Company Information

SCOPE OF SERVICE

ESP Healthcare Group, LLC provide medical equipment for home use. We provide services only to clients whom we can meet their homecare needs based on the information provided to us by the referral source.

Our Respiratory Care Practitioners will provide instructions on equipment requiring clinical instructions or from one of our trained Service Technicians for equipment not requiring clinical instructions.

We provide services to Southern and Central California Counties.

These products include but not limited to:

· Home Ventilators (Invasive & Non-Invasive)

· BILEVEL, CPAP and AUTO-PAPs

· Cough Assist

- HFCWO (High Freq Chest Wall Oscillators - aka Vest Therapy)

· Portable Suction

· Oxygen Concentrators

- Portable O2 Concentrators

TERMS AND CONDITIONS

For the purpose of this Rental Agreement, ESP Healthcare Group, LLC (EHG), shall mean its owners and employees and “CUSTOMER” shall mean Customer, its agents, heirs, representative, employees &/or assigns.

PURCHASE RETURN POLICY

Goods accepted for return will be solely at the discretion of EHG. No goods will be accepted for return after ten (10) days. All returns must be in new/unused condition, in the original packaging, and accompanied by the original invoice. RENTAL may be charge on some returned items, 25% restocking fee for special order items. Personal hygiene items are NOT returnable.

INSPECTION, ACCEPTANCE & OPERATION OF EQUIPMENT

Customer acknowledges and agrees that Customer has received, inspected and approved the equipment or merchandise listed on the delivery ticket, and that it is in good working order. Customer agrees to notify EHG immediately & cease using any rented property if it becomes unsafe or in disrepair. EHG liability shall extend only to replacement or repair thereof. Customer agrees to operate the equipment only in a reasonable manner consistent with the use for which the equipment was designed. Customer is responsible for rental equipment and shall solely be liable for its misuses, loss, damage or theft. Rental equipment shall be returned to EHG in the same condition that it was delivered, reasonable wear and tear excepted.

RENTAL PERIOD/RENT – PURCHASE/TITLE TRANSFER

All rentals and charges continue until equipment is RETURNED TO EHG. The rental period indicated on the delivery ticket is the minimum period and fee charged. Rental items are not to be removed from delivery point without permission from EHG. In the event that the customer desires to convert their rental to a purchase one month paid rental may apply towards purchase. Rental items remains the property of EHG until the purchase has been paid in full.

PAYMENT/LEGAL FEES

Customer agrees to pay in full the purchase or rental price as specified, without offset or deduction. If customer has directed that charges hereunder be billed to another person or organization, and if payment is not made as provided,
Customer agrees to pay on demand all amounts due and hereby guarantees payment thereof, as well as performance of all other terms contained herein to EHG. Failure neither to provide accurate information nor to notify EHG of any change in insurance information coverage will result in patient being responsible for 100% of charges. A late payment of 1.5% per month (18% annually) will be added to past due accounts. All accounts are due and payable within thirty (30) days from the date of the invoice. In the event an attorney is to recover reasonable attorney’s fees and court costs in such action or proceeding, in an amount to be determined by the court.

REPOSSESSION OF RENTAL ITEMS

If for any reason it becomes necessary for EHG to retake the rental items, Customer authorizes EHG to retake the rental items without further notice or further legal process and, agrees that EHG shall not be liable for any claims for damage or trespass arising out of the removal of the rental items.

TITLE AND SECURITY INTEREST

Title to rental equipment remains with EHG. Customer shall not remove or alter any identification on the equipment and all rental equipment must be returned to EHG on demand. Customer hereby grants a security interest to EHG or purchased equipment or merchandise until all amounts due EHG are paid in full. Customer agrees that if after reasonable notice customer fails to pay any charge when due, EHG may, in addition to all other remedies available, sell equipment or merchandise to the customer and proceed to collect the amount.

