Failure to Provide Timely Medicare Non-Coverage Notices
Summary
The facility failed to provide the required Notice of Medicare Non-coverage (NOMNC) form-10123 to two residents, R22 and R78, 48 hours prior to their discharge. R22's physical and occupational therapy discharge summaries indicated that services were no longer required as of 5/21/24, but the NOMNC form was signed on 5/28/24, with the last covered day being 5/29/24. Similarly, R78's therapy discharge notification indicated the last covered day was 9/4/24, but the NOMNC form was signed on 9/3/24, with the last covered day being 9/3/24. Additionally, the Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) form-10055 for R17 was not provided in a timely manner, as the form was dated 11/24/24, despite the last covered day being 11/13/24. Interviews with the Minimum Data Set (MDS) coordinator and the administrator confirmed these findings. The MDS coordinator acknowledged responsibility for completing the forms and admitted to the oversight in providing them 48 hours prior to discharge. The coordinator also noted that R17 had put the wrong date on the form, which was supposed to be signed on 11/11/24. The administrator confirmed the MDS coordinator's responsibility and stated that the expectation was for the forms to be provided at least 48 hours in advance to allow residents time to appeal if necessary. The facility's policy on Medicare Denial Notice was reviewed, indicating a failure to meet the Centers for Medicare and Medicaid Services (CMS) requirements for timely notification.
Penalty
Resources
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The facility did not provide two residents with complete and accurate Advance Beneficiary Notices and Notices of Medicare Non-Coverage when ending Medicare Part A skilled services. Forms were missing required details such as the specific services ending, reasons for non-coverage, and estimated costs, and in one case, the ABN was not provided at all. Staff interviews confirmed a lack of awareness and incomplete documentation, preventing residents or their representatives from making informed decisions.
Facility staff did not provide a required SNF Advanced Beneficiary Notice of Non-coverage (ABN) to a resident discharged from a Medicare Part A stay, and were unable to locate or produce any related documentation when requested by surveyors. Leadership confirmed the absence of the required notice and documentation during the survey process.
A resident with chronic kidney disease and other conditions was not provided a Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) as required for their October discharge. The Regional Director of Social Work confirmed the oversight, attributing it to the social worker's responsibility at the time. Despite the lapse, the resident reported no concerns.
Three residents were discharged from Medicare Skilled Nursing services without being issued the required Advance Beneficiary Notice (ABN), even though they still had days remaining in their benefit period. Clinical records lacked documentation of the ABN, and staff interviews revealed that the therapy department, responsible for issuing the notices, was unaware of this duty at the time.
Staff failed to properly complete and deliver required ABNs for two residents, omitting key information such as coverage end dates, estimated costs, and appeal instructions. The forms were incomplete, unsigned, and lacked documentation of proper notification to the residents or their representatives. Periods without a qualified social worker contributed to these deficiencies.
A resident admitted for skilled services with Medicare as the primary insurance did not receive the required Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN Form CMS-10055). Documentation confirmed the absence of this form, and staff interviews revealed that the responsible social services director was unable to provide the necessary beneficiary notification documentation.
Failure to Provide Complete Advance Beneficiary Notices and Medicare Non-Coverage Information
Penalty
Summary
The facility failed to provide complete and accurate Advance Beneficiary Notices (ABNs) and Notices of Medicare Non-Coverage (NOMNC) to two residents who were ending their Medicare Part A skilled services. For one resident with a history of stroke, chronic respiratory failure, moderate cognitive impairment, and communication difficulties, the facility issued an ABN and NOMNC that were incomplete. The forms did not specify which Medicare Part A services were ending, the reason for non-coverage, or an estimated cost for continued services, despite the resident's cognitive and communication challenges. The Social Services Director (SSD) confirmed that information from therapy regarding the reason for service termination was not transcribed onto the forms, and she lacked knowledge of the estimated costs to include. For another resident with severe cognitive impairment and communication problems following a stroke, the facility did not provide the required ABN at the time of Medicare Part A service termination. The NOMNC issued was signed by staff on behalf of the resident but did not specify which services were ending. The SSD acknowledged that the ABN was not provided and that the NOMNC lacked necessary details. She also stated that she was unsure why the resident's Medicare services ended and that all areas of the forms should have been completed for informed decision-making. Interviews with facility staff, including the Business Office Manager, SSD, Director of Nursing, and Administrator, revealed a lack of awareness and understanding regarding the proper completion and issuance of ABN and NOMNC forms. Staff confirmed that forms were not fully completed and that required information was missing, preventing residents or their representatives from making informed choices about their care and financial responsibilities.
