Failure to Provide Required Notification of Medicare Coverage Changes
Penalty
Summary
The facility failed to notify residents or their responsible parties when there was a change in their level of care and services, specifically when Medicare Part A skilled nursing facility (SNF) coverage ended and the residents remained in the facility. For two residents, the facility initiated discharge from Medicare Part A services while benefit days remained, but did not provide the required Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN). Although the Notice of Medicare Non-Coverage (NOMNC) was provided, there was no documentation that the SNF ABN was given to inform the residents of their financial responsibility for continued services. Staff interviews revealed that the person responsible for providing these notifications had not received proper training and was under the impression that the SNF ABN was not necessary if the resident had Medicaid as a payor source. Additionally, the facility was unable to provide a policy related to the notification of services to residents or their representatives. Facility records and progress notes lacked documentation that the required notifications were given, resulting in residents not being properly informed of their potential liability for services not covered by Medicare.