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Based on policy review, medical record review, and interview the facility failed to document the patient or patients' representative had been informed of patients' rights for 4 of 5 medical records reviewed (N1, N3, N4, and N5).

1. Facility policy "Integrated Care Management Documentation Process", last reviewed/revised October 2011, provided on page 4, 6 (B) (3) (g) that "Choice Letter and Medicare Important Message Letter (IM) given if applicable".

2. Review of medical records indicated:
A. N1 was a Medicare patient admitted on 1-10-2012 and discharged on 1-18-2012 to an LTAC. N1 had a health care representative appointed due to N1's incapacity. The medical record lacked documentation that "Important Message from Medicare About Your Rights" (IM) had been provided to the patient's health care representative within 2 days of discharge. N1 was admitted on 2-21-2012 and discharged to a SNF on 3-22-2012. IMs were given on 3-14-2012 and 3-19-2012; both more than 2 days prior to discharge.
B. N3 was a Medicare patient admitted on 1-8-2012 and discharged to an LTAC on 2-2-2012. The medical record lacked documentation that an IM had been provided to patient or patient's representative within 2 days of discharge.
C. N4 was a Medicare patient admitted on 1-10-2012 and discharged to an LTAC on 1-26-2012. The medical record lacked documentation that an IM had been provided to patient or patient's representative within 2 days of discharge.
D. N5 was a Medicare patient admitted on 1-12-2012 and discharged to an LTAC on 1-20-2012. The medical record lacked documentation that an IM had been provided to patient or patient's representative within 2 days of discharge.

3. During interview with P2 on 5-11-2012 at 8:45 AM, P2:
A. Confirmed that N1, N3, N4, and N5 were Medicare patients and confirmed the above findings from N1's, N3's, N4's, and N5's medical record.
B. Indicated that IM's should have been provided to patient or patient's representative in the above instances for N1, N3, N4, and N5.

Based on policy review, medical record review, and interview, the facility failed to implement its policy regarding documentation of the care management process for 1 of 5 medical records reviewed (N3).

1. Facility policy "Integrated Care Management Documentation Process", last reviewed/revised 10/2011, stated on page 4 (3) "The Care Management Discharge Note (CMDC)" will be documented only for patients in any status receiving discharge interventions. The discharge note will be completed by the social worker or case manager primarily responsible for arranging the discharge services and will include:
a. Date/time of note
b. Discharge date
c. Discharge disposition: home, home with home care, outpatient services, community resources, skilled nursing care, etc.
d. If a facility placement, the name of the facility, location and contact information will be documented as well as the level of care the patient is to receive there
e. Transporation arrangements including vendor name, contact name/number, and date/time of the pick up.
f. Confirmation of the plan with the patient/family/multidisciplinary team, including name of family member and contact number when applicable.
h. The patient's discharge disposition
i. Signature/pager number


2. Review of N3's medical record indicated N3 was a Medicare patient admitted on 1-8-2012 and discharged to an LTAC on 2-2-2012. The medical record lacked documentation of a final Care Management Discharge Note at time of discharge.

3. During interview with P2 on 5-11-2012 at 8:45 AM, P2:
A. Verified the above findings in N3's medical record that it lacked a final Care Management Discharge Note.
B. Confimed that N3 received discharge interventions and that the medical record was not completed according to facility policy in that a final Care Management Discharge Note should have been documented in the medical record.