HR HEALTHCARE PATIENT SERVICES
PATIENT BILL OF RIGHTS AND RESPONSIBILITIES

We believe that all patients receiving services from HR HealthCare should be informed of their rights. Therefore, you are entitled to:

  1. Be fully informed in advance about care/service to be provided, including the disciplines that furnish care and the frequency of visits, as well as any 
    modifications to the plan of care. 
  2. Be informed, both orally and 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/patient will be responsible.
  3. Receive information about the scope of services the organization will provide and specific limitations on those services. 
  4. Participate in the development and periodic revision of the plan of care. 
  5. Refuse care or treatment after the consequences of refusing care or treatment are fully presented. 
  6. Be informed of client/patient rights under state law to formulate an Advanced Directive, if applicable. 
  7. Have one’s property and person treated with respect, consideration, and recognition of client/patient dignity and individuality. 
  8. Be able to identify visiting personnel members through proper identification. 
  9. Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of client/patient property. 
  10. Voice grievances/complaints regarding treatment or care, lack of respect of property or recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal. 
  11. Have grievances/complaints regarding treatment or care that is (or fails to be) furnished, or lack of respect of property investigated. 
  12. Confidentiality and privacy of all information contained in the client/patient record and of Protected Health Information. 
  13. Be advised on the agency’s policies and procedures regarding the disclosure of clinical records. 
  14. Choose a health care provider, including choosing an attending physician, if applicable. 
  15. Receive appropriate patient-centered care in accordance with physician or allowed practitioner orders, if applicable. 
  16. Be informed of any financial benefits when referred to an organization. 
  17. Be fully informed of one’s responsibilities.

PATIENT RESPONSIBILITIES 

  1. Patient agrees that rental equipment will be used with reasonable care, not altered or modified, and returned in good condition (normal wear and tear excepted). 
  2. Patient agrees to promptly report to HR HealthCare any malfunctions or defects in rental equipment so that repair/replacement can be arranged. 
  3. Patient agrees to provide HR HealthCare access to all rental equipment for repair/replacement, maintenance, and/or pick-up of the equipment. 
  4. Patient agrees to use the equipment for the purposes so indicated and in compliance with the physician’s prescription. 
  5. Patient agrees to keep the equipment in their possession and at the address, to which it was delivered unless otherwise authorized by HR HealthCare. 
  6. Patient agrees to notify HR HealthCare of any hospitalization, change in customer insurance, address, telephone number, physician, or when the medical need for the rental equipment no longer exists. 
  7. Patient agrees to request payment of authorized Medicare, Medicaid, or other private insurance benefits paid directly to HR HealthCare for any services furnished by HR HealthCare. 
  8. Patient agrees to accept all financial responsibility for home medical equipment furnished by HR HealthCare. 
  9. Patient agrees to pay for the replacement cost of any equipment damaged, destroyed, or lost due to misuse, abuse or neglect. 
  10. Patient agrees not to modify the rental equipment without the prior consent of HR HealthCare. 
  11. Patient agrees that any authorized modification shall belong to the titleholder of the equipment unless equipment is purchased and paid for in full. 
  12. Patient agrees that title to the rental equipment and all parts shall remain with HR HealthCare at all times unless equipment is purchased and paid for in full. 
  13. Patient agrees that HR HealthCare shall not insure or be responsible to the patient for any personal injury or property damage related to any equipment; including that caused by use or improper functioning of the equipment; the act or omission of any other third party, or by any criminal act or activity, war, riot, insurrection, fire or act of God. 
  14. Patient understands that HR HealthCare retains the right to refuse delivery of service to any patient at any time. 
  15. Patient agrees that any legal fees resulting from a disagreement between the parties shall be borne by the unsuccessful party in any legal action taken.

When the patient is unable to make medical or other decisions, the family should be consulted for direction. All staff members will understand and be able to discuss the Patient Bill of Rights and Responsibilities with the patient and caregiver(s). Each staff member will receive training during orientation and attend an annual in-service education class on the Patient Bill of Rights and Responsibilities. The patient and caregiver(s) will also receive a copy of the DMEPOS Supplier Standards, which is included in the Patient Handouts forms.

