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 standard , 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.Approved by: ACHC
Original approval date: 06/01/2021
Date revised:
ACHC Standard: DRX5-3A
The organization expects that most services will be requested by the patient’s primary care physician or specialist or hospital attending physician. In the event that a patient requests care/service on their own then an evaluation will be performed to determine their eligibility, level of care and support needs. A care plan would then be put into place for the patient. The plan of care would be appropriate and as stated in Standard DRX5-2CR the physician would become involved at this point.
When supplying equipment, items, and services to patients and caregivers, we will:
When available we will leave written instructions, or oral communication, preferably in English, to the patient/caregiver regarding use, maintenance, cleaning, and disinfecting the equipment.
Our goal is that the patient knows how to use the equipment and understands everything about it when we leave. They are always welcome to call the pharmacy with any questions.
We will offer the patient/caregiver follow-up services, consistent with the equipment, items, and services given, and the prescribing physician recommendations.
Approved by: ACHC
Original approval date: 06/01/2021
Date(s) revised:
ACHC Standard: DRX5-5CR
Written and/or verbal instructions will be provided to the patient at the initiation of service and will be specific to the product or service provided. These instructions will include manufacturer's guidelines on safe use, care (and maintenance if required), and hazards of use of any product or service we render.
These instructions will be offered by the pharmacist on duty.
Acceptance and/or refusal of instructions will become a part of the patient file.
Approved By: ACHC
Original Approval Date: 06/01/2021
Date(s) Revised:
ACHC Standard: DRX5-8A
We do not supply services that are not specifically requested by the patient or their physician. This means that the patient, their caregiver, or their physician must contact the pharmacy to request a refill of DMEPOS supplies—we do not auto-refill these products.
When the refill was requested, how much quantity was requested and who requested the refill will be documented on the patient record.
Approved By: ACHC
Original Approval Date: 06/01/2021
Date(s) Revised:
ACHC Standard: DRX5-2CR
A pharmacist or appropriately trained pharmacy technician will initially evaluate the eligibility, service and support needs of the patient. The patient’s physician will then be contacted to confirm and/or address the recommendations of the evaluation, if required.
The evaluation will include such things as the requested needed supplies, the physician order, diagnosis, physician name, length of need, any special patient needs, and how to contact the pharmacy in case of emergency.
Approved By: ACHC
Original Approval Date: 06/01/2021
Date(s) Revised:
ACHC Standard: DRX7-7CR
When we receive recall notices either from the manufacturer, wholesaler, or a governmental agency the organization will respond immediately. On medical products such as wheelchairs, walkers, nebulizers and ostomy/enteral nutrition pumps the manufacturer and serial number will be recorded on the patient profile. On prescription drugs a recall typically is only to the retail level and of course we would check our stock and pull any affected products. If it goes to a patient level recall we would be able to review who received a particular manufacturers’ product and contact them with instructions on how to return or to safely dispose of the drug.
If there is an external report of a defect in one of our products by the patient or their caregiver we will respond immediately and attempt to remedy or replace if necessary. The patient’s physician will be notified regarding any defect or recall.
Approved By: ACHC
Original Approval Date: 06/01/2021
Date(s) Revised:
ACHC Standard: DRX2-5A
The patient has the right to a confidential record. The organization ensures this right by way of policies and procedures designed to secure patient information.
Protected Health Information (PHI) is health data created, received, stored, or transmitted by HIPPA- covered entities and their business associates in relation to the provision of healthcare, healthcare operations and payment for healthcare services. This information may be received electronically, by telephone, fax or verbally.
Only the pharmacist on duty may release PHI or confidential information. Conditions/persons that allow release of PHI would include a request from the patient’s primary care physician, a request from a hospital where the patient is being treated, and from other healthcare providers attending to the patient. The patient themself may also request their PHI.
Patients must sign a release before any PHI may be given to anyone. This release will also include what kind of PHI may be released and to whom.
Patient records will be secured electronically by the pharmacy software vendor. This software is password protected and only medical pharmacy personnel have access to this information.
