm your status, at least on a daily basis, and regardless of whether you receive a MOON notice or not. The guidelines for giving patients the notice is usually 36 hours, but some States require prompter notification

2.     Never ignore a MOON notice, as you may lose coverage for a subsequent SNF stay, end up with heavy Part B copays, and be unable to get your status changed after you have been discharged.

3.     If you stay 2 or more midnights in the hospital, make sure your status has been changed to “Inpatient” and that the MOON notice you received is no longer in effect. Although Medicare suggests that a stay of at least 2 midnights should be considered “Inpatient” (and therefore covered under part A), ultimately it is up to the supervising physician’s to admit you or not.

window showing moon in dark sky
MOON notice

4.     If you are to be transferred to a SNF, make sure the medical records and discharge paperwork clearly indicate you were “inpatient” for at least 3 midnights

5.     Always ask questions and double check the information you are given before you sign. Better do so before you leave the hospital, and medical bills start coming!

Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances. - (424) 999 4705 - F (424) 226 1330

@martine brousse 2024 @ the medical bill whisperer 2024

3 views0 comments


bottom of page