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Based on observation, record review and staff interview the facility failed to provide two (#10, #13) of six of the fourteen patients sampled with the Important Message from Medicare Letter upon admission or discharge.

Findings include:

Record reviews conducted on 2/10/13 at approximately 2:00 p.m. revealed the facility did not include the Important Message Letter from Medicare (IM) as part of the patient medical record for patients #10 and #13.

1. Staff member (A) along with surveyor #2 conducted an electronic medical review for patient #10 on 2/10/13. The patient was admitted on 9/09/13 at 4:31 p.m. from a skilled nursing facility. Further record review revealed the patient was discharged back to the skilled nursing facility on 9/28/13. The patient first received an IM on 9/9/13 at 4:58 p.m. in the Emergency Department. It was noted the patient was unable to sign. The second IM dated 9/10/13 at 12:15 a.m. appeared to be signed by the patient. The patient was discharged from the hospital on 9/28/13. The electronic medical record did not reveal the required second IM letter upon discharge on 9/28/13.

2. Staff member (A) along with the surveyor #2 conducted an electronic medical review for patient #13 on 2/10/13. It revealed the patient was admitted on 12/30/13 and discharged on 1/2/14. The IM was signed and dated 12/18/13 at 4:06 p.m. Further record review revealed the patient did not have IM within the correct timeframe of admission or one upon discharge.

An interview with the Risk Manager was conducted on 2/10/14 at approximately 2:45 p.m. She was informed of the missing documentation.

A review of the facility's policy BO.010A with an origination date of 4/1/13 titled "Important Message from Medicare" was provided by Risk Management. Under the heading policy bullet point (C) it read: Hospitals will issue the IM within two calendar days of the day of admission and obtain the signature of the beneficiary or his representative to indicate that she or he understood the notice. (E) Hospitals may deliver the initial copy of notice if the beneficiary is seen during a preadmission visit, but not more than 7 calendar days in advance of admission, and (F) The IM or a copy of the IM, must also be provided to each beneficiary within 2 calendar days of the day of discharge.