Failure to Provide NOMNC to Residents After Discontinuation of Skilled Services
Penalty
Summary
The facility failed to provide a Notice of Medicare Non-Coverage (NOMNC) to two residents after their Medicare Part A skilled services were discontinued. According to the facility's policy, a NOMNC must be issued to residents or their representatives when Medicare-covered services are ending, regardless of whether the resident is leaving the facility or remaining for long-term care. Medical record reviews showed that one resident with diagnoses including atherosclerosis of the aorta, anemia, cardiomegaly, and muscle weakness, and another resident with muscle weakness, history of falling, age-related physical debility, and hypertension, did not receive the required NOMNC after their last covered skilled service days. This omission meant that the residents were not informed about the end of their Medicare coverage for therapy services and were not given the opportunity to make an informed decision regarding the continuation of therapy services at their own expense or to file an appeal. The President of Clinical Reimbursement confirmed during an interview that the required notices were not provided to these residents prior to their discharge from skilled services.