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Based on record review and interview, facility staff failed to inform patients of their Medicare discharge rights upon admission for 2 of 8 Medicare-eligible inpatients (Patient #10, Patient #12) and failed to inform patients of their rights upon discharge for 4 of 5 discharged patients reviewed (Patients #2, #4, #5 and #10), in a total sample of 21.

Findings include:

Review of the facility's Job Breakdown Instruction Sheet for "Medicare, Tricare of Inpatients and Medicare Rights Document for Observation Document" revealed "1. Registration: Registers Patient and Obtains Signature on 'An Important Message from Medicare...' Form needs to be given to patients so they understand their rights, this is a federal law. Signature needs to be obtained to prove the form was given to the patient. 2. Review to see if they have an appointed healthcare power of attorney. If yes, beneficiary representative should sign if they are able. Then have the HUC or RN get the signature/call from the patient record: -Contact via phone if can't do in person; -Document per phone call to POA... 6. If patient is not able to sign a family can sign this form. In addition to the signature you also need to have a date and time. Signature should be obtained within 48 hours of admission." Review of the instruction sheet did not include instructions for obtaining a signature or informing patients of their rights prior to discharge.

Per medical record review, Patient #10 was admitted to the facility on 7/31/2019. Review of Patient #10's document "CMS Important Message" revealed under status "Not Received" with the description "patient unable to sign" on 7/31/2019. Patient #10 was discharged from the facility on 8/6/2019, there was no evidence in the medical record that Patient #10 received notice of their discharge rights prior to discharge.

Per medical record review, Patient #12 was admitted to the facility on 7/31/2019 and #12's Important Message from Medicare was signed on 8/5/2019, more than 48 hours after admission.

During an interview on 8/6/2019 at 2:10 PM, Unit Clerk F stated registration obtains patient signatures on the discharge rights form upon admission and the unit clerks review them on Mondays, Wednesdays and Fridays to "catch" anyone who does not have one on file. Per F, patients should be receiving the form within 48 hours of discharge and "we should be documenting that in the chart."


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Findings include:

Per medical record review, Patient #2 was admitted to the facility on 4/13/2019. Patient #2 was discharged from the facility on 4/16/2019, there was no evidence in the medical record that Patient #2 received notice of their discharge rights within 48 hours prior to discharge.

Per medical record review, Patient #4 was admitted to the facility on 5/22/2019 and #4's Important Message from Medicare was signed on 5/25/2019, more than 48 hours after admission. Patient #4 was discharged from the facility on 5/29/2019, there was no evidence in the medical record that Patient #4 received notice of their discharge rights within 48 hours prior to discharge.

Per medical record review, Patient #5 was admitted to the facility on 6/6/2019. Patient #5 was discharged from the facility on 6/13/2019, there was no evidence in the medical record that Patient #5 received notice of their discharge rights within 48 hours prior to discharge.