Failure to Establish Compliance with Resident Rights for Medicare and Medicaid Information
Summary
The facility failed to establish a structure to comply with the resident's right to receive information about Medicare and Medicaid benefits. During the survey, it was found that no personnel were assigned to monitor compliance with resident rights. The resident rights policy and procedure, reviewed with the institutional program director, was hospital-based and included the logo of Episcopal Hospital San [NAME] Metro, indicating it was not tailored to the facility's specific needs. Additionally, the policy was a 13-page document that included all 483.10 resident rights statements in one policy, lacking individualized mechanisms to ensure compliance with CMS Medicare requirements.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
Surveyors found that the facility did not display required written information in common posting areas, such as the lobby and hallways near nursing units, explaining how residents and their representatives can apply for and use Medicare and Medicaid benefits and obtain refunds for previous payments covered by those programs. During an interview, the NHA confirmed that this information was not posted anywhere in the building, resulting in noncompliance with state requirements for licensee responsibility and management.
The facility did not display required written information about how to apply for and use Medicare and Medicaid benefits, or how to receive refunds for previous payments covered by these benefits. This was confirmed during observations and an interview with the NHA.
The facility did not display written information on how to apply for Medicare and Medicaid benefits or how to receive refunds for previous payments covered by these programs on either the West Wing or East Wing. This was confirmed by observation and staff interview.
The facility did not display written information for residents or their responsible persons on how to apply for Medicare and Medicaid benefits or obtain refunds for payments covered by these programs, as confirmed by observation and the DON.
The facility did not display required written information about applying for Medicare and Medicaid benefits or obtaining refunds for previous payments covered by these programs on both nursing floors, as confirmed by observations and the NHA.
A resident’s family member paid for a private room with the understanding that other charges would be covered by Medicare and supplemental insurance, but was later billed for an excessive amount due to a billing error that charged for 484 days instead of 22. The bill was sent to collections before the error was identified, and a partial refund was eventually issued, but not in a timely manner.
Failure to Post Required Medicare/Medicaid Information for Residents
Penalty
Summary
The facility failed to display required written information for residents and/or their responsible persons on how to apply for and use Medicare and Medicaid benefits and how to receive refunds for previous payments covered by those benefits. During observations on 2/11/26 at approximately 11:30 a.m., surveyors inspected the first-floor lobby and hallways in and around the nursing units, where postings are typically available, and found that information on applying for Medicare and Medicaid and obtaining refunds for prior payments covered by these programs was not posted. In a subsequent interview on 2/12/26 at 9:00 a.m., the Nursing Home Administrator confirmed that the facility had not displayed this required written information anywhere in the building. The deficiency was cited under 28 Pa. Code: 201.14(a) Responsibility of licensee and 28 Pa. Code: 201.18(e) Management.
Failure to Display Medicare and Medicaid Benefit Information
Penalty
Summary
The facility failed to display written information for residents and their responsible persons regarding how to apply for and use Medicare and Medicaid benefits, as well as how to receive refunds for previous payments covered by these benefits. During observations conducted in the building, it was noted that this required information was not posted. Additionally, during an interview, the Nursing Home Administrator confirmed that the facility did not have the necessary written information displayed as required by regulations. No information was provided to residents or applicants for admission about these benefits or the refund process.
Failure to Display Required Medicare and Medicaid Information
Penalty
Summary
The facility failed to display written information regarding the application process for Medicare and Medicaid benefits, as well as information on receiving refunds for previous payments covered by these programs. During an observation in the Main Entrance Hallway, it was noted that although various information was posted for residents, there was no information available about applying for Medicare and Medicaid benefits or about obtaining refunds for payments previously covered by these programs. This deficiency was confirmed during an interview with the Nursing Home Administrator, who acknowledged that the required information was not displayed on either the West Wing or East Wing nursing floors.
Failure to Display Required Medicare and Medicaid Information
Penalty
Summary
The facility failed to display written information for residents and/or their responsible persons regarding how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by these programs. During observations of the first-floor lobby and the second-floor nursing unit posting locations, it was noted that this required information was not posted. In an interview, the Director of Nursing confirmed that the facility did not have the necessary written information displayed as required by regulations. No specific residents or medical conditions were mentioned in relation to this deficiency.
Failure to Display Medicare and Medicaid Application Information
Penalty
Summary
The facility failed to display written information regarding how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by these programs on both the First Floor and Second Floor nursing units. This deficiency was identified during observations conducted on both nursing floors, where the required information was not present. The Nursing Home Administrator confirmed during an interview that the facility did not have the necessary written information displayed as required by regulations.
Failure to Ensure Accurate Billing and Timely Refunds for Private Room Charges
Penalty
Summary
The facility failed to ensure accurate billing and timely refunds for a resident who was admitted and later discharged after a short stay. The resident’s family member requested a private room and paid $3,720 as requested by the facility, with the understanding that all other charges would be covered by Medicare and supplemental insurance. Despite this, the family member later received a bill for over $56,000, reflecting an erroneous charge for 484 days of private room care, when the actual stay was only 22 days. The family member contacted the facility multiple times regarding the excessive bill. Upon review, the Business Office Manager confirmed that a billing entry error had occurred, resulting in the resident being billed for far more days than were actually provided. Documentation showed that the bill was sent to collections for the unjustified amount. Eventually, a partial refund of $992 was issued to the resident. The facility’s admission agreement stated that overpayments would be refunded as soon as possible after insurance claims were verified and paid, but the refund was not provided in a timely manner.
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