cms_WV: 49
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 49 | GUARDIAN ELDER CARE AT WHEELING | 515002 | 20 HOMESTEAD AVENUE | WHEELING | WV | 26003 | 2018-05-03 | 582 | E | 0 | 1 | X20F11 | Based on interview and record review, the facility failed to issue liability and appeal notices as required. Specifically, the facility failed to issue the Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) letter to Resident #253, issued the incorrect Center for Medicare and Medicaid Services (CMS) form letter to Resident #254 and issued an inaccurately completed SNFABN form letter and an altered NOMNC form letter to Resident #144. This failed practice had the potential to affect more than a limited number of residents. Resident identifiers: #253, #254, and #144. Facility census: 142. Findings included: a) Review of guidelines Review of the current guidelines for the Centers for Medicare and Medicaid Services instructions for the SNFABN letters of notice, revised 1/18, revealed .Medicare requires SNFs (skilled nursing facilities) to issue the SNFABN (Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage) to original Medicare, also called fee-for-service, beneficiaries, prior to providing care that Medicare usually covers . The SNFABN has the following 5 (five) sections for completion: Header, Body, Option Boxes, Additional Information, Signature and Date . SNFs must enter the first and last name of the beneficiary receiving the notice . There are 3 (three) options listed on the SNFABN with corresponding check boxes. The beneficiary must check only one option box . Review of the current guidelines for the CMS instructions for the NOMNC letter of notice revealed, .The NOMNC (Notice of Medicare Non-Coverage) must be delivered at least two calendar days before Medicare covered services end . The provider must ensure that the beneficiary or representative signs and dates the NOMNC to demonstrate that the beneficiary or representative received the notice . b) Resident #253 Review of the clinical record for Resident #253 revealed no SNFABN letter was issued when Medicare benefits ended. c) Resident #254 Review of the clinical record for Resident #254 revealed the SNFABN letter was issued on 1/3/18 and signed, however the form letter was not the correct CMS required form letter. Resident #254 was issued an older version of the SNFABN form letter (CMS R-131) instead of the correct and current form (CMS- ). In addition, the required sections were not completed. d) Resident #144 Review of the clinical record for Resident #144 revealed the SNFABN letter was issued on 4/19/18 and signed, however the form section for Reason Medicare (MONTH) Not Pay, was inaccurately completed according to the CMS instructions. The NOMNC letter was issued on 4/19/18, however was altered from its original form according to the CMS instructions. Page 1 of the NOMNC form ran over onto page 2. e) Staff interviews An interview with the Administrator and the Director of Nursing on 5/3/18 at 11:30 AM revealed they were unaware the SNFABN and NOMNC form letters were not being issued regularly or being completed accurately according to the CMS instruction sheets. The Administrator and the Director of Nursing stated they would refer to the most current CMS instruction sheets for further education. The Administrator stated she felt the missing SNFABN for Resident #253 was an isolated situation and stated she felt the facility had issued the resident a letter but could not provide proof of the issued letter. | 2020-09-01 |