DISCLAIMER OF WARRANTIES

EHG makes no warranty of merchantability or fitness for any particular use or purpose, either expressed or implied. There is no warranty or representation that the rental items are fit for Customer’s particular intended use or that it is free of latent defects. EHG shall not be responsible to Customer or any of their party for any loss, damage or injury resulting from, or in any way attributable to the operation of, use of, or any failure of the rental items. EHG shall not be responsible for any defect or failure unknown to EHG. Customers sole remedy for any failure of or defect in the rental items shall be Termination of the rental charges at the time of failure provided that the customer notifies EHG immediately of such failure and returns the rental time to EHG within 24 hours of such failure.

INDEMNITY/HOLD HARMLESS

Customer will take all necessary precautions regarding the items rented and protect all persons and property from injury or damage. Customer agrees to hold harmless EHG from and against any and all liability, claims, not limited to injuries or death to persons and damage to property, arising out of the use, maintenance, instruction, operation, possession, ownership or rental of the items rented, however, caused, except claims or litigation arising through the sole negligence or willful misconduct to EHG.

NOTICE OF NON-WAIVER/SEVERABILITY

Any failure of EHG to insist upon strict performance by Customer as regards to any provision of the Rental Agreement shall not be interpreted as a waiver of EHG rights to demand strict compliance with all other provisions of the Rental Agreement against Customer or any other person. The provisions of the Rental Agreement shall be several so that the unenforceability, invalidity or waiver of any provision shall not affect any other provision. (See attached Medicare Standards)

SUPPLIER STANDARDS

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 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 advice 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 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, 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. Failure to maintain required insurance at all times will result in revocation of the supplier’s billing privileges retroactive to the date the insurance lapsed.
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 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 though 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 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 Supplier 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.
Complain 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.
Must meet the surety bond requirements specified in 42 C.F.R. 424.57c. Implementation date – May 4, 2009.
A supplier must obtain oxygen from 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.

PATIENT BILL OF RIGHTS & RESPONSIBILITIES

Rights & protections for everyone with Medicare

Be treated with dignity and respect at all times.
Be protected from discrimination. Every company or agency that works with Medicare must obey the law. They can't treat you differently because of your race, color, national origin, disability, age, religion, or sex.
Have your personal and health information kept private.
Get information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors.
Get understandable information about Medicare to help you make health care decisions, including:
What’s covered.
What Medicare pays.
How much you have to pay.
What to do if you want to file a complaint or appeal.
Have your questions about Medicare answered.
Have access to doctors, specialists, and hospitals.
Learn about your treatment choices in clear language that you can understand, and participate in treatment decisions.
Get health care services in a language you understand and in a culturally-sensitive way.
Get Medicare-covered services in an emergency.
Get a decision about health care payment, coverage of services, or prescription drug coverage.
When a claim is filed, you get a notice letting you know what will and won’t be covered. The notice comes from one of these:
Medicare
Your Medicare Advantage Plan (Part C)
Your other Medicare health plan
Your Medicare Prescription Drug Plan (Part D)
If you disagree with the decision of your claim, you have the right to file an appeal.
Request a review (appeal) of certain decisions about health care payment, coverage of services, or prescription drug coverage.
If you disagree with a decision about your claims or services, you have the right to appeal.
File complaints (sometimes called "grievances"), including complaints about the quality of your care.

