Failure to Provide Required Medicare Advanced Beneficiary Notice
Penalty
Summary
The facility failed to provide a CMS-10055 Skilled Nursing Facility Advanced Beneficiary Notice (ABN) to a resident prior to the end of their Medicare Part A skilled services. The resident was admitted and began receiving Medicare Part A services, and a CMS-10123 Notice of Medicare Non-Coverage (NOMNC) was issued to inform the resident that Medicare coverage for skilled services would end. However, the required ABN, which notifies the resident of potential financial liability for services not covered by Medicare, was not provided, even though the resident remained in the facility after skilled coverage ended. Interviews with facility staff revealed confusion regarding responsibility for issuing the required forms during a transition period when a new Business Office Manager (BOM) was being hired. The BOM stated she was responsible for issuing both the NOMNC and ABN but had not started employment at the time the resident's Medicare Part A benefit ended. The former Social Worker and the Administrator provided conflicting accounts of who was responsible for issuing the forms, but both acknowledged that both forms should have been provided when a resident remained in the facility after Medicare Part A coverage ended.