Failure to Provide Timely Medicare Coverage Notices
Penalty
Summary
The facility failed to provide timely Skilled Nursing Facility-Advanced Beneficiary Notice (SNF-ABN) and Notice of Medicare Non-Coverage (NOMNC) forms to two residents following the end of their Medicare skilled services. For both residents, documentation showed that Medicare coverage had ended, but the NOMNC forms provided were undated, and there was no evidence indicating when the residents were informed. Additionally, the required SNF-ABN forms were not given to the residents at least 48 hours before the end of their therapy, as required by facility policy and federal regulations. Interviews with the Business Office Manager revealed a lack of awareness regarding the requirement to provide these notices in a timely manner. The Director of Nursing provided an undated policy that specified the need to give residents or their representatives at least two days' notice before the end of Medicare Part A coverage, but this policy was not followed in the cases reviewed. The deficiency was identified through record review and staff interviews, confirming that the necessary notifications were not provided as required.