Failure to Provide Cost Information on ABN for Skilled Services
Penalty
No penalty information released
The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.
Summary
The facility failed to provide required cost information on the Advanced Beneficiary Notice (ABN) CMS form 10055 for a resident receiving skilled services. Specifically, the ABN for one resident did not include documentation regarding the cost for continued skilled services ending on 7/24/25. This omission was identified during a review of records for three residents sampled for Medicare Liability Notices out of a total sample of twelve. An administrative nurse confirmed that the ABN should have included the cost to properly notify the resident. The facility's policy, dated 11/05/24, requires timely notices about Medicare eligibility and coverage, including informing beneficiaries of their potential payment liability.