You have the responsibility to:
- give accurate and complete
health information concerning your past use
of equipment and any change in address, doctor,
insurance carrier, prescription.
- assist in developing and maintaining
a safe environment.
- follow instruction in care
and use of all equipment and request further
information concerning anything you do not
understand.
- treat Great Lakes Medical
associates with respect, courtesy, and consideration.
- to order supplies on a timely
basis to accommodate reasonable delivery.
- to have someone at home when
delivery is scheduled.
- to pay all invoices that are
due; not covered by insurance.
- Accept the consequences of
any refusal or choice of noncompliance, including
changes in reimbursement eligibility.
Our company is dedicated to maintaining the
privacy of your identifiable health information.
In conducting our business, we will create records
regarding you and the services we provide to
you. This Notice tells you about the ways in
which Great Lakes Medical (referred to as “we”)
may collect, use, and disclose your protected
health information and your rights concerning
your protected health information. “Protected
health information” is information about
you that can reasonably be used to serve you
and that relates to you, or the payment for that
care.
We are required by law to maintain the confidentiality
of health information that identifies you; as
well as by federal and state laws to provide
you with this Notice about your rights and our
legal duties and privacy practices with respect
to your protected health information. We must
follow the terms of this Notice while it is in
effect. Some of the uses and disclosures described
in this Notice may be limited in certain cases
by applicable state laws that are more stringent
than the federal standards.
If you have questions about this notice, please
contact the Privacy Officer at Great Lakes Medical
at 517-536-7350 for further information.
The terms of this notice apply to all records
containing your health information that are created
or retained by our organization. We reserve the
right to revise or amend our notice of privacy
practices. Any revision or amendment to this
notice will be effective for all of your records
our practice has created or maintained in the
past, and for any of your records we may create
or maintain in the future. Our organization will
post a copy of our current notice in our office
in a prominent location, and you may request
a copy of our most current notice by calling
us.
This notice describes how protected health information
about you may be used and disclosed and how you
can get access to this information. Please
review it carefully.
HOW WE
MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION
We may use and disclose your protected health
information for different purposes. The examples
below are provided to illustrate the types of
uses and disclosures we may make without your
authorization for payment, home care operations,
and treatment.
- Payment. We
use and disclose your protected health information
in order to bill and collect payment for the
services and items you may receive from us.
For example,
we may contact your health insurer to certify
that you are eligible for benefits and we may
provide your insurer with details regarding
your treatment to determine if your insurer
will cover, or pay for, your equipment. We
also may use and disclose your health information
to obtain payment from third parties that may
be responsible for such costs, such as family
members. Also, we may use your health information
to bill you directly or services and items.
- Home Care Operations. We
use and disclose your protected health information
in order to perform our home care activities,
such as providing equipment appropriate to
your needs, or administrative activities, including
data management or quality assessment activities.
- Treatment. We
may use and disclose your protected health
information to coordinate services with other
health care providers involved in your care.
For example, we may obtain and disclose information
on CPT diagnosis codes, diagnosis and prognosis,
functional limitations, pre-existing health
conditions, hospitalizations, prior use of
equipment, and information specific to qualifying
the patient as dictated by CMN / detailed written
order forms.
- Appointment Reminders. We
may use and disclose your health information
to contact you and remind you of visits / deliveries.
- Health-related Benefits
and Services. We may use and disclose
your health information to inform you of
health-related benefits or services that
may be of interest to you.
- Release of information
to Family / friends. We may release
your health information to a friend or family
member that is helping you to pay for your
health care, or who assists in taking care
of you.
- Disclosures Required
by Law. We will use and disclose your
health information when we are required to
do so by federal, state or local law.
OTHER
PERMITTED OR REQUIRED DISCLOSURES
- As Required by Law. We
must disclose protected health information
about you when required to do so by law.
- Public Health Activities. We
may disclose protected health information to
public health agencies for reasons such as
preventing or controlling disease, injury,
or disability.
