Failure to Provide Advance Notice of Change in Billing for Non-Covered Services
Penalty
Summary
A resident was admitted to the facility and subsequently exhausted their insurance coverage for nursing home stay, as indicated by an Eligibility Verification Notice received by the facility. The facility became aware of the change in coverage and, on the same day, read a Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) over the phone to the resident's responsible party, informing them that they would be responsible for payment starting the following day. However, the facility began billing the resident and responsible party for services from the last date of coverage, prior to providing notification of the change in billing status. Facility staff confirmed that the resident and responsible party were not informed in advance of the change in billing, and billing for uncovered services occurred before notification was given.