Failure to Provide Medicare Beneficiary Notices
Penalty
Summary
The facility failed to provide appropriate liability and appeal notices to Medicare beneficiaries, as required by Medicare guidelines. This deficiency was identified during a recertification survey, where it was found that two residents, who were receiving Medicare Part A Skilled Services, were not given the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN- form CMS-10055) upon the termination of their Medicare benefits. The facility's policy mandates the issuance of this notice to inform residents of potential liability for services not covered by Medicare, but there was no documented evidence that the notice was provided to the affected residents. Interviews conducted during the survey revealed that the Minimum Data Set Coordinator, who is responsible for informing residents about their Medicare coverage, was unaware of the requirement to issue the SNF ABN. The Director of Nursing Services stated that they were not involved in the beneficiary notification process, which is handled by the Minimum Data Set Coordinator. This lack of awareness and communication within the facility led to the failure to provide the necessary notices to the residents, resulting in a deficiency under the regulation 10 NYCRR 415.3(h)(2)(i).
Plan Of Correction
Plan of Correction: Approved January 3, 2025 Immediate Corrective Action: - The Facility Administrator on 12/09/2024 issued the Minimum Data Set Coordinator a memorandum regarding Medicaid/Medicare Coverage/Liability Notice and updated protocols for ensuring residents are aware of their rights. - An Adhoc meeting was held by the DON on 12/09/2024 with the MDS coordinator and Compliance Officer to review and discuss the notification process and policy. No amendments were made to the policy. Resident #24 and Resident #36 were individually notified at the conclusion of the meeting regarding the ineffective notification and the facility’s commitment to minimizing these deficiencies. Identification of Others Potentially Affected: - The facility respectfully submits all residents were potentially affected by this practice. A list of other residents that remained in the facility and were discharged from a MCR Part A stay were reviewed and will be given the SNFABN as appropriate. Systemic Changes to Prevent Recurrence: - The Compliance officer and DON formulated and reinstated the protocol and procedure for Medicaid/Medicare Coverage/Liability Notification on 12.10.2024. - The MDS coordinator and RN Managers were re-in-serviced on 12.12.2024 by DON for the protocols and procedures regarding NOTIFYING RESIDENTS OF MEDICAID/MEDICARE COVERAGE OR LIABILITY. Quality Assurance Monitoring: - The Minimum Data Set Coordinator will perform weekly audits for residents for the next 2 months, then monthly thereafter to maintain compliance. Any discrepancies identified during the audit will be reported and documented to the DON. The qualitative summary and analytics will be presented quarterly at the QAPI team meetings. - Audit tool has been created and implemented for ongoing monitoring. Responsible Party: Minimum Data Set Coordinator