Failure to Provide Required Medicare Coverage and Liability Notices
Penalty
Summary
The facility failed to provide the required Skilled Nursing Facility Advanced Beneficiary Notice of Non-Coverage (SNF ABN) and Notification of Medicare Non-Coverage (NOMNC) forms to two residents who were reviewed for beneficiary protection notification practices. For one resident, there was no evidence that either the SNF ABN or NOMNC forms were provided or signed prior to the last covered day of Medicare Part A skilled services for both occupational and physical therapy. Discharge summaries indicated that therapy services ended because the resident had achieved the highest practical level or met all goals, but the required notifications were not issued. Staff interviews confirmed that the social worker was not made aware by therapy that the resident was at maximum potential and would be completing services, resulting in the failure to provide the necessary forms. For another resident, the required NOMNC form was not issued prior to the last covered day of Medicare Part A services, as confirmed by a review of the electronic medical record and staff interviews. Therapy discharge summaries indicated that all goals were met or the highest practical level was achieved, but the social worker was unaware that the NOMNC needed to be presented due to the resident's decision to go home. The therapy manager confirmed that the resident was discharged from services after meeting maximum potential, but the required notification was not provided.