Failure to Provide Updated and Complete NOMNC Forms
Penalty
Summary
The facility failed to provide complete and updated Notification of Medicare Non-Coverage (NOMNC) forms to four sampled residents. For each resident, the NOMNC form used was outdated, having last been approved by CMS in 2011 rather than the most recent version. Additionally, the forms lacked required information, specifically the name and telephone contact of the appeal organization. There was also no documentation in the residents' electronic health records indicating that the residents or their representatives were given an explanation of the NOMNC form or the appeal process. Interviews with the Social Service Director revealed a lack of awareness regarding the need to update the NOMNC form and include the appeal organization's contact information. The Social Service Director stated they were responsible for issuing and explaining the NOMNC form but was unaware that the forms in use were outdated and missing required information. This deficiency was identified through both record review and staff interviews.