Failure to Provide and Document NOMNC and Appeal Rights for a Resident’s Responsible Party
Penalty
Summary
The facility failed to provide a resident’s responsible party with a written Notice of Medicare Non-Coverage (NOMNC), ensure understanding of the notice, and inform her of appeal rights prior to discharge. The responsible party reported that she received a phone call from the Social Service Designee (SSD) stating the resident was being discharged to a room and board setting. She stated she did not fully understand the NOMNC notice and was not given the option to appeal the decision, explaining that she simply complied with what she was told and did not know she had options. Record review with the SSD showed the NOMNC letter for the resident contained a line for the patient representative’s signature to indicate receipt and understanding, but there was no signature from the responsible party. The SSD stated that the responsible party was notified by phone of the NOMNC and that the option to appeal was not discussed because the responsible party was not opposed to discharge. A facility form titled “Optional Form to Document Alternate Delivery Notice of Medicare Non-Coverage” indicated the responsible party was notified by phone, with instructions to document that the representative verbalized understanding of the information. However, upon review of the clinical record, the SSD was unable to provide documentation that the responsible party verbalized understanding of the NOMNC notice.
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