Failure to Provide Timely Medicare Non-Coverage Notices
Penalty
Summary
The facility failed to ensure that residents or their designated representatives were appropriately notified at the termination of Medicare Part A benefits. This deficiency was identified during a recertification survey, where it was found that the facility did not mail the Notice of Medicare Non-Coverage to the residents' representatives on the same day that telephone notifications were made. Specifically, for two residents, the facility left voice messages for their representatives but did not follow up with mailed notices as required by the facility's policy and CMS instructions. The policy mandates that notices be mailed on the same day as the phone call, but this was not adhered to in these cases. The Minimum Data Set Coordinator acknowledged that while they informed representatives by phone, they did not mail the notices unless requested by the representatives, which was contrary to the policy. The Coordinator also stated that they mailed notices with certified mail receipt only if they could not reach the representative by phone. However, there was no documented evidence of the representatives' refusal to receive the notices. The Administrator confirmed that the Coordinator was responsible for ensuring the notices were provided and that proof of receipt should be maintained, but this was not done in these instances.
Plan Of Correction
Plan of Correction: Approved January 31, 2025 F582 483.10 Medicaid/ Medicare Coverage/ Liability Notice SS=D TAG I. The following actions were accomplished for the resident(s) identified in the sample: The facility mailed the Beneficiary Notification to the designated representatives of resident #36 and #55. On 1/8/25, the Beneficiary Notification was mailed certified to the designated representative of Residents #36 and #55. II. The following corrective actions will be implemented to identify other residents who may be affected by the same practice: All residents on Medicare are potentially affected by the same practice. The MDS Coordinator will audit residents who received Beneficiary Notification for the last six months. If any deficient practice is identified, immediate corrective action will be implemented and findings reported to the Administrator and Quality Assurance Committee. The Administrator educated the MDS Coordinator on the facility policy entitled “Advanced Beneficiary Notice of Medicare Non-Coverage Benefit Exhaust Letters” to ensure compliance with regulations. III. The following system changes will be implemented to ensure continuing compliance with regulations: The Facility reviewed the policy and procedures “Advanced Beneficiary Notice of Medicare Non-Coverage Benefit Exhaust Letters” to ensure regulation compliance and no revision needed. The MDS Coordinator/Designee will keep a log of all residents receiving the Beneficiary Notification. The log will indicate the date the resident/designated representative was notified, and the Beneficiary Notification was mailed to the designated representative. The MDS Coordinator/Designee will maintain a log for all residents who receive the Beneficiary Notification of Medicare Non-Coverage. The log will also indicate the date of mailing with certified tracking receipt and notification. IV. The facility’s compliance will be monitored utilizing the following quality assurance system: The corrective action will be monitored weekly through audits and the findings will be presented to the quality assurance committee for six months to ensure deficient practice will not recur. Compliance with this regulation will be assessed utilizing an audit tool developed by the MDS Coordinator. The findings from the audit will be reported to the Quality Assurance Committee for six months by the MDS Coordinator. Responsible: The MDS Coordinator/Designee is responsible for compliance.