1. Patient/Client Bill of Rights
As an individual recieving home care services from Medical Supply Inc, dba MSI, let it be
known and understood that you have the following rights;
1. To select those who provide your home care services.
2. To be provided with legitimate identification by any person or persons entering your
residence to
provide home care for you.
3. To be provided with adequate information from which you can give your informated
authorization for
the commencement of service,
the continuation of service, the transfer of service to another health care provider, or the termination
of service.
4. To be fully informed in advance of any changes in the care or treatment to be provided by
our organization when those changes may affect your well being.
5. To be fully informated in advance about services and/or care to be provided, including
the dsiciplines that furnish care and the frequency of visits as
any modification of your service or care again.
6. To participate in the development and periodic revision of the plan of service or care.
7. To accept or refuce care, within the boundaries set by law , and recieve professional
information relative to the ramifications or consequences that will or may result
due to such refusal.
8. To be advised, before care is initiated, of the extent to which payment for services may
be expcected from Medicare/Medicaid, insurance, or you liability for payment,
billing cycles and changes in payment.
9. To have your privacy and your propery respected at all times and to be treated with
respect, considration, and recognition of dignity and individuality.
10. To express concerns or grievances or recommend modifications to your home care service
without fear of restraint, interference, coercion,
descrimination, or reprisal.
11. To expect that any and all concerns, grievances or complaints will be properly
investigated.
12. To expect that all informatio nrecieved by this organization shall be kept confidetial
and shall not be released
without written authorization.
13. To review Medical Supply Inc. dba MSI Privacy Notice.
14. To confidentiality and privacy of all patient/client medical information or Protected
Health Information.
15. To be advised on agency's privacy policies and procedures regarding the disclosure of
clinical records.
16. To recieve the appropriate or prescrived service in a professional manner without
discrimination.
17. TO be informated of any financial benefits when referred to another organization.
18. TO be fully informed of your rights and responsibilities in a language you understand.
19. To be promptly informed if the prescribed care of services are not within the scope,
mission or philosophy of the organization, and therefoire be provided
with transfer assistance to an appropriate care of service organization.
20. To formulate and have honored by all health care personnel an advance directive such as
a Living Will or a Durable
Power of Attorney for Health Care, or a Do Not Resucitate order. (Required for clinical/professional
services.)
21. To be informed of anticipated outcomes of services or care and of any barriers in
outcome achievement.(Required for clinical/professional services.)
2. Responsibilities of the Client/Patient
You and Medical Supply Inc. dba MSI are partners in your health care plan. To ensure the
finest care possible, you must
understood your role in your health care program. As a patient of Medical Supply Inc, dba MSI, your are
responsible for the following;
1. To provide complete and accurate information concerning your present health, medication,
allergies, etc.., when appropriate your care/service.
2. To inform a staff member, as appropriate, of your health history, including past
hospitalizations, illnesses, onjuries, etc.
3. To involve yourself, as needed and as able, in developing, carrying out, and modifying
your home care service plan, such as properly cleaning
and storing your equipment and supplies.
4. To review Medical Supply Inc, dba MSI safety materials and actively participate in
maintaining a safe environment in your home.
5. To request additional assistance or information on any phase of your health care plan you
do not fully understand.
6. To notify your attending physician when you feel ill, or encounter any unusual physical
or mental stress or sensations.
7. To notify Medical Supply Inc, dba MSI when you will not be home at the time of a
scheduled home care visit.
8. To notify Medical Supply Inc. dba MSI prior to changin your place of residence or your
telephone number.
9. To notify Medical Supply Inc. dba MSI when encoutering any problems with equipment or
service.
10. To notify Medical SUpply Inc. dba MSI if you are to be hospitalized or if your physician
modifies or ceases your home care prescription.
11. To make a concious effort to properly care for equipment supplied and to comply with all
other aspects of the home health care plan developed for you.
12. To notify Medical Supply Inc, dba MSI of denial and/or restriction of the Medical Supply
Inc. dba MSI privacy policy.
Medicare DMEPOS Supplier Standard
Note: This is an abbreviated version of the supplier standards every Medicare DMEPOS
supplier must meet in order to obtain and retain their billing
privilages. 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
(0).
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)(3) of the Act) or physical and occupational therapists or a
DMEPOS supplier working with custom made orthotics and prosthetics.
Note: If you do not know which Regional Carrier to call, please ask Medical Supply Inc. dba
MSI.
