MOON VIDEO INSTRUCTIONS

HomeTown Health is excited to offer our hospitals this video for use as a patient education tool. The Medicare Outpatient Observation Notice (MOON) was implemented March 8, 2017 by CMS. Hospitals and CAHs are required to present the CMS standardized notice to Medicare observation patients.

This video is to be used as a patient education tool to assist hospitals and CAHs when explaining the MOON notice to patients. Per CMS, “a staff person must always be available to answer questions related to the MOON”. HomeTown Health recommends a staff person be in the room during the presentation of the video so that they are available to answer questions and get the required signature on the form. Graphic breaks have been inserted into the video to allow hospitals to pause, if needed, for additional explanations or beneficiary questions.

When presenting the video, inform the patient that you have a Medicare form for them to sign and the video will explain the details of the form.

For further information related to the timing of delivery and explanation of the form please go to .

The materials and information presented and contained within this document are provided as general information only, and do not, and are not intended to constitute legal advice or to substitute for any insurance coverage determinations.

Any opinions expressed within this video are solely the opinion of the individual and may not reflect the position of CMS or your secondary insurance carrier.

The materials and information described in the video, and on the forms, are for the sole use of the recipient as education and do not guarantee payment for the services under any state, federal or private insurance plan.

If you have any questions about your Medicare benefits, please refer to the Medicare Manual and the CMS website