Clarification of Medicare Outpatient Observation Notice form requirements

Here’s when hospitals must notify members:
Hospitals must notify Blue Cross Medicare Plus Blue^SM PPO and BCN Advantage^SM members that they’re receiving outpatient, rather than inpatient, services by using the Medicare Outpatient Observation Notice form, available on the CMS website** under Downloads, when a member is:

Being moved to observation status within the hospital from any other status or source
In observation status for 24 hours or more, if the member hasn’t already received the form before being admitted for observation

This is a Centers for Medicare & Medicaid Services requirement. Hospitals should also review the instructions** for notifying members using the Medicare Outpatient Observation Notice.

Here’s when hospitals do not need to notify members:

Blue Cross or BCN has approved an inpatient admission.
The member isn’t being considered for inpatient care; there’s no need to notify the plan either in this case.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.