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Beneficiary Notices Initiative (BNI)

Both Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers. Use the navigation tool on the left side of this page to link to the following financial liability notices and their instructions:
  • FFS Advance Beneficiary Notice of Noncoverage (FFS ABN)
  • FFS Home Health Change of Care Notice (FFS HHCCN)
  • FFS Skilled Nursing Facility Advance Beneficiary Notice (FFS SNFABN) and SNF Denial Letters
  • FFS Hospital-Issued Notices of Noncoverage (FFS HINNs)
  • FFS Expedited Determination Notices for Home Health Agencies, Skilled Nursing Facility, Hospice and Comprehensive Outpatient Rehabilitation Facility  (FFS Expedited Determination Notices)
  • MA Denial Notices (MA Denial Notices)
  • MA Expedited Determination Notices (MA Expedited Determination Notices)
  • Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) (Hospital Discharge Appeal Notices)
  • FFS Notice of Exclusion from Medicare Benefits - Skilled Nursing Facility (FFS NEMB SNF)

Medicare Outpatient Observation Notice (MOON)

The MOON is a standardized notice to inform Medicare beneficiaries (including health plan enrollees) that they are outpatients receiving observation services and are not inpatients of a hospital or critical access hospital (CAH).  

The MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), passed on August 6, 2015.  The NOTICE Act requires all hospitals and CAHs to provide written and oral notification under specified guidelines.

Medicare Outpatient Observation Notice and accompanying form instructions are available in “Downloads” below. 

Frequently asked questions ("MOON FAQs") are available under "Downloads" below.

Full instructions related to MOON implementation ("CR9935 MOON Instructions") are available under “Downloads” below. The MOON instructions will be included as Section 400 of Chapter 30 of the Medicare Claims Processing Manual. 

CMS informed Medicare Advantage plans of the MOON instructions via a Health Plan Management System email blast.  MA plans are to follow the MOON instructions available under "Downloads" below.

All hospitals and CAHs are required to provide the MOON, per CMS guidance, beginning no later than March 8, 2017.

See "Federal Register - IPPS - NOTICE Act Final Rule" in "Related Links" below to view the final NOTICE Act regulation (Section L and 42 CFR 489.20). 

Questions?

Effective April 13, 2017, questions regarding any of the Fee For Service BNI notices may be sent to our new mailbox: BNImailbox@cms.hhs.gov.

Continue to send questions regarding Medicare Advantage notices to: Part_C_Appeals@cms.hhs.gov

Continue to send questions regarding the MOON to: MOONMailbox@cms.hhs.gov.