Failure to Provide Required Notice of Medicare Non-Coverage
Penalty
Summary
The facility failed to provide a Notice of Medicare Non-Coverage (NOMNC) to a resident whose Medicare Part A skilled services were ending. The resident, who was admitted with multiple diagnoses including type 2 diabetes, schizoaffective disorder, major depressive disorder, hypertension, and anxiety disorder, was cognitively intact and required assistance with several activities of daily living. According to the resident's records, the last covered day for Medicare Part A services was identified, and the discharge from Medicare services was initiated by the facility before benefit days were exhausted. However, the NOMNC was not provided to the resident because she left the facility to go home. Interviews with the Business Office Manager and the Director of Nursing confirmed that the resident should have received the NOMNC, as the discharge was planned and initiated by the facility. Both staff members acknowledged that the NOMNC is necessary to inform residents of their last covered day and their right to appeal the discharge. Review of facility policy and CMS guidelines further supported the requirement to provide the NOMNC at least two days before the end of covered services, which was not done in this case.