Failure to Issue Required ABNs When Medicare Part A Coverage Ended
Penalty
Summary
The facility failed to provide required CMS-10055 Skilled Nursing Facility (SNF) Advanced Beneficiary Notices of Non-Coverage (ABN), including estimated costs for continued services, to two Medicare Part A beneficiaries when their skilled coverage ended and they remained for custodial care. Record review showed that one resident had a Medicare Part A episode from 09/18/25 to 10/20/25 and then remained in the facility for custodial care, but the electronic medical record contained no evidence that an ABN was issued. Another resident had a Medicare Part A episode from 10/25/25 to 12/24/25 and also remained for custodial care, with no documentation in the electronic medical record that an ABN was provided. The facility’s policy on Advance Beneficiary Notices, reviewed 05/07/25, required timely notices regarding Medicare eligibility and coverage and informing beneficiaries of potential liability for payment, including issuing a liability notice upon admission or during the stay before providing items or services that may not be covered because they are not medically reasonable and necessary or are custodial care. Interviews confirmed that the responsible social services staff member was not aware of the requirement to complete and issue the ABN, and the facility was unable to produce evidence that the CMS-10055 form was given to either resident.
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