Failure to Provide Complete Advance Beneficiary Notices and Medicare Non-Coverage Information
Penalty
Summary
The facility failed to provide complete and accurate Advance Beneficiary Notices (ABNs) and Notices of Medicare Non-Coverage (NOMNC) to two residents who were ending their Medicare Part A skilled services. For one resident with a history of stroke, chronic respiratory failure, moderate cognitive impairment, and communication difficulties, the facility issued an ABN and NOMNC that were incomplete. The forms did not specify which Medicare Part A services were ending, the reason for non-coverage, or an estimated cost for continued services, despite the resident's cognitive and communication challenges. The Social Services Director (SSD) confirmed that information from therapy regarding the reason for service termination was not transcribed onto the forms, and she lacked knowledge of the estimated costs to include. For another resident with severe cognitive impairment and communication problems following a stroke, the facility did not provide the required ABN at the time of Medicare Part A service termination. The NOMNC issued was signed by staff on behalf of the resident but did not specify which services were ending. The SSD acknowledged that the ABN was not provided and that the NOMNC lacked necessary details. She also stated that she was unsure why the resident's Medicare services ended and that all areas of the forms should have been completed for informed decision-making. Interviews with facility staff, including the Business Office Manager, SSD, Director of Nursing, and Administrator, revealed a lack of awareness and understanding regarding the proper completion and issuance of ABN and NOMNC forms. Staff confirmed that forms were not fully completed and that required information was missing, preventing residents or their representatives from making informed choices about their care and financial responsibilities.