Failure to Provide Timely and Accurate Medicare Coverage and Liability Notices for Therapy Services
Penalty
Summary
The deficiency involves the facility’s failure to provide required Medicare notices regarding the end of coverage and potential financial liability for therapy services. For one resident, a therapy discharge notification dated 8/31/25 indicated the last treatment date would be 9/4/25 with a discharge date of 9/5/25. That resident signed a Notice of Medicare Non-Coverage (NOMNC), CMS Form 10123, on 9/2/25 stating coverage of therapy services would end on 9/5/25, and then signed a Skilled Nursing Facility Advanced Beneficiary Notice (SNF‑ABN), CMS Form 10055, on 9/5/25 indicating the resident would begin incurring costs for therapy on 9/6/25 if choosing to continue services. The facility did not provide the resident with documentation of the specific charges that would occur prior to the last date of covered services and did not maintain consistent dates between the therapy department’s discharge notification and the coverage/discharge dates reflected on the notices. For another resident, a therapy discharge notification dated 1/13/26 indicated the last treatment date and discharge date would both be 1/20/26, with discharge planned because all goals were met and the resident was returning home at prior level of function. This resident signed the NOMNC on 1/20/26, meaning the facility did not provide notification of the ending of Medicare-covered services prior to the discharge date. Interviews with the Assistant Administrator/Billing Manager and the Administrator confirmed that documents related to NOMNC and SNF‑ABN were not consistently provided as soon as notification for discontinuation of therapy services was made, despite the facility’s ABN policy requiring that a SNF‑ABN be issued before providing services that may not be covered and before reducing services that the facility believes Medicare will not pay for, allowing time for the beneficiary to sign and ask questions.
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