- Victims of Abuse. Neglect,
or Domestic Violence. We may disclose protected
health information to government agencies about
abuse, neglect, or domestic violence.
- Health Oversight Activities. We
may disclose protected health information to
government oversight agencies. Oversight activities
can include, for example, investigations, inspections,
audits, surveys, licensure and disciplinary
actions; civil, administrative, and criminal
procedures or actions; or other activities
necessary for the government to monitor government
programs, compliance with civil rights laws
and the health care system in general.
- Judicial and Administrative
Proceedings. We may disclose protected
health information in response to a court
or administrative order. We may also disclose
protected health information about you in
certain cases in response to a subpoena,
discovery request, or other lawful process.
- Law Enforcement. We
may disclose protected health information under
limited circumstances to a law enforcement
official in response to a warrant or similar
process; to identify or locate a suspect; or
to provide information about the victim of
a crime.
- To Avert a Serious
Threat to Health or Safety. We may
disclose protected health information about
you, with some limitations, when necessary
to prevent a serious threat to your health
and safety or the health and safety of the
public or another person.
- Special Government
Functions. We may disclose information
as required by military authorities or to
authorized federal officials for national
security and intelligence activities.
- Workers Compensation. We
may disclose protected health information to
the extent necessary to comply with state law
for workers’ compensation programs.
YOUR RIGHTS
REGARDING YOUR PROTECTED HEALTH INFORMATION
- Right To Access Your
Protected Health Information. You
have the right to review or obtain copies
of your protected health information records,
with some limited exceptions. Usually the
records include referral information, delivery
forms, billing, claims payment, and medical
management records. Your request to review
and/or obtain a copy of your protected health
information records must be made in writing.
We may charge a fee for the costs of producing,
copying, and mailing your requested information,
but we will tell you the cost in advance.
- Right To Amend Your
Protected Health Information. If you
feel that protected health information maintained
by us is incorrect or incomplete, you may
request that we amend the information. Your
request must be made in writing and must
include the reason you are seeking a change.
We may deny your request if, for example,
you ask us to amend information that was
not created by us, or you ask to amend a
record that is already accurate and complete.
If we deny your request to amend, we will
notify you in writing. You then have the
right to submit to us a written statement
of disagreement with our decision and we
have the right to rebut that statement.
- Right to an Accounting
of Disclosures. You have the right
to request an accounting of disclosures we
have made of your protected health information.
The list will not include our disclosures
related to your treatment, our payment or
health care operations, or disclosures made
to you or with your authorization. The list
may also exclude certain other disclosures,
such as for national security purposes. Your
request for an accounting of disclosures
must be made in writing and must state a
time period for which you want an accounting.
This time period may not be longer than six
years and may not include dates before April
14, 2003. Your request should indicate in
what form you want the list (for example,
on paper or electronically). The first accounting
that you request within a 12-month period
will be free. For additional lists within
the same time period, we may charge for providing
the accounting, but we will tell you the
cost in advance.
- Right To Request Restrictions
on the Use and Disclosure of Your Protected
Health Information. You have the right
to request that we restrict or limit how
we use or disclose your protected health
information for services, payment, or health
care operations. We may not agree to your
request.
- Right To Receive Confidential
Communications. You have the right
to request that we use a certain method to
communicate with you or that we send information
to a certain location. For example, you may
ask that we contact you at work rather than
at home. Your request to receive confidential
communications must be made in writing..
We will accommodate all reasonable requests.
Your request must specify how or where you
wish to be contacted.
- Right to a Paper Copy
of This Notice. You have a right at
any time to request a paper copy of this
Notice. You may ask us to give you a copy
of this notice at any time.
- Contact Information
for Exercising Your Rights. You may
exercise any of the rights described above
by contacting our privacy Office.
