Failure to Provide Timely Medicare Coverage Termination Notices
Penalty
Summary
The facility failed to provide timely notice of the end of Medicare coverage to two residents, as required by policy and federal regulations. For one resident, the Notice of Medicare Non-Coverage (NOMNC) and Advance Beneficiary Notice (ABN) were not signed until after the last covered date, rather than at least two days prior to the end of Medicare-covered services. This was confirmed by the Regional Business Office Manager, who acknowledged that the required notices were not provided within the appropriate timeframe. For another resident, there was no evidence that the NOMNC or ABN were completed at all when Medicare Part A services ended. The facility's policy states that such notices must be provided at least two days before the end of Medicare coverage to allow residents or their representatives sufficient time to make informed decisions regarding their care and financial responsibility. Record reviews and staff interviews confirmed that these procedures were not followed for the two residents in question.