SUPPLIER STANDARDS
HR HealthCare adheres to the following standards as required by the Centers for Medicare and Medicaid Service:

  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. 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. 
  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 mobile communications devices 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 calling beneficiaries in order to solicit new business. 
  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, 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 of DMEPOS and other items and services 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 
  23. All DMEPOS suppliers must notify their accreditation organization when a new DMEPOS location is opened. The accreditation organization may accredit the new supplier location for 3 months after it is operational without requiring a new site visit. 
  24. All DMEPOS supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare. An accredited supplier may be denied enrollment or their enrollment may be revoked, if CMS determines that they are not in compliance with the DMEPOS quality standards. 
  25. All DMEPOS suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation. If a new product line is added after enrollment, the DMEPOS supplier will be responsible for notifying the accrediting body of the new product so that the DMEPOS supplier can be re-surveyed and accredited for these new products. 
  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.

HOW TO MAKE YOUR HOME SAFE FOR MEDICAL CARE

At HR HealthCare, we want to make sure that your home medical treatment is done conveniently and safely. Many of our patients are limited in strength, or unsteady on their feet. Some are wheelchair- or bed-bound. These pages are written to give our patients some easy and helpful tips on how to make the home safe for home care.

Fire Safety and Prevention

  • Smoke detectors should be installed in your home. Make sure you check the batteries at least once a year.
  •  If appropriate, you may consider carbon monoxide detectors as well. Ask your local fire department if you should have one in your home.
  • Have a fire extinguisher in your home, and have it tested regularly to make sure it is still charged and in working order.
  • Have a plan for escape in the event of a fire. Discuss this plan with your family.
  • If you use oxygen in your home, make sure you understand the hazards of smoking near oxygen. Review the precautions. If you aren’t sure, ask your oxygen provider what they are.
  • If you are using electrical medical equipment, make sure to review the instruction sheets for that equipment. Read the section on electrical safety.

Electrical Safety

  • Make sure that all medical equipment is plugged into a properly grounded electrical outlet. 
  • If you have to use a three-prong adapter, make sure it is properly installed by attaching the ground wire to the plug outlet screw. 
  • Use only good quality outlet “extenders” or “power strips” with internal circuit breakers. Don’t use cheap extension cords.

Safety in the Bathroom
Because of the smooth surfaces, the bathroom can be a very dangerous place, especially for persons who are unsteady.

  • Use non-slip rugs on the floor to prevent slipping. 
  • Install a grab-bar on the shower wall, and non-slip footing strips inside the tub or shower. 
  • Ask your medical equipment provider about a shower bench you can sit on in the shower. 
  • If you have difficulty sitting and getting up, ask about a raised toilet seat with arm supports to make it easier to get on and off the commode. 
  • If you have problems sensing hot and cold, you should consider lowering the temperature setting of your water heater so you don’t accidentally scald yourself without realizing it.

Safety in the Bathroom
If you are now using assistant devices for ambulating (walking), here are some key points:

  • Install permanent or temporary guardrails on stairs to give you additional support if you are using a cane or are unsteady. 
  • If you are using a walker, make sure that furniture and walkways are arranged to give you enough room. 
  • If you are using a walker or wheelchair, you may need a ramp for getting into or out of the house. Ramps can be purchased ready-made, or may be constructed for you. Talk to your home medical equipment provider about available options.

What To Do If You Get Hurt: In case of emergency, contact Fire, Police, Ambulance: 911

Hospital: _________________________________________________________________________________ Phone: ____________________________________
Home Care Agency: _______________________________________________________________________ Phone: ____________________________________
Doctor: __________________________________________________________________________________ Phone: ____________________________________
HR HealthCare: ___________________________________________________________________________ Phone: 877-424-2562

If you have any questions about safety that aren’t in this booklet, please call us and we will be happy to give you recommendations for your individual needs.

HIPAA NOTICE OF PRIVACY PRACTICES
As required by the Privacy Regulations Promulgated Pursuant to the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)

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 of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. 

Uses and Disclosures of Protected Health Information:
Your protected health information may be used and disclosed by our organization, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the organization, and any other use required by law. 

Treatment:
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. 

