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ADVANCE DIRECTIVES
We at LTMS have provided you with a Bill of Rights and shall honor those rights. We understand that the formation of Advance Directives and/or living wills is part of your rights as a patient. The staff of LTMS will not assist in the formation of advance directives, we advise you to contact your physician, attorney, and/or clergy to assist in the formation of such directives.
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The employees of LTMS will honor those advance directives that have been directed to us by you or your physician, to the best of our ability. Due to the ethical and moral preferences of the staff, our policy states that we shall not remove life support equipment from a patient without their physicians order. We hope that you understand this policy and if you have any questions will call us and discuss it with one of our professional staff members.
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In an emergency situation where medical assistance is required and there is not an advance directive in place, employees of LTMS would call 911 and wait for emergency medical assistance to arrive.
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BILLING INFORMATION
LTMS strives to help its customers with obtaining account payments through their insurance carrier. Insurance claims are submitted for our customers without charge as a courtesy. In all cases the customer is responsible for providing the necessary information to make claim submittal possible. This pertains to both personal insurance and medical information. All accounts billed are due within 60 days of claim filing or invoice except for Medicaid and assigned Medicare items. Private Insurance and non-assigned Medicare items, like private pay situations may require payment at the time of purchase, with the customer receiving reimbursement from the insurance carrier.
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PRIVATE INSURANCE
Customers are responsible for payment in full on their accounts regardless of claim submittal. Special circumstances apply for claims sent to Medicare primary and private insurance secondary. (See Medicare section below.)
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MEDICARE
Long Term Medical Supply Corp. may or may not accept Medicare Assignment at their discretion on a per item basis. If Medicare Assignment is elected then the customer or their co-insurance will be billed 20% of the Medicare allowable and/or for the Medicare deductible. The customer is ultimately responsible for the payment of the co-pay amount and deductible. When assignment is not taken, the customer will be responsible for payment in full. A Medicare claim will be sent to Medicare on behalf of the customer provided that the item is a Medicare covered item. Items not covered by Medicare will be submitted upon customer request. Any claims must first have all information from the customer and their physician, supplied to LTMS before claims can be filed.
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MEDICAID
Long Term Medical Supply Corp. may provide equipment or supplies to Medicaid recipients if there is medical justification, the item is approved for payment, the customer provides a valid State Beneficiaries Identification Card, a personal ID, and coverage is verified. Co-pay is required by Medicaid and will be collected.
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MANAGED CARE / WORKMAN'S COMP
Payment arrangements will be made on a case-by-case basis for all customers covered under Managed Care, or Workman's Comp insurance. All customer and medical information must be provided before a decision can be made.
PATIENT BILL OF RIGHTS
As an individual receiving home medical equipment/supplies from our organization, let it be known and understood that you have the following rights:
- To choose the medical equipment supplier of your choice and to receive timely response to your request for service and information to help you make informed decisions regarding your care.
- To expect considerate and respectful service without regard to age, sex, race, creed, national origin or illness.
- To accept or refuse any part of your service plan of care, within the boundaries set by law, and receive professional information relative to the ramifications or consequences that will or may result due to such refusal.
- To express concerns, grievances or recommend modifications to your home care records and service without fear of discrimination or reprisal.
- To expect that all information about you is to be kept confidential and shall not be released without written authorization, to view our Privacy Notice, and to have your privacy and property respected at all times.
- To an explanation of charges and payment policies.
- To be promptly informed if the prescribed care or services are not within the scope, mission, or philosophy of the organization, and therefore be provided with transfer assistance to an appropriate care or service organization.
- To formulate an advance directive, and have it honored.
- The right to request restrictions on releasing medical information and revoke any previous consent for release of medical information.
- Right to examine and obtain a copy of your health records and request corrections and to request any disclosures of your medical record.
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RESPONSIBILITIES OF THE PATIENT
You and LTMS are partners in your health care plan. To insure the finest care possible, you must understand your role in your health care program. As a patient of our organization, you are responsible for the following:
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- To provide complete and accurate information necessary to obtain payment for services and assume responsibility for charges not covered. You are responsible for settlement in full of your account.
- To inform a staff member, as appropriate, of your health history, and to contact us if you acquire an infectious disease during the time we provide services to you.
- To involve yourself, as needed and as able, in developing, carrying out, and modifying your home care service plan, such as protecting, properly cleaning, storing your equipment and supplies and to follow instructions for the equipments proper use.
- To review the organization's safety materials and actively participate in maintaining a safe environment in your home.
