Failure to Provide and Follow Up on Required Medicare Coverage Notices
Penalty
Summary
Facility A failed to obtain and properly follow up on the required CMS-10055 Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) and CMS-10123 Notice of Medicare Non-Coverage (NOMNC) for one resident when Medicare Part A services ended. According to facility policy, these forms are necessary to inform Medicare patients about their potential financial responsibility for noncovered services and their right to appeal. The resident's last covered day under Part A was documented, and the required forms were emailed to the resident's power of attorney (POA) prior to the end of coverage. However, there was no response from the POA, and the facility did not conduct any follow-up to ensure receipt or completion of the beneficiary notification paperwork. As a result, the resident or their representative was not given the opportunity to review the forms and make an informed decision regarding continued therapy services or to appeal the facility's decision to discontinue Medicare Part A therapy.