Payment:
Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for equipment or supplies coverage may require that your relevant protected health information be disclosed to the health plan to obtain approval for coverage. 

Healthcare Operations:
We may use or disclose, as needed, your protected health information in order to support the business activities of our organization. These activities include, but are not limited to, quality assessment activities, employee review activities, accreditation activities, and conducting or arranging for other business activities. For example, we may disclose your protected health information to accrediting agencies as part of an accreditation survey. We may also call you by name while you are at our facility. We may use or disclose your protected health information, as necessary, to contact you to check the status of your equipment. 

We may use or disclose your protected health information in the following situations without your authorization:
as Required By Law, Public Health issues as required by law, Communicable Diseases, Health Oversight, Abuse or Neglect, Food and Drug Administration requirements, Legal Proceedings, Law Enforcement, Criminal Activity, Inmates, Military Activity, National Security, and Workers’ Compensation. Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500. Other Permitted and Required Uses and Disclosures Will Be Made Only with Your Consent, Authorization or Opportunity to Object, unless required by law.You may revoke this authorization, at any time, in writing, except to the extent that your physician or this organization has taken an action in reliance on the use or disclosure indicated in the authorization.

Your Rights:
Following is a statement of your rights with respect to your protected health information.

You have the right to inspect and copy your protected health information.
Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

You have the right to request a restriction of your protected health information.
This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Our organization is not required to agree to a restriction that you may request. If our organization believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us,
upon request, even if you have agreed to accept this notice alternatively, e.g., electronically.

You may have the right to have our organization amend your protected health information.
If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.

Complaints:
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.

We are required by law
to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information, if you have any questions concerning or objections to this form, please ask to speak with our Vice President of Patient Services in person or by phone at
877-424-2562.

Associated companies with whom we may do business,
such as an answering service or delivery service, are given only enough information to provide the necessary service to you. No medical information is provided.

We welcome your comments:
Please feel free to call us if you have any questions about how we protect your privacy. Our goal is always to provide you with the highest quality services.

This notice was published and becomes effective on/or before April 14, 2003.

EMERGENCY PLANNING FOR THE HOME CARE PATIENT

This pamphlet has been provided by HR HealthCare to help you plan your actions in case there is a natural disaster where you live. Many areas of the United States are prone to natural disasters like hurricanes, tornadoes, floods, and earthquakes. Every patient receiving care or services in the home should think about what they would do in the event of an emergency. Our goal is to help you plan so that we can try to provide you with the best, most consistent service we can during the emergency.

Know What to Expect
If you have recently moved to this area, take the time to find out what types of natural emergencies have occurred in the past, and what types might be expected.
Find out what, if any, time of year these emergencies are more prevalent.
Find out when you should evacuate, and when you shouldn’t.
Your local Red Cross, local law enforcement agencies, local news and radio stations usually provide excellent information and tips for planning.

Know Where to Go
One of the most important pieces of information you should know is the location of the closest emergency shelter.
These shelters are opened to the public during voluntary and mandatory evaluation times. They are usually the safest place for you to go, other than a friend or relative’s home in an unaffected area. 

Know What to Take with You
If you are going to a shelter, there will be restrictions on what items you can bring with you. Not all shelters have adequate storage facilities for medications that need refrigeration.
We recommend that you call ahead and find out which shelter in your area will let you bring your medications and medical supplies, in addition, let them know if you will be using medical equipment that requires an electrical outlet.
During our planning for a natural emergency, we will contact you and deliver, if possible, at least one week’s worth of medication and supplies. Bring all your medications and supplies with you to the shelter. 

Reaching Us if There Are No Phones
How do you reach us during a natural emergency if the phone lines don’t work? How would you contact us? If there is warning of the emergency, such as a hurricane watch, we will make every attempt to contact you and provide you with the number of our cellular phone. (Cellular phones frequently work even when the regular land phone lines do not.) 

If you have no way to call our cellular phone, you can try to reach us by having someone you know call us from his or her cellular phone. (Many times cellular phone companies set up communication centers during natural disasters. If one is set up in your area, you can ask them to contact us.)If the emergency was unforeseen, we will try to locate you by visiting your home, or by contacting your home nursing agency. If travel is restricted due to damage from the emergency, we will try to contact you through local law enforcement agencies.

