Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide required cost information on the Advanced Beneficiary Notice (ABN) CMS form 10055 for a resident receiving skilled services. Specifically, the ABN for one resident did not include documentation regarding the cost for continued skilled services ending on 7/24/25. This omission was identified during a review of records for three residents sampled for Medicare Liability Notices out of a total sample of twelve. An administrative nurse confirmed that the ABN should have included the cost to properly notify the resident. The facility's policy, dated 11/05/24, requires timely notices about Medicare eligibility and coverage, including informing beneficiaries of their potential payment liability.