HINN, IM , and MOON: Alphabet Soup of Forms Can Be Confusing.

The Centers for Medicare & Medicaid Services requires hospitals to give patients an array of documents to explain their rights, their status, and any financial obligations they may incur — and it’s usually up to case managers to see that the hospital complies. •The Medicare Outpatient Observation Notice (MOON) is the latest requirement, but the Important Message (IM) from Medicare also is required under the Medicare Conditions of Participation. In order to bill patients for services that are incurred but not covered, hospitals also must give patients a Hospital Issued Notice of Noncoverage (HINN). •If the documents are delivered at the proper time, they could affect the hospital’s reimbursement, increase the risk of audit, and affect patients’ understanding of their rights and responsibilities. •The entire treatment team should be aware of the documents and intentions. Education on delivering these documents should be part of case management orientation and regular education. •Hospitals should develop a process for delivering HINNs if the need arises. Before that happens, case managers should communicate frequently with the patient and family about the next level of care. •Patients may demand that their status be changed from observation to inpatient, but they can’t be admitted unless they meet inpatient criteria.