Failure to Provide Required Medicare Beneficiary Notification Forms
Penalty
Summary
The facility failed to provide required Centers for Medicare and Medicaid Services (CMS) beneficiary notification forms to a resident when Medicare Part A skilled services were discontinued, despite the resident not having exhausted all available benefit days. Specifically, the resident was admitted under Medicare Part A and continued to reside in the facility after skilled services ended, but there was no evidence in the medical record that the CMS SNF Advanced Beneficiary Notification (ABN) or the Notice of Medicare Non-Coverage (NOMNC) forms were issued at the time services ended. Interviews with the Business Office Manager confirmed the resident had not used all covered days, and the Responsible Party reported not receiving the required forms. Further interviews revealed that the Social Worker, who was responsible for issuing these forms, was new to her position at the time and did not recall providing the notifications. The DON became aware that the forms were not being issued and informed the Social Worker of her responsibility, but this occurred after the deficiency for the resident in question. The Administrator also confirmed the Social Worker’s inexperience contributed to the failure to provide the required notifications.