1. Patient Rights and Responsibilities DRX2-2A

Your Rights

• Respect & Dignity – Be treated with courtesy, dignity, and respect at all times.
• Non-Discrimination – Receive services without discrimination based on race, color, religion, sex, age, national origin, disability, sexual orientation, marital status, or source of payment.
• Safe, Appropriate Services – Receive equipment and services appropriate to your needs, consistent with physician orders and our scope of services.
• Information in a Way You Understand – Have your care, equipment, and services explained in a language and manner you can understand, including interpreters/communication aids when needed.
• Participation in Your Plan of Care – Participate in decisions about your care and equipment, including the right to refuse treatment/services (and to be informed of possible consequences).
• Know Who Is Providing Your Care – Know the name of our company and, upon request, the names and roles of staff involved in your services.
• Involvement of Family/Representative – Have a family member, legal representative, or other person you choose involved in care decisions to the extent permitted by law and your wishes.
• Privacy & Confidentiality – Have your medical and financial information kept confidential in accordance with HIPAA and applicable laws.
• Access to Your Record – Request access to your record, ask for copies (fees may apply as allowed by law), and request corrections to information you believe is inaccurate or incomplete.
• Information on Charges – Be informed, in advance when possible, of charges and your financial responsibility, including any non-covered services.
• Freedom from Abuse or Neglect – Receive services in an environment free from mental, physical, sexual, or verbal abuse, neglect, or exploitation.
• Voice Complaints Without Retaliation – Express complaints/concerns about equipment, services, staff, or billing without fear of reprisal, and expect a fair review and timely response.
• Choice of Provider – Choose your health care providers when choice is available; be informed if RRMS is unable to provide requested services so alternate resources can be discussed.
• Referrals & Continuity of Care – Be informed when referrals or transfers are necessary, and know the reasons for them.
• Exercise of Rights When You Cannot Speak for Yourself – Have your rights respected through a legally authorized representative consistent with applicable law.

Your Responsibilities

• Provide complete and accurate health, contact, and insurance information, and update us about changes.
• Follow the instructions and safety guidelines given for your equipment and supplies.
• Ask questions if you do not understand how to use equipment, your plan of care, or your financial responsibility.
• Use the equipment only as prescribed and do not lend, sell, or give it to others.
• Protect equipment from loss, theft, or damage and notify us promptly if these occur.
• Let us know about any change in your condition that may affect safe use of the equipment.
• Pay co-pays, deductibles, co-insurance, and non-covered amounts as explained under Financial Responsibility.

2. Medicare DMEPOS Supplier Standards (30 Standards) DRX2-2C

If you are a Medicare beneficiary and we bill Medicare for your equipment or supplies, RRMS must comply with all 30 DMEPOS Supplier Standards. Below is a plain-language summary:

• We follow all applicable federal and state licensure and regulatory requirements.
• We provide complete, accurate information on our DMEPOS enrollment and report changes within required timeframes.
• Our enrollment application is signed by an authorized individual whose signature is legally binding.
• We fill orders from our own inventory or qualified contractors; we do not contract with excluded entities.
• We inform beneficiaries when they can rent or purchase equipment, including options for capped rentals.
• We notify you of warranty coverage, honor warranties, and repair/replace covered items under warranty at no charge.
• We maintain a physical facility with posted hours and adequate space (with applicable exceptions).
• We allow CMS/contractors to perform on-site inspections to verify compliance.
• We maintain a primary business phone line under the business name during business hours.
• We maintain comprehensive liability insurance (and product liability if we manufacture items).
• We do not improperly solicit Medicare beneficiaries; we comply with telemarketing rules.
• We are responsible for delivering items, instructing patients, and maintaining proof of delivery and education.
• We answer questions and respond to complaints, keeping documentation of beneficiary contacts.
• We maintain/repair/replace rented items we provide, directly or via proper service arrangements.
• We accept returns of substandard or unsuitable items.
• We disclose these standards to each Medicare beneficiary and provide a written copy upon request.
• We disclose required ownership/financial/control interests.
• We do not sell, transfer, or share our Medicare supplier number.
• We maintain a complaint resolution process and keep complaint records at our physical site.
• Complaint records contain required details and actions taken.
• We furnish CMS with required information under Medicare laws and regulations.
• We maintain accreditation from a CMS-approved organization for the products/services we provide.
• We notify our accrediting organization when opening new DMEPOS locations.
• All locations that bill Medicare are separately accredited and meet quality standards.
• We disclose all product lines/services for which we seek accreditation.
• We meet surety bond requirements, where applicable.
• If oxygen is provided, it is obtained from a state-licensed oxygen supplier (RRMS does not provide oxygen).
• We maintain required ordering/referring documentation consistent with Medicare rules.
• We are generally prohibited from sharing a practice location with other Medicare suppliers except as allowed.
• Except for limited exceptions, we are open to the public at least 30 hours per week.

