New Patient Information Pack

Care Airways Corporation 1095 Broken Sound Parkway NW Suite 101 Boca Raton, FL 33487

Phone : 855.713.1012 Fax : 561.634.3424

Location: 1095 Broken Sound Parkway NW Suite 101Boca Raton, FL 33247

Scope of Services Sales and Rentals of Oxygen Concentrators Sales and Rentals of Portable Oxygen Concentrators

Geographic Coverage Nationwide USA. Please call for any State Restrictions

Mission Statement

Compliance and Commitment

• 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.
• Be informed, in advance of care/service being provided of their financial responsibility.
• Receive information about the scope of services that the organization will provide and any specific
• limitations on those services.
• Participate in the development and periodic revision of the plan of care.
• Refuse care or treatment after the consequences of refusing care or treatment are fully presented.
• Be informed of client/patient rights under state law to formulate an Advanced Directive, if applicable.
• Have one’s property and person treated with respect, consideration and recognition of client/patient dignity and individuality.
• Be able to identify visiting personnel members through proper identification.
• Be free from mistreatment, neglect, or verbal, mental, sexual and physical abuse, including injuries of unknown source and misappropriation of client/patient property.
• Voice grievances/complaints regarding treatment or care of lack of respect of property, or recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal.
• Have grievance/complaints regarding treatment of care/service that is (or fails to be) furnished, or lack of respect of property investigated.
• Confidentiality and privacy of all information contained in the client/patient record and of Protected Health Information (PHI).
• Be advised of the agency’s policies and procedures regarding the disclosure of client/patient records.
• Choose a healthcare provider, including an attending physician, if applicable
• Receive appropriate care/service without discrimination, in accordance with physician orders, if
• applicable.
• Be informed of any financial benefits when referred to an organization.
• Be fully informed of one’s responsibilities.

• Ask questions about any part of the plan of service or plan of care that you do not understand.
• Protect the equipment from fire, water, theft or other damage while it is in your possession.
• Use the equipment for the purpose for which it was prescribed, following instructions provided for use, handling care, safety and cleaning.
• Supply us with needed insurance information necessary to obtain payment for services and
• assume responsibility for charges not covered. You are responsible for settlement in full of your
• account.
• Be at home for scheduled service visits or notify us in advance to make other arrangements.
• Notify us immediately of:
  • Equipment failure, damage or need of supplies.
  • Any change in your prescription or physician.
  • Any change or loss in insurance coverage.
  • Any change of address or telephone number, whether permanent or temporary.
  • Discontinued equipment or services
• Be respectful of the property owned by our company and considerate of our personnel.
• Contact us if you acquire an infectious disease during the time we provide services.

• Obtain a letter from your doctor stating the need for priority service due to “life support” equipment.
• Call your utility provider for your local district’s office address and mail the doctor’s letter to them.

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete.
• Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
• Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests. Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information. Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
• We will provide you with a paper copy promptly. Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action. File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us using the information on page 1.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/
• We will not retaliate against you for filing a complaint.

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory

• Marketing purposes
• Sale of your information
• Fund-raising

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

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. A supplier must have an authorized individual (whose signature is binding) sign the enrollment application for billing privileges.
4. A supplier must fill orders from its own inventory, or contract with other companies for the purchase of items necessary to fill orders. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or 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 and must maintain a visible sign with posted hours of operation. The location must be 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.
8. A supplier must permit CMS or its agents to conduct on-site inspections to ascertain the supplier’s compliance with these standards.
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, answering service or cell phone during posted business hours 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 is prohibited from direct solicitation to Medicare beneficiaries. For complete details on this prohibition see 42 CFR § 424.57 (c) (11).
12. A supplier is responsible for delivery of and must instruct beneficiaries on the use of Medicare covered items, and maintain proof of delivery and beneficiary instruction.
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 cost either directly, or through a service contract with another company, any 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 standards to each beneficiary it supplies a Medicare-covered item.
17. A supplier must disclose 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 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 for 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. A supplier must meet the surety bond requirements specified in 42 CFR § 424.57 (d).
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 CFR § 424.516(f).
29. A supplier is prohibited from sharing a practice location with other Medicare providers and suppliers.
30. A supplier must remain open to the public for a minimum of 30 hours per week except physicians (as defined in section 1848(j) (3) of the Act) or physical and occupational therapists or a DMEPOS supplier working with custom made orthotics and prosthetics.
31. DMEPOS suppliers have the option to disclose the following statement to satisfy the requirement outlined in Supplier Standard 16 in lieu of providing a copy of the standards to the beneficiary. The products and/or services provided to you by Affordable Home Healthcare are subject to the supplier standards contained in the Federal regulations shown at 42 Code of Federal Regulations Section 424.57(c). These standards concern business professional and operational matters (e.g. honoring warranties and hours of operation). The full text of these standards can be obtained at . Upon request, we will furnish you a written copy of the standards.

Thank you for signing the Medicare required documentation. You will automatically be sent a copy to keep for your own records. These documents are required to be compliant with Medicare Supplier Standards.

Care Airways Corporation is the Claims Division having referral relationships with sister companies; 1st Class Medical, LPT Medical, and Sprylyfe. Care Airways Corp is Accredited by the Medicare approved Accreditation Commission for Healthcare (ACHC).

1. Your paperwork and Method of Payment will be processed and kept on file.
2. The equipment you selected with your representative will be shipped promptly.
3. The equipment will require a signature at delivery which will be kept on file.
4. You will be contacted shortly after delivery, usually within 2 to 3 days by a setup specialist that will spend any amount of time you might need to get comfortable with the equipment and answer any questions you have.
5. We will then need to contact your current oxygen provider (if applicable) and let them know that their rental equipment is no longer in use, no longer needed, and to be picked up immediately.
6. We will issue a Change Provider Notice (sent to you for signature) that formally ceases any billing activity for your previous service with them.
7. They must release your Documentation of Medical Necessity and billing records to us they were required to keep on file. These are the same documents we will use to submit claims on your behalf.
8. You will receive treasury checks in the mail (monthly) that will be equal to the amount that was being paid to your oxygen provider. You will continue to receive monthly checks based the number of months remaining in your eligibility (max=36 months).

It would be helpful and beneficial to you or your loved one to get started on item #7 above. The records being kept by your oxygen provider are YOURS and are only on loan to them. They are compelled to give them to you. This will make the claims we process on your behalf happen much more quickly and minimize any delay. You may ask for your records at anytime. They will not be able to pick up the rental equipment until we tell them to. Don’t let them intimidate you as they occasionally try to do.

If you have any questions or concerns, please call us anytime at 855.713.1012.

Thanks again for your business!

CARE AIRWAYS CORPORATION