Failure to Provide Required Medicare/Medicaid Beneficiary Notification Forms
Penalty
Summary
The facility failed to provide required Medicare/Medicaid beneficiary notification forms to a resident whose Medicare Part A coverage was ending and who was transitioning to long-term care. Specifically, the CMS form 10055 Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) and the CMS form 10123 Notice of Medicare Non-Coverage (NOMNC) were not issued to the resident. Documentation in the electronic medical record indicated that staff discussed the end of Medicare coverage, the transition to LTC, and the right to appeal with the resident and their family, but the actual forms were not provided as required. A review of the facility's policy confirmed that residents should be informed in writing about services, charges, and their rights to appeal at least three days prior to a change in payor status or discharge. Social services staff acknowledged that due to a recent staff changeover, the required ABN and NOMNC forms had not been issued to residents as they should have been. This lapse was identified during the survey when the forms could not be produced upon request.