Failure to Provide ABN Upon Change in Medicare Coverage
Penalty
Summary
The facility failed to provide a Skilled Nursing Facility Advance Beneficiary Notice (ABN) to a resident when there was a change in Medicare Part A coverage. According to the facility's policy, residents must be informed before or at admission and periodically during their stay about available services and any charges for services not covered by Medicare or Medicaid. In this case, a resident was admitted with diagnoses including rib fractures, weakness, and arthritis, and required setup assistance for activities of daily living. The resident had intact cognition and remained in the facility after Medicare Part A coverage ended, transitioning to Medicaid coverage. Documentation review showed that the resident received Medicare Part A skilled services until the last covered day, then continued to stay in the facility for several days under Medicaid coverage before discharge. There was no documentation that the required ABN was issued to the resident upon the change in coverage. Staff interviews confirmed that the ABN should have been provided when Medicare Part A coverage ended, but it was not given, resulting in a failure to notify the resident of potential financial liability for services not covered.