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F0842
B

Inaccurate Completion of Medicare UB Form for Discharged Resident

Longview, Texas Survey Completed on 11-18-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that the medical record for one resident was complete and accurately documented, specifically regarding the completion of the Medicare UB form. The Business Office Manager incorrectly marked the resident's discharge status as 'expired' (code 20) instead of 'discharged to another facility' (code 03) on the Medicare UB form. This error was not identified or corrected because the Business Office Manager was the only person reviewing the UB forms, and there was no process in place for a secondary review. The resident in question was a male with diagnoses of heart failure and dementia, who was transferred to another facility, as documented in the progress notes. During interviews, the Business Office Manager acknowledged the mistake and stated she was unaware of the potential impact, as she was not informed of any issues by the resident or family. The Administrator confirmed that there was no policy addressing the accurate documentation of Medicare claim forms and that the Business Office Manager was solely responsible for reviewing these forms. The facility's Month End Close Cheat Sheet included a step to verify discharge status, but this process did not prevent the error in this instance.

An unhandled error has occurred. Reload 🗙