- Complaints. If
you believe that your privacy rights have been
violated, you may file a complaint with us
and/or with the Secretary of the Department
of Health and Human Services. All complaints
must be submitted in writing. You will not
be penalized for filing a complaint.
YOUR INSURANCE
We work with most insurance companies. We submit
all documentation necessary to assure that your
claim is processed correctly and accurately.
It is important to remember that your
insurance policy is just that…yours. Our goal is
to utilize our years of experience to assist
in getting your claim paid correctly. The ultimate
responsibility for payment of our charges is
yours.
MISSION
STATEMENT
At Great Lakes we specialize in supplying high-quality
compression therapy products and service. Great
Lakes utilizes trained compression therapy fitters
with many years of experience working with lymphatic
and venous disorder patients. We provide education & support
on an individual basis to enhance the results
of treatment and improve the patient’s
quality of life. We will endeavor to provide
the right equipment for the right patient based
on our years of experience in providing specialized
Medical Equipment.
MEDICARE
DMEPOS SUPPLIER STANDARDS
- Great Lakes Medical must be in compliance
with all applicable Federal and State licensure
and regulatory requirements.
- Great Lakes Medical 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.
- An authorized individual (one whose signature
is binding) must sign the application for billing
privileges.
- Great Lakes Medical must fill orders from
its own inventory, or must contract with other
companies for the purchase of items necessary
to fill the order Great Lakes Medical 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.
- Great Lakes Medical 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.
- Great Lakes Medical 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.
- Great Lakes Medical must maintain a physical
facility on an appropriate site.
- Great Lakes Medical 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.
- Great Lakes Medical 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.
- Great Lakes Medical 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.
- Great Lakes Medical 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.
- Great Lakes Medical is responsible for delivery
and must instruct beneficiaries on use of Medicare
covered items, and maintain proof of delivery.
- Great Lakes Medical must answer questions
and respond to complaints of beneficiaries,
and maintain documentation of such contacts.
- Great Lakes Medical 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.
- Great Lakes Medical 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.
- Great Lakes Medical must disclose these
supplier standards to each beneficiary to whom
it supplies a Medicare-covered item.
- Great Lakes Medical must disclose to the
government any person having ownership, financial,
or control interest in the supplier.
- Great Lakes Medical must not convey or reassign
Great Lakes Medical number; i.e., the supplier
may not sell or allow another entity to use
its Medicare billing number.
- Great Lakes Medical 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.
- Great Lakes Medical must agree to furnish
CMS any information required by the Medicare
statute and implementing regulations.
- Great Lakes Medical Equipment 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.
- Great Lakes
Medical Equipment must notify their accreditation
organization when a new
DMEPOS location is opened. The accreditation
organization may accredit the supplier location
for three months after it is operational
without requiring a new site visit.
- All
Great Lakes Medical Equipment 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.
- Great Lakes
Medical Equipment 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.
- Great Lakes
Medical Equipment must obtain a surety bond
in order to receive
and retain
a supplier billing number.
- Great
Lakes Medical Equipment must obtain oxygen
from a state-licensed
oxygen supplier.
- Great Lakes Medical
Equipment must maintain ordering and referring
documentation
consistent
with provisions found in 42 C.F.R.
424.516(f).
- Great Lakes Medical
Equipment is prohibited from sharing a practice
location with certain
other Medicare providers and
suppliers.
- Great Lakes Medical Equipment
must remain open to the public
for a minimum
of 30 hours
per week with certain exceptions.
The Joint
Commission encourages those having concerns
or complaints about the quality of care being
provided to bring those concerns or complaints
first to the attention of Great Lakes Medical
management. If your concerns are not addressed
to your satisfaction, you may contact the Joint
Commission’s Office of Quality Monitoring
to report any concerns or register a complaint
by calling 1-800-994-6610 or emailing complaint@jcaho.org.
Matters concerning billing, insurance and payment
disputes are not within the authority of the
Joint Commission.
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