Failure to Provide Required Medicare Coverage and Liability Notices
Penalty
Summary
The facility failed to provide required Medicare notices to three residents or their representatives regarding the end of skilled services and potential financial liability for services not covered by Medicare. Specifically, one resident or their representative did not receive the completed Skilled Nursing Facility Advanced Beneficiary Notice (ABN) form 10055, and two other residents or their representatives did not receive either the ABN form 10055 or the Notice of Medicare Non-Coverage (NOMNC) form 10123. These forms are intended to inform beneficiaries that Medicare may not pay for certain skilled therapy services and to outline their options and potential financial responsibilities. The lack of these notices was confirmed by administrative staff during the survey. The facility's policy required timely issuance of these notices, including hand delivery and proper documentation, to ensure residents and their representatives were aware of Medicare eligibility, coverage, and any changes in charges. The policy also specified that the Business Office Manager or designee was responsible for issuing these notices and that the current CMS-approved versions of the forms must be used. Despite these requirements, the facility did not provide the necessary forms to the affected residents or their representatives when skilled services ended, as verified through record review and staff interviews.