An Ounce of Prevention
We would much rather prepare you for an emergency ahead of time than wait until it has happened and then send you the supplies you need.
To do this, we need for you to give us as much information as possible before the emergency. We may ask you for the name and phone number of a close family member, or a close friend or neighbor. We may ask you where you will go if an emergency occurs. Will you go to a shelter, or a relative’s home? If your doctor has instructed you to go to a hospital, which one is it?
Having the address of your evacuation site, if it is in another city, may allow us to service your therapy needs through another company.

Helpful Tips

  • Get a cooler and ice or freezer gel-packs to transport your medication.
  • Get all of your medication information and teaching modules together and take them with you if you evacuate.
  • Pack one week’s worth of supplies in a plastic-lined box or waterproof tote bag or tote box. Make sure the seal is watertight.
  • Make sure to put antibacterial soap and paper towels into your supply kit.
  • If possible, get waterless hand disinfectant from HR HealthCare or from a local store. It comes in very handy if you don’t have running water.
  • If you are going to a friend or relative’s home during evacuation, leave their phone number and address with HR HealthCare and your home nursing agency.
  • When you return to your home, contact your home nursing agency and HR HealthCare so we can visit and see what supplies you need.

For More Information

There is much more to know about planning for and surviving during a natural emergency or disaster. Review the information from Federal Emergency Management Agency (FEMA) https://www.fema.gov/related-link/are-you-ready-guide-citizen-preparedness. The information includes:

  • Get informed about hazards and emergencies that may affect you and your family.
  • Develop an emergency plan.
  • Collect and assemble disaster supplies kit , which should include:
    • Three-day supply of non-perishable food.
    • Three-day supply of water – one gallon of water per person, per day.
    • Portable, battery-powered radio or television and extra batteries.
    • Flashlight and extra batteries.
    • First aid kit and manual.
    • Sanitation and hygiene items (moist towelettes and toilet paper).
    • Matches and waterproof container.
    • Whistle.
    • Extra clothing.
    • Kitchen accessories and cooking utensils, including a can opener.
    • Photocopies of credit and identification cards.
    • Cash and coins.
    • Special needs items, such as prescription medications, eye glasses, contact lens solutions, and hearing aid batteries.
    • Items for infants, such as formula, diapers, bottles, and pacifiers.
    • Other items to meet your unique family needs.
  • Learn where to seek shelter from all types of hazards.
  • Identify the community warning systems and evacuation routes.
  • Include in your plan required information from community and school plans.
  • Learn what to do for specific hazards.
  • Practice and maintain your plan.

 

An Important Reminder:
During any emergency situation, if you are unable to contact our company and you are in need of your prescribed medication, equipment or supplies, you must go to the nearest emergency room or other treatment facility for treatment.

MAKING DECISIONS ABOUT YOUR HEALTH CARE
Advance Directives are forms that say, in advance, what kind of treatment you want or don’t want under serious medical conditions. Some conditions, if severe, may make you unable to tell the doctor how you want to be treated at that time. Your Advance Directives will help the doctor to provide the care you would wish to have. Most hospitals and home health organizations are required to provide you with information on Advance Directives. Many are required to ask you if you already have Advance Directives prepared.

This pamphlet has been designed to give you information and may help you with important decisions. Laws regarding Advance Directives vary from state to state. We recommend that you consult with your family, close friends, your physician, and perhaps even a social worker or lawyer regarding your individual needs and what may benefit you the most. 

What Kinds Of Advance Directives Are There?
There are two basic types of Advance Directives available. One is called a Living Will. The other is called a Durable Power of Attorney.

A Living Will gives information on the kind of medical care you want (or do not want) if you become terminally ill and unable to make you own decision. 

  • It is called a “Living” Will because it takes effect while you are living.
  • Many states have specific forms that must be used for a Living Will to be considered legally binding. These forms may be available from a social services office, law office, or possibly a library.
  • In some states, you are allowed to simply write a letter describing what treatments you want or don’t want.
  • In all cases, your Living Will must be signed, witnessed, and dated. Some state require verification.
 
