Failure to Issue Accurate Medicare Non-Coverage Notices
Penalty
Summary
The facility failed to properly issue the required Notice of Medicare Provider Non-Coverage (NOMNC) and Skilled Nursing Facility (SNF) Advance Beneficiary Notice of Non-coverage (ABN) for two out of three sampled residents. For one resident, the NOMNC form indicated the last covered day for Medicare Part A services, but the form was only signed by the social services director with a note that verbal notice was received by the resident's representative. Additionally, the SNF ABN form for this resident was found to have another resident's name at the top, and it did not include the required reason why Medicare may not pay or the estimated cost of the services. The form was also signed by the social services director with a note of verbal receipt by the representative. For another resident, the SNF ABN form indicated the last covered day for Medicare Part A services, but again failed to include the reason Medicare may not pay or the estimated cost. Interviews with the interim DON and MDS coordinator confirmed that the NOMNC and ABN forms were inaccurate. Review of facility policy showed that residents are to be informed in writing in advance when changes to their Medicare coverage occur, including the reasons for non-coverage and potential financial liability, but this process was not followed as required.