Failure to Provide SNF-ABN Notification for Non-Covered Medicare Services
Penalty
Summary
The facility failed to provide required notification to residents regarding their potential financial liability for services no longer covered by Medicare. Specifically, after issuing the Notice of Medicare Non-Coverage (NOMNC) to three residents whose Medicare coverage was ending, the facility did not provide the Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF-ABN; Form CMS-10055) as required. This form is necessary to inform residents or their representatives of the estimated costs for continued care and to document their understanding and choices regarding ongoing services not covered by Medicare. Documentation review confirmed that each of the three residents remained in the facility after their Medicare coverage ended, but there was no evidence that the SNF-ABN was issued to any of them. An interview with the Nursing Home Administrator further confirmed that the required notice was not provided. This omission resulted in a lack of documented communication to the residents or their representatives about their financial responsibility for non-covered services.