The Centers for Medicare & Medicaid Services has updated its Medicare claims processing manual to include guidance on implementing the Medicare Outpatient Observation Notice, a standard notice that all hospitals and critical access hospitals must provide effective March 8 to all Medicare beneficiaries who receive outpatient observation services for more than 24 hours. Under the Notice of Observation Treatment and Implication for Care Eligibility Act of 2015, hospitals must provide oral and written notice to beneficiaries within 36 hours after observation services are initiated, or sooner if the individual is transferred, discharged or admitted as an inpatient. The notice informs them that they are an outpatient receiving observation services, not an inpatient, and the associated implications for cost-sharing and eligibility for Medicare coverage of skilled nursing facility services. The guidance, among other things, addresses the scope of the requirements; how hospitals must deliver the notice and delivery timeframes; steps to take if a beneficiary refuses to sign the MOON or the notice must be delivered to a beneficiary’s representative; ensuring beneficiary comprehension; what may be provided in the “additional information” field of the MOON; retention requirements for the MOON; and the intersection with state laws on observation notices. CMS issued the final policies for implementing the NOTICE Act last August with the inpatient prospective payment system final rule, but delayed implementation until 90 days after the updated MOON was posted.