Failure to Provide Required Medicare Beneficiary Notices Upon Discharge from Skilled Services
Penalty
Summary
The facility failed to provide required Medicare beneficiary notices to two residents who were discharged from Medicare Part A skilled services. For one resident, Medicare Part A skilled services began on 10/16/2024 and ended on 01/01/2025 due to a facility-initiated discharge. Although the resident remained in the facility and had additional benefit days available, the facility did not provide the required Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN, Form CMS-10055) to inform the resident that Medicare would no longer pay for their services. Staff explained that the resident did not indicate a desire to continue therapy at the time, but no documentation of the required notice was found. Similarly, another resident began Medicare Part A skilled services on 10/17/2024 and was discharged from these services on 11/20/2024, also through a facility-initiated process with benefit days remaining. The facility did not provide the SNF ABN, Form CMS-10055, nor the Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123), which is required to inform beneficiaries of their right to appeal the termination of Medicare coverage. Staff interviews confirmed that documentation for these notices could not be located, and the Assistant Administrator acknowledged that changes in social services had led to lapses in required documentation.