You may also contact the following agencies regarding any unresolved compliant or concern:
A. National Heritage Insurance Company 1-800-633-4227
B. State Attorney General Office
I. Pennsylvania Attorney General
1. By Mail: Pennsylvania Office of Attorney General 16th FloorStrawberry Square
Harrisburg,
PA 17120
List of all Regional Offices
2. By Phone:
717-787-3391
3. By Fax:
717-787-8242
4. Press Office:
717-787-5211
5. Hotlines:
Child Predator Unit 800-385-1044
Elder Abuse Unit
866-623-2137
Consumer Protection 800-441-2555
Health Care Section
877-888-4877
C. Office of Inspector General (OIG) 1-800-447-8477
D. Accreditation Commission for Health Care, Inc. 4700 Falls of Neuse Rd., Suite 280,
Raleigh, NC 27609 Ph:919-785-1214
www.achc.org
Medical Supply, Inc.
P.O. Box 88
Essington, PA 19029
Notice of Privacy Practices for Protected Health Information
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
I. Medical Supply, Inc. Uses and Discloses Your Health Information:
MSI may use your protected health information and disclose it to other health and
human
service professionals, to:
a. Communicate with health care professionals who care for you.
b. Describe the products you recieve.
c. Obtain reimbursement from private insurers or other goverment programs.
d. Verify that services billed were actually provided.
e. Educate health professionals
f. Inform public health officials charged with improving healthcare
g. Administer programs which provide public benefits, and/or health, or human
services.
h. Asses and improve the services provided and the outcomes achieved.
i. Pay for services you recieve.
j. Inform you about other public programs and services.
MSI will not use or disclose your protected health information except as described in
this
notice, or otherwise authorized by law.
II. Your Health Information Rights:
You have the right to:
a. Request a restriction on certain uses and disclosures of your protected health
information.
b. Obtain a paper copy of this Notice of Information Practices upon request.
c. Inspect and copy your protected health information.
d. Request amendments to your protected health information.
e. Obtain an accounting of disclosures of your protected health information.
f. Request communications of your protected health information by alternative means or
at an alternative address.
g. Revoke your consent to use or disclose protected health information to the extent
that it has not already been relied upon.
h. File a complaint to MSI and/or the Secretary of the U.S. Department of Health and
Human Service if you belive your privacy rights have been violated.
III. Medical Supply, Inc. Duties:
MSIO has a duty to:
a. Maintain the privacy of your protected health information.
b. Provide you with a notice as to our legal duties and privacy practices with respect
to protected health information we collect and maintain about you.
c. Abide by the terms of this notice.
d. Notify you if we are unable to agree to a requested restriction.
e. Accommodate reasonable requests you may have to communicate health information by
alternative means or at an alternative address
f. Provide an accounting of disclosures of your protected health information.
Medical Supply, Inc. may change its privacy practices and make the new privacy
practices
effective for all protected health information we maintain. Should our privacy practices change, we will
mail a revised notice to the address you have supplied us.
IV. For More Information or to Report a Problem:
If you have questions and would like additional information, you may contact:
Mark Saltis
P.O. Box 88
Essington, PA 19029
For anonymous HIPAA and compliance complaints call:
Voice Mailbox: 610-5210-7402 x 20
If you belive your privacy rights have been violated, you can file a complaint with:
Privacy Complaints
P.O. Box 8050
U.S. Department of Health and Human Services
Centers for Medicare and Medicaid Services
7500 Security Boulivard
Baltimore, MD 21244-1850
V. Examples of Disclosures ofr Treatment, Payment and Health Operations:
We will use your health information for treatment.
For Example: Information obtained by a care manager or physician to help provide you with
the best produt for you.
We will use your health information for payment.
For Example: A bill may be sent to you or any private or public source of health coverage
you have identified. The information on or
accompanying the bill may include information that identifies you, as well as your diagnosis, procdures
and supplies used.
VI. Others who may recieve your health information
Business Associates: there are some services provided in our organization
through contracts with business associates. When these services are contracted, we may disclose your
health information to our business associate so that they can perform the job we've asked them to do.
However, we require the business associate to appropriately safeguard your information.
Public health: We may disclose your health information to public health or legal
authorities charged with preventing or controlling disease, injury, or disability.
Law enforcement: We may disclose health information for law enforcement purposes.
Law enforcement: We may disclose health information for law enforcement
purposes.
