The Center recently worked with an ombudsman whose client was billed nearly $10,000 for almost two weeks of care in a skilled nursing facility (SNF) and physical therapy when the resident remained in the SNF after she had received 100 days of Medicare Part A coverage. The SNF had not told the resident that her SNF coverage had ended.
Although the Medicare program does not require a SNF to issue a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) when the beneficiary has exhausted his or her 100 day benefit period, we discussed: (1) various residents’ rights provisions of the Nursing Home Reform Act’s regulations, 42 C.F.R. §483.10(f), that provide “self-determination,” “the right to make choices about aspects of his or her life in the facility that are significant to the resident,” “the right to manage his or her financial affairs,” “the right to know, in advance, what charges a facility may impose against a resident’s personal funds,” and more; (2) state Consumer Protection Law; and (3) general contract law (which requires an agreement to pay a specific amount. When the resident was admitted as a Medicare beneficiary, nothing was said about a private-pay rate, or what that rate would be, in the event that Medicare coverage ended). The facility backed down from billing the resident for the two-week stay and billed Medicare Part B for the therapy services
March 26, 2026 – T. Edelman