Failure to Provide SNF-ABN Notification to Residents Ending Medicare Part A Coverage
Penalty
Summary
The facility failed to provide the required Centers for Medicare and Medicaid Services (CMS) Skilled Nursing Facility Advanced Beneficiary Notice (SNF-ABN) form 10555 to two residents prior to the end of their Medicare Part A skilled services. Both residents were admitted to Medicare Part A skilled services and remained in the facility after their skilled coverage ended. Record reviews showed no documentation that either resident or their responsible parties received the SNF-ABN, which is necessary to inform them of the end of Medicare coverage and potential financial liability for continued services. Interviews with the previous facility Social Worker confirmed that issuing the SNF-ABN was her responsibility when a resident's Medicare Part A skilled services were about to end and the resident was staying in the facility. The Social Worker could not provide a reason for the oversight in both cases. The Administrator also confirmed that the Social Worker was responsible for issuing the SNF-ABN and acknowledged that both residents should have received the notice as required by federal guidelines.