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HCS Policies

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.
  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. A supplier must have an authorized individual (whose signature is binding) sign the enrollment application for billing privileges.
  4. A supplier must fill orders from its own inventory, or contract with other companies for the purchase of items necessary to fill orders. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or 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 and must maintain a visible sign with posted hours of operation. The location must be 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.
  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 is prohibited from direct solicitation to Medicare beneficiaries. For complete details on this prohibition see 42 CFR § 424.57 (c) (11).
  12. A supplier is responsible for delivery of and must instruct beneficiaries on the use of Medicare covered items, and maintain proof of delivery and beneficiary instruction.
  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 cost either directly, or through a service contract with another company, any 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 standards to each beneficiary it supplies a Medicare-covered item.
  17. A supplier must disclose 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 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 for those specific products and services (except for certain exempt pharmaceuticals).
  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. A supplier must meet the surety bond requirements specified in 42 CFR § 424.57 (d).
  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 CFR § 424.516(f).
  29. A supplier is prohibited from sharing a practice location with other Medicare providers and suppliers.
  30. A supplier must remain open to the public for a minimum of 30 hours per week except physicians (as defined in section 1848(j) (3) of the Act) or physical and occupational therapists or a DMEPOS supplier working with custom made orthotics and prosthetics.

MEDICARE DMEPOS SUPPLIER STANDARDS DMEPOS suppliers have the option to disclose the following statement to satisfy the requirement outlined in Supplier Standard 16 in lieu of providing a copy of the standards to the beneficiary. The products and/or services provided to you by ( supplier legal business name or DBA) are subject to the supplier standards contained in the Federal regulations shown at 42 Code of Federal Regulations Section 424.57(c). These standards concern business professional and operational matters (e.g. honoring warranties and hours of operation). The full text of these standards can be obtained at http://www.ecfr.gov. Upon request we will furnish you a written copy of the standards.

HOME CARE SPECIALISTS RETURN POLICY

Home Care Specialists, Inc. (HCS) will accept returns for any items that are deemed to be defective, substandard or inappropriate for the indicated use. Our return policy is as follows:

Rental Equipment:

Equipment actively being rented from HCS may be returned at any time for any reason. In some instances, rental equipment that has been ordered by a physician and is being returned without physician approval may require us to inform your physician of the discontinuation of service. Rental items in the middle of a month’s rental will not be pro-rated.

Purchased Equipment:

Equipment that is purchased outright may be returned within 30 days if the equipment is found to be defective, substandard or inappropriate for the indicated use. For any defects or deficiencies occurring after the initial 30 days HCS Warranty Service & Repair policy shall be in effect.

Supplies & Consumables:

Supplies and consumables provided by HCS may be returned within 7 days of the date of delivery if deemed to be inappropriate or unnecessary. Defective or incorrect supplies may be exchanged within 30 days of the date of delivery. All supplies being returned or exchanged must be in the original sealed packaging.

Personal Care Items:

Personal care items such as sheets, cushions, mattress overlays & bath safety items may not be returned once opened. Please inspect the item at the time of delivery to ensure it meets your satisfaction.

Special Orders:

Any items that are not routinely stocked by HCS and are Specially ordered for a customer at their request will not be eligible for returns.

Return Policy
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EQUIPMENT WARRANTY SERVICE & REPAIR

Every product sold or rented by our company carries a minimum of a 1-year manufacturer’s warranty.

Home Care Specialists, Inc. will notify all Medicare beneficiaries of the warranty coverage, and we will honor all warranties under applicable law. Warranty information for all inexpensive or routinely purchased items shall be provided to you at the time of delivery. Warranty information for all capped rental items shall be mailed to you upon the completion of the capped rental period. An owner’s manual with warranty information will be provided to beneficiaries for all durable medical equipment where this manual is available.

Home Care Specialists, Inc. (HCS) will repair, replace or service any items that we provide according to the manufacturer’s warranty and insurance guidelines. For any requested service or repair to items that are not covered by warranty HCS shall asses the item and given an estimate cost for the repair. If the item is brought to HCS location for assessment there will be no charge. If HCS performs an in-home assessment of the product there will be a $ service fee payable at the time of the assessment.