- To request additional assistance or information on any phase of your health care plan you do not fully understand.
- To notify your attending physician when you feel ill, or encounter any unusual physical or mental stress or sensations.
- To notify the organization when you will not be home at the time of a scheduled home care visit.
To notify LTMS immediately of:
- Equipment failure, damage, need of supplies or other related problems.
- Any change in your prescription, need for services or physician
- Any loss or change of you insurance coverage;
- Any change of billing information whether temporary or permanent.
- Discontinued use of equipment, hospitalizations or breaks in service.
- As a customer of LTMS, we expect that you will report any concerns regarding pain and pain management as it relates to the services provided.
- To notify LTMS of denial and/or restriction of the organization's privacy policy.
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IN AN EMERGENCY
- Dial 911
- Give the full address and explanation of the emergency.
- Don't hang up.
- Keep emergency contact numbers by your phone
- Have escape routes posted and have a first aid kit available in a known location.
- Have fire extinguishers near the kitchen and near bedrooms and make sure everyone is trained to use them.
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CASE OF FIRE
- Make sure everyone knows the plan, and where to meet. Have a flash light and a warning device like a whistle at every bedside and train everyone to respond when they hear it.
- Make sure you have smoke detectors, especially in the kitchen and near sleeping areas. Check them routinely and change batteries as directed by the manufacture.
- Intermittent beeps from your detector usually mean the battery needs changing.
- Plan ahead. Determine evacuation routes from every room have routes drawn on a plan, including all alternate routes and make sure everyone is aware of the plan.
- Pick a meeting place outside your home, somewhere at a safe distance.
- Inhalation can be just as deadly as flames. Get out! Do not stop to dress or to collect valuables. Make sure there is help for those unable to help themselves. Semi or totally incapacitated individuals must sleep on ground level with a window large enough for ease of evacuation.
- Keep flammable items stored away from flames and label them well.
- Keep stoves free from grease, paper, and other flammable items.
- Conduct routine drills.
- Keep bedroom doors closed at night and touch the door knob before opening. If
the knob is hot, leave the door closed and evacuate through a window.
- If trapped in a room, place wet towels under the door and in cracks, stay low and
near an open window. Cover your mouth and nose with a cloth, damp, if possible.
- Make sure someone is responsible for taking roll to assure all are evacuated.
- Keep animals restrained at a safe distance from the home.
- Prevention is key. Extinguish candles when you're not physically present.
- Keep matches stored in a metal container and away from children,
- Keep stoves and heaters away from curtains and turn them off when you retire or leave home.
- NO SMOKING IN BED. NEVER SMOKE OR HAVE OPEN FLAMES NEAR OXYGEN DELIVERY SYSTEMS, OR USE OXYGEN NEAR THE STOVE WHEN COOKING.
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GAS LEAKS
- Evacuate, using your fire escape plan, if you can not quickly find and stop the leak.
- Call the fire dept or utility company from another location, away from your home.
- Check to make sure everyone is evacuated and that animals are restrained
So they can not reenter the home.
- Use a flashlight at night. Do not use anything that could cause a spark or flame.
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STORMS AND NATURAL DISASTERS
- Keep apprised of local weather conditions through the TV, radio or other media. Have a battery operated radio handy.
- Plan ahead. Determine what type of shelter you will use for each type of emergency. Evacuate when advised. Go to a predetermined safe place that is capable of meeting your needs, like electricity, heat, etc. Take water with you if you have time to prepare.
- Arrange ahead of time with family, neighbor or friend to help you if you need to evacuate and can not assist yourself.
- If necessary in a tornado, when underground shelter is not available, move to the center of the house away from outside doors or windows, find shelter under beds, heavy tables, or in a bathtub (unless there is a glass door) etc. Cover yourself with blankets and pillows.
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- Keep heavy objects in a low area and don't hang pictures or mirrors over beds. Make sure cracks and leaks are repaired as noticed and gas connections are secure. Keep water heater, and other fixtures secured in place against studs.
- Keep combustibles in metal containers and safely stored away.
- Stay away from downed power lines.
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SAFETY INFORMATION
SAFETY IN THE KITCHEN
- Keep a fire extinguisher mounted near the stove and place cooking utensils in a
space, easy to access without reaching over, burners or open flames.
- Wipe up grease and spills right away and always use an oven mitt to prevent burns.
- Don't wear your oxygen when near an open flame.
- Be aware of loose clothing when near flames.
