The role of case managers as patient advocates while upholding the compliance and regulatory requirements for patients assigned to observation status. Defines the role hospital case managers play in managing patients in observation status and why their understanding of the Centers for Medicare and Medicaid (CMS) regulatory rules and compliance mandates is critical to patients. Case managers understand that payment for observation care is covered through Medicare Part B and the financial impact that may have for the patient. Patients must be informed of their status and how it affects access to post-acute care, in addition to possible financial liability for certain medications they receive. Case managers inform patients of their observation status through distribution of the Medicare Outpatient Observation Notice (MOON) letter and their availability to answer questions and provide a safe and expedient discharge from the hospital.