cms_GA: 6734
Data source: Big Local News · About: big-local-datasette
rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
6734 | HARBORVIEW HEALTH SYSTEMS JESUP | 115414 | 1090 W ORANGE ST | JESUP | GA | 31545 | 2017-08-17 | 156 | E | 0 | 1 | 73MR11 | Based on staff interview and record review, the facility to provide accurate information on the Notice of Medicare Non-Coverage (Form CMS- ) for five residents (#3, #5, #2, #108 and #94) and failed to provide the skilled Nursing Facility Advance Beneficiary Notice (SNFABN) (Form CMS- ) for two residents (#108 and #94) being discharged from medicare part A services from a total sample of six residents. Findings include: During an interview on 8/17/17 at 9:40 a.m., the Minimum Data Set (MDS) coordinator stated that Resident (R) #3, R#5 and R#2 were receiving skilled services while on Medicare Part A. 1. The facility issued the Notice of Medicare Non-Coverage (Form CMS- ), signed by R#3 on 5/11/17, for skilled services ending on 5/17/17. However, the form incorrectly documented that the skilled services that were ending were Medicare Part B services. 2. The facility issued the Notice of Medicare Non-Coverage (Form CMS- ), signed by R#5 on 5/6/17, for skilled services ending on 5/8/17. However, the form incorrectly documented that the skilled services that were ending were Medicare Part B services. 3. The facility issued the Notice of Medicare Non-Coverage (Form CMS- ), signed by R#2 on 4/3/17, for skilled services ending on 4/5/17. However, the form incorrectly documented that the skilled services that were ending were Medicare Part B services. During an interview on 8/17/17 at 11 a.m., the Social Service Director stated that R#108 and R#94 received skilled services while under Medicare Part A services. 4. The facility issued the Notice of Medicare Non-Coverage (Form CMS- ), signed by R#108 on 7/24/17, for skilled services ending on 7/26/17. However, the form incorrectly documented that the skilled services that were ending were Medicare Part B services. In addition, the facility issued Form CMS-R-131, instead of the required skilled Nursing Facility Advance Beneficiary Notice (SNFABN) (Form CMS- ). 5. The facility issued the Notice of Medicare Non-Coverage (Form CMS- ), signed by R#94 on 8/4/17 for skilled services ending on 8/11/17. However, the form incorrectly documented that the skilled services that were ending were Medicare Part B services. In addition, the facility issued Form CMS-R-131, instead of the required skilled Nursing Facility Advance Beneficiary Notice (SNFABN) (Form CMS- ). | 2017-10-01 |