Failure to Provide Required Medicare Coverage and Liability Notices
Penalty
Summary
The facility failed to provide required beneficiary protection notifications to a resident who was discharged from Medicare Part A services but continued to reside at the facility. Specifically, the resident was not issued a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN: CMS 10055) or a Notice of Medicare Non-Coverage (NOMNC: CMS 10123) when their Medicare Part A coverage ended, despite having remaining skilled benefit days. This was confirmed through review of facility records and an interview with the DON, who acknowledged that the necessary forms were not provided to the resident at the time of the change in coverage. Facility policy states that a SNF ABN should be issued prior to providing care that Medicare may not pay for, and a NOMNC should be given at least two days before Medicare-covered services end. The DON verified that these notifications were not given to the resident, and there was no documentation to show that the resident or their representative was informed of the change in coverage or potential financial liability. The deficiency was identified through review of the resident's records and staff interviews.