What do you need to know about insurance and what is covered under your insurance regarding the purchase of home medical equipment? 

Insurance Providers (This is only a sample list of providers)

• Aetna
• America’s PPO
• Blue Cross Blue Shield
• Blue Plus
• Cigna
• Champus
• HealthPartners
• Hospice Contracts
• Humana
• Medica
• Medical Assistance
• Medicare

INSURANCE RESPONSIBILITY

Medicare, Medical Assistance, HMOs and other commercial insurance claims are filed for you by our office. Your portion after insurance coverage is due upon receipt of invoice. For detailed billing, payment and/or insurance information, please ask your customer service representative.

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.

Product Resources (Owner’s manuals linked offsite)

Customer Responsibility

OPTIONS:

Pay in full by check, money order or cash

Pay by major credit or check card, except American Express

Private Pay portions will be submitted to you on an invoice or statement, which will be mailed to you. This payment is due upon receipt. If your insurance denies payment, you are responsible for all outstanding charges. If your physician does not complete and forward to Ridgeview Home Medical Equipment all necessary documentation supporting medical necessity as defined by your insurance, you will be responsible for all outstanding charges.

Insurance Responsibility

Insurance claims are filed at no charge. Your portion is due upon receipt of invoice. If your insurance carrier does not remit payment within 60 days of our billing date, the balance will be due from you. If we do not have a contract with your insurance, we will bill them as a courtesy to you; however, our office does not accept responsibility for collecting on these claims.

As a service to our MEDICARE customers, our office accepts ASSIGNMENT of most Medicare claims. If Medicare denies your claim, we will bill you, and you can choose one of the above credit options. In some instances, claims will be billed NON-ASSIGNED. Non-assigned means we will bill the retail amount directly to you, which is due upon receipt. Our office will process the claim with Medicare on your behalf, and Medicare will reimburse you directly (the allowable amount).

If you are covered by MEDICAL ASSISTANCE, we will bill Medical Assistance for all eligible dates of service.

Please notify our office immediately of any changes to your medical insurance. If we are not notified of a change to your medical insurance, we will bill the retail amount directly to you.

A returnable item must be refunded or exchanged within 14 days of purchase with receipt, no receipt - no return approved. Non Returnable items include:

• Personal care items
• Bathroom equipment
• Compression stockings
• Damaged or used items
• Items that have been billed to insurance
• Food products
• Opened supplies are not returnable
• Special orders will require payment up front and will be subject to a 25 percent restocking fee if returned.
• For defective/non-working items, please reference manufacturer warranty.

If a refund is requested, the refund will be issued by Ridgeview Medical Center. No cash refunds will be given. Returns are accepted during routine business hours. Ridgeview Home Medical Equipment is a department of Ridgeview.

Equipment rental agreements are between Ridgeview Home Medical Equipment and the customer. If your insurance covers the rental item, we will bill your insurance company on your behalf; however, the rental agreement remains with you, not the insurance carrier. It is your responsibility to understand your insurance coverage and its effects on the rental agreement, especially when you consider changing insurance plans. Before you change insurance, we advise you to call your new insurance carrier and inquire about coverage for the equipment you are renting. In some instances, the rental period and number of rental payments applied towards purchase (if available) may change or start over when changing insurance plans.

Customer Responsibilities

You will be instructed on safe and proper use of your equipment by a Ridgeview Home Medical Equipment staff member. If you have any questions about the use of your equipment, be sure to ask the staff member or call customer service at any time. Your responsibility for using the equipment is to:

• Follow the instructions given for using your equipment in a safe manner. For example, never smoke near oxygen equipment because it is a fire hazard.
• Store equipment safely as directed by the Technician. For example, oxygen equipment must have adequate clearance from other items to prevent fire hazards.
• Keep your equipment and accessories clean. Follow the cleaning instructions and schedule given by the Technician.
• Call us if you need help with moving equipment to a different location. Moving heavy or dangerous items on your own could cause harm to you and damage the equipment.
• Tell us about any new instructions or prescription changes you have received from your doctor about the use of your equipment. Tell the technician or call customer service.
• Rental equipment should be returned in good working order and in the same condition as when delivered, with some ordinary wear expected. In the event that the equipment is damaged or not in good working order, the cost of the repairs will be your responsibility.
• If equipment is lost or damaged beyond repair, you will be charged for replacement at the current retail rate.
• Equipment should remain at delivery address. Please notify the supplier immediately of an address change or if equipment is moved to another address.

Staff Responsibilities

A home health care provider may not require a person to surrender these rights as a condition of receiving services. A guardian or conservator or, when there is no guardian or conservator, a designated person may seek to enforce these rights. A provider must protect and promote these rights. As your home care provider, we strive to provide quality services.

If you need assistance, have questions, or a complaint, please contact us at:

Ridgeview Home Medical Equipment
501 S. Maple Street
Waconia, Minnesota 55387
952-442-2283 or 1-800-666-6497

STATEMENT OF RESPONSIBILITIES: The staff at Ridgeview Home Medical Equipment strive to provide the best care possible to the patient their families. To assist us in that care, we have identified several areas of responsibility for the patient and their families to enable the staff to effectively manage each patient’s plan of care. Together, we can accomplish he goals for effective home health care services. All patient’s of in-home health care services, or their families, possess responsibilities. These include the responsibility to:

1. Remain under a doctor’s care while receiving services, report any unexpected changes in health status to doctor, and keep agency informed of physician visits and/or changes in prescribed care.
2. Provide the agency with all requested insurance and financial information and notification of additions or changes in insurance coverage. Sign the required consents and releases for insurance billing or have a designated authorized representative sign for the patient.
3. The patient and/or family is responsible for participating in the development of the plan of care and subsequent changes, including participation in your care by asking questions and expressing concerns.
4. The patient and/or family is responsible for assisting in the provision of a safe environment in which care can be given in so much as he/she is able. This includes a safe environment for the patient’s care as well as Ridgeview Home Medical Equipment staff during this provision of care.
5. The patient and/or family has the responsibility to notify the agency when scheduled visits cannot be kept.
6. The patient and/or family has the responsibility to properly care for an follow instructions in regard to equipment. Notify the agency if there are questions or problems with the equipment.
7. The patient and/or family has the responsibility for supplying accurate and complete information regarding past illness, hospitalizations, medications, documentation of Health Care Directive, and other matters relating to his/her health in so much as is possible.
8. Follow instructions given by the health care team, according to the plan of care. The patient and/or family is responsible for his/her actions if the plan of care is not observed, including responsibility for any refusal of treatment.
9. The patient and/or family is responsible to express concerns about the course of treatment or ability to comply if not understood or cannot be followed.
10. Abide by agency policies that restrict duties our staff may perform.
11. Advise agency administration of any dissatisfaction or problems with your care.