Welcome and thank you for choosing Optimal Home Rehab, LLC to provide your outpatient in the home rehabilitation needs. At Optimal, we specialize in providing high quality, evidenced based physical, occupational and speech therapy to the older adult in the convenience of their homes. Enclosed is some information that will help you understand our practice.

Safety and Employee Background Checks

Optimal Home Rehab LLC is a mobile Therapy Practice where clinicians come into your home to provide therapy. For your safety and our reputation, all of our therapists have criminal background checks, are licensed and insured.

Safety and Sexual Harassment Policy

It is the policy of Optimal Home Rehab, LLC that violence, intimidation and harassment on any basis as well as for protected status’ (race, creed, religion, sex, national origin, marital status, with regard to public assistance, disability, age, membership on a local human rights commission and sexual orientation) and sexual harassment is prohibited. Such behavior violates the law, creates an offensive working environment, adversely affects the positive working relationships, increases costs to the agency and tarnishes the image of the agency. No employee, contractor, patient, family member / care giver, person in the home or treatment area etc. A violation of this policy may be grounds for termination of therapy services, immediate discipline or termination of employee/ contractor or other appropriate actions. A complaint should be made in writing, contain the name and address of the person filing it, and briefly describe the action alleged. A complaint should be filed in the office of the within 30 days after the person filing the complaint becomes aware of the alleged action. The Administrator will conduct an investigation of the complaint to determine validity. The Administrator will issue a written decision determining the validity of the complaint no later than (30) days after its filing.

Scheduling Appointments & Wait Times:

Optimal Home Rehab, LLC is a mobile Therapy practice. This means our clinicians conveniently come to you saving you time and money. Much like a medical offices due to reasons outside of our control there may be a wait time and a therapist may arrive before or after your scheduled appointment time due to circumstances such as patient cancellations, traffic, accidents, road closures, detours etc. Our appointment times will be within an hour window to give space for incidents such as the aforementioned. For instance, if your appointment is at 2:00 pm a therapist may arrive between 1:30 and 2:30 pm. Unexpected events will happen and on occasion, your appointment may be delayed or postponed. If that should happen, we will call you in advance of the appointment with options to reschedule. Your therapist will contact you when on route, giving you a specific estimated time of arrival. If you have a specific need and have to be seen at a specific time for whatever reason, please do not hesitate to contact your therapist and or the office and we will try our best to accommodate you and or your schedule. If there is a scheduling conflict that cannot be resolved, we will be sure to notify you and make attempts to refer you to another clinician or company that will best accommodate your needs. If there is a scheduling conflict that cannot be resolved, we will be sure to notify you and make attempts to refer you to another clinician or company that will best accommodate your needs.

 

Cancellations, No Shows, and Rescheduling Appointments

Optimal Home Rehab, LLC understands that scheduling conflicts, medical appointments, personal commitments and circumstances beyond our control will require patients to reschedule or cancel a therapy appointment. Please extend us the courtesy of being on time and keeping all of your scheduled appointments. Should you need to cancel an appointment, we require at least 24 hours notice or there will be a $25.00 cancellation fee. This cancellation fee may be waived for instances when the patient being treated has a medical emergency that requires that the patient leaves the home to seek medical attention. All missed appointments will be rescheduled to comply with the therapy prescription from your doctor, or with Medicare policy.

Pest Control and Communicable Disease Policy

In order to protect our staff as well as other patients, please notify Optimal Home Rehab Therapy Staff if you become ill with a communicable disease. In most cases the spread of disease can be prevented by wearing protective body gear and with appropriate hand washing. In the case of infestations with pests that are known to travel such as bed bugs, fleas, etc. we ask that you notify your therapist of these situations as soon as possible. If pests that are known to travel are sighted by staff, we have the right to terminate therapy and or hold therapy until we have proof that the property has been thoroughly exterminated by a licensed professional.

