Legal – HOME HEALTH PAVILION

CMS Medicare DMEPOS supplier standards

Note: This list is an abbreviated version of the application certification standards, that 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. pt. 424, sec 424.57(c) and are effective on December 11, 2000. A supplier must disclose these standards to all customers/patients who are Medicare beneficiaries (standard 16).

Home Health Pavilion must be in compliance with all applicable Federal and State laws and regulatory requirements.

Home Health Pavilion must provide complete and accurate information on the DMEPOS Home Health Pavilion application. Any changes to this information must be reported to the National Pavilion Clearinghouse within 30 days.

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

Home Health Pavilion must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. Home Health Pavilion 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.

Home Health Pavilion 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.

Home Health Pavilion 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.

Home Health Pavilion must maintain a physical facility on an appropriate site.

Home Health Pavilion must permit CMS (formerly HCFA), or its agents to conduct on-site inspections to ascertain the Home Health Pavilion’s compliance with these standards. Home Health Pavilion location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation.

Home Health Pavilion 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 or cell phone is prohibited.

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

Home Health Pavilion must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits Home Health Pavilion from calling beneficiaries in order to solicit new business.

Home Health Pavilion is responsible for delivery and must instruct beneficiaries on use of Medicare covered items, and maintain proof of delivery.

Home Health Pavilion must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.

Home Health Pavilion 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.

Home Health Pavilion 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. Home Health Pavilion must disclose these Home Health Pavilion standards to each beneficiary to whom it supplies a Medicare-covered item.

Home Health Pavilion must disclose to the government any person having ownership, financial, or control interest in the Home Health Pavilion.

Home Health Pavilion must not convey or reassign the Home Health Pavilion number; i.e., the Home Health Pavilion may not sell or allow another entity to use its Medicare billing number.

Home Health Pavilion 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.

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.

Home Health Pavilion must agree to furnish CMS (formerly HCFA) any information required by the Medicare statute and implementing regulations.

National Supplier Clearinghouse
P.O. Box 100142
Columbia, South Carolina 29202-3142
(866) 238-9652
A CMS Contracted Intermediary and Carrier

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Product returns policy

Medical Supplies:

All Supply Items must be returned within seven (7) business days of delivery, along with original receipt and manufacturer packaging.

No Sterile or Opened Items can br returned. All returns are subject to HHP Inspection.

Durable Medical Equipment:

All DME should be returned within seven (7) business days, along with original receipt, manufacturer packaging and all related manuals/documents.

Enteral Nutrition Products:

We will not accept returns of Enteral Nutrition Products due to manufacturer and medical compliance requirements. Special & Custom Medical Equipment & Supply Orders:

All Special & Custom Medical Equipment & Supplies Orders are non-returnable after delivery/installation is complete. We will honor the manufacturer warranties on ant special or custom order.

All Special Orders require customer deposit, before we can process the order.

We appreciate Your trust in us, please be assured that, if Home Health Pavilion has made any error in processing Your order, we will ensure that it is corrected to Your satisfaction - or we will issue full credit for that particular Order.

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Patient rights and responsibilities

You have the right to:

Refuse delivery of any and all equipment.

Receive a clear explanation about your condition.

Prompt delivery and to be fully informed on the use, and care of all Home Health Pavilion equipment in your home.

Have Home Health Pavilion staff communicate in a language that is understandable to you.

Expect that all information will be kept in strictest confidence.

Have your personal privacy respected.

Expect all equipment to be clean and in good repair.

Have your property respected during visits.

Have any question answered promptly, correctly and courteously.

Have personal, cultural, and ethnic preferences considered.

To participate in planning how service will be provided to you and to be informed of all options if the need for transfer of care arises.

To expect a resolution to any problem or complaint.

Express dissatisfaction and suggest changes without coercion, discrimination, reprisal, or unreasonable interruption in service.

To appropriate assessment and management of pain.

You have the responsibility to:

Give accurate and complete health information concerning your past use of equipment and any change in address, doctor, insurance carrier, prescription.

Assist in developing and maintaining a safe environment.

Follow instruction in care and use of all equipment.

Request further information concerning anything you do not understand.

Treat Home Health Pavilion associates with respect, courtesy, and consideration.

To order supplies of refills on a timely basis to accommodate reasonable delivery.

To have someone at home on the day delivery is scheduled.

To be financially responsible for services rendered to you that, are not covered by their insurance.

Accept the consequences of delivery refusal or choice of noncompliance, including changes in reimbursement eligibility.

Any questions or concerns regarding your service or equipment please call 845-569-1250. It is our responsibility to review all formal complaints. You are entitled to a timely response to your complaint. Home Health Pavilion is a privately held company.