Failure to Provide SNF ABN Notification for Medicare Coverage Change
Penalty
Summary
The facility failed to inform a resident of changes in Medicare coverage and potential financial liability for services not covered, as required. Specifically, a male resident with acute kidney failure and moderate cognitive impairment, who was receiving occupational and physical therapy, was not provided with a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) when he was discharged from Medicare Part A skilled services before his covered days were exhausted. This notice would have informed him of his option to continue services at his own expense. Interviews with facility staff, including the Regional Financial Specialist and the Administrator, confirmed that the Business Office Manager (BOM) was responsible for issuing the SNF ABN but failed to do so. The staff acknowledged the importance of providing the form to ensure the resident was aware of his financial responsibilities. Additionally, it was revealed that the facility did not have a policy regarding the issuance of SNF ABNs.