Notifications to Members

Hospital Discharge Notices

Important Message from Medicare (IM) form (CMS-R-193):
The Centers for Medicare & Medicaid Services (CMS) requires hospitals to deliver the IM to all MediGold hospital inpatients to inform the member of his/her hospital discharge appeal rights. Members who choose to appeal a discharge decision must receive the Detailed Notice of Discharge (DND) form CMS-10066. You can find the forms at:


Medicare Outpatient Observation Notice (MOON) CMS-10611: CMS requires hospitals or critical access hospitals (CAH) to deliver the MOON to all Medicare beneficiaries receiving observation services as outpatients for more than 24 hours. The MOON must be provided no later than 36 hours after observation services as an outpatient begin. This includes beneficiaries who(m):

  • Do not have Medicare Part B coverage (observation stays are covered under Part B). 
  • Are subsequently admitted as an inpatient prior to the required delivery of the MOON
  • Medicare is either the primary or secondary payor.

 For complete details, see


        Updated 01/2020