Failure to Include Estimated Daily Rate on SNF ABN Notices
Penalty
Summary
The facility failed to properly complete CMS-10055 Skilled Nursing Facility (SNF) Advance Beneficiary Notices of Non-coverage (ABNs) by omitting the estimated daily rate for continued services when Medicare Part A coverage ended. Record review showed that one resident’s Medicare Part A episode ran from 01/08/26 to 02/09/26, after which the resident remained in the facility for custodial care. The ABN issued on 02/09/26 did not include a daily rate for services. Another resident’s Medicare Part A episode ran from 08/25/25 to 11/07/25, and this resident also remained in the facility for custodial care. The ABN issued on 11/05/25 likewise lacked a daily rate for services. During interviews, the administrative nurse responsible for issuing ABNs at the time of discharge from skilled therapy stated that she had been instructed by the regional manager not to include the daily rate for services on the ABN due to fluctuations in the rate. Administrative staff also confirmed that the facility did not include the rate for services on ABN notices because the rate changed. The facility’s Beneficiary Notices policy, last approved in 07/2025, documented that Medicare beneficiaries have the right to have Medicare determine coverage for skilled services and described both expedited and standard appeals processes, including the need to inform beneficiaries of possible non-coverage and potential cost shifting from the SNF to the beneficiary, but the ABNs reviewed did not contain the required cost information.
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