Failure to Provide Written Medicare Non-Coverage Notice to Resident's Representative
Penalty
Summary
The facility failed to provide timely and appropriate written notification to a resident's representative regarding the termination of Medicare Part A skilled therapy services. According to facility policy, when a resident is no longer eligible for Medicare-covered services, the provider must notify the resident or their representative both verbally and in writing, including by mail if verbal contact is made. In this case, the social services director (SSD) verbally notified the resident's representative by phone that skilled therapy services would be ending, but did not follow up with a written Medicare Notice of Non-Coverage (NOMNC) as required. Record review showed that the NOMNC form lacked documentation of a mailed notice, and there was no evidence in the electronic medical record (EMR) that a written notice was sent to the representative. The resident's representative reported not receiving any written notification about the change in Medicare coverage and was unaware that skilled therapy services had ended, believing the resident was still receiving those services. The resident, who had diagnoses including cerebral palsy, monoplegia, and peripheral vascular disease, also had documented memory deficits, making proper notification to the representative especially important. Interviews with facility staff, including the SSD, director of rehabilitation (DOR), and nursing home administrator (NHA), confirmed that the required written NOMNC was not provided to the resident's representative. Staff acknowledged their responsibility for notification and described the process, but admitted that in this instance, the written notice was not sent and documentation was incomplete. The NHA was unaware that a written copy of the NOMNC was required to be provided to the representative and that documentation of delivery was missing from the EMR.