Terms of service.
NOTICE OF PRIVACY PRACTICES
COMMITMENT TO PRIVACY
Caremore Medical is dedicated to maintaining the privacy of your healthcare information, and we adhere to laws that maintain the confidentiality of information that identifies you. Any use of healthcare information beyond the uses described below requires your individual written authorization. The Health Insurance Portability and Accountability Act (HIPAA) ensures that Caremore Medical provides you with a copy of our Notice of Privacy Practices, outlining the way we safeguard your health information. Caremore Medical abides by the terms of the Notice of Privacy Practices currently in effect, and reserves the right to revise or amend the Notice, as needed.
INSTANCES OF DISCLOSURE FOR SERVICE, PAYMENT, AND HEALTHCARE OPERATIONS
We will use your health information for service. Information obtained by our company will be documented in your record, and will be used to provide you with medical supplies. The order from your physician will be part of the record, and will determine the medical supplies you receive. We will use your health information for payment. In order to determine your eligibility for medical supplies, we may contact your insurance company and disclose healthcarerelated information. Also, we will bill you or a third-party payer for products you receive from our company. The health information that identifies you, your diagnosis, and medical supplies may be included on this bill. We will use your health information for healthcare operations. We may use your health information to evaluate the quality of service you receive from us, to conduct cost management assessments, and to plan business activities. This information is used in an effort to continually improve the quality and effectiveness of the products and services we provide.
YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of the healthcare provider that compiled it, the information belongs to you. You have the right to:
• Request a restriction on certain uses and disclosures of your information
• Obtain a paper copy of the Notice of Privacy Practices
• Obtain an accounting of your health information
• Inspect and copy your healthcare record
• Request confidential communication
• Amend your healthcare record
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken
OUR RESPONSIBILITIES
Caremore Medical is required to:
• Maintain the privacy of your health information
• Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• Abide by the terms of the Notice
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests you may have to communicate health information by alternative means Caremore Medical reserves the right to change our practices, and to make any new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised Notice to your address on file. We will not use or disclose your health information without your authorization, except for services, payment, and healthcare operations.
OTHER USES OR DISCLOSURES
BUSINESS ASSOCIATES
There are some individuals who are under contract with Caremore Medical and, from time to time, are engaged in the improvement or financial enhancement of our business. We require any business associate to appropriately safeguard your information so that your health information is protected.
PUBLIC HEALTH
As required by law, 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 as required by law, or in response to a valid subpoena.
HEALTH OVERSIGHT AGENCIES
We may disclose health information to health oversight agencies for activities authorized by law, including surveys, audits, and compliance inspections.
FOR MORE INFORMATION
Please contact Caremore Medical’s HIPAA Compliance Officer at 1-917-809-9090 if you require additional information, and/or want to pursue your rights, including:
• Requesting restrictions
• Inspecting and copying your record
• Securing an account of disclosure
• Requesting additional disclosures
• Revoking authorizations at any time
• Filing a complaint
OTHER USES OR DISCLOSURES
If you believe your privacy rights have been violated, you may contact our HIPAA Compliance Officer. You may also file a complaint with the Secretary of Health and Human Services (Office of Civil Rights). Include your name, address, and phone number. There will be no retaliation for filing a complaint.
RETURN POLICY
If for any reason you would like to exchange or return products from Caremore Medical, you may return it to Caremore Medical within thirty (30) days of the purchase date according to the policy below.
• All returns and exchanges must have a Return Authorization (RA) number. Obtain an RA number by calling customer service at 1-917-809-9090.
• If you ordered an item from Caremore Medical and we shipped the wrong item, or the item is defective, we will gladly exchange the order for the proper items provided the exchange is requested within thirty (30) days of the date of service.
• All products and packaging must be returned in the condition in which they were received in order for Caremore Medical to process refunds. Any product(s) showing signs of wear will not be accepted for exchange or return.
• Refunds for product returns will be credited to the insurance company. If Medicare or your insurance company paid for the order, we will send them a refund. Caremore Medical will only credit a customer’s account if the order was paid for directly by the customer.
CUSTOMER RIGHTS
1. To be fully informed in advance about care/service to be provided as well as any modification to the plan of care
2. To be informed both verbally or in writing, in advance of care being provided, of the charges, including payment for care/service expected from third parties and any charges for which the client will be responsible
3. To receive information about the scope of services that the organization will provide and specific limitations on those services
4. To participate in the development and periodic revision of the plan of care
5. To refuse care or treatment after the consequences of refusing care or treatment are fully presented
6. To have one’s property and person treated with respect, consideration, and recognition of client dignity and individuality
7. To be able to identify visiting personnel members through proper identification
8. To be free from mistreatment, neglect, or mental, physical, sexual, and verbal abuse, including injuries of unknown source, and misappropriation of client/patient property
9. To voice grievances/complaints regarding treatment or care that is furnished or recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal
10. To have grievances/complaints regarding treatment or care that is furnished investigated
11. To be assured that the privacy, confidentiality, and security of information in the client record and all Protected Health Information is secured
12. To be advised on agency’s policies and procedures regarding the disclosure of clinical records
13. To choose a healthcare provider, including choosing an attending physician, if applicable
14. To receive appropriate care/supplies without discrimination in accordance with physician orders
15. To be informed of any financial benefits when referred to an organization
16. To be fully informed of ones responsibilities (see below)
CUSTOMER RESPONSIBILITIES
1. To dial 911 whenever a life threatening medical emergency arises
2. To comply with your physician’s orders and treatment plan
3. To report any changes in status, including address, medical condition, physician, billing information, or insurance coverage to Caremore Medical promptly
4. To fulfill all financial obligations to Caremore Medical as promptly as possible
5. To provide, to the best of your knowledge, accurate and complete information about matters relating to your care that may impact products provided by Caremore Medical
6. To report any unexpected changes in your condition that may impact the services provided by Caremore Medical
7. To show consideration and respect for the rights of Caremore Medical personnel when communicating with Caremore Medical staff
8. To use and care for medical supplies as instructed, and to not allow use by anyone else
COMPLAINT PROCEDURE
1. If you have any concerns about the products or services provided to you by Caremore Medical, you may express these concerns by e-mail, telephone, or in writing. Direct your call or letter to our Customer Service Manager or to our Compliance Officer:
• E-mail: info@caremoremedical.com
• Address: 7 Bay 35th Street, Brooklyn, NY 11214
• Telephone: 1-917-809-9090
2. If we are not able to respond to you verbally at the time reported, you will receive a response by telephone within five (5) business days. A written complaint will be responded to within five (5) business days.