Service & Repair Policy
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PRIVATE PAY HOME CARE SPECIALISTS, INC. EQUIPMENT RENTAL & PURCHASE POLICY

Rental Items:

  • HCS Requires a two-month minimum for all rental items.
  • Rental items may be returned to HCS at any time by contacting us between Monday through Friday between the hours of 8:30-4:30. Minimum of one business day is required for scheduling.
  • HCS will not refund any payments for rental items returned during the initial two-month rental period.
  • $75.00 delivery will be applied for all orders not picked up at HCS office.

Purchase Items:

  • Equipment that is purchased outright may be returned within 30 days if the equipment is found to be defective, substandard or inappropriate for the indicated use. For any defects or deficiencies occurring after the 30 days HCS service and repair policy will be in effect. Personal care items such as cushions, mattress overlays & commodes may not be returned once opened. Please inspect the item at the time of delivery to ensure it meets your satisfaction.

Order Cancellation:

  • Orders canceled prior to day of delivery: HCS will issue a full refund minus a $25 processing fee.
  • Orders canceled day of delivery: HCS will issue a refund for the rental months minus a $25 processing fee. Delivery fee will not be refunded.

Home Preparation for Deliveries:

  • An adequate space needs to be clear in the home for the technician to set up the hospital bed before the technician arrives.
  • HCS staff is not permitted to move any personal items in the home - Upon arrival if a space is not clear for the equipment to be set up, the delivery will be rescheduled as appropriate and another $75.00 delivery fee will be charged

Service and Repair Policy:

  • HCS will repair, replace or service any items that we provide according to the manufacturer’s warranty and insurance guidelines. For any requested service or repair to items that are out of warranty or for repairs that are not covered under warranty HCS will assess the item and give an estimate cost for repair. If the item is brought to HCS’ office for assessment there will be no charge for the assessment and estimate. If HCS performs an in-home assessment of the product there will be a $75.00 service fee payable at the time of the assessment.
  • If you have any questions regarding the warranty for your specific item, please refer to the warranty information that was provided to you at the time of purchase or at the end of your rental period. If you no longer have this information, please contact HCS at 978-373-7771 and we will provide you with a replacement copy.

Electronic Payment Policy

  • It is the policy of HCS that all patients who wish to receive items that are rented continuously must store a form of electronic payment on file with Home Care Specialists, Inc. This can be in the form of a credit card or electronic check. Monthly charges will be automatically processed to the electronic payment method on file.
  • It is very important that any equipment that is no longer needed or that the patient does not wish to be charged for be returned to Home Care Specialists as soon as possible. Home Care Specialists does not pro rate billed charges for returns made in the middle of a rental period.
  • It is the patient’s responsibility to ensure that the electronic payment source on file remains valid for the entire rental period of the equipment. If the payment source is no longer valid Home Care Specialists reserves the right to demand return of the equipment as well pursue collections activity if necessary.
Equipment Rental & Purchase Policy: Private Pay
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NOTICE OF PRIVACY POLICY

This notice describes how protected health information about you may be used and disclosed and how you can get access to this information.  Please review it carefully. Our company is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, we will create records regarding you and the services we provide to you.  This Notice tells you about the ways in which Home Care Specialists (referred to as “we”) may collect, use, and disclose your protected health information and your rights concerning your protected health information.  “Protected health information” is information about you that can reasonably be used to serve you and that relates to you, or the payment for that care. We are required by law to maintain the confidentiality of health information that identifies you; as well as by federal and state laws to provide you with this Notice about your rights and our legal duties and privacy practices with respect to your protected health information.  We must follow the terms of this Notice while it is in effect.  Some of the uses and disclosures described in this Notice may be limited in certain cases by applicable state laws that are more stringent than the federal standards. If you have questions about this notice, please contact the Privacy Officer at Home Care Specialists at 800-698-8113 for further information.

The terms of this notice apply to all records containing your health information that are created or retained by our organization.  We reserve the right to revise or amend our notice of privacy practices.  Any revision or amendment to this notice will be effective for all of your records our practice has created or maintained in the past, and for any of your records we may create or maintain in the future.  Our organization will post a copy of our current notice in our office in a prominent location, and you may request a copy of our most current notice by calling us.

How we may use and disclose your protected health information

We may use and disclose your protected health information for different purposes. The examples below are provided to illustrate the types of uses and disclosures we may make without your authorization for payment, home care operations, and treatment.

