Incomplete SNF ABN Form Fails to Inform Resident of Potential Financial Liability
Penalty
Summary
The facility failed to ensure that the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) Form CMS-10055 was fully completed for a resident who was reviewed for beneficiary notices. Specifically, the SNF ABN form for this resident did not include the estimated daily cost of services, which is required to inform the resident of potential financial liability if Medicare does not cover the services. The resident had selected the option to receive the listed services and have Medicare billed, with the understanding that if Medicare did not pay, the resident would be responsible for payment. However, the absence of the estimated cost on the form meant the resident was not fully informed of the amount they might owe. Interviews with the Social Services Director (SSD) confirmed that it was their responsibility to provide residents with the SNF ABN forms prior to the last day of Medicare-covered services, and that the form should include the estimated cost. The SSD acknowledged that the required information was missing from the resident's form and verified that there was no other documentation in the medical record indicating the resident had been informed of the potential financial responsibility. The Director of Nursing (DON) was also made aware of these findings and acknowledged them.