AMARILLO, TX – Medicare pays a hospice under Part A. This means that when a DME supplier provides equipment to a hospice patient, the hospice will pay the supplier (i.e., the supplier will not bill Medicare for the equipment). The supplier and hospice will need to enter into a Hospice Durable Medical Equipment (“Agreement”) that sets out the rights and responsibilities of the supplier and the hospice. Set out hereafter are some of the key provisions to the Agreement.
- Hospice is engaged in providing end-of-life care for individuals and their families at patients’ homes and in Hospice’s inpatient facility (“Facility”).
- Supplier is a duly licensed and Medicare-certified supplier of durable medical equipment, prosthetics, orthotics, and supplies (“DMEPOS”) in the business of providing durable medical equipment and supplies (“Equipment”).
- Hospice and Supplier wish to enter into this Agreement for Supplier to provide needed Equipment to Hospice such that Hospice can meet its mission to serve its patients and their
- Hospice will use Supplier as its supplier of Equipment listed in Attachment A.
- Hospice will provide as much advance notice to the Supplier as possible when placing an order for Equipment. All non-urgent orders will be delivered on the next business day after the order is submitted.
- Hospice will retain professional and financial responsibility for all hospice
- On a daily, business-day basis, unless otherwise agreed in writing, Hospice will provide Supplier with a list or orally communicate the names of patients who have been utilizing Supplier’s Equipment and who were transferred from home or Facility to a facility not operated by Hospice or discharged from Hospice.
- Hospice will obtain and keep on record all prescriptions and dispensing orders required by law for Equipment ordered. Hospice will provide the same to the Supplier for its records as requested.
- At the commencement of this Agreement, Hospice will provide the name of the current Medical See Attachment B. Should the Medical Director change during the term of this Agreement, Hospice will notify Supplier within five business days.
- Hospice will be solely responsible for ensuring that the equipment ordered is clinically appropriate and safe for the use of the individual patients.
- Supplier represents and warrants that it and all individuals employed or acting on its behalf will comply with all applicable legal and regulatory requirements. Supplier also warrants that it and all individuals employed or acting on its behalf will comply with all applicable professional standards of conduct in providing Equipment and services to patients of Hospice.
- Supplier represents and warrants that all individuals employed by or acting on its behalf who are assigned by Supplier to deliver Equipment for and provide services to patients of Hospice will have:
- Prior to hiring or contracting, been subject to: (i) a statewide and national criminal search; (ii) Social Security number validation and tracing; (iii) screening for healthcare sanctions nationwide; (iv) validation of professional license; (v) screening for presence on the National Sex Offender Registry; and (vi) verification that the individual has not been excluded by Office of Inspector General, the federal government’s System for Award Management, or any state Medicaid program.
- Not been excluded or otherwise made ineligible from participating in federally sponsored health care programs.
- Received appropriate education and training on the confidentiality, privacy, and security of patient health information and signed an agreement to comply with all applicable federal and state laws and regulations and professional standards concerning the confidentiality, privacy, and security of patient health information.
- Satisfied any other mutually agreed upon specific requirements communicated to Supplier by Hospice prior to the employee’s or agent’s assignment.
- Supplier further represents and warrants that it will maintain documentation of the foregoing requirements and provide said documentation to Hospice upon request.
- Supplier will provide services 24 hours a day, seven days per week, as appropriate.
- Supplier will deliver Equipment as requisitioned by the Non-urgent orders will be delivered on the next business day after Hospice places an order for the Equipment. Urgent deliveries will be delivered the same day as ordered. Urgent deliveries will include: [List the Equipment]
- Supplier will provide Equipment that is in proper working
- Supplier, as ordered and determined to be appropriate by Hospice and with consent of the patient or authorized representative, will provide the following services in a prompt and professional manner: (i) supplying and setting up Equipment ordered by Hospice including fitting and/or applying supplied Equipment to the patient; (ii) providing any necessary education, training, and/or instructions to the patient, the patient’s caregivers, and such other individuals as designated by the patient for supplied Equipment; and (iii) any necessary follow-up services to the patient, the patient’s caregivers, and such other individuals as designated by the patient for supplied Equipment.
- Supplier will provide the patient and/or caregiver(s) with oral and written instructions regarding each item of Equipment including, but not limited to, its purpose, operation, proper location within the home, safety precautions, any maintenance and cleaning/disinfecting procedures, troubleshooting and emergency plans, appropriate response to alarms and indicators, operation of backup oxygen when power is lost, and the phone number to call 24 hours per day if failure occurs.
- Supplier will maintain all Equipment in proper working order and will respond promptly to service calls.
- Supplier will provide basic safety checks on all Equipment according to manufacturer’s guidelines and maintain documentation of all quality control checks. Upon Hospice’s request, Supplier will provide copies of said documentation to Hospice.
- Supplier will pick up Equipment from a patient’s home or skilled facility, including the Facility, in a timely manner. Supplier will coordinate with family or patient caregiver within one business day of a request to schedule retrieval of Equipment at a mutually agreeable time.
- Supplier will participate in Hospice’s Quality Assessment and Performance Improvement program and cooperate with Hospice’s assessment of the quality of the services provided by the Supplier under this Agreement.
Billing And Payment
- For the Equipment and related services provided under this Agreement, Supplier will submit an invoice to Hospice in accordance with Attachment A.