  • Payment.  We use and disclose your protected health information in order bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your equipment.   We also may use and disclose your health information to obtain payment from third parties that may be responsible for such costs, such as family members.  Also, we may use your health information to bill you directly or services and items.
  • Home Care Operations. We use and disclose your protected health information in order to perform our home care activities, such as providing equipment appropriate to your needs, or administrative activities, including data management or quality assessment activities.
  • Treatment.  We may use and disclose your protected health information to coordinate services with other health care providers involved in your care.  For example, we may obtain and disclose information on CPT diagnosis codes, diagnosis and prognosis, functional limitations, pre-existing health conditions, hospitalizations, prior use of equipment, and information specific to qualifying the patient as dictated by CMN / detailed written order forms.
  • Appointment Reminders. We may use and disclose your health information to contact you and remind you of visits / deliveries.
  • Health-related Benefits and Services.  We may use and disclose your health information to inform you of health-related benefits or services that may be of interest to you.
  • Release of information to Family / friends.  We may release your health information to a friend or family member that is helping you to pay for your health care, or who assists in taking care of you.
  • Disclosures Required by Law. We will use and disclose your health information when we are required to do so by federal, state or local law.
  • As Required by Law. We must disclose protected health information about you when required to do so by law.
  • Public Health Activities.  We may disclose protected health information to public health agencies for reasons such as preventing or controlling disease, injury, or disability.
  • Victims of Abuse. Neglect, or Domestic Violence.  We may disclose protected health information to government agencies about abuse, neglect, or domestic violence.
  • Health Oversight Activities. We may disclose protected health information to government oversight agencies.  Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
  • Judicial and Administrative Proceedings. We may disclose protected health information in response to a court or administrative order.  We may also disclose protected health information about you in certain cases in response to a subpoena, discovery request, or other lawful process.
  • Law Enforcement.  We may disclose protected health information under limited circumstances to a law enforcement official in response to a warrant or similar process; to identify or locate a suspect; or to provide information about the victim of a crime.
  • To Avert a Serious Threat to Health or Safety.  We may disclose protected health information about you, with some limitations, when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
  • Special Government Functions. We may disclose information as required by military authorities or to authorized federal officials for national security and intelligence activities.
  • Workers Compensation.  We may disclose protected health information to the extent necessary to comply with state law for workers’ compensation programs.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

  • Right to Access Your Protected Health Information. You have the right to review or obtain copies of your protected health information records, with some limited exceptions. Usually the records include referral information, delivery forms, billing, claims payment, and medical management records. Your request to review and/or obtain a copy of your protected health information records must be made in writing. We may charge a fee for the costs of producing, copying, and mailing your requested information, but we will tell you the cost in advance.
  • Right to Amend Your Protected Health Information. If you feel that protected health information maintained by us is incorrect or incomplete, you may request that we amend the information. Your request must be made in writing and must include the reason you are seeking a change. We may deny your request if, for example, you ask us to amend information that was not created by us, or you ask to amend a record that is already accurate and complete.  If we deny your request to amend, we will notify you in writing. You then have the right to submit to us a written statement of disagreement with our decision and we have the right to rebut that statement.
  • Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures we have made of your protected health information. The list will not include our disclosures related to your treatment, our payment or health care operations, or disclosures made to you or with your authorization. The list may also exclude certain other disclosures, such as for national security purposes.   Your request for an accounting of disclosures must be made in writing and must state a time period for which you want an accounting. This time period may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first accounting that you request within a 12-month period will be free. For additional lists within the same time period, we may charge for providing the accounting, but we will tell you the cost in advance.
  • Right to Request Restrictions on the Use and Disclosure of Your Protected Health Information. You have the right to request that we restrict or limit how we use or disclose your protected health information for services, payment, or health care operations. We may not agree to your request. If we do agree, we will comply with your request unless the information is needed for an emergency. Your request for a restriction must be made in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit how we use or disclose your information, or both; and (3) to whom you want the restrictions to apply.
  • Right to Receive Confidential Communications. You have the right to request that we use a certain method to communicate with you or that we send information to a certain location. For example, you may ask that we contact you at work rather than at home.  Your request to receive confidential communications must be made in writing. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Complaints. If you believe that your privacy rights have been violated, you may file a complaint with us and/or with the Secretary of the Department of Health and Human Services.

Below are links to some of the most common policies that we receive questions about. Please read through them and if you have questions, get in touch with us.