Plan of Care
Depending on which DME item was prescribed for you, you should have received specific instructions from your physician, his/her office and further information from our fitter. Below are general guidelines for the use of DME items:
Orthopedic Braces: If your doctor prescribed a back, knee or other extremity brace, the general goal of these items is to reduce mobility in the impacted area to reduce pain and allow time to heal. You should wear your brace for the amount of time indicated by your physician. Your physician, their office and our fitter will provide specific instructions for use based on your condition.
Traction Devices: If your doctor prescribed a traction device, such as a cervical or lumbar traction unit, the general goal of these items is to reduce pressure in the impacted area which will reduce pain and allow time to heal. You should wear your traction device for the amount of time indicated by your physician. Your physician, their office and our fitter will provide specific instructions for use based on your condition.
CPM Machines: Knee, shoulder and other types of Continuous Passive Motion (CPM) machines are designed to help you improve your range of motion, reduce pain and reduce swelling following an injury or surgery. You should use your CPM machine for the amount of time indicated by your physician and/or until you reach your doctor’s range of motion target. Your physician, their office and our fitter will provide specific instructions for use based on your condition.
TENS/NMES: TENS and NMES units deliver electronic stimulation to an effected area and are used to decrease pain and increase muscle use to reduce atrophy. You should use your TENS or NMES unit for the amount of time indicated by your physician. These units may have different “programs” and your fitter will show you how to select the proper program. Your physician, their office and our fitter will provide specific instructions for use based on your condition.
Lymphedema Pumps: Lymphedema Pumps generate pressure on certain areas of your body, such as your arm or leg, to reduce swelling. You should use your lymphedema pump and the associated sleeves for the amount of time indicated by your physician. Your fitter will show you how to adjust the settings on the pump and use the sleeves to meet the goals set by your physician. Your physician, their office and our fitter will provide specific instructions for use based on your condition.
Bone Growth Stimulators: Bone Growth Stimulators deliver electronic stimulation to an effected area and are used to promote the healing and growth of bone mass. They are typically used to heal a break that isn’t healing properly or to assist in bone generation after a surgery. You should use your Bone Growth Stimulator for the amount of time indicated by your physician. Your physician, their office and our fitter will provide specific instructions for use based on your condition.
Client Bill of Rights
The right to be fully informed orally and in writing of the following before care is initiated:
1. Be fully informed in advance about service/care to be provided and any modifications to the service/care plan.
2. Participate in the development and periodic revision of the plan of service/care.
3. Informed consent and refusal of service/care or treatment after the consequences of refusing service/care or treatment are fully presented
4. Be informed both orally and in writing, in advance of the charges, including payment for service/care expected from third parties and any charges for which the client/patient will be responsible.
5. Have one’s property and person treated with respect, consideration, and recognition of client/patient dignity and individuality.
6. Be able to identify visiting staff members through proper identification.
7. Voice grievances/complaints regarding treatment or care, lack of respect of property or recommend changes in policy, staff or service/care without restraint, interference, coercion, discrimination or reprisal.
8. Have grievances/complaints regarding treatment or care that is (or fails to be) furnished, or lack of respect of property investigated.
9. Choose a health care provider.
10. Confidentiality and privacy of all information contained in the client/patient record and of Protected Health Information.
11. Be advised on agency’s policies and procedures regarding the disclosure of clinical records.
12. Receive appropriate service/care without discrimination in accordance with physician orders.
13. Be informed of any financial benefits when referred to an organization.
14. Be fully informed of one’s responsibilities.
15. Be informed of provider service/care limitations.
16. Be informed of client/patient rights under state law to formulate advanced care directives
Any concerns regarding services may be addressed during normal business hours by contacting our customer service representative at 610-404-4900 or 1-800-494-8680. Within 5 days of receiving a complaint, you will be contacted by telephone, email, fax, or letter that we have received your complaint. Within 14 calendar days, we will provide a written notification of the results of your inquiry and the resolution. You may also contact ACHC @ 919-785-1214, Medicare @ 1-800-447-8477, or Pennsylvania State Medicaid @ 1-866-379-8477 with any concerns about services or fraud and abuse.
Renter = Patient or responsible party Rentor = J & J Medical, Inc. Equipment = Equipment and accessories listed
This Equipment is being provided for Renter’s use on a rental basis. After reviewing the information supplied with the Equipment, please call J & J Medical, Inc. if there are any questions or further assistance required at 610-404-4900. Any questions regarding the Patient’s treatment program must be directed to the Physician, Nurse, or Therapist.
Renter will be billed on a monthly basis. If Renter has insurance, J & J Medical, Inc. will bill the appropriate insurance entity directly. Renter will be responsible for the balance unpaid. Any questions regarding the billing process should also be addressed to J & J Medical, Inc.
