Hospital Observation Status

Post Date:March 12, 2018

Medicare Observation Status – What to Do

by Erin Fisher

While NAHU and many advocacy groups continue to press CMS and await action from lawsuits regarding Observation Status, what can a person do if caught in this status?

1. Patients can send their prescription claims into their Part D provider.  Most hospital pharmacies are not “in network” with any Part D plans.  The claim forms can be found on the Part D plan’s website.

2. If the patient did not receive the MOON notice in the emergency room, he/she can send the Medicare Administrative Contractor (need to ask Medicare at 1-800-Medicare) the claim to review for inpatient status or observation status determination stating they were not give the mandatory notice.

3. If the person went to a skilled facility after “observation” status, he/she should send in this claim work at the same time as the emergency room claim.

4. Send the denial notices into the Medicare Administrative Contractor for review on whether the diagnosis warranted an inpatient stay and not observation.

There are also professional medical claims individuals and companies who would do this claim work for a person working for an inpatient conclusion if a skilled nursing admit occurred.
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