Failure to Provide Required Medicare Coverage and Liability Notices
Penalty
Summary
The facility failed to provide required Medicare notifications to residents regarding coverage and potential financial liability for services not covered. Specifically, record reviews and staff interviews revealed that two residents were not given the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (CMS-10055), which is intended to inform beneficiaries when Medicare may no longer cover their skilled services and to clarify their payment responsibilities if they choose to continue receiving those services. The facility's own completion of the SNF Beneficiary Protection Notification Review form (CMS-20052) confirmed that these notifications were not issued as required. Additionally, one of these residents was not provided with the Notice of Medicare Non-coverage (CMS-10123), which is necessary to inform beneficiaries of their right to appeal and request an expedited review when Medicare coverage is ending. During interviews, the Nursing Home Administrator acknowledged that the required forms were not provided to the affected residents, as indicated on the facility's internal review documentation.