Monroe Wheelchair

CUSTOMER WELCOME

Welcome to Monroe Wheelchair. We thank you for giving us the opportunity to meet your home medical equipment needs. Our employees are dedicated to a common goal- providing excellent service with quality equipment. All of Monroe Wheelchair’s operations are continuously monitored in order to ensure that our customers receive only the highest quality service. Our commitment to excellence is exemplified by supplying state-of-the-art home medical equipment combined with the expertise of our professional staff. In addition, personnel are kept current on insurance programs to assist you with proper selection of equipment and related coverage requirements for Medicare and other insurance companies. For your convenience, Monroe Wheelchair offers a complete line of products and supplies. Please feel free to call us regarding any of your equipment or supply needs. Additionally, for your information please note the following.

HOURS OF OPERATION: Monroe Wheelchair is open from 8:00 a.m. to 5:00 p.m. Monday through Friday. Our offices are closed on Saturday and Sunday.

PLACING ORDERS: We do provide same day delivery service however when possible, please place your equipment orders one day prior to the required delivery date.

INSURANCE: We offer billing services to Medicare, Medicaid, and most private insurance companies. Please provide us with all pertinent billing information at the time of order. It is your responsibility to inform us of any changes in your insurance.

Monroe Wheelchair strives for 100% compliance with all government and private insurance companies. Any billing compliance issues should be addressed with our Chief Compliance Officer Mary Shutes (585)385-3920 x 324, .

SERVICE AREA: Monroe Wheelchair offers a home delivery and pick up service for all of Western & Central New York, as well as New York’s Southern Tier and Capital District.

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If at any time during your course of service with Monroe Wheelchair you have questions, please call us. One of our customer service representatives will be glad to assist you.

“A Privately Owned Corporation

Doug Westerdahl, President

MEDICAL EQUIPMENT AND SUPPLIES

The following is a listing of some of the items available through Monroe Wheelchair. If you have a need for any of these items or for more information please call us at any of the following branch locations:

Monroe WheelchairMonroe Wheelchair of the Capital Region

3340 Monroe Avenue 18 Hemlock Street

Rochester, NY14618Latham, NY12110

Phone:585-385-3920 Phone:518-783-1653

Fax:585-385-6966Fax:518-783-6305

Toll Free:888-546-8595Toll Free:877-562-4484

Monroe Wheelchair of Central New York

6181 Thompson Road, Suite 500

Syracuse, NY 13206

Ph:315-445-2220

Fax:315-445-2059

Toll Free:877-666-7630

PRODUCTS

Manual WheelchairsAlternating Pressure Pads

Power WheelchairsTransport Chairs

Hospital BedsTrapeze

Bath BenchesCommodes

WalkersWheelchair Cushions Hand Held Showers Seat Lift Chairs

Support SurfacesScooters

Wheelchair RampsPatient Lifts

Grab BarsBed Side Rails

Rehabilitation EquipmentRepair Services

MONROE WHEELCHAIR

OUR COMPANY VALUES

1-WE HONOR AND UPHOLD THE AUTHORITY OF OUR LEADERS

2-WE CONCENTRATE AND FOCUS ON OUR MISSION

3-WE SPEAK POSITIVELY AND ENCOURAGE OTHERS

4-WE DEVOTE TIME TO RECREATION AND REFLECTION

5-WE REVERE THOSE WITH WISDOM

6-WE DIGNIFY THE GIFT OF LIFE

7-WE SUPPORT TRADITIONAL FAMILY VALUES

8-WE UTILIZE ONLY WHAT IS RIGHTFULLY OURS

9-WE VALUE HONESTY AND TELL THE TRUTH

10-WE RESPECT THE PROPERTY AND RIGHTS OF OTHERS

OUR MISSION STATEMENT:

“WE ARE DEDICATED TO IMPROVING

OUR CUSTOMERS QUALITY OF LIFE”

MONROE WHEELCHAIR

HOME ENVIRONMENT

GENERAL SAFETY INFORMATION

FOR HOME MEDICAL EQUIPMENT USE

IN CASE OF FIRE IT IS RECOMMENDED THAT YOU:

-HAVE A WORKING SMOKE DETECTOR

-DO NOT BLOCK EXIT DOORS/WINDOWS

-HAVE A FIRE EXTINGUISHER AND KNOW ITS PROPER USE

-KNOW HOW TO SUMMON EMERGENCY ASSISTANCE

WHEN USING ELECTRICALLY POWERED EQUIPMENT:

-USE PROPERLY RATED EXTENSION CORD

-KNOW HOW TO USE ELECTRICAL ADAPTERS FOR GROUNDING

-AVOID CONNECTING MULTIPLE PIECES OF EQUIPMENT TO ONE

OUTLET

-BE AWARE OF POSSIBLE CIRCUIT OVERLOAD

-AVOID LIQUID EXPOSURE TO ALL ELECTRICAL EQUIPMENT

KEEPING YOUR HOME ENVIRONMENTALLY SAFE:

