Failure to Provide SNF ABN Notification After End of Medicare Coverage
Penalty
Summary
The facility failed to provide the required Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) to a resident after the end of their Medicare Part A skilled services coverage. According to interviews and record reviews, the resident's Medicare Part A coverage ended, but the resident continued to stay in the facility as a long-term care resident. The Admissions Coordinator confirmed that the SNF ABN notice, which informs residents of changes to their Medicare coverage and potential financial liability, was not issued when the skilled services ended. The Social Services Director and Director of Nursing also confirmed that there was no documentation in the resident's medical record indicating that the SNF ABN was provided. Facility policy requires that Medicare beneficiaries be informed of their potential liability for payment and that the SNF ABN (Form CMS-10055) be issued before providing items or services not covered by Medicare. Staff interviews revealed that the SNF ABN should have been given three days before the last covered day to ensure the resident was aware of their rights and had the opportunity to appeal. The failure to provide this notice was acknowledged by facility staff, and it was confirmed that the resident did not receive the required notification.