Failure to Provide Timely Notice of Medicare Non-Coverage Prior to Resident Transfer
Penalty
Summary
The facility failed to issue the required Notice of Medicare Non-coverage (NOMNC) or Form CMS-10123 to a resident who was being transferred to another healthcare facility. Review of the resident's progress notes indicated a transfer occurred, but there was no documented evidence in the electronic medical record that the NOMNC was completed or any explanation for its absence. The physician certification and re-certification form was reviewed, and a NOMNC letter was provided by the Licensed Nursing Home Administrator (LNHA), but the dates on the letter did not align with the resident's actual discharge date. The NOMNC letter was signed by the resident with a date that was after the actual transfer, indicating the notice was not provided within the required timeframe. Interviews with facility staff, including the Director of Social Services (DSS), LNHA, and Director of Nursing (DON), confirmed that the NOMNC should have been signed at least two days prior to discharge, but this did not occur. The DSS could not provide an explanation for the incorrect date, and the LNHA acknowledged that the date should have been checked before the resident signed the form. The DON confirmed that the resident left for another nursing home and that the NOMNC should have been completed, but it was not done in accordance with regulatory requirements.