Failure to Provide SNF ABN Notification Upon Discharge from Skilled Services
Penalty
Summary
The facility failed to ensure that a resident was properly informed about Medicare/Medicaid coverage and potential financial liability for services not covered. Specifically, the facility did not provide a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) to a resident who was being discharged from Medicare Part A skilled services before their covered days were exhausted. The resident, who had a diagnosis of pneumonitis due to inhalation of food and vomit and was assessed as having severely impaired cognition, continued to reside in the facility after skilled services ended. Although the resident's representative was verbally informed about services that might not be covered, this was not documented on the required SNF ABN form. Interviews with facility staff revealed that the MDS Coordinator was responsible for issuing the SNF ABN and acknowledged that the form should have been provided in this situation. The Administrator also confirmed the expectation that the SNF ABN be given when a resident with remaining benefit days is discharged from Part A services. Additionally, it was noted that the facility did not have a policy regarding the issuance of SNF ABNs.