Failure to Provide Required Medicare Advance Beneficiary Notice
Penalty
Summary
The facility failed to provide the required CMS Form 10123, Advanced Beneficiary Notice (ABN), to a resident or their representative when Medicare-covered skilled services were ending. Record review and staff interviews confirmed that the ABN, which informs beneficiaries about potential non-coverage and their financial liability, was not given to the resident when their skilled services ended. The form is intended to allow residents to make informed decisions about continuing services and to appeal Medicare decisions, but there was no documentation that the resident or their representative received this notice. Administrative staff interviews revealed that responsibility for issuing the ABN was assigned, but the required documentation could not be located, and staff confirmed the form was not provided. The facility's own policy required that the ABN be issued at least two calendar days before the end of Medicare-covered services, but this procedure was not followed, resulting in the deficiency.