Family medical

 MEDICARE DMEPOS SUPPLIER STANDARDS

Note: This is an abbreviated version of the supplier standards every Medicare DMEPOS supplier must meet in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R. 424.57(c).

1. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements and cannot contract with an individual or entity to provide licensed services.

2. A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.

3. An authorized individual (one whose signature is binding) must sign the application for billing privileges.

4. A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal procurement or non-procurement programs.

5. A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment.

6. A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare covered items that are under warranty.

7. A supplier must maintain a physical facility on an appropriate site. This standard requires that the location is accessible to the public and staffed during posted hours of business. The location must be at least 200 square feet and contain space for storing records.

8. A supplier must permit CMS, or its agents to conduct on-site inspections to ascertain the supplier’s compliance with these standards. The supplier location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation.

9. A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine, answering service or cell phone during posted business hours is prohibited.

10. A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier’s place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations.

11. A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits suppliers from contacting a Medicare beneficiary based on a physician’s oral order unless an exception applies.

12. A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare covered items, and maintain proof of delivery.

13. A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.

14. A supplier must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.

15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.

16. A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item.

17. A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier.

18. A supplier must not convey or reassign a supplier number; i.e., the supplier may not sell or allow another entity to use its Medicare billing number.

19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.

20. Complaint records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.

21. A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations.

22. All suppliers must be accredited by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment of those specific products and services (except for certain exempt pharmaceuticals). Implementation Date - October 1, 2009

23. All suppliers must notify their accreditation organization when a new DMEPOS location is opened.

24. All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare.

25. All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation.

26. Must meet the surety bond requirements specified in 42 C.F.R. 424.57(c). Implementation date- May 4, 2009

27. A supplier must obtain oxygen from a state- licensed oxygen supplier.

28. A supplier must maintain ordering and referring documentation consistent with provisions found in 42 C.F.R. 424.516(f).

29. DMEPOS suppliers are prohibited from sharing a practice location with certain other Medicare providers and suppliers.

30. DMEPOS suppliers must remain open to the public for a minimum of 30 hours per week with certain exceptions.

To file a complaint with Family Medical, please contact Erin at 309-682-19800 x 123, our accrediting body, ACHC, at 855-937-2242 or to contact the Illinois Department of Insurance at 877-527-9431. All are open Monday-Friday 9-5. You may also print this page and mail or drop-off.

Date & Time of Complaint: ___________________________________________________________________

Person Receiving the Complaint: ____________________________________________________________

Name and phone number of the person reporting the complaint: ________________________

__________________________________________________________________________________________________

Nature of the complaint: _____________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________________________

Was there an incident report filed? Yes No

Actions initiated by staff at the time of receiving the complaint and any outcomes: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PATIENT RIGHTS AND RESPONSIBILITIES

You have the following patient rights:

 The right to be fully informed in advance about the care, treatments, and/or services to be provided, including the disciplines that furnish care and the frequency of visits as well as any modifications to the plan of care.

 The right to choose a health care provider and to be able to identify visiting staff members through proper identification.

 The right to be cared for and choose an organization that adheres to ethical care and business practices.

 The right to be informed of care, treatment, and/or service limitations.

 The right to be involved in his or her care including the development of the plan of care.

 The right to have the plan of care adapted to his or her specific needs and limitations.

 The right to make informed decisions regarding care.

 The right to have their values and preferences, including decisions to refuse care, discontinue care treatments, and services respected.

 The right to confidentiality of the information collected about them and to control access to this information.

 The right to privacy and security and to have their property respected.

 The right to have care, treatments, and services provided in a manner that safeguards each patent’s dignity and cultural, psychosocial, and spiritual values.

 The right to be free from mental, physical, sexual, verbal abuse, neglect, and exploitation.

 The right to have a complaint heard, reviewed, and, if possible, resolved.

 The right to be involved in resolving conflicts, dilemmas or ethical issues about care or service decisions.

 The right to formulate advance directives.

 The right to be involved in decisions to withhold resuscitation and decisions to forgo or withdraw life-sustaining care.

 The right to be involved in decisions when the organization’s review results in a denial of care, treatment, services, or payment.

 The right to choose whether or not to participate in research, investigational or experimental studies, or clinical trials.

 The right to be communicated with, both directly and indirectly through other providers, in an ethical and efficient manner.

 The right to help patients, family members, and other care providers understand and exercise their rights.

 The right to be informed of his or her responsibilities in the provision of care, treatments, and services.

 The right to be informed of any obligation the organization has under applicable laws and/or regulations.

 The right to have consequences of any requested modifications and actions that are not recommended explained and to have alternative care, treatments, and services explained.

 The right to be provided with information about the charges for which the patient is responsible.

 The right to access, request amendments to, and receive an accounting of disclosures regarding their own health information as permitted under applicable law.

 The right to be informed of any existing or potential conflict of interest, including financial benefits that can affect provision of care when referred to an organization.

You have the following patient responsibilities:

 Responsibility to provide accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to your health.

 Responsibility to report perceived risks in your care and unexpected changes in your condition.

 Responsibility to help our organization understand your environment by providing feedback about service needs and expectations.

 Responsibility to ask questions when you do not understand any aspect of care or expectations.

 Responsibility to follow the care, treatments, and services as planned.

 Responsibility for the outcomes if you do not follow the care, treatments, and services we provide.

 Responsibility to follow our organization’s rules and regulations.

 Responsibility for you and your family to be considerate of our staff and property.

 Responsibility to meet any financial obligation agreed to with our organization

Emergency Preparedness Policy

If there is a natural disaster or an emergency situation where the physical building at 3641 N. Meadowbrook Rd, Peoria, IL is unable to accept customers, the managers on staff will facilitate the assistance of the ostomy and urological customers to find other modes of acquiring product. Since Brightree is internet based, the managers can contact those customers and direct them to Liberator Medical or Edgepark.