Failure to Provide Required Medicare Liability Notices
Penalty
Summary
The facility failed to provide two residents with a fully completed Advanced Beneficiary Notice (ABN) using the required CMS Form 10055 when skilled services were ending. Instead, the facility issued CMS Form 10124, which is not the appropriate form for this situation. The ABN is intended to inform residents or their representatives about potential Medicare non-coverage for continued skilled therapy services and to provide an estimated cost of those services. The forms given to the residents did include options for the beneficiary to choose whether to receive the therapy and how billing should be handled, but did not meet the regulatory requirement for the specific form and content. Additionally, when requested, the facility was unable to provide a Medicare beneficiary policy. Administrative staff reported that the use of CMS Form 10055 had been discontinued based on corporate direction. This failure to use the correct form and provide the necessary policy documentation resulted in residents not being properly informed about their potential financial liability for services not covered by Medicare.