Failure to Provide Proper SNF ABN and Documentation to Resident's Responsible Party
Penalty
Summary
The facility failed to provide an accurate and properly documented Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) for one resident who was reviewed for beneficiary notices. The resident, who had diagnoses including hypertension, dementia, and hyperlipidemia, was admitted to the facility and had a responsible party (RP) managing their affairs due to cognitive deficits. The facility's records showed that the Notice of Medicare Non-Coverage (NOMNC) and SNF ABN were not properly signed or dated, and there was no evidence that the required notice was physically provided to the RP. Instead, the Business Office Manager (BOM) stated that the information was read to the RP over the phone, but there was no documentation to confirm this communication or to indicate that the RP was informed of the resident's financial responsibility for continued services. Interviews with the BOM confirmed the lack of documentation and the absence of a signed SNF ABN form. The BOM acknowledged that the notice was not provided in accordance with requirements and that the resident remained in the facility after the notice was given. The Director of Nursing (DON) indicated there was a miscommunication regarding the proper use of the SNF ABN form and expected the BOM to follow the correct procedure.