Failure to Provide Required Medicare Coverage Notices
Penalty
Summary
The facility failed to provide required written notification to residents regarding the initiation, reduction, or termination of Medicare Part A benefits. Specifically, three residents who remained in the facility after their Medicare Part A skilled services ended did not receive a Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) or a denial letter, as mandated by CMS guidelines. Medical record reviews confirmed that for each of these residents, there was no documentation of the SNFABN form being issued at the appropriate time. Interviews with facility staff revealed a lack of clarity regarding responsibility for issuing the SNFABN. The MDS Nurse stated that Social Services previously handled the notifications, but she had since assumed responsibility and was unaware that the forms had not been completed for all applicable residents. The Administrator and DON both indicated that they expected the SNFABN to be completed after a resident's discharge from Medicare Part A, but this was not consistently done.