Failure to Provide Correct Medicare Non-Coverage and ABN Forms
Penalty
Summary
The facility failed to provide the appropriate Centers for Medicare & Medicaid Services (CMS) Notice of Medicare Non-Coverage (NOMNC) and Advanced Beneficiary Notice (ABN) forms to a resident regarding service options and potential financial liability for non-covered services. Record review showed that the resident and/or their representative received the NOMNC (CMS form 10123) with information on the right to appeal, but instead of the required ABN (CMS form 10055), the facility provided a different form (CMS form 10124-DENC), which did not indicate the option to receive or decline continued skilled services. Interviews with the Administrator revealed that there was no social worker at the facility, and the Administrator was responsible for handling ABNs, relying on forms provided by the corporate office. The Administrator believed the correct form was used but confirmed there was no facility policy for ABNs.