Our goal is to help you return to your prior level of function and to maximize independence and safety in your living environment, as well as educate you on your particular condition to help you prevent a reoccurence. You will be treated with the utmost quality care at Optimal Home Rehab, LLC. Please feel free to voice any concerns you may have about your treatment to your therapist. We look forward to working with you and your physician on achieving your goals. Welcome again.

I verify that I understand the Optimal Home Rehab's Policy on:

 

1. Safety and Sexual Harassment

2. Scheduling Appointments and Wait Times

3. Cancellations, No Shows and Rescheduling Appointments

4. Pest Control and Communicable Disease 

If patient is unable to sign, representative information as follows:

Patient Authorization and Guarantee Form  

 

 I hereby authorize the release of any information by telephone or in writing, including reports of diagnosis, treatment prognosis, recommendation, benefits payable, as well as any other data pertinent to my treatment, by Optimal Home Rehab LLC to the physician who referred me for therapy as well as any organization responsible for payment of my account. I also authorize the release of any information by telephone or in writing for utilization and quality review purposes.

Assignment of Insurance Benefits I hereby authorize that the payment of authorized benefits be made directly to Optimal Home Rehab LLC of any services that are reimbursable by Medicare, Medicaid, or any third party

I hereby consent to such treatment procedures and patient care which, in the judgment of my therapist and/or physician, may be considered necessary or advisable while I am a patient of Optimal Home Rehab LLC.

In consideration of services rendered to me by Optimal Home Rehab LLC, I hereby guarantee payment for any and all services rendered to me which are not covered or allowable by insurance, together with collection costs, including reasonable attorney fees. I also understand that all bills are due and payable upon presentation. I understand that the patient responsibility portion of my bill shall be due and payable at time of services.

I hereby certify that the information given by me in applying for payment under title XVIII of the Social Security Act is correct. I authorize any holder of medical or other information about me to release to the Social Security Administration or its intermediaries or carriers any such information needed for this or a related Medicare Claim. I request that the payment of authorized benefits be made on my behalf.

By signing this document, I authorize OHR to furnish treatment which is considered necessary and proper in diagnosing or treating my medical condition. 

If patient is unable to sign, representative information as follows:

Patient Financial Policy: Contracted/Commercial Insurance

Optimal Home Rehab LLC participates with several insurance companies and will file claims on your behalf. As a patient, it is in your best interest to know if your plan is contracted with Optimal Home Rehab LLC and to understand your insurance plan benefits and your responsibility for any deductibles, co-insurance, or co- payment amounts prior to any visit.

It is also important to understand your insurance plan's current benefits and coverage rules. Policies and coverage determinations may vary from year to year. Please be aware that your insurance carrier may send you a payment for the services provided by Optimal Home Rehab LLC (depending on your plan's benefits In this case, you are required to remit the payment to Optimal Home Rehab LLC

In case you will fail to remit the above mentioned payment, Optimal Home Rehab LLC holds the right to report the case to an outside collection agency. In the event that your account is turned over for collections, you agree to pay all additional fees associated to the collection of debt. These fees may include collection agency fees and attorney fees.

I certify that the information given by me in applying for payment from my insurer is correct. I request that payment of authorized benefits be made on my behalf to Optimal Home Rehab LLC I understand that I am fully responsible to Optimal Home Rehab LLC for all charges not paid by my insurer within 60 days of claim filing.

I authorize Optimal Home Rehab LLC to release medical information pertinent to my treatment for appeal purposes.

The undersigned acknowledges receipt of the Optimal Home Rehab LLC Financial Policy and understands the patient rights and responsibilities. The undersigned agrees to the

If patient is unable to sign, representative information as follows:

HIPAA Privacy Policies  

 

It is the policy of Optimal Home Rehab, LLC that all providers and staff preserve the integrity and the confidentiality of protected health information (PHI) pertaining to our patients. The purpose of this policy is to ensure that our practice and its providers and staff have the necessary medical and PHI to provide the highest quality physical, occupational and speech therapy care possible while protecting the confidentiality of the PHI of our patients to the highest degree possible. Patients should be confident to provide information to our practice and its providers and staff for purposes of treatment, payment and healthcare operations (TPO), knowing that our practice and its providers and staff will--

Adhere to the standards set forth in the Notice of Privacy Practices.

