Patient Bill of Rights  

As a patient receiving Durable Medical Equipment (DME) and/or rental medical equipment, you have the right to: 1. Receive respectful, considerate, and dignified care at all times. 2. Receive equipment and services without discrimination based on race, color, religion, sex, age, disability, national origin, or source of payment. 3. Be informed of your rights and responsibilities in advance of receiving equipment or services. 4. Receive clear explanations regarding the equipment provided, including proper use, maintenance, and safety. 5. Participate in decisions regarding your care and equipment selection when applicable. 6. Privacy and confidentiality of your personal and medical information in accordance with HIPAA regulations. 7. Access, inspect, and request copies of your medical and billing records as permitted by law. 8. Voice complaints or grievances without fear of retaliation. 9. Receive information on how to file a complaint with the company or appropriate regulatory agencies. 10. Receive services in a safe setting and in accordance with professional standards.  

Patient Responsibilities  

As a patient receiving DME and/or rental equipment, you are responsible for: 1. Providing accurate and complete medical, insurance, and contact information. 2. Notifying the company of any changes in address, phone number, physician, or insurance coverage. 3. Using equipment only as instructed and for its intended medical purpose. 4. Maintaining equipment in a clean and safe condition. 5. Notifying the company immediately if equipment is damaged, malfunctioning, lost, or stolen. 6. Following manufacturer instructions and safety guidelines. 7. Ensuring a safe home environment for delivery, setup, and use of equipment. 8. Returning rental equipment in a timely manner when no longer needed or upon request. 9. Meeting financial obligations, including copayments, deductibles, or non-covered charges. 10. Treating company staff with courtesy and respect. 

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.  

Uses and Disclosures of Protected Health Information (PHI)  

We may use and disclose your protected health information (PHI) for the following purposes: -Treatment: To coordinate delivery, setup, and instruction of medical equipment and supplies. -Payment: To bill and collect payment from insurance companies or other responsible parties. -Health Care Operations: For quality assessment, accreditation, licensing, and business operations.  

-As Required by Law: To comply with federal, state, or local laws and regulations. 

Your Rights Regarding Your PHI  

You have the right to:   

-Inspect and obtain copies of your health and billing records.  

-Request corrections or amendments to your records.  

-Request restrictions on certain uses or disclosures.  

-Request confidential communications.  

-Receive an accounting of disclosures.  

-Obtain a paper copy of this Notice upon request. 

Our Responsibilities 

We are required by law to:   

-Maintain the privacy and security of your PHI.  

-Provide you with this Notice of our legal duties and privacy practices.  

-Notify you following a breach of unsecured PHI. 

Emergency Planning for the Home Care Patient  

Emergencies such as power outages, severe weather, fires, floods, or other  disasters may impact your ability to safely use medical equipment.  

Patient Responsibilities  

-Maintain emergency contact numbers in an easily accessible location.  

– Keep an updated list of medications, physicians, and medical equipment.  

-Notify the company if you rely on life-sustaining or power-dependent equipment.  

– Arrange a backup power source if applicable.  

– Register with your local utility provider and emergency management agency if dependent on electrically powered equipment.  

– Follow local emergency alerts and evacuation instructions.  

Company Responsibilities  

– Identify patients who are dependent on life-sustaining or power-dependent equipment.  

– Provide education on emergency preparedness specific to the equipment provided.  

– Maintain after-hours contact availability for urgent equipment-related issues.  

– Coordinate reasonable assistance during emergencies when feasible.  

Company Emergency Contact Information: 

-Main Office Phone: 972-578-4831  

– After-Hours Emergency Line: Same number; follow phone prompts to reach the  

emergency line 

How to Make Your Home Safe for Medical Care 

To ensure safe use of medical equipment in your home:  

General Home Safety  

– Keep walkways and floors clear of clutter, cords, and throw rugs.  

– Ensure adequate lighting throughout the home, especially hallways and bathrooms.  

– Secure loose carpets and use non-slip mats where appropriate.  

– Keep pets secured during equipment use or transfers.  

Electrical Safety  

– Use grounded outlets for powered medical equipment.  

– Avoid using extension cords or power strips unless approved by the equipment  

manufacturer.  

– Do not overload outlets.  

– Notify the company if outlets are not accessible or functioning properly.  

Oxygen Safety (if applicable)  

– Do not smoke or allow smoking near oxygen equipment.  

– Keep oxygen at least 5 feet away from open flames or heat sources.  

– Store oxygen cylinders upright and secured to prevent tipping.  

– Post “No Smoking” signs where oxygen is in use.  

Fall Prevention  

– Use assistive devices as instructed.  

– Wear non-slip footwear.  

– Install grab bars or handrails when recommended. 

MEDICARE DMEPOS SUPPLIER STANDARDS 

Note: This is an abbreviated version of the supplier standards every Medicare DMEPOS supplier must meet in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R. 424.57(c).  

1. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements.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 a beeper, answering machine or cell phone 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 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). 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©. 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. 

Patient Satisfaction and Follow-Up Policy 

To measure patient satisfaction, identify service improvement opportunities, and ensure  

timely follow-up after delivery or service. This applies to all patients receiving products or services.  

1. Timing: A patient satisfaction follow-up is attempted within seventy-two (72) 

hours of delivery or service (preferred method: phone call). 

2. Alternate Methods: If phone contact is not successful, alternate methods maybe used (text, email, QR survey, mail).
3. Documentation: Responses are documented on the Patient Satisfaction Follow-Up Log.
4. Escalation: Any negative response, complaint, or safety concerninitiates the Complaint Management process. 
5. Trending: Satisfaction results are trended monthly and summarized quarterly.
6. QI Review: Quarterly results are reviewed during QI meetings; corrective actions

and follow-up are documented. 

Satisfaction records are retained for seven (7) years. 

Patient Complaint Handout 

Your Right to File a Complaint  

If you have any concerns about our products or services, please contact us immediately so we can help. We will acknowledge your complaint within 5 calendar days and will work to resolve it within 14 calendar days whenever possible. 

How to Contact Us 

Company: Affordable Medical Supplies  

Phone: (972) 578-4831 

Email: info@amednow.com 

Address: 2709 West 15th St., Suite B. Plano, TX 75075 

Accreditor Complaint Statement: 

“In the event your complaint remains unresolved, you may file a complaint with our Accreditor,  

The Compliance Team, Inc., via their website 

(https://portal.thecomplianceteam.org/complaint_form.aspx) or via phone (215) 654-9110.