-REMOVE AREA RUGS FROM SLIPPERY FLOORS

-KEEP FLOOR SURFACES DRY

-AVOID USE OF EXCESS WAX ON FLOORS

-MAKE SURE YOU HAVE PROPER LIGHTING

-FURNITURE SHOULD BE ARRANGED FOR SAFE ACCESS AND

MOBILITY FOR EQUIPMENT BEING USED

-AVOID CLIMBING STAIRS WITHOUT ASSISTANCE IF YOU ARE

UNSTEADY ON YOUR FEET

HAVE EMERGENCY NUMBERS POSTED BY YOUR PHONE:

-AMBULANCE

-FIRE

-POLICE

-PHYSICIAN

-LOCALHOSPITAL EMERGENCY ROOM

-MONROE WHEELCHAIR AND OTHER AGENCIES INVOLVED IN

YOUR CARE AT HOME

PLEASE CALL MONROE WHEELCHAIR BEFORE ATTEMPTING ANY REPAIRS ON YOUR EQUIPMENT

Customer Complaints

Any customer who feels his/her rights have been denied, who desires further clarification of rights, or who desires to lodge a complaint or express concern with any aspect of Monroe Wheelchair’s service or equipment, including concerns about patient safety and risk of falls, shall contact us through our main telephone number. This can be done without fear of reprisal by Monroe Wheelchair or any of its employees. If the issue cannot be resolved via a telephone call with a customer service representative, the matter will automatically be forwarded to the appropriate member of our management team. If the matter is still not resolved to the customer’s satisfaction a complaint may be registered with the Joint Commission without fear of retaliatory action from Monroe Wheelchair. They may be contacted the following ways:

Web Site:

Phone:630-792-5000

Mail:The Joint Commission

One Renaissance Blvd.

Oakbrook Terrace, IL 60181

Patient Rights and Responsibility

Patients receiving Home Durable Medical Equipment have the right to:

1)Be cared for with respect and kindness

2)Be told about their health care problems

3)Be told how their health care problems are usually treated

4)Be told what they can expect from treatment

5)Agree to their treatment

6)Refuse any part of treatment and/or items prescribed

7)Be told what will happen if they refuse any treatment

8)Privacy

9)Voice concerns if they feel their rights have been denied

10)Appeal any decisions they feel are not in their best interest

11)Have their appeal rights and method for appeal explained to them

12)Be discharged from the Durable Medical Equipment Program at any time

13)Be trained in use, maintenance and infection control of item provided

14)Have an item repaired if eligible for this service

Patients receiving Home Durable Medical Equipment have the responsibility to:

1)Treat personnel delivering service with courtesy and respect

2)Ask questions about any part of their care and items provided that they do not understand

3)Communicate any changes in their conditions

4)Communicate other health problems they have had in the past

5)Follow the instructions given to them for maintenance of items provided

6)Communicate problems they are having following any instructions

7)Indicate if they decide not to follow some of the instructions given to them

8)Not abuse the equipment provided

9)Notify Monroe Wheelchair if they have any other problems or difficulties with items provided

10) Notify Monroe Wheelchair if they have an Advanced Directive(DNR)

Monroe Wheelchair

Parts & Labor Warranty Policy

Monroe Wheelchair honors all manufacturer’s warranties. Parts considered to be warranty eligible will be replaced at no charge. Customer’s Insurers will not be billed for warranty eligible parts.

Parts needing replacement due to normal wear and tear are not warranty eligible.

Parts needing replacement due to customer abuse are not eligible for warranty replacement. Customer abuse is determined by the manufacturer, not Monroe Wheelchair.

Typically the manufacturers in our industry provide “parts only” warranties. Labor is not covered under their warranties.

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 and cannot contract with an individual or entity to provide licensed services.
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. 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.

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, 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 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.

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). Implementation Date - October 1, 2009

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(c). 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.

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.

If you have any questions about this notice, please contact: Doug Westerdahl 585-385-3920.

OUR OBLIGATIONS:

We are required by law to:

  • Maintain the privacy of protected health information
  • Give you this notice of our legal duties and privacy practices regarding health information about you
  • Follow the terms of our notice that is currently in effect

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION:

The following describes the ways we may use and disclose health information that identifies you (“Health Information”). Except for the purposes described below, we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to our practice Privacy Officer.

For Treatment: We may use and disclose Health Information for your treatment and to provide you with treatment-related health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.

For Payment: We may use and disclose Health Information so that we or others may bill and receive payment from you, an insurance company or a third party for the treatment and services you received. For example, we may give your health plan information about you so that they will pay for your treatment.

For Health Care Operations: We may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office. For example, we may use and disclose information to make sure the obstetrical or gynecological care you receive is of the highest quality. We also may share information with other entities that have a relationship with you (for example, your health plan) for their health care operation activities.

Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services: We may use and disclose Health Information to contact you to remind you that you have an appointment with us. We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care: When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.

SPECIAL SITUATIONS:

As Required by Law: We will disclose Health Information when required to do so by international, federal, state or local law.

To Avert a Serious Threat to Health or Safety: We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.

Business Associates: We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

Military and Veterans: If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.

Workers’ Compensation: We may release Health Information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Health Oversight Activities: We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Data Breach Notification Purposes: We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your health information.