Failure to Provide Required Medicare Coverage Termination Notices and Appeal Rights
Penalty
Summary
The facility failed to provide required written notice of Medicare coverage termination, including an explanation of the Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF-ABN) and the right to appeal, to residents and/or their representatives prior to the end of Medicare Part A services. For one resident with Parkinson's disease, muscle weakness, and diabetes, the clinical record showed that the SNF-ABN form was completed and the responsible party's information was documented, but there was no evidence that the resident or her responsible party received the notice, reviewed the form, or were informed of the opportunity to appeal. The resident's daughter confirmed during an interview that she was not contacted regarding the SNF-ABN and was not advised of the right to appeal. For another resident with Parkinson's disease and a history of falls, who had moderate cognitive impairment, the SNF-ABN form was signed by the resident, and the social worker documented no appeal. However, there was no evidence that the resident was provided with an explanation of the form or informed of the right to appeal. The resident stated in an interview that he was asked to sign the form without any explanation or information about the right to appeal the denial of coverage. The Nursing Home Administrator acknowledged the findings when reviewed by the surveyor.