Failure to Provide Required Medicare Non-Coverage Notices
Penalty
Summary
The facility failed to provide the correct Centers for Medicare and Medicaid Services (CMS) notification forms to two residents or their representatives regarding the end of their skilled services and potential financial liability for non-covered services. Specifically, one resident received the CMS-R-131 and CMS 10055 forms but did not receive the required CMS Form 10123, while another resident received only the CMS-R-131 and did not receive either the CMS 10055 or the CMS 10123 forms. These forms are necessary to inform beneficiaries about the potential for Medicare non-coverage and to allow them to make informed decisions about continuing services and accepting financial responsibility. Administrative staff confirmed that the incorrect forms were provided and that the required notifications were not issued as per facility policy and CMS requirements. The facility's policy states that advance written notice must be given to beneficiaries before the termination of services or when services are likely to be denied by Medicare, in order to transfer financial liability. The failure to provide the correct forms meant that the residents or their representatives were not properly informed about their options or potential financial obligations related to the discontinuation of skilled services.