Term - Equipment is rented by the day or by the month.
Discontinuation - Renter should notify Rentor immediately in writing if Physician should request discontinuation of the equipment’s use. Upon expiration of the rental period, Renter is responsible for transferring Equipment to Rentor. Renter agrees to return said Equipment to Rentor upon demand. This Agreement constitutes the entire Agreement between the Rentor and the Renter and supersedes any prior understanding or oral agreement between the parties.
Equipment - Rentor exercises great care and expense to ensure that all of its equipment is in good working order and that it is clean according to all regulatory authorities. Renter acknowledges that the Equipment and Accessories have been inspected and received in good condition and accepted as is. Renter is responsible for the Equipment noted on the face of the agreement. The Renter agrees to protect same from all loss and damage and is responsible for any missing or damaged items. Renter agrees not to release or redeliver said Equipment to any other person, firm, or corporation without the written consent of Rentor. Renter agrees to use this Equipment only in the manner for which it is intended and not to attempt to make any repairs of any nature, kind, or description and in the event said Equipment becomes inoperative, Rentor is to be notified at once.
Accessories - Accessory sale items noted for the operation of the equipment shall be purchased by the Renter.
Disclaimer - RENTOR GIVES NO WARRANTY EXPRESSED OR IMPLIED, AS TO THE MATERIAL, WORKMANSHIP, OR CAPACITY OF THE EQUIPMENT INCLUDING THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. RENTER AGREES TO SAVE AND HOLD HARMLESS THE RENTOR FOR ANY DAMAGES FROM SAME WHILE IN RENTER’S POSSESSION.
In the event Rentor is called upon to pay any expenses or attorney’s fees to enforce this Agreement, Renter agrees to pay said fees.
Medicare Supplier Standards
The products and/or services provided to you by J&J Medical, Inc., Aflex CPM Therapy LLC or any affiliate or subcontractor are subject to the supplier standards contained in the Federal regulations show at 42 Code of Federal Regulations Section 424.57 (c). Below is an abbreviated version of the supplier standards every Medicare Durable Medical Equipment, Prosthetics, Bracing & Supports, and Supplies (DMEPOS) supplier must meet in order to obtain and retain their billing privileges.
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.
HIPAA Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice is provided to you pursuant to the Health Insurance Portability and Accessibility Act of 1996 and it’s implementing regulations (HIPAA). It is designed to tell you how we may, under federal law, use or disclose your Health Information.
I. We May Use or Disclose Your Health Information for Purpose of Treatment, Payment, or Healthcare Operation without Obtaining Your Prior Authorization and Here is One Example of Each:
We may provide your Health Information to other health care professionals – including doctors, nurses, and technicians – for purposes of providing you with care.
Our billing department may access your information – and send relevant parts – to other insurance companies to allow us to be paid for the services we render to you.
We may access or send your information to our attorneys or accountants in the event we need the information in order to address one of our own business functions.
II. We May Also Use or Disclose Your Health Information Under the Following Circumstances without Obtaining Your Prior Authorization:
To Notify and/or Communicate with your Family. Unless you tell us you object, we may use or disclose your Health Information in order to notify your family or assist in notifying your family, your personal representative, or another person responsible for your care about your location, your general condition, or in the event of your death. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in any communications with your family and others.
As Required by Law.
For Public Health Purposes. We may use or disclose your Health Information to provide information to state or federal public health authorities, as required by law to prevent or control disease, injury, or disability; to report child abuse or neglect; report domestic violence; report to the Food and Drug Administration problems with products and reactions to medication; and report disease or infection exposure.
For Health Oversight Activities. We may use or disclose your Health Information to health oversight agencies during the course of audits, investigations, certification and other proceedings.
In Response to Civil Subpoenas or for Judicial and Administrative Proceedings. We may use or disclose your Health Information, as directed, in the course of any civil administrative or judicial proceeding. However, in general, we will attempt to ensure that you have been made aware of the use or disclosure of your Health Information prior to providing it to another person.
To Law Enforcement Personnel. We may use or disclose your Health Information to a law enforcement official to identify or locate a suspect, fugitive, material witness or missing person, comply with a court order or grand jury subpoena and other law enforcement purposes.
To Coroners or Funeral Directors. We may use or disclose your Health Information for purposes of communication with coroners, medical examiners, and funeral directors.
For Purposes of Organ Donation. We may use or disclose your Health Information for purposes of communicating to organizations involved in procuring, banking, or transplanting organs and tissues.
For Public Safety. We may use or disclose your Health Information in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
To Aid Specialized Government Functions. If necessary, we may use or disclose your Health Information for military or national security purposes.
For Workers Compensation. We may use or disclose your Health Information to comply with workers compensation laws.
To Correctional Institutions or Law Enforcement Officials, if You are an Inmate.