Patient Responsibilities

To provide complete and accurate information concerning your health, when appropriate to your care/services.
To inform a staff member as appropriate, of your health history, including past hospitalization, illnesses, injuries, etc.
To participate as needed and as able, in developing, carrying out and modifying your home care service plan, such as properly cleaning and storing your equipment and supplies.
To be familiar with safety information provided and actively participates in maintaining a safe environment in your home.
To request additional assistance or information on instructions, plan of care you do not fully understand.
To notify your health care provider when you feel ill or encounter any unusual physical or mental stress or sensations.
To notify ESP Healthcare Group, LLC if you will not be home at the time of scheduled home visits.
To notify ESP Healthcare Group, LLC prior to changing your place of residence or telephone number.
To notify ESP Healthcare Group, LLC if you are encountering problem with equipment or service.
To notify ESP Healthcare Group, LLC if you are to be hospitalized or if your physician modifies or ceases your home care prescription.
To make conscious effort to properly care for equipment supplied and to comply with all other aspects of the home care plan developed for you.
To notify ESP Healthcare Group, LLC of denial and/or restrictions of the ESP Healthcare Group Privacy Policy.
To notify ESP Healthcare Group, LLC of any change of insurance.
To notify ESP Healthcare Group, LLC of any change in physician that affects your care as it relates to your equipment.
To promptly return the signed Equipment Delivery Ticket to acknowledge receipt of equipment or supplies delivered.

TRANSFER OF EQUIPMENT OWNERSHIP

Medicare Fact Sheet

Under a special rule established for certain patient-owned equipment, such as a power wheelchair for which the title has been transferred to the patient after 13 continuous months of rental, the supplier must replace the equipment free of charge if it does not last the full 5-year period (i.e., is no longer serviceable or needs substantial repairs). This replacement equipment does not need to be ‘new'. For more information, refer to 42 Code of Federal Regulations (CFR) Section 414.210(e)(4).

This passage references regulations that implemented the Deficit Reduction Act of 2005 (DRA). This regulation stipulates that the supplier is responsible for replacement of a capped rental item if it is determined to be incapable of lasting for the entire 5 year reasonable useful lifetime. Replacement is provided at no cost to the beneficiary or to the Medicare program. 42 Code of Federal Regulations (CFR) Section 414.210(e)(4) states:

(4)Supplier replacement of beneficiary-owned equipment based on accumulated repair costs. A supplier that transfers title to a capped rental item to a beneficiary in accordance with §414.229(f)(2)* is responsible for furnishing replacement equipment at no cost to the beneficiary or to the Medicare program if the carrier determines that the item furnished by the supplier will not last for the entire reasonable useful lifetime established for the equipment in accordance with §414.210(f)(1)**. In making this determination, the carrier may consider whether the accumulated costs of repair exceed 60 percent of the cost to replace the item.

* §414.229(f)(2) describes requirements for providing a capped rental item

** §414.210(f)(1) describes reasonable useful lifetime requirements

The default reasonable useful lifetime (RUL) of durable medical equipment (DME) is five years unless otherwise specified. Therefore, DME dispensed to Medicare beneficiaries is expected to remain in proper working condition throughout the required five year RUL. If it is determined based upon accumulated repair costs that the item is unable to last for the entire 5 year RUL, the supplier must replace the equipment with properly working equipment at no charge to the beneficiary or the Medicare program.

"Accumulated repair costs" refer to all repair claims from all suppliers for a given item after the rental period ends. These repair costs represent the total of all repair costs after the beneficiary has assumed ownership of the item.

The DME MACs encourage suppliers to provide DME items of sufficient quality to last for the entire 5 year RUL.

Refer to the Supplier Manual and/or the applicable Local Coverage Determination and related Policy Article for additional information on repairs and replacement.

Last Updated May 23, 2017

ESP Healthcare Group

ESP Healthcare Group

CLIENT SERVICES

PAP Device and Supplies Order Form

Company Information & Terms of Condition

Company Information & Terms of Condition

Company Information & Terms of Condition

Company Information & Terms of Condition

Company Information & Terms of Condition

Supplier Standards

Company Information & Terms of Condition

Patient Bill of Rights & Responsibilities

Patient Bill of Rights & Responsibilities

Patient Bill of Rights & Responsibilities

Patient Bill of Rights & Responsibilities

Privacy Practice

Patient Bill of Rights & Responsibilities

Transfer of Equipment

Transfer of Equipment

Patient Bill of Rights & Responsibilities

Transfer of Equipment

Additional Forms & Resources

Additional Forms & Resources

Additional Forms & Resources