Failure to Provide Complete Medicare ABN Forms with Cost Estimates
Penalty
Summary
The facility failed to provide fully completed Advanced Beneficiary Notice (ABN) CMS Form 10055 to residents or their representatives when skilled services ended. Specifically, for three residents reviewed for Medicare Liability Notices, the ABN forms given did not include the required estimated cost of continued services. The ABN is intended to inform beneficiaries that Medicare may not pay for future skilled therapy services and to provide an estimate of the potential financial liability if Medicare denies coverage. Record review showed that the ABN forms for these residents, issued at the end of their skilled services, were missing the estimated costs section. Administrative staff confirmed that the cost should be presented to allow for the possibility of appeal. The facility's policy indicated that the standard appeals process serves to notify beneficiaries of possible non-coverage and potential financial responsibility, but the omission of estimated costs on the ABN forms meant residents were not fully informed as required.