- Move slowly and don't reach high or bend low suddenly, or at all if this makes you
dizzy. Use an adjustable height, lockable caster wheeled chair to help you reach
counters if you have problems with instability of gait or get dizzy.
- Do not store items in high, or very low cabinets if you can not reach them safely.
- Mop up spills right away to prevent falls. Use your feet to move a cloth around the floor
if you can not safely bend.
- NEVER USE OXYGEN EQUIPMENT NEAR BURNERS OR OPEN FLAMES
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HOME SAFETY, BED AND BATH
- Keep your pathway clear of clutter such as furniture, electrical cords, books, oxygen tubing etc. to prevent falls.
- Don't try to do anything you don't feel physically capable of doing.
- Keep the shades open or use other means of supplying adequate light.
- Keep necessary items like a telephone, water, etc. within easy reach and if necessary a bell or other alarm device in a manner that it can not be dropped.
- NEVER SMOKE IN BED OR NEAR CUMBUSTABLES.
- Make sure your bathroom has non slip coverings to prevent falls and all floors are dry.
- Install bath tub rails, grab bars, bath seats, flexible shower heads, elevated toilet seats, commodes or safety rails in the bath room as needed.
- An adjustable bed and bed rails, special support mattresses, patient lift or trapeze and an overbed table can aid Patient mobility, safety and comfort greatly in the bedroom. Arrange for help when needed and make sure care givers are properly trained to meet your need.
- Dispose of out of date medicine and only take meds your doctor prescribes. Dispose of those meds that he tells you to quit taking.
- Keep all poisons out of your medicine cabinet! Store your meds away from children, in a dry location and away from direct light.
- Use securely fastened hand rails on stairs and keep stairways free of clutter and well lit.
- Replace worn surfaces with non slip coverings, especially on stairs. Never use throw rugs near or on stairs. Install an electric stair lift if necessary.
- Keep outside stairs free from snow and ice as well as other clutter.
- Install ramps for safe outside access if needed. Make sure the incline is approximately 10 to 11 feet for each one foot rise and not steeper for maximum safety. Always have hand rails installed on all ramps and stairs.
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ELECTRIAL SAFETY
- Keep all electrical devices at least an arms length away from water, the stove or other grounded objects. Make sure your hands are dry and you are not standing in water before touching them. Never use exposed outlets or wiring.
- Use only UA approved electrical cords and make sure that they are not worn or damaged.
- Make sure that all electrical outlets are grounded and that all outlets receive only the recommended electrical load. Never remove or bypass the ground prong on a plug.
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GENERAL SAFETY
- Keep emergency phone numbers near the phone.
- Use smoke detectors on every level, maintain them, have a fire extinguisher handy.
- Keep your path clear and use rails and other supports throughout the house.
- Have an emergency plan for all type of situations practice them and use them.
- Keep flammable items away from heat or electrical sources and label them.
- Keep medication high and away from children. Throw out old medication.
- DO NOT USE OXYGEN NEAR HEAT SOURCES OR OPEN FLAMES
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TIPS ON INFECTION CONTROL
Infections can be spread by contact with body fluids or droplets that are sprayed into the air by a cough or a sneeze. The best way to control the travel of infection is by good personal hygiene and cleanliness in your environment.
- Keep your body, hair, and clothes clean. Bathe, or wash up daily and change your clothes. Keep fingernails trimmed and brush your teeth as the dentist recommends.
- Wash your hands often. Never prepare food before washing your hands. Wash your hands after going to the bathroom or whenever they come into contact with body fluids or are otherwise soiled.
- Wash your hands thoroughly using plenty of soap and warm water, briskly rubbing your hands and wrists. Clean under your finger nails and rinse thoroughly. Dry your hands with a clean towel.
- Clean your medical equipment and replace supplies as directed. Use your equipment as your doctor directs you.
- Eat a balanced diet, get plenty of rest, drink enough fluids and exercise all in the way that your doctor has instructed you.
- Avoid contact with persons with know contagious diseases.
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MEDICARE SUPPLIER STANDARDS
NOTE: This list is an abbreviated version of the application certification standards, that every Medicare
Durable Medical Equipment, Prosthetic, orthotic (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. pt. 424, sec. 424.57 © and are effective on December 11, 2000.
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- A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements.
- A supplier must provide complete and accurate information on the DEMPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.
- An authorized individual (one whose signature is binding) must sign the application for billing privileges.
- 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 nonprocurement programs.
- 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.
- 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.
- A supplier must maintain a physical facility on an appropriate site,
- A supplier must permit HCFA, or its agents to conduct on-site inspections to ascertain the supplier's compliancy 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 service.
