cms_GA: 8561
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 8561 | OAKS - BETHANY SKILLED NURSING, THE | 115705 | 1305 EAST NORTH STREET | VIDALIA | GA | 30475 | 2011-03-09 | 156 | B | 0 | 1 | 78N611 | Based on a review of the facility's Skilled Nursing Facility Advance Beneficiary Notice and Notice of Medicare Provider Non-Coverage forms, it was determined that the facility failed to issue the mandatory denial notices to two residents (#21 and #25) that included their potential liability for payment of non-covered services in order to allow them to make an informed decision about whether or not they wanted to continue to receive specific items or services, knowing that they might have to pay for those items or services themselves, and failed to be sufficiently specific as to the reason why the facility expected Medicare to deny payment. Findings include: According to CMS' Liability Notices/Notice of Medicare Provider Non-coverage instructions, the Notice of Medicare Provider Non-Coverage form (CMS- ) was supposed to be issued when all covered services ended for coverage reasons. If the facility expected the beneficiary to remain in the facility in a non-covered stay, either the CMS- form or a Denial Letter was required to be issued to inform the beneficiary of the potential liability for the non-covered stay. The standards for use by Skilled Nursing Facilities (SNF) in implementing the CMS- form as described in the 70-Form CMS- Skilled Nursing Facility Advance Beneficiary Notice, instructed the SNF to give the specific reason(s) why it expected Medicare to deny payment. The reason(s) cited were to be in understandable lay language and sufficiently specific to allow the resident to understand the basis for the expectation that Medicare would deny payment. Estimated cost amounts could be provided either with the description of extended care items and services or on the estimated cost line. The facility believed that two residents' (#21 and #25) continued stay in the facility would not be paid for by Medicare Part A. However, the Skilled Nursing Facility Advance Beneficiary form (CMS- ) issued to those residents on 3/1/11 and 3/3/11 respectively, did not conform with the notice requirements to explain to the beneficiary his/her potential liability for payment of specific, non-covered services and did not include the estimated cost for the continuation of those services. In an interview on 3/9/11 at 11:30 a.m., staff KK, responsible for issuing the denial letters to the residents or residents' representatives, confirmed that the estimated costs of the items or services had not been provided to the residents. 1. The facility issued a Skilled Nursing Facility Advance Beneficiary Notice to resident #21 on 3/1/11. The facility documented on that form that the current skilled nursing care and therapy services would end on 3/4/11. The facility failed to describe the specific items or services that were to have been discontinued and an estimated cost for the continuation of those items or services. 2. The facility issued a Skilled Nursing Facility Advance Beneficiary Notice to resident #25 on 3/3/11. The facility documented on that form that the current skilled nursing care and therapy services would end on 3/6/11. The facility failed to describe the specific items or services that were to have been discontinued and an estimated cost for the continuation of those items or services. There was no evidence on either the Skilled Nursing Facility Advance Beneficiary Notice or the Notice of Medicare Provider Non-Coverage forms that the resident or residents' representative had received those notices. The signature and date sections were blank. | 2016-01-01 |