Failure to Provide Timely Medicare Coverage Termination Notice
Penalty
Summary
The facility failed to provide the required Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN-CMS-10055) to a resident within the mandated timeframe. Specifically, the resident was admitted and later discharged, with their Medicare Part A services ending on a specified date. The SNFABN, which informs residents of the end of Medicare coverage and their potential financial responsibility, was given to the resident on the same day that services ended, rather than at least 48 hours in advance as required by both facility policy and federal guidelines. Interviews with the office manager and administrator confirmed that the notice was not provided within the required timeframe. The office manager acknowledged responsibility for completing the SNFABN forms and stated that they typically rely on notifications from therapy or the MDS nurse regarding the end of services. Both the office manager and administrator recognized the importance of timely notification to allow residents to make informed decisions about their care and financial obligations. Review of facility policy further confirmed the expectation that such notices be provided at least two days before the end of Medicare coverage.