- 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.
- 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.
- 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.
- A supplier is responsible for delivery and instructions to beneficiaries on use of Medicare covered items, and maintain proof of delivery.
- A supplier must answer questions, respond to and document complaints of beneficiaries.
- 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.
- 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.
- A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item.
- A supplier must disclose to the government persons having ownership, financial, or control interest in the supplier.
- A supplier must not convey or reassign a supplier number; ie.; the supplier may not sell or allow another entity to use its Medicare billing number.
- 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.
- 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.
- A supplier must agree to furnish HCFA any information required by the Medicare statute and implementing regulations.
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NOTICE OF PRIVACY INFORMATION PRACTICES
MEDICAL INFORMATION IS TAKEN, AND RECEIVED BY LONG TERM MEDICAL SUPPLY CORP. IN ORDER TO INSURE THAT OUR CUSTOMERS RECEIVE THE APPROPRIATE EQUIPMENT TO MEET THEIR MEDICAL NEEDS AND TO AID IN THE REIMBURSEMENT OF EQUIPMENT OR SUPPLY COSTS FOR THE CUSTOMER. TO ACCOMPLISH THIS TASK IT IS NECESSARY TO SHARE THIS INFORMATION WITH INSURANCE CARRIERS, OTHER PROVIDERS OF CARE AND SOMETIMES WITH FAMILY MEMBERS OF THE CUSTOMERS WE SERVE.
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOS
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE CONTACT YOUR AREA LONG TERM MEDICAL SUPPLY CORP. LOCATION FOR AN EXTENDED VERSION OF THIS POLICY.
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YOUR HEALTH INFORMATION MAY BE SHARED OR USED TO:
- Assure that the equipment or supplies fit the intended use prescribed by your physician
- Gain reimbursement on the customer's behalf from insurance carriers, Governmental and private.
- Assure that individuals involved in your care understand the proper use of your equipment.
- Alert organizations in disaster relief of your equipment use and special needs.
- Disclose information under State and Federal Law and regulations to meet Public Health reporting obligations. Example: Recall notices on product, cases of suspected abuse or neglect, Evidence of disease exposure that could result in a Public Health and Safety issue.
- Conduct Health Oversight activities; These may include audits, investigations or licensure surveys all geared to make sure that Health Care Providers are in compliance with rules and regulations.
- Satisfy Judicial or Administrative proceedings, pursuant to a subpoena or court order, summons, warrant or similar lawful process.
- Aid in the investigation of a criminal act or to report a crime or other emergency situations.
- Report to Coroners, Medical Examiners or funeral directors information needed to perform their duties.
- Comply with Military command authorities, and National Security and Intelligence Activities, as authorized by law.
- Assure that inmates under custody of law enforcement receive appropriate equipment and supplies.
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YOU HAVE A RIGHT TO:
- Inspect and copy your health information, by submitting a request in writing to the Executive Officer of LONG TERM SUPPLY CORP.
- Request an amendment if you feel that the information we have about you is incorrect. Your request must be in writing to the Executive Officer of LONG TERM MEDICAL SUPPLY CORP. who will investigate the request and determine what changes can appropriately be made. Information not generated in this office may not be appropriate for us to amend. No information can be falsely amended.
- An accounting of disclosures that we have made regarding your health information. A request must be made in writing to the Executive Officer of LONG TERM MEDICAL SUPPLY CORP. and list a time period which may no be longer than six (6) years prior to the date of your request and may not include dates before April 14, 2003.
- Request restrictions or limitations on the health care information we use or disclose to someone, such as a particular friend or family member. We are not required to agree to your request if we feel it would create a dangerous situation for you. Requests for restrictions or limitations must be made in writing to the Executive Officer of LONG TERM MEDICAL SUPPLY CORP. Listing the specific information involved in the request. (What information, limit to use or disclosure, or both, to whom you want the limits to apply.)
- Request confidential communications. (Example: Contact me only by mail.) This request must be made in writing to the Executive Officer of LONG TERM MEDICAL SUPPLY CORP. We will accommodate all reasonable requests.
- A detailed copy of this policy. A detailed, paper copy of this notice will be supplied upon request from any of our LONG TERM MEDICAL SUPPY CORP. offices. You may also obtain a copy from our corporate website abcmcorp.com.
Please feel free to call us at 1-866-203-9605 or come in to see us at any of our locations listed on the cover of this booklet. If you believe your rights have been violated you may also fill out the postage paid Complaint form provided in this booklet.
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