Incomplete Beneficiary Notifications for Medicare Coverage
Penalty
Summary
The facility failed to ensure that beneficiary notifications regarding Medicare coverage and potential liability for non-covered services were completed accurately for two of three sampled residents. For one resident with moderate cognitive impairment and a diagnosis of metabolic encephalopathy, the Advance Beneficiary Notice of Non-coverage (ABN) was incomplete, with critical sections such as the reason Medicare may not pay and the options for the resident left blank. The ABN was also not signed or dated, and a Notice of Medicare Non-coverage (NOMNC) was not issued. The Business Office Manager acknowledged these omissions, stating that the form was not filled out completely and that the resident's representative was not contacted for a signature. Similarly, for another resident with intact cognition and a history of a left tibia fracture, the ABN was also incomplete, with the section for the reason Medicare may not pay and the options section left blank. The Business Office Manager admitted that the form was not filled out correctly and that a NOMNC was not issued due to a lack of communication. Both the Director of Nursing and the Administrator stated they were not involved in the beneficiary notification process but expected the notifications to be completed accurately and within the required timeframe.