Failure to Provide Required Payment Coverage Notification
Penalty
Summary
The facility failed to provide the required notification to a resident whose payment coverage changed. Specifically, for one of the three residents reviewed, identified as Resident 2, the facility did not issue the necessary CMS-10055 form after Medicare payment for the resident's care ended. The clinical record review indicated that Medicare payment for Resident 2's care ended on July 26, 2024, yet the resident remained in the facility without receiving the appropriate notification of potential liability for the non-covered stay. The review of the CMS-10123 form confirmed that the last covered day of Medicare payment was July 26, 2024, but there was no evidence that the CMS-10055 form was provided to Resident 2. An interview with the Nursing Home Administrator confirmed the absence of this documentation, indicating a lapse in the facility's compliance with the notification requirements for changes in payment coverage.
Plan Of Correction
1. No residents were harmed. Resident 2 expired so the facility was unable to provide the notice to the resident. 2. The social services department evaluated the accuracy of residents requiring a CMS-10055 form to verify that they had been notified timely regarding the termination of their Medicare coverage. 3. The facility administrator educated the social services department about the necessity of promptly notifying residents when their Medicare coverage has concluded, emphasizing that the resident must sign a CMS-10055 form as part of this notification process. 4. The facility administrator or designee will conduct weekly audits for a duration of four weeks, followed by monthly audits for three months. This process aims to confirm that residents are informed about the Medicare cut-off date and are signing the CMS-10055 form. The results of these audits will be presented at the monthly Quality Assurance meeting for evaluation.