Failure to Provide Timely Notification of Medicare Coverage Changes
Penalty
Summary
The facility failed to provide timely written notification to residents regarding changes in their Medicare payment coverage, as required by federal regulations. For one resident, services were primarily paid for by Medicare Part A, but the facility did not deliver the Notice of Medicare Non-Coverage (NOMNC) at least two days before the end of Medicare coverage. Documentation showed that the resident was scheduled for discharge and no longer required skilled therapy, but the required notice was not provided within the mandated timeframe. Interviews with the Director of Nursing and the Nursing Home Administrator confirmed that the resident did not leave against medical advice and that the notice was not issued as required. For another resident, Medicare A coverage ended and the resident transitioned to private payment. Although the responsible party signed the NOMNC and the Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN), the facility did not document that staff discussed the change in payment and the estimated cost per day with the responsible party as soon as reasonably possible when the change in coverage was anticipated. The required notification and discussion regarding financial responsibility were not completed in a timely manner, as confirmed by review of the clinical record and interviews with facility leadership.