Pedi-Care Plus, Inc. personnel are available to assist any physician, case manager, discharge planner, clinician, and office personnel with any ongoing information. We are continually striving to be the first choice for all your home medical equipment needs.
Pedi-Care Plus, Inc is prepared to serve any Medicare patients who needs the services we are contracted for or other homecare services and products that were not subject to the competitive bidding program.
Medicare pays for durable medical and respiratory equipment in different ways, depending on the item or service (service includes service calls for repair and routine maintenance) and whether you buy or rent the equipment.
MEDICARE’S COMPETITIVE BIDDING PROGRAM
The Centers for Medicare and Medicaid Services (CMS, or “Medicare”) is implementing a new program governing home healthcare suppliers called Competitive Bidding. This program applies only to patients who have traditional fee-for-service Medicare Part B.
This program requires your Durable Medical Equipment, Prosthetics/Orthotics and Supplies (DMEPOS) providers to bid on the right to serve patients within certain Competitive Bidding Areas (CBAs) across the United States. Only qualified DMEPOS providers meeting certain CMS criteria may become Medicare contracted providers.
Effective January 2014 Pedi-Care Plus, Inc. is a bid winner in Medicare’s Competitive Bidding program for respiratory services and supplies for Miami-Dade, Broward and West Palm Beach areas.
MEDICARE DOCUMENTATION REQUIREMENTS
Enforcement of Medicare’s documentation requirements has become more stringent, and it’s affecting healthcare professionals and patients. If a claim is denied, the patient may have to assume financial responsibility. We’re helping everyone understand the new policies in order to help patients get qualified claims covered by Medicare, rather than denied . All supporting medical records and completed documentation from order physician must be in our office prior to any equipment being delivered.
MEDICARE SUPPLIER STANDARDS
- A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements and cannot contract with an individual or entity to provide licensed services.
- 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.
- 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 non-procurement 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. This standard requires that the location is 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.
- 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.
- 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.
- 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 contacting a Medicare beneficiary based on a physician’s oral order unless an exception applies.
- A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare covered items, and maintain proof of delivery.
- A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.
- 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 any person having an ownership, financial, or control interest in the supplier.
- 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.
- 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 CMS any information required by the Medicare statute and implementing regulations.
- 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).
- All suppliers must notify their accreditation organization when a new DMEPOS location is opened.
- All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare.
- All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation.
- All suppliers must meet the surety bond requirements specified in 42 C.F.R. 424.57(c).
- A supplier must obtain oxygen from a state-licensed oxygen supplier.
- A supplier must maintain ordering and referring documentation consistent with provisions found in 42 C.F.R. 424.516(f).
- DMEPOS suppliers are prohibited from sharing a practice location with certain other Medicare providers and suppliers.
- DMEPOS suppliers must remain open to the public for a minimum of 30 hours per week with certain exceptions.