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.
Hospitals are required to deliver the Important Message from Medicare (IM), CMS-R-193 to all Medicare beneficiaries (Original Medicare beneficiaries and Medicare Advantage plan enrollees) who are hospital inpatients. The IM informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights. Beneficiaries who choose to appeal a discharge decision must receive the Detailed Notice of Discharge (DND) from the hospital or their Medicare Advantage plan, if applicable.
8.4.2020 CMS posted this detail: Due to COVID-19 concerns, CMS is going to expand the deadline for use of the renewed ABN, Form CMS-R-131 (exp. 6/30/2023). At this time, the renewed ABN will be mandatory for use on 1/1/2021. The renewed form may be implemented prior to the mandatory deadline. The ABN form and instructions may be found at: https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN
Links to the following financial liability notices and their instructions:
Note: Guidance is available for the FFS Expedited Determination Process. See “Related Links” below, titled “Transmittal 2711 – Expedited Det (Eff Aug 26, 2013)”.
Updated June 7, 2017:
Medicare Outpatient Observation Notice (MOON)- Listening Session December 21, 2015
On August 6, 2015, Congress enacted the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act). Under this law, all hospitals and critical access hospitals (CAHs) are required to provide written notification and an oral explanation of such notification to individuals receiving observation services as outpatients for more than 24 hours.
The Medicare Outpatient Observation Notice (MOON) was developed to inform beneficiaries (including Medicare health plan enrollees) that they are an outpatient receiving observation services, and are not an inpatient of the hospital or CAH. The statute prescribes that the notice must include the reasons the individual is an outpatient receiving observation services, and the implications of receiving outpatient services, such as cost sharing, and post-hospitalization eligibility for Medicare coverage of skilled nursing facility (SNF) services.
CMS-10611-1 (Draft MOON Forms) ZIP file contains the form, instructions, and supporting statement.
CMS held a listening session on December 21, 2015 to solicit the input of the hospital industry, beneficiary advocates, and other stakeholders regarding CMS’s implementation of the NOTICE Act. See the link to the written transcript in “Downloads” below. The link to the audio file of this listening session can be found in “Related Links” below.
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This page last updated July 5, 2017
