Failure to Issue and Retain Advance Beneficiary Notices for Medicare Coverage
Penalty
Summary
The facility failed to provide the required Advance Beneficiary Notices (ABN) to two of three sampled residents whose Medicare Part A coverage ended during their stay. For one resident, who was re-admitted after an acute hospitalization with diagnoses of generalized muscle weakness and fatigue, there was no evidence that the ABN was issued or retained when Medicare Part A coverage began and ended. Similarly, for another resident admitted with Medicare Part A as the payor source, the facility did not retain a copy of the ABN to show it was provided to the resident or their representative. The Facility Administrator confirmed in interviews that there was no documentation to support that the required notices were given, as mandated by facility policy and Medicare regulations.