PHI may be released to legal authorities only upon a warrant or subpoena.
The medical pharmacy personnel will log out of the computer system if they are not working at the workstation, i.e., bathroom break, lunch break or leaving for the day.
Signed confidentiality statements will be maintained in the personnel file. These policies/procedures will be abided by daily and reviewed annually by the pharmacist-in-charge.
The individual contacting the patient for the first time will provide written information and will discuss confidentiality/privacy of patient-specific information as included in the Patient Rights and Responsibilities statement. Documentation of receipt of confidentiality information is maintained in the patient record. Patient records contain signed release of information statements when the organization bills a third-party payor or shares information with others outside the organization as required by HIPPA and other applicable laws and regulations.
In accordance with the provisions of the HITECH Act, any breaches to confidentiality of patient PHI must be investigated and the affected individuals must be notified that their health information was breached.
Approved By: ACHC
Original Approval Date: 06/01/2021
Date(s) Revised:
ACHC Standard: DRX2-2CR
Southeast Community Pharmacy Statement of Patient Rights and Responsibilities
This Statement of Patient Rights and Responsibilities will be reviewed upon a new hire and annually thereafter and made a part of the worker’s personnel file. This statement will be updated if/when State or Federal changes are made. We truly want the patient or patient’s caregiver to fully understand their rights and responsibilities and to exercise them. This statement will always be available in written format and may also be found on our website in the ‘About Us’ section. We will document receipt of this statement onto the patient’s record.
Approved By: ACHC
Original Approval Date: 06/01/2021
Date(s) Revised:
ACHC Standard: DRX7-4A
In an attempt to furnish needed medical supplies to patients during an emergency, which for our area typically would be hurricanes, we would do our utmost to see that they do not run out of supplies. For our organization this would relate mainly to ostomy/urological supplies and enteral nutrition products.
We would want to be prepared for loss of electricity for a number of days following a hurricane, which itself lasts ten to fifteen hours. Knowing that a storm is coming would allow us to contact our patients to make sure that they have enough supplies and this is normally three to five days in advance.
Cell phones are our primary method of communication with personnel to keep them informed of the situation at the store and to determine if they are needed on site during the event. Since we live on a peninsula oftentimes the state directs traffic only out of our area and not into it. Therefore, we would contact our patients who would possibly need ostomy/urological supplies or enteral nutrition products and get them in advance of the storm.
Regarding “911” EMS services, we have cell phones and a land line at the pharmacy. If these are not available, then us and everyone else effected by the storm would be incommunicado for a time.
These procedures will be reviewed annually by all personnel.
The patient has the right to voice grievances/complaints regarding treatment of care that is (or fails to be) furnished and lack of respect of property by anyone who is furnishing care/service on behalf of the organization, and must not be subjected to discrimination or reprisal for doing so.
The organization ensures this right and investigates all grievances/complaints. In light of this standard the following will apply:
Approved By: ACHC
Original Approval Date: 06/01/2021
Date(s) Revised:
ACHC Standard: DRX3-4B
We will inform the patient of their financial responsibility prior to or at the time of delivery of the service or equipment. If there is a change in payment information, we let the patient know as soon as possible but no later than 30 days after we become aware of the change. We will inform all Medicare and Medicaid patients as to whether assignment is accepted or not. We will verify insurance coverage, including deductibles and copays, to the best of our ability. This will also include an Advance Beneficiary Notice of Non-coverage.
The right medicine for the right person taken at the right time in the right dose is critical.
Your doctor has tried very hard to make the correct diagnosis for your condition and thought long and hard about the right medicine to use. The pharmacist is very diligent to accurately fill the prescription and to answer any questions that you may have and to work with your insurance company to get the best value for your dollar. Now you have to do your part: Know your medicines (what they look like and what they’re for), how and when to take them (empty stomach, full stomach, bedtime or breakfast), who to call if there is a problem (side effects or something just doesn’t feel right or I can’t afford it). We’re here to help with all of these questions.