Failure to Provide Timely SNF ABN Notification for Medicare Coverage Termination
Penalty
Summary
The facility failed to provide a completed Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) in writing to a resident or their responsible party prior to the end of Medicare Part A coverage, as required. Specifically, the SNF ABN form for a resident with severe cognitive impairment and diabetes was not completed to indicate the resident's or representative's choice among the three required options regarding continued care and financial responsibility. The form was signed by the responsible party 19 days after the last covered day, rather than at least 72 hours before coverage ended, as confirmed by both the Accounts Receivables Supervisor and the Director of Nurses during interviews. The facility did not have a policy for beneficiary notices and relied on CMS guidelines, which require timely notification to allow beneficiaries to make informed decisions about their care and financial obligations. The failure to provide the SNF ABN in a timely manner meant the resident or their representative was not properly informed in advance of the end of Medicare coverage and the potential for out-of-pocket costs, nor were they given the opportunity to appeal the decision or determine the course of care before coverage ended.