A Durable Power of Attorney is a legal agreement that names another person (frequently a spouse, family member, or close friend) as a agent or proxy. This person would then be able to make medical decisions for you if you should become unable to make them for yourself. A Durable Power of Attorney can also include instructions regarding specific treatments that you want or do not want in the event of a serious illness.
 
What Type Of Advance Directive Is Best For Me?
This is not a simple question to answer. Each individual’s situation an preferences are unique.
  • For many persons, the answer depends on their specific situation, or personal desires for their health care. 
  • Sometimes the answer depends on the state in which you live. In some states, it is better to have one versus the other. 
  • Many times you can have both, either as separate forms or as a single combined form.
 
What Do I Do If I Want An Advance Directive?
  • First, consult with your physician’s office or home care agency about where to get information specific for your state. 
  • Once you have discussed the option available, consult with any family members or friends who may be involved in your medical care. This is extremely important if you have chosen a friend or family member as your “agent” in the Durable Power of Attorney. 
  • Be sure to follow all requirements in your state for your signature, witness signature, notarization (If required), and filing. 
  • You should provide copies of your Advance Directive(s) to people you trust, such as close family members, friends and/or caregiver(s). The original document should be filed in a secure location known to those to whom you give copies. 
  • Keep another copy in a secure location; if you have a lawyer, he or she will keep a copy as well.

How Does My Health Care Team Know I Have An Advance Directive?
You must tell them. Many organizations and hospitals are required to ask you in you have one. Even so, it is a good idea to tell your physicians and nurses that you have an Advance Directive, and where the document can be found. Many patients keep a small card in their wallet that states they type of Advance Directive they have, where a copy of the document(s) is located, and a contact person, such as your Durable Power of Attorney “agent” and how to contact them.

What If I Change My Mind?
You can change your mind about any part of your Advance Directive, or even about having an Advance Directive, at any time. If you would like to cancel or make changes to the document(s), it is very important that you follow the same signature, dating, and witness procedure as the first time, and that you make sure all original versions are deleted or discarded, and that all health care providers, your caregiver(s), your family and friends have a revised copy.

What If I Don’t Want An Advance Directive?
You are not required by law to have one. Many home care companies are required to provide you with this basic information, but what you choose to do with it is entirely up to you.

For More Information:
This pamphlet has been designed to provide you with basic information. It is not a substitute for consultation with and experienced lawyer or knowledgeable social worker. These persons, or your home care agency, can best answer more detailed questions, and help guide you towards the be Advance Directive for you. 

GRIEVANCE/COMPLAINT REPORTING
You may lodge a complaint without concern for reprisal, discrimination, or unreasonable interruption of service. To place a grievance, please call 877-424-2562 and speak to the Customer Service Supervisor. If your complaint is not resolved to your satisfaction within 5 working days, you may initiate a formal grievance in writing and forward it to the Governing Body. You can expect a written response within 14 working days of receipt. You may also make inquiries or complaints about this company by calling you local Social Services Department, Medicare at 1-800-MEDICARE and/or the Accreditation Commission for Health Care (ACHC) at 919-785-1214.

CAPPED RENTAL POLICY
I understand Medicare defines the piece of equipment I received as being either a capped rental or inexpensive routinely purchased item.

  • Capped Rental Item – Medicare will pay a monthly rental fee for the Medicare specified period of months, after which ownership of the equipment is transferred to the Medicare beneficiary. Once equipment ownership is transferred to the Medicare beneficiary, they are responsible to arrange for any required equipment service or repair. 
  • Inexpensive or Routinely Purchased Item – Equipment can be purchased or rented; however, the total amount paid for monthly rentals cannot exceed the fee schedule purchase amount.

WARRANTY INFORMATION
All patients who either purchase or rent equipment will be informed of the manufacturer’s warranty coverage and we will honor all warranties under applicable law. HR HealthCare will repair or replace, free of charge, equipment that is under warranty. Additionally, if available, an owner’s manual with warranty information will be provided to beneficiaries for all durable medical equipment. The patient will be required to sign a form stating that they received and understand the warranty coverage. 

I acknowledge I have been given written information and instructions on how to use Medicare-covered items safely and effectively.