Failure to Notify Designated POA of Medicare Coverage Termination
Penalty
Summary
The facility failed to properly recognize and notify the appropriate resident representative regarding the end of Medicare coverage and related appeal rights for one resident. The resident, who was cognitively intact and had a history of stroke, hypertension, and depression, was admitted with a consent form listing one family member (FM-B) as the first emergency contact and guarantor, and another family member (FM-A) as the second emergency contact. The consent form was signed by FM-B. A statutory short form power of attorney (POA) document, dated several years earlier, identified FM-A as the attorney-in-fact and FM-B only as the successor attorney-in-fact, to act if the named attorney-in-fact could not serve. This POA document was uploaded into the resident’s medical record after admission. When the Notice of Medicare Non-Coverage (NOMNC) was issued, it stated the last day of Medicare coverage and included a handwritten note that FM-B was updated by phone about the last coverage day, the appeal process, and the email address to which the document was sent; the NOMNC was signed by FM-B. FM-A later reported she had provided the POA paperwork to the facility before the NOMNC was issued and that she was never informed of the end of Medicare coverage or the appeals process. The administrator stated the NOMNC was issued to FM-B because she had signed the admission papers and was indicated as the first contact, and reported being unaware that POA paperwork had been provided at that time. The Medicare Account Technician confirmed sending the NOMNC to FM-B based on her status as first contact and did not look for POA documentation, expecting social services to update the chart if POA paperwork was received. The social services designee stated that although the POA paperwork for this resident had been uploaded, the first contact had not been changed to the POA, resulting in the failure to notify the designated attorney-in-fact.
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