Failure to Provide Accurate CMS-10055 Beneficiary Notices
Penalty
Summary
The facility failed to provide residents with accurate and complete CMS-10055 forms, which are required to notify residents of the end of Medicare/Medicaid coverage for skilled services and their potential financial liability for services not covered. For three sampled residents, the forms either listed the admission date instead of the last covered date, provided a date prior to admission, or omitted the cost of continued skilled services. These errors were identified through record review, which showed discrepancies between the dates on the forms and the residents' actual admission and service end dates, as well as missing cost information. Interviews with staff revealed a lack of understanding regarding the purpose and correct completion of the CMS-10055 form. An LPN responsible for reviewing the forms with residents admitted to incorrectly entering admission dates and omitting required cost information. The administrator confirmed that the form should indicate the last covered date and inform residents of the costs and options for continuing services after coverage ends, but this was not done correctly for the sampled residents.