UNITED STATES─Toni: Yesterday, my wife was ambulanced to the hospital after falling and breaking her leg. Now the hospital billing department had me sign a form that I knew she was an outpatient and not an inpatient. I am a little confused because I thought when you went in the hospital you were always an inpatient.

I don’t understand why I had to sign the form. The hospital knows my wife can’t walk and needs medical care. Please explain what I should do so that I have control back on my side and not at the mercy of the hospital. Thanks, Tom from West U area.

Tom: An important Medicare rule called Medicare Outpatient Observation Notice (MOON) applies to those with an Original Medicare hospital stay. The Medicare and You handbook states “Staying overnight in a hospital doesn’t always mean you’re an inpatient. You only become an inpatient when a hospital formally admits you as an inpatient, after a doctor orders it. You’re still an outpatient if you haven’t been formally admitted as an inpatient, even if you’re getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays. You or a family member should always ask if you’re an inpatient or an outpatient each day during your stay, since it affects what you pay and can affect whether you’ll qualify for Part A coverage in a skilled nursing facility.”

A few years ago, hospitals and critical access hospitals began providing the MOON (Medicare Outpatient Observation Notice) to Medicare beneficiaries or their legal representative if receiving observation services as an outpatient for more than 24 hours. The MOON must be provided in written form which is signed and dated with an oral explanation from the facility no later than 36 hours from the time the Medicare patient begins receiving outpatient observation services. This time limit is considered the new two midnight stay observation policy.

Tom, this is why you had to sign the form from the hospital’s business office or case manager because if your wife is still an outpatient and needs additional care or skilled nursing, then she may not qualify because she does not meet the skilled nursing qualifications.

Many on Medicare would not see this information in the Medicare & You handbook and may have to pay thousands of dollars for additional hospital or skilled nursing care.

Below is what America should know when having a hospital stay and need to advise their family members or caregivers:

  1. Remember the MOON rule applies to those on “Original Medicare” and not Medicare Advantage plans, as Medicare Advantage Plans have their own rules and options regarding inpatient/outpatient services.

2.       The Medicare Outpatient Observation Notice (MOON) which must be signed by you or a family member to be aware if the one in the hospital’s status

is qualified as an outpatient rather than inpatient in the hospital.

  1. Remember one can only become an inpatient once the hospital, not your doctor, “formally admits” you with a doctor’s order.
  2. You or a family member should ask every day if you or your loved one is an inpatient or an outpatient.
  3. Know that outpatient status does not cover Medicare skilled nursing costs.

For questions regarding the maze of Medicare, call the Toni Says Medicare hotline at 832-519-8664.

Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book to the Toni Says Medicare column readers at www.tonisays.com.