| 73 |
HAVEN OF SCOTTSDALE |
35059 |
3293 NORTH DRINKWATER BOULEVARD |
SCOTTSDALE |
AZ |
85251 |
2017-10-25 |
156 |
D |
1 |
1 |
DB1811 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on clinical record reviews, staff interviews, and policy review, the facility failed to provide two residents (#s 13 and 18) with Notifications of Medicare Non-Coverage (NOMNC), prior to discharge. Findings include: -Resident #18 was admitted to the facility on (MONTH) 21, (YEAR), with [DIAGNOSES REDACTED]. A review of the Admission Record dated (MONTH) 21, (YEAR) revealed the resident's primary payer source was Medicare [NAME] Review of an undated and unsigned Case Management Activity note revealed DC (discharge) to group Home .will get house cleaned on 6/8 and wants to be home on that day to make sure all goes well. Review of the Physical Therapy Discharge Summary dated (MONTH) 7, (YEAR) revealed the resident's discharge destination was a group home, and the reason for discharge was Highest Practical Level Achieved. A review of the Occupational Therapy Discharge Summary dated (MONTH) 7, (YEAR) revealed the resident's discharge destination was a group home, and the reason for discharge was Highest Practical Level Achieved. Review of the clinical record revealed no documented evidence that a Notice of Medicare Non-Coverage was provided to the resident, prior to being discharged to the community on (MONTH) 8, (YEAR). -Resident #13 was admitted to the facility on (MONTH) 15, (YEAR), with [DIAGNOSES REDACTED]. A review of the Admission Record dated (MONTH) 15, (YEAR) revealed the resident's primary payer source was Medicare [NAME] Review of an unsigned and undated Case Management/Interdisciplinary Discharge Plan-Tier Two Active Inpatient Plan revealed Resident wants to return home on date/week of 6/5 for family reunion. Review of the Physical Therapy Discharge Summary dated (MONTH) 6, (YEAR) revealed the resident's discharge destination was Home, and the reason for discharge was Highest Practical Level Achieved. A review of the Occupational Therapy Discharge Summary dated (MONTH) 6, (YEAR) revealed the resident's discharge destination was Home, and the reason for discharge was Highest Practical Level Achieved. Review of the clinical record revealed no documented evidence that a Notice of Medicare Non-Coverage was provided to the resident, prior to being discharged to the community on (MONTH) 7, (YEAR). During an interview conducted at 12:35 p.m. on (MONTH) 25, (YEAR), the Administrator stated he was responsible for providing the Notice of Medicare Non-Coverage letters to the residents, prior to discharge. He stated that he had not provided these residents with the NOMNC letters, because the residents had told him they wished to go home and indicated the dates they wished to leave. During the survey, the facility provided undated Business Office Manager Auditor notes which included the following: .also discussed with .administrator, the importance of ensuring NOMNCs are done for all residents even if the resident chooses to leave on their own . Review of the facility's policy regarding Medicare Denial Notices revealed under the section Notice of Medicare Non Coverage that for residents currently under the Medicare A benefit in the facility, when the facility determined that Medicare A is no longer the appropriate payer for the resident or the resident is planning on discharging from the facility, the CMS NOMNC (Notice of Medicare Non Coverage) is to be issued to the resident and/or the appropriate Responsible Party two days before the resident is to come off Medicare A or be discharged . Once signed and dated appropriately, this is to be uploaded into the EHR (electronic health record). |
2020-09-01 |