Failure to Provide Required Beneficiary Notifications at Discharge
Penalty
Summary
The facility failed to provide required beneficiary notifications regarding Medicaid/Medicare coverage and potential liability for non-covered services to a resident upon discharge. Specifically, clinical record review showed that a resident who was admitted and later discharged did not receive the Advanced Beneficiary Notification (ABN) or the Notice of Medicare Non-Coverage (NOMNC) as mandated by federal regulations. When surveyors requested documentation, the facility was unable to produce the required notifications for this resident, although notifications for two other residents were provided. Interviews with facility staff revealed that the Social Services Coordinator, who was newly hired, discovered the missing notifications while auditing previous work. She confirmed that the required notifications had not been given to some residents at discharge. The DON acknowledged awareness of the missing notifications but stated that overseeing this process was not within his responsibilities. The facility administrator reported that there was no formal policy on ABN/NOMNC notifications, but that the facility follows CMS guidelines.