You may request a full written copy of the official DMEPOS Supplier Standards at any time, or view them online in the federal regulations.

3. Grievance / Complaint Policy DRX2-4C; DRX2-2A

We encourage you to tell us if you have a concern or complaint. You may file a complaint without fear of retaliation.

How to contact RRMS about a complaint:

What we will do:

• We log all complaints and review them promptly.
• Our goal is to acknowledge your complaint within 5 business days.
• We will attempt to resolve complaints as quickly as possible.

For Medicare-related complaints:

RRMS will provide a written response within 14 calendar days of receiving the complaint, whenever possible, explaining findings and actions taken.

If you are not satisfied with our response, you may contact external agencies such as:

• Our accrediting organization (ACHC)
• State health agencies
• Medicare (1-800-MEDICARE)

Contact information for external agencies will be provided upon request.

4. Confidentiality, Privacy & Release of Information DRX2-5A

We are committed to protecting your Protected Health Information (PHI) in accordance with HIPAA and other laws. We may use and disclose your PHI for:

• Treatment – coordinating your care and equipment.
• Payment – billing your insurance, verifying coverage, and processing claims.
• Health Care Operations – quality improvement, audits, training, and regulatory compliance.

We may also use or disclose PHI as required or permitted by law (e.g., public health reporting, suspected abuse/neglect, health oversight, or legal processes).

Your rights related to PHI include:

• The right to receive our detailed Notice of Privacy Practices (NPP).
• The right to request restrictions on certain uses/disclosures (we will review and respond; we may not always be able to agree).
• The right to request confidential communications (e.g., alternate address/phone).
• The right to access and request copies of your record (fees may apply where permitted by law).
• The right to request corrections (amendments).
• The right to request an accounting of certain disclosures.

We will not share your PHI with individuals not involved in your care, payment, or operations, except as allowed by law or with your written authorization. You may revoke an authorization in writing at any time, except to the extent already relied upon.

A full copy of our Notice of Privacy Practices is provided separately and is available at our office or upon request.

5. Financial Responsibility DRX3-4B

We want you to understand your financial responsibility for equipment and supplies. We make a good-faith effort to verify insurance and obtain authorizations when required. Verification is not a guarantee of payment.

You are responsible for:

• Co-pays, co-insurance, and deductibles determined by your plan.
• Non-covered items or upgrades, if you choose to receive them.
• Any cash-pay arrangements for items not billed to insurance.

If we believe an item may not be covered, we will discuss this with you and may ask you to sign a form confirming that you accept financial responsibility.

Questions about a bill?
Billing/Financial Questions: 817-553-1562 or rapidresponsedme@gmail.com

We will make reasonable efforts to work with you when there are financial concerns consistent with our policies.

6. Warranty Information DRX7-16A; Supplier Standard 6

• RRMS honors all manufacturer warranties and applicable state law related to equipment we provide.
• For items under warranty, we will repair or replace the item at no charge to you or Medicare for issues covered by the warranty.
• We will inform you of warranty coverage, including the length of the warranty and how to request service.
• We will not bill you or Medicare for services or replacement that are covered by the warranty.
• For rented items, we are responsible for maintaining, repairing, or replacing those items as appropriate, either directly or through a qualified service vendor.

If you have a problem with an item you believe is under warranty, please contact us at 817-553-1562.

7. Emergency Preparedness Information DRX7-4C

RRMS participates in emergency preparedness planning to support patients who use medical equipment in the home.

For your safety:

• We will review basic emergency instructions when we set up equipment (e.g., what to do in a power outage, fire, severe weather, or evacuation).
• You should keep at least the following available when needed for your equipment (if applicable):

• Back-up batteries or manual options (if available).
• Contact information for your prescriber, RRMS, and local emergency services.

In a life-threatening emergency, call 911 first.

If an event (such as recall, power outage impact, or safety issue) affects equipment we have provided, RRMS will follow its emergency and recall procedures, which may include contacting you, your prescriber, or a subcontracted vendor as appropriate.