Failure to Provide Timely Medicare Non-Coverage Notices
Penalty
Summary
The facility failed to provide timely notice of Medicare non-coverage for two residents, identified as R217 and R218, which is a requirement under federal regulations. The facility's policy, last reviewed on 10/20/24, mandates that appropriate Advance Beneficiary Notices (ABNs) be issued in accordance with CMS guidelines. However, the facility did not deliver the Notice of Medicare Non-Coverage (NOMNC) to these residents at least two calendar days before the end of their Medicare-covered services, as required. This failure prevented the residents from having the opportunity to appeal the non-coverage decision. Specifically, the SNF ABN form for Resident R218 indicated that payment for skilled nursing services would end on 8/2/24, but the facility did not provide the necessary documentation or time for appeal. Similarly, for Resident R217, the SNF ABN form indicated that payment would end on 10/21/24, yet the facility again failed to provide the document and appeal time. During an interview, the Nursing Home Administrator confirmed the absence of the NOMNC form for Resident R217 and the SNF ABN for both residents, highlighting a lapse in compliance with the required notification process.
Plan Of Correction
Resident 217 and 218 have been discharged on 10/22/2024 and 8/2/2024 respectively. The facility has determined that residents with a qualifying hospital stay and Medicare Part A benefit days available have the potential to be affected. An audit was conducted on current residents who were admitted in the past six months, and corrective actions were completed on 3/21/2025. The Administrator educated the following personnel on the facility's Advance Beneficiary Notices policy: Business Office Manager, Social Services Director and Assistant, MDS Coordinator, Director of Nursing, and Rehabilitation Program Manager. Copies of the relevant forms were placed in a binder in the offices of the Business Office Manager and Social Services Director. The Social Service Director, or designee, will conduct a random audit of five (5) residents weekly for four (4) consecutive weeks to verify that notices were issued timely. This plan of correction will be monitored at the Quality Assurance meeting until such time consistent substantial compliance has been met.