Failure to Provide Required Medicare Coverage and Liability Notices
Penalty
Summary
The facility failed to provide required Medicare beneficiary notices related to the end of Medicare Part A skilled coverage for two residents. For one resident, whose Medicare Part A skilled services ended on 10/31/25 and who discharged home the same day, review of the medical record and the facility’s Beneficiary Notice worksheet showed no evidence that a Notice of Medicare Non-Coverage (NOMNC) was reviewed with or provided to the resident or the responsible party. The MDS Coordinator, who is responsible for issuing NOMNCs and SNF ABNs, stated that therapy staff notify her when skilled coverage is scheduled to end and she then consults with the provider to determine if any additional skilled needs exist before issuing the appropriate notice. She reported that when this resident discharged home, the social worker and financial counselor were covering her duties while she was on vacation and the NOMNC issuance was overlooked. The Administrator confirmed that the MDS Coordinator is expected to issue a NOMNC at least two days before skilled services end and that there was no documentation that this occurred for this resident. For another resident, a NOMNC was discussed with and signed by the resident, indicating that Medicare Part A coverage for skilled services would end on 11/15/25, and the resident remained in the facility after skilled coverage ended. However, review of the medical record revealed no evidence that a Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) was reviewed with or provided to this resident. The MDS Coordinator again stated she is responsible for issuing both NOMNCs and SNF ABNs and explained her usual process of being informed by therapy when skilled coverage is ending and then determining if any other skilled needs exist before issuing the applicable notices. She acknowledged that she simply forgot to provide a SNF ABN to this resident when the NOMNC was issued. The Administrator stated that the MDS Coordinator is responsible for issuing a SNF ABN when a resident remains in the facility and/or appeals the NOMNC and that he would have expected this resident to receive a SNF ABN when Medicare Part A skilled services ended.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.