Failure to Obtain Signature on Medicare Non-Coverage Notice
Penalty
Summary
The facility failed to inform a resident of the option to appeal a discharge from Medicare Part A Skilled Services. The resident, who had moderately impaired cognition and multiple medical diagnoses including anemia, hypertension, renal failure, malnutrition, and metabolic encephalopathy, was receiving occupational and physical therapy services. Documentation showed that the resident was discharged home with her daughter after completing skilled rehabilitation services. Although the Notice of Medicare Non-Coverage (NOMNC) was prepared and a call was made to the resident's Power of Attorney (POA) to discuss the end of skilled care and appeal rights, the NOMNC document lacked a signature from either the resident or the POA, indicating that receipt and understanding of the right to appeal was not properly documented. Staff interviews revealed that while the staff member responsible discussed the discharge and appeal process with the POA over the phone, she was unaware that a signature was required to confirm receipt of the NOMNC. The Director of Nursing also stated that the facility did not realize a signature was necessary if the conversation was documented. Facility policy required that the Advance Beneficiary Notice (ABN) or NOMNC be reviewed with the beneficiary or representative, all questions answered, and the form signed before providing a copy to the beneficiary or representative. This process was not followed in this instance.