III. For All Other Circumstances, We May Only Use or Disclose Your Health Information After You Have Signed an Authorization. If you authorize us to use or disclose your Health Information for another purpose, you may revoke your authorization in writing at any time.
IV. You Should Be Advised that We May Also Use or Disclose Your Health Information for the Following Purposes:
Appointment Reminders. We may use your Health Information in order to contact you to provide appointment reminders or to give information about other treatments or health-related benefits and services that may be of interest to you.
Change of Ownership. In the event that our Practice is sold or merged with another organization, your Health Information/record will become the property of the new owner.
V. Your Rights.
1. You have the right to request restrictions on the uses and disclosures of your Health Information. However, we are not required to comply with your request.
2. You have the right to receive your Health Information through confidential means through a reasonable alternative means or at an alternative location.
3. You have the right to inspect and copy your Health Information. We may cost you a reasonable cost-based fee to cover copying, postage and/or preparation of a summary.
4. You have the right to request that we amend your Health Information that is incorrect or incomplete. We are not required to change your Health Information and will provide you with information about our denial and how you can disagree with the denial.
5. You have the right to receive an accounting of disclosures of your Health Information made by us, except that we do not have to account for disclosures: authorized by you; made for treatment, payment, health care operations; provided to you; provided in response to an Authorization; made in order to notify and communicate with family; and/or for certain government functions, to name a few.
6. You have the right to paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact J & J Medical.
VI. Our Duties.
We are required by law to maintain the privacy of your Health Information [and to provide you with a copy of this Notice].
We are also required to abide by the terms of this Notice.
We reserve the right to amend this Notice at any time in the future and to make the new Notice provisions applicable to all your Health Information – even if it was created prior to the change in the Notice. If such amendment is made, we will immediately display the revised Notice at our office. We will provide you with another copy, of this Notice at any time, upon request.
VII. Complaints to the Government.
You may make complaints to the Secretary of the Department of Health and Human Services (“DHHS”) if you believe your rights have been violated.
We promise not to retaliate against you for any complaint you make to the government about our privacy practices.
VIII. Contact Information.
You may contact us about our privacy practices by calling the Privacy Officer at: 610-404-4900. You may contact the DHHS at: 1-877-696-6775.
Note: Your regional carrier is DMERC, Region A. The Medicare hotline number is 1-800-213-5452.
Prepare for an Emergency or Disaster
Be Responsible and Be Prepared! By being prepared and staying informed, you can prevent or reduce harm to yourself, your family members and loved ones, or persons for whom you advocate.
Know If Your Area is in a Disaster or Emergency Area
If you live in an area that's been declared an emergency or disaster, the usual rules for your medical care may change for a short time. Affected areas are ones where either:
The President has declared it an emergency or disaster. Visit the Federal Emergency Management Agency (FEMA) website, or call 1-800-621-FEMA (1-800-621-3362) to see if your area is affected. TTY users should call 1-800-462-7585.
A governor has declared it an emergency or disaster. Visit your state government's official website to find out if your area is affected.
The Secretary of the Department of Health and Human Services (HHS) has declared a public health emergency. Visit the HHS Public Health Emergency website, or call 1-800-MEDICARE to find out if your area is affected.
Replacing Lost or Damaged Durable Medical Equipment or Supplies in a Disaster or Emergency
If Original Medicare already paid for durable medical equipment (DME) (like a wheelchair or walker) or supplies (like diabetic supplies) damaged or lost due to an emergency or disaster:
In certain cases, Medicare will cover the cost to repair or replace your equipment or supplies
Generally, Medicare will also cover the cost of rentals for items (such as wheelchairs) during the time your equipment is being repaired.
Medicare Advantage Plan or other Medicare Health Plan
Contact your plan directly to find out how it replaces DME or supplies damaged or lost in an emergency or disaster. You can get your plan’s contact information by calling 1-800-MEDICARE.
Contacting Your Equipment Supplier
DMEPOS Supplier Directories may be found on the internet.
This tool lists suppliers of the following medical equipment and supplies:
· Durable Medical Equipment
· Prostheses & Prosthetic Devices
Receiving Care During an Emergency or Disaster
If you have Original Medicare and want more information about getting care from doctors or other providers during an emergency or disaster, call 1-800-MEDICARE.
Medicare Advantage Plan or other Medicare health plan
If you are in a Medicare Advantage Plan or other Medicare health plan, contact your plan to get more information about getting care from doctors or other providers during an emergency or disaster. You can get your plan’s contact information by calling 1-800-MEDICARE.
Medicare Prescription Drug Plan
If you have a Medicare Prescription Drug Plan and want more information on getting prescription drugs during an emergency or disaster, contact your plan, or call 1-800-MEDICARE.