3. In addition to the complaint procedures listed above, if you do not receive satisfactory resolution from us, you can contact our accrediting organization, The B.O.C, at 877.776.2200, or if you are a Medicare beneficiary, you can contact Medicare at 1-800-633-4227. Our mission is to provide superior customer service to you.
4. Medicaid fraud means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself/herself. It includes any act that constitutes fraud under applicable federal or state law as it relates to Medicaid. The Office of the Inspector General at the Agency for Health Care Administration accepts complaints regarding suspected fraud and abuse in the New York Medicaid system. To report suspected Medicaid fraud, please call toll-free at 1-866-966-7226
5. To report abuse, neglect, or exploitation of a disabled adult or an elderly person, please call
toll-free 1-800-962-2873.
Medicare Supplier Standards
Note: This is an abbreviated version of the supplier standards that every Medicare DMEPOS supplier must meet in order to obtain and retain its billing privileges. These standards, in their entirety, are listed in 42 C.F.R. 424.57(c). For additional information go to www.cms.gov.
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 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 healthcare 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 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 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, replace at no charge, or repair, directly or through a service contract withanother 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, rented, or sold) from beneficiaries.
16. A supplier must disclose these standards to each beneficiary to whom 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 with 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.
1) Terms and conditions: Caremore Consulting, Inc. is the provider of the medical supplies. I have been instructed in its proper fitting and usage. Warranty information: Caremore Consulting, Inc., will honor all warranties extended by the manufacturer of the product.
I agree to pay all amounts that are not covered by my insurer(s) including applicable co-payments and/or deductibles for which I am responsible. I request that payment of Medicare, Medicaid, Medicare Supplemental, or other insurance benefits be made on my behalf to Caremore Consulting, Inc. for any medical supplies furnished to me by Caremore Consulting, Inc. I authorize any holder of medical information about me to release to Medequip, Inc., my physician(s), caregiver, CMS, its agents, and to my primary and/or other medical insurers any information needed to determine or secure eligibility information and/or reimbursement for covered services. I agree to pay all amounts that are not covered by my insurer(s) and for which I am responsible.
2) Consent to Privacy Practices of Caremore Consulting, Inc. Effective Date: January 01, 2009
You have been provided with a copy of Caremore Consulting, Inc.’s “Notice of Privacy Practices” that describes how we will use health information concerning our service to you. The notice details how we will use this information to provide treatment care for you, to gain reimbursement for our services and to improve our operations to better serve you and other patients.
We are required to document that:
• We have given you our Notice of Privacy Practices and that you have had the opportunity to review it;
• Caremore Consulting, Inc. will notify you of changes in our Notice of Privacy Practices prior to implementing those changes;
• You may request restrictions as to how your health information may be used although Caremore Consulting, Inc. is not required to agree to those restrictions;
• Any restrictions to which Caremore Consulting, Inc. agrees to will be respected.
• You may revoke this consent in writing at any time, although Medequip, Inc. can proceed with uses and disclosures that pertain to treatment, payment, or
healthcare issues that take place before the consent was revoked.
3) This Assignment of Benefits permits Caremore Consulting Inc. to do the following on your behalf.
• Assignment of Medicare, Medicaid, Medicare Supplemental, or other insurance benefits to Caremore Consulting, Inc. for medical supplies furnished to me by Caremore Consulting, Inc.
• Direct billing to Medicare, Medicaid, Medicare Supplemental, or other insurers (s).
• Release of my medical information to Medicare, Medicaid, Medicare Supplemental, or other insurers and their agents.
• Caremore Consulting, Inc. to obtain medical or other information necessary in order to process my claim(s), including determining eligibility and seeking reimbursement for medical supplies provided.
• Caremore Consulting, Inc. to contact me by telephone or mail regarding my medical supplies order.
By signing below I acknowledge that I understand and consent for use of health information, AOB, and the Terms & Conditions of Caremore Consulting, Inc. My signature on this form indicates my authorization to use the phrase "signature on file" on any claim forms in order to process for services rendered. Notice of Privacy Practices. Also, I received and was informed of the Medicare Supplier Standards, Cleaning/Maintenance Info., Infection Control Tips, Complaint Process, Scope of Services, Follow-up Instructions, written Product Instructions, Warranty Info, and Patient Rights & Responsibilities.