Failure to Inform Residents of Charges and Provide Required Medicare Notices
Penalty
Summary
The facility failed to consistently inform residents and/or their legal representatives about items and services included in nursing services, which may or may not be charged for, and the potential costs for services not covered under Medicare, Medicaid, or the facility's per diem rate. For four out of five sampled residents reviewed for admission, there was no documentation that the admission agreement, which includes information on basic charges, payments, interest on late payments, and the facility's discharge check-out time and associated fees, was reviewed or discussed with the resident or their representative upon admission. Several cognitively intact residents stated they did not recall staff reviewing these items and services or potential charges with them at admission. Additionally, the facility was unable to provide complete admission packets for the majority of recent admissions, and staff interviews confirmed that admission paperwork was not being completed or reviewed in a timely manner due to staffing vacancies in the admissions department. The report also found that the facility failed to provide required beneficiary notices related to Medicare coverage. Specifically, two residents who had their Medicare Part A services end did not receive the required Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN), which informs residents of their financial responsibility if they choose to continue receiving services that may not be covered by Medicare. Staff interviews revealed that the absence of a Business Office Manager (BOM) contributed to these notices not being provided, as the duties were divided among remaining staff and corporate oversight. These failures resulted in residents not being fully informed of their rights, financial responsibilities, and facility rules at the time of admission or when Medicare services ended. The lack of timely and complete communication regarding charges, fees, and coverage placed residents at risk of not understanding their obligations and the costs associated with their care.