- The charge amounts listed on Attachment A will remain in effect for the term of this Agreement, unless otherwise agreed to by the parties in The parties represent that the rates are consistent with the fair market value of the Equipment and related services. On the anniversary of the Effective Date, the parties will reevaluate whether the rates are still consistent with the fair market value for the Equipment and related services offered pursuant to this Agreement.
- Supplier and Hospice agree the rates in Attachment B will be kept confidential from third parties, other than payors.
- Supplier will submit invoices directly to Hospice at the address listed in Section 10, or such other address as provided by Hospice, to the attention of the Accounts Payable Supplier will submit invoices for all non-formulary items with accompanying documentation as agreed upon by both parties. Supplier will submit invoices to the address or email provided by Hospice.
- Billing under this Agreement will be in accordance with federal and state
- Billing of rental items will continue until the earliest of the:
- Date Hospice notifies Supplier of a patient’s transfer or discharge from Hospice, provided; however, that Hospice will notify Supplier of any such patient transfer or discharge prior to the occurrence of same. If Hospice notifies Supplier after the date of such transfer or discharge, the date of discontinuation will be the date on which Hospice notifies Supplier of the transfer or discharge; or
- Date Equipment is picked up by Supplier, if Supplier is not notified of discharge or transfer directly from Hospice,
- Supplier will not bill any other party in connection with Equipment provided under this Agreement.
- In the event that Supplier is unable to recover Equipment as a result of loss, Hospice’s actions or inactions, or a patient’s or caregiver’s refusal to return Equipment, or if the Equipment is damaged beyond repair through misuse, neglect, or intentional vandalism of any employee or agent of Hospice, Hospice will be billed the fair market value of the replacement cost of the An account representative for Supplier will work with Hospice to make all reasonable recovery efforts before billing Hospice for Equipment. Fair market value will be discussed and agreed upon with Hospice based on the age, condition, and replacement cost of the Equipment, and situation resulting in its loss.
- Any disputed charges must be submitted to supplier in writing within 45 days. Any charges not disputed in writing within 45 days will remain the responsibility of Hospice regardless of future findings. Hospice will pay the Supplier within 45 days of receipt of the Supplier’s invoice.
- Supplier will review and reconcile all payments within 45 days of receipt of payment. Supplier will notify Hospice of any improper payments in writing within 45 days and any incorrect or underpaid amounts not reported to Hospice within 45 days of payment receipt will be deemed uncollectable by Supplier.
- Hospice will be responsible for payment for all Equipment ordered and provided under this Agreement independent of a Medicare beneficiary’s hospice election or benefit enrollment status at the time the Equipment is provided.
Term and Termination
- This Agreement will be effective as of the Effective Date in the first paragraph and will continue in effect unless either party terminates the contract by providing the other party with 60 days’ written Effective termination date will be the first calendar day of the month following the provision of the 60 day written notice.
- Upon the effective date of the termination of this Agreement, Supplier will not provide Equipment for any new The termination date will not affect the provision of Equipment or services to patients to whom Supplier has already been providing Equipment or services as of that termination date. In order to fulfill the parties’ continuing obligations to Hospice’s patients, Supplier and Hospice agree that Supplier will continue to provide Equipment to patients already being served by Supplier at the rates in Attachment A for one calendar month following the effective termination date (the “Attrition Period”) until either the patient is no longer under Hospice’s care, or a time period mutually agreed upon by the parties in writing.
- Within one calendar month of Attrition Period end date, Hospice agrees to coordinate (i) the transition of any remaining patients to another vendor and (ii) the retrieval of any of Supplier’s Equipment by Supplier. Billing will continue at rates outlined in Attachment A until date equipment is picked up.
- In the event Hospice is unable to facilitate pickup of Supplier equipment during the one calendar month transition period, all remaining patients will be billed at the monthly rate outlined in Attachment A until equipment is picked up by Supplier.
- After consulting with Hospice, Supplier will coordinate with remaining patients, family, and/or patient caregivers to determine a mutually agreeable time to remove Equipment.
Business Associate Addendum
- In providing Equipment to Hospice patients, Supplier will be acting as Hospice’s Business Associate, as that term is defined in regulations promulgated under the Health Insurance Portability and Accountability Act (“HIPAA”). Accordingly, the parties will execute the Business Associate Agreement in Attachment C.
Jeffrey S. Baird, JD, is chairman of the Health Care Group at Brown & Fortunato, PC, a law firm with a national health care practice based in Texas. He represents pharmacies, infusion companies, HME companies, manufacturers and other health care providers throughout the United States. Mr. Baird is Board Certified in Health Law by the Texas Board of Legal Specialization and can be reached at (806) 345-6320 or email@example.com.
AAHOMECARE’S EDUCATIONAL WEBINAR
Six-Year Lookback Audits: How to Prepare and Respond
Presented by: Denise M. Leard, Esq., Brown & Fortunato & Jeffrey S. Baird, Esq., Brown & Fortunato
Tuesday, December 13, 2022
1:30-2:30 p.m. CENTRAL TIME
The Affordable Care Act includes the 60-day overpayment rule that requires DME suppliers to refund overpayments within 60 days of identification. What many suppliers are not aware of is that if an overpayment is identified, either internally or externally, suppliers are mandated by law to perform a six-year look-back audit. If suppliers do not comply with this rule, they are at risk for false claim penalties. This webinar will (i) discuss the 60-day overpayment rule and the six-year lookback obligation; (ii) discuss steps that suppliers can take to reduce the risk of being subjected to the 60-day overpayment rule; and (iii) set out the steps the supplier should take to successfully fulfill its obligations under the rule.