Failure to Provide Estimated Costs on ABN Forms
Penalty
Summary
The facility failed to inform residents of the charges for services for which they may be responsible, specifically in cases where Advanced Beneficiary Notices of Non-Coverage (ABN) were issued. Record review showed that for three sampled residents who received ABNs, the section of the ABN form (CMS-10055) requiring an estimated cost per day, item, or service for continuing daily skilled nursing care was left blank. This omission was identified during a review of the facility's ABN policy, which requires a good faith effort to provide a reasonable cost estimate or to indicate if no estimate is available. Interviews with facility staff confirmed the deficiency. The administrator was unaware of why the estimated cost section was not completed, and the accounts manager, who was responsible for presenting and documenting the ABN forms, acknowledged that she failed to document the estimated costs on the forms. The accounts manager confirmed that the estimated cost should have been included on the ABN forms for the affected residents but was not.