Medicare Outpatient Observation Notice
We wanted to reach out to you to let you know about a new notification that Highmark Members who are placed under Outpatient Observation Care will receive. Starting March 8th, 2017, there will be a Medicare Outpatient Observation Notice (MOON) issued by the facility which will help to clear up any confusion for Highmark Members who believe they have been admitted inpatient. The notice is required for Highmark Members who are under observation for longer than 24 hours and should be issued within 36 hours after the observation services are initiated. Please be advised that Highmark Members will be receiving a letter directing them to Highmark for any questions they may have regarding their benefit information and the letter will indicate the reason they are under the observation.
As a reminder, if a Highmark Member is kept in the hospital overnight but not admitted to the hospital, they will be charged for observation care which will follow outpatient benefits for services completed (diagnostic testing, X-Rays, Advanced Imaging, etc.). There is coverage for these services; however, during this time the hospital doesn’t have enough clinical proof of needing to “admit” the patient. This process is followed to provide the member with an explanation on why they have been kept overnight in the hospital but their inpatient benefits have not been applied.
Click the button below to download an example notice for your reference.