Failure to Provide Required SNF ABN Notification
Penalty
Summary
Facility staff failed to provide a Skilled Nursing Facility (SNF) Advanced Beneficiary Notice of Non-coverage (ABN) notification to one of three residents selected for SNF Beneficiary Notification Review. During the survey, the administrator supplied a list of Medicare beneficiaries discharged from a Medicare Part A stay with benefit days remaining, from which three residents were chosen for review. For one resident, documentation showed that the SNF ABN was not provided, with a hand-written note indicating uncertainty and inability to locate the document in the file. Interviews with the administrator confirmed that staff could not find any beneficiary documentation for this resident. The issue was discussed with facility leadership, but no further information or documentation was provided before the survey concluded.
Failure to Provide SNF ABN to Resident
Penalty
Summary
The facility staff failed to provide a Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) to a resident, identified as R49, who was sampled for ABN review. R49 had diagnoses including chronic kidney disease stage IV, vascular dementia, iron deficiency anemia, peripheral vascular disease, and unsteadiness on feet. The resident's Minimum Data Set (MDS) assessment indicated intact cognition with a Brief Interview for Mental Status (BIMS) score of 13 out of 15. During the SNF Beneficiary Protection Notification Review, it was found that a SNF ABN should have been issued for R49's October 2024 discharge from SNF services, but it was not provided. The Regional Director of Social Work confirmed that the SNF ABN was not issued as required, stating that it was the responsibility of the social worker at the time. The facility's policy, which aligns with Medicare requirements, mandates that SNFs issue the SNF ABN to Original Medicare beneficiaries before providing care that Medicare may not cover. Despite the oversight, R49 expressed no concerns during an interview. The issue was discussed with the facility's administration and social work team, but no further information was provided to the survey team before the exit conference.
Failure to Provide Required Medicare ABN Prior to Discharge
Penalty
Summary
Facility staff failed to provide the required Medicare Advance Beneficiary Notice (ABN) to three residents prior to their discharge from Medicare Skilled Nursing services, despite each resident still having days remaining in their skilled nursing benefit at the time of discharge. Clinical record reviews for each resident did not contain documentation of the ABN, which is mandated by facility policy to inform Medicare beneficiaries of their potential liability for payment when services may not be covered. The absence of these notices was confirmed through staff interviews and review of facility policy. Interviews with administrative staff revealed that the therapy department was responsible for issuing ABNs, but at the time of the discharges, the department was unaware of this responsibility. This lack of awareness led to the failure to issue the required ABNs to the affected residents. The deficiency was communicated to facility leadership, including the administrator, DON, and regional directors, during the survey process.
Failure to Provide Complete Advanced Beneficiary Notices
Penalty
Summary
Facility staff failed to properly complete and provide Advanced Beneficiary Notices (ABNs) for two residents who were discharged within the past six months. Specifically, the forms for these residents lacked critical information, including the date when insurance coverage would end, the estimated cost for continued services, and instructions regarding the appeal process. Additionally, neither the residents nor their representatives signed the forms, and there was no documentation that letters were sent to inform them of their rights or responsibilities. The forms were completed by therapy staff, but lacked essential details such as the name of the responsible party, date, and time of contact. During the review, it was noted that the facility had periods without a vetted, acceptable social worker, which may have contributed to the improper administration of the required notices. The newly hired social worker acknowledged the deficiencies in the documentation after reviewing the forms. The DON and Administrator were informed of these findings during the survey debriefing, and facility staff did not provide any additional information to address the identified issues.
Failure to Provide Required Beneficiary Notification for Medicare Services
Penalty
Summary
Facility staff failed to provide required beneficiary notification to a resident who was admitted for skilled services with Medicare as the primary insurance. The resident, who was not cognitively impaired according to the most recent BIMS assessment, was still residing in the facility at the time of the survey. Documentation review showed that the resident received a welcome packet with general information and resident rights, but there was no evidence that the required Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN Form CMS-10055) was provided. The Beneficiary Protection Notification Review form for this resident confirmed that the form was not found. During staff interviews, the director of social services, who had just started in her role, acknowledged responsibility for beneficiary notices but was unable to provide the required documentation for this resident. The facility's policy indicated that the ABN is to be used to notify beneficiaries or their responsible parties when care will not be covered by Medicare B, but no further information or documentation was provided to demonstrate compliance with this requirement.
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