Failure to Notify Residents of Changes in Medicare/Medicaid Coverage and Financial Liability
Penalty
Summary
The facility failed to provide required notifications to residents regarding changes in Medicare and Medicaid coverage and the resulting financial liability for services not covered. Specifically, three residents whose Medicare Part A services had ended did not receive the appropriate Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN, CMS-10055) as required. Documentation indicated that the correct form was not used due to a recent change in business office staff, and the new staff member had not been properly educated on the correct process. The Nursing Home Administrator confirmed that the facility had not provided the up-to-date SNF ABN notice to residents discharging from Medicare Part A services over the past year. Additionally, a review of another resident's records revealed that changes in Medicaid coverage, which affected the resident's monthly patient payment amount, were not communicated in writing to the resident. The business office coordinator acknowledged that the facility did not provide written notice of these changes, assuming that Medicaid would notify the resident directly. The resident, who was cognitively intact, expressed frustration at not being informed of the increased charges prior to receiving his monthly statement. The facility's failure to notify residents of changes in coverage and financial responsibility was confirmed through interviews and record reviews.