NAHAM Launches Monitoring Program for Key Patient Access Regulatory Issues

NAHAM’s Policy Development and Government Relations (PD & GR) Committee has identified and will actively monitor nine regulatory issues that impact the daily workflow of Patient Access.  Most are regulatory items required specifically by the Centers for Medicare and Medicaid Services (CMS):

•         the Important Message from Medicare (IM)
•          the Medical Outpatient Observation Notice (MOON)
•          the Advance Beneficiary Notice of Noncoverage (ABN)
•          the Emergency Medical Treatment & Labor Act (EMTALA) requirements
•         Medicare Secondary Payer (MSP)
•          CMS documentation requirements for Administrative Gender.  T

The Committee is also monitoring

•          501(r) Pricing Transparency
•          HIPAA privacy rules

Visit the NAHAM Key Issues Management Page on the NAHAM website. Membership is not required to view the page.  Each issue is briefly explained and source material is provided through outside sources and NAHAM toolkits. The NAHAM toolkits include best practices and guidance documents relating to CMS surveys, Joint Commission surveys, and positive patient identification.  NAHAM Toolkits are available on the NAHAM website as a members-only benefit.

To highlight the Medical Outpatient Observation Notice (MOON), the Key Issues Management Page includes a brief description that Hospitals and CAHs are required to provide the MOON to Medicare beneficiaries (including Medicare Advantage health plan enrollees) informing them that they are outpatients receiving observation services and are not inpatients of the hospital.  The description also includes background information that the MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), passed on August 6, 2015. This law amended Section 1866(a)(1) of the Social Security Act by adding new subparagraph (Y) that requires hospitals and CAHs to provide written notification and an oral explanation of such notification to individuals receiving observation services as outpatients for more than 24 hours.

Resources posted on the webpage include a link to Form CMS-10611, a link to CMS’s Frequently Asked Questions for the MOON, and instructions for the use and completion of the MOON.  There is a link to section 400 of Chapter 30 of the CMS Claims Processing Manual where full instructions on the MOON’s use, execution, and delivery are included.  There is also a link to the basic CMS landing page for the MOON and a link to NAHAM’s CMS Survey Toolkit which includes an entry for “Regulations and Guidance: Medical Outpatient Observation Notice (MOON).

In addition to this resource, the PD&GR Committee will respond to questions and host discussions on NAHAM’s Access Forum for regulatory issues.  Members are encouraged to subscribe to the Regulatory Issue forum and post their questions about these and other regulatory issues here. The Regulatory Issues Forum is open to both members and non-members.