Failure to Issue Required Medicare Non-Coverage Notices
Penalty
Summary
The facility failed to provide the required Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) and Notice of Medicare Non-coverage (NOMNC) to a resident whose Medicare Part A coverage was ending. The SNF ABN and NOMNC are mandated forms that inform residents or their representatives about the end of Medicare coverage, their right to an expedited review, and their potential financial liability if they choose to continue receiving services that may not be covered. In this case, the facility was unable to produce documentation that these notices were issued to the resident when their last covered day of Part A service occurred, despite the resident remaining in the facility after coverage ended. Interviews with facility staff revealed that the social service department was responsible for issuing these notices, but the previous social worker had not consistently provided them as required. The administrator acknowledged that the resident should have been informed about the end of coverage and potential out-of-pocket expenses. The current social worker, who was not employed at the time, confirmed that the resident should have received the ABN to be made aware of the estimated costs and reasons for non-coverage.