Failure to Provide Required Medicare Coverage Notices
Penalty
Summary
The facility failed to provide required Medicare notifications to residents or their responsible parties when skilled services under Medicare Part A were ending. Specifically, three residents who were receiving skilled nursing facility (SNF) services did not receive the Advanced Beneficiary Notice (ABN) or the Notice of Medicare Non-Coverage (NOMNC) as mandated. In each case, the ABN was not issued because the social worker was unaware of the requirement, and the NOMNC was either not provided at all or was given after the end date of covered services, rather than at least two days prior as required by facility guidelines. Record reviews showed that for each of the three residents, the last covered Medicare A service date was documented, but the necessary notifications were either missing or provided late. Interviews with facility staff confirmed that the social worker responsible for issuing these notices was not aware of the need to provide both the ABN and NOMNC, having previously been told by prior administration that only the NOMNC was required. Facility policy states that both forms must be given in writing to the resident or their representative when Medicare Part A coverage ends due to no longer requiring daily skilled services, and that this notice must be delivered with at least two days' notice.