Collect, use and disclose PHI only in conformance with state and federal laws and current patient covenants and/or authorizations, as appropriate. Our practice and its providers and staff will not use or disclose PHI for uses outside of practice's TPO, such as marketing, employment, life insurance applications, etc. without an authorization from the patient.

Use and disclose PHI to remind patients of their appointments only with their consent.

Recognize that PHI collected about patients must be accurate, timely, complete, and available when needed. Our practice and its providers and staff will:

Implement reasonable measures to protect the integrity of all PHI maintained about patients.

Recognize that patients have a right to privacy. Our practice and its providers and staff respect the patient's individual dignity at all times. Our practice and its providers and staff will respect patient's privacy to the extent consistent with providing the highest quality medical care possible and with the efficient administration of the facility.

Act as responsible information stewards and treat all PHI as sensitive and confidential. Consequently, our practice and its providers and staff will:

Treat all PHI data as confidential in accordance with professional ethics, accreditation standards, and legal requirements.

Not disclose PHI data unless the patient (or his or her authorized representative) has properly consented to or authorized the release or the release is otherwise authorized by law.

Recognize that, although our practice "owns" the medical record, the patient has a right to inspect and obtain a copy of his/her PHI.

HIPAA Privacy Policies Con't

 

In addition, patients have a right to request an amendment to his/her medical record if he/she believes his/her information is inaccurate or incomplete. Our practice and its providers and staff

Permit patients access to their medical records when their written requests are approved by our practice. If we deny their request, then we must inform the patients that they may request a review of our denial. In such cases, we will have an on-site healthcare professional review the patients' appeals.

Provide patients an opportunity to request the correction of inaccurate or incomplete PHI in their medical records in accordance with the law and professional standards.

All providers and staff of our practice will maintain a list of all disclosures of PHI for purposes other than TPO for each patient. We will provide this list to patients upon request, so long as their requests are in writing.

All providers and staff of our practice will adhere to any restrictions concerning the use or disclosure of PHI that patients have requested and have been approved by our practice.

All providers and staff of our practice must adhere to this policy. Our practice will not tolerate violations of this policy. Violation of this policy is grounds for disciplinary action, up to and including termination of employment and criminal or professional sanctions in accordance with our practice's personnel rules and regulations.

Our practice may change this privacy policy in the future. Any changes will be effective upon the release of a revised privacy policy and will be made available to patients upon request.

HIPAA Acknowledgement and Consent Form 

 

I understand that under the Health Insurance Portability and Accountability Act of 1996(HIPAA), I have certain rights to privacy regarding my protected health information. I

understand that this information can and will be used to:

Conduct, plan and direct my treatment and follow-up care among the multiple healthcare providers who may be involved in that treatment directly or indirectly. Obtain payment from designated third-party payers. Conduct normal health care operations such as quality assessments or evaluations and physician certifications.

I have been informed by you of your Notice of Privacy Practices containing a more complete description of the uses and disclosures of my health information (available in the office in print form I have reviewed such Notice of Privacy Practices prior to signing this consent, and acknowledge that I have studied the Privacy Practices prior to signing this consent, and acknowledge that I have studied the Privacy Practices. I understand that this organization has the right to change its Notice of Privacy Practices from time to time, and that I may contact this organization at any time at the address above to obtain a current copy of the Notices of Privacy Practices.

I understand that I may request in writing that this organization restrict how my private information is used or disclosed to carry out treatment, payment or health care operations. I also understand the organization is not required to agree to my requested restrictions, but if the organization does agree, then it is abound to abide by such restrictions.

I understand that I may revoke this consent in writing at any time, except to the extent that the organization has taken action relying on this consent.

If patient is unable to sign, representative information as follows: