Medicare Cop Hospital Case Study

changed a patient 's status from inpatient to outpatient/observation this is known, as a Condition Code 44, (CC44). Now, the hospitals, including UAB are responsible for presenting the patient with the MOON to ensure Medicare patients fully understand they are in outpatient status and their financial liability when they are in as observation. The organization understood the significance of being compliant to this new rule as being a Medicare Cop Hospital. They also wanted to decrease any financial liability to the patient. Therefore, senior leadership, worked with the Utilization Management Department (UM), and gave them their full support to design and implement the process for obtaining the MOON. UM is also responsible for notifying an educating

It is my responsibility to have admission and continued reviews done promptly and accurately to determine whether the patient meets medical necessity for inpatient or outpatient status. I review all patients’ charts, especially those in an observation status. They are reviewed frequently and in real-time to ensure they are actively being managed and in the correct status. Observation patients are given priority in order to catch patients that may be discharged. Collaboration continues with the physicians and if there is a question about status, the chain of command listed above is followed. Once, receipt of the Notice Act has been provided to the patient, and the patient signs or refuses to sign, a copy is made for the patient and a copy is scanned into the Electronic Medical Record (EMR). A Utilization Review note is documented in the EMR. After this process is completed, there is continued collaboration with the physicians, care coordinators and discharge facilitators to ensure patients receive quality efficient care as they transition through the continuum of care whether that is being discharged home or admitted as inpatient. As a member of the Health Care Management Team and UM, RN I can help improve the organization’s position by working with the physicians and helping them by providing education and real-time assistance in determining the correct status of the

Lastly, and maybe most important can patients truly comprehend the full extent of the Notice Act? The information is presented in a way that the average layperson may not truly understand. Even the most knowledgeable person may have issues with the language and the lengthy content. Most documents are supposed to be on the level of a middle school student. Barron and Greiner noted that the MOON is written on a 12th -grade level according to the Felesch-Kincaid Readability test, although most American’s reading level is on a 5th to 7th- grade level. The patients have a piece of paper they can read but, do they really comprehend what they have read? The MOON in three words should be easy, clear, and brief for the patient to understand. The purpose of the MOON is to notify patients if they are in observation status. The Notice Act did not go far enough and it does need additional recommendations. I think this policy falls short of its goals and objective, which is to protect the patient. The ultimate goal is for the patient to receive safe, quality, affordable care. To ensure effective and efficient care Congress, CMS and all stakeholders involved will need to review, address and revise the issues and concerns surrounding this policy to prevent undue harm to the