MEDICARE DMEPOS SUPPLIER STATEMENT
The products and/or services provided to you by Healthcare Alliances LLC–Milk N Mamas Baby 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 http://ecfr.gpoaccess.gov. Upon request we will furnish you a written copy of the standards.
Medicare Capped Rental and Inexpensive or Routinely Purchased Items Notification for Services on or after January 1,2006
I received instructions and understand that Medicare defines the equipment I received (listed on my delivery ticket) as being either a capped rental or an inexpensively or routinely purchased item.
FOR CAPPED RENTAL ITEMS:
Medicare will pay a monthly rental fee for a period not to exceed 13 months, after which ownership of the equipment is transferred to the Medicare beneficiary. After ownership of the equipment is transferred to the Medicare Hospital beds, wheelchairs, alternating pressure pads, air-fluidized buds, nebulizers, suction pumps, continuous airway pressure (CPAP) devices, patient lifts, and trapeze bars.
FOR INEXPENSIVE OR ROUTINELY PURCHASED ITEMS:
Equipment in this category can be purchased or rented; however, the total amount paid for monthly rentals cannot exceed the fee schedule purchase amount.
Examples of this type of equipment include:
Canes, walkers, crutches, commode chairs, low pressure and positioning equalization pads, home blood glucose monitors, seat lift mechanisms, pneumatic compressors (lymphedema pumps), bedside rails, and traction equipment.
MY SIGNATURE ON THE DME DELIVERY TICKET ACKNOWLEDGES THAT I HAVE BEEN INSTRUCTED, PROVIDED AND UNDERSTAND THE INEXPENSIVE OR ROUTINELY PURCHASED INFORMATION ON THE PRODUCT THAT I HAVE RECEIVED.
Equipment Warrant Information Form
Every product rented by Healthcare Alliances LLC–Milk N Mamas Baby carries a 1year manufacturer’s warranty. Healthcare Alliances LLC–Milk N Mamas Baby will notify all patients of the warranty coverage, and we will honor all warranties under applicable law. Healthcare Alliances LLC–Milk N Mamas Baby will repair or replace free of charge, covered equipment that is under warranty. In addition, an owner’s manual with warranty information will be provided to beneficiaries for all durable medical equipment where this manual is available. If the item falls outside the manufacturer’s warranty but is still being rented from Healthcare Alliances will honor the product for any issues that would have been covered by the manufacturers warranty.
Items sold by Healthcare Alliances LLC–Milk N Mamas Baby have a limited warranty. Please refer to the insert provided with your item for the specific warranty information.
Healthcare Alliances LLC–Milk N Mamas Baby does not warranty any issues cause by normal wear and tear or patient abuse of neglect.
MY SIGNATURE ON THE DME DELIVERY TICKET ACKNOWLEDGES THAT I HAVE BEEN INSTRUCTED, PROVIDED AND UNDERSTAND THE WARRANTY COVERAGE ON THE PRODUCT THAT I HAVE RECEIVED.
Healthcare Alliances LLC – Milk N Mamas Baby, are concerned with the satisfaction of their patients and clients. If during the course of your association with our company there are issues that you feel are examples of quality of service or are in need of attention, please do not hesitate to call us at the above number. You will receive a response from us within 5 days of your request. Unresolved complaints will receive a written response within 14 days. If you feel your complaint was unresolved and you did not receive a written response from us please call 844-645-5666. In the event your complaint remains unresolved, you may file a complaint with our Accreditor: The Compliance Team In., via their website: www.thecomplianceteam.org or via phone: 1-888-291-5353.