cms_NE: 4720

In collaboration with The Seattle Times, Big Local News is providing full-text nursing home deficiencies from Centers for Medicare & Medicaid Services (CMS). These files contain the full narrative details of each nursing home deficiency cited regulators. The files include deficiencies from Standard Surveys (routine inspections) and from Complaint Surveys. Complete data begins January 2011 (although some earlier inspections do show up). Individual states are provides as CSV files. A very large (4.5GB) national file is also provided as a zipped archive. New data will be updated on a monthly basis. For additional documentation, please see the README.

Data source: Big Local News · About: big-local-datasette

This data as json, copyable

rowid	facility_name	facility_id	address	city	state	zip	inspection_date	deficiency_tag	scope_severity	complaint	standard	eventid	inspection_text	filedate
4720	OLD MILL REHABILITATION (OMAHA TCU)	285289	1131 PAPILLION PARKWAY	OMAHA	NE	68154	2016-05-09	156	E	0	1	5T6711	Based on record review and interview, the facility staff failed to issue a required Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) of potential liability for Medicare non-coverage (called a Medicare Denial Letter/Demand Bill request) for 3 (Residents 96, 141 and 144) residents reviewed. The facility census was 40. Findings are: Record review of a Centers for Medicare and Medicaid Services Survey and Certification letter 09-20 revealed that the Skilled Nursing Facility (SNF) must inform the beneficiary of potential liability for payment for non-covered services when limitation of liability applies. The SNF's responsibility to provide notice can be fulfilled by use of either the Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) or one of 5 uniform Denial Letters. The SNFABN and the Denial Letters also inform the beneficiary of the right to have a claim (i.e., demand bill) submitted to Medicare. Issuing the Notice to Medicare Provider Non-coverage to a beneficiary only conveys notice to the beneficiary of the right to an expedited review of a service termination and does not fulfill the providers ' obligation to advise the beneficiary of potential liability of payment. The provider must still issue the SNFABN or a Denial Letter to address liability of payment. Review of the facility's Medicare Demand Bill process revealed that 3 (Residents 96, 141 and 144) residents files reviewed had not been informed of the right to submit a Demand Bill to Medicare through the standard claim appeal and had not been issued a SNFABN or a Denial Letter to address liability of payment. Review of the resident files revealed the following: - Resident 96: Medicare services ended 11/23/15. The resident was not issued a SNFABN and was only provided with an expedited appeal notice (a way to request a quick decision by Medicare). - Resident 141: Medicare services ended 04/27/16. The resident was not issued a SNFABN and was only provided with an expedited appeal notice. - Resident 144: Medicare services ended 11/24/15. The resident was not issued a SNFABN and was only provided with an expedited appeal notice. Interview on 05/09/16 at 9:04:47 AM with Care Manager C confirmed that Residents 96, 141 and 144 had been issued an expedited appeal notice but had not been issued an SNFABN/ Denial Letter to address liability for payment. Interview on 5/9/16 with the Facility Administrator revealed that the policy on transfers and discharge did not include information related to Medicare Denial Notices until it had been updated on 5/9/16.	2020-04-01