Failure to Provide Accurate Medicare Coverage Notices and Documentation
Penalty
Summary
The facility failed to provide accurate Notice of Medicare Non-Coverage (NOMNC) letters to residents, specifically regarding the correct last covered day (LCD) for skilled services. In five cases reviewed, the NOMNC letters indicated the end date for Medicare coverage, but the residents' medical records did not contain documentation of the next payor source beginning immediately after the LCD. Additionally, for residents who were discharged, there was no documentation in the medical record explaining the reason for discharge on or before the LCD. Staff interview with a Licensed Social Worker confirmed discrepancies in the documentation of LCDs and the absence of progress notes explaining changes in coverage or payor concerns. This deficiency affected five out of eleven residents reviewed for liability notices, with the facility census at 81. The lack of proper documentation and communication regarding coverage and payor source transitions was directly observed in the medical records and confirmed by staff.