Failure to Provide Required Financial Liability Notice When Payer Source Changed
Penalty
Summary
The facility failed to notify a resident and/or the resident’s representative of potential financial liability when the payer source changed from Medicare to private pay. The resident was admitted with chronic kidney disease stage 3, gait and mobility abnormalities, depression, and a history of transient ischemic attack, and the admission record identified the resident’s representative as the guarantor. The case manager stated the resident had full Medicare coverage for 100 days upon admission and that a Notice of Medicare Non-Coverage (NOMNC) dated 3/17/23 indicated Medicare-covered services would end on 3/20/23, with discharge scheduled for 3/21/23. However, the NOMNC was unsigned and lacked attestation. A plan of care note documented that the Kaiser case manager emailed the NOMNC to the facility case manager, stating the resident was to be discharged to a board and care, and that the facility case manager would follow up the next day. The business office manager reported that the resident’s payer changed effective 3/21/23, requiring private payment from that date until discharge due to lack of secondary insurance, and that this change was based on the unsigned NOMNC. The business office manager acknowledged that the NOMNC should have been signed by the resident and that a notice of private pay costs should have been provided, but neither occurred. The medical records assistant confirmed there was no signed NOMNC in the chart and no documentation that a private pay cost notice was issued. Review of the facility’s contract with Kaiser showed that residents may be billed for non-covered or unauthorized services only if notified beforehand and if a Financial Responsibility Form is signed, and otherwise the facility cannot charge more than the resident’s cost share. The facility’s policy on Notice of Covered and Non-Covered Services required that residents receive a notice detailing covered and non-covered services and associated charges upon admission and periodically throughout their stay, but this was not documented for this resident at the time of the payer change.
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