Failure to Provide Required Cost Estimates on SNF ABN Forms
Penalty
Summary
The facility failed to provide completed Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN CMS 10055) forms to two residents whose Medicare Part A coverage ended and who remained in the facility. Specifically, the SNF ABN forms for both residents did not include an estimated cost for services, instead instructing the resident to 'see business office' for this information. Interviews with the business office manager and the MDS nurse revealed that neither routinely provided a monetary estimate on the SNF ABN forms, and the MDS nurse was unaware that a cost estimate was required. All SNF ABNs were completed in this manner, without the required cost information. Further review of the SNF ABN form instructions confirmed that a good faith estimate of the projected costs of care should be included, and that omitting this information should not be a routine practice. One resident's family member, who was also employed at the facility, stated that no written cost information was provided on the form, and another resident did not recall being told the amount they would have to pay. The deficiency was identified through interviews and document review, confirming that the facility did not meet the requirement to provide residents with adequate notice of potential financial liability for non-covered services.