January 2019 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

JAN UARY 2019

2019 Changes to Medicare’s Deductibles and Copays P.16

Defining and Measuring Patient Satisfaction P.28

Achieving

BALANCE HOW THE PROFESSION IS ADAPTING TO AN INFLUX OF FEMALE CLINICIANS P.22

Medicare Enrollment: Paper Versus PECOS Applications P.32

Evolution of the AMP and Other Measurement Tools P.35

E! QU IZ M EARN

4

BUSINESS CE

CREDITS

WWW.AOPANET.ORG

P.18 & 34

This Just In: Assessing the Potential Impact of Competitive Bidding for Off-the-Shelf Orthoses P.20

YOUR CONNECTION TO

EVERYTHING O&P

THE P REMI E R M E E TI N G F O R O RT H OT IC , PR OST HET IC , AND PEDOR T HIC PR OFESSIONAL S.

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contents

JAN UARY 2019 | VOL. 68, NO. 1

2

COVER STORY

FEATURES

JANUARY 2019 | O&P ALMANAC

22 | Achieving Balance Women now comprise about half of the new practitioners entering O&P residencies, resulting in increasingly diverse staffs at facilities. Many companies are reaping the benefits of new perspectives, alternate means of problem solving, and an increased ability to relate to patients. But some challenges remain for females in the profession, with some seeking more flexible working conditions and more accessible advancement opportunities.

By Christine Umbrell

20 | This Just In

Speaking Out Against Competitive Bidding In the wake of CMS’s recent proposal to include some off-the-shelf (OTS) spinal orthosis and knee orthosis codes in the next round of Medicare competitive bidding, AOPA has submitted extensive comments explaining why competitive bidding for OTS orthoses is not in the best interest of O&P patients or the Medicare program.

28 | High Scores Patient satisfaction has become a much more important consideration at many O&P facilities. While some companies are seeking input from patients to revamp feedback forms, others are leveraging iPad-enabled survey instruments that capture and compare patient data at each visit. The aggregated information can be used to drive decision making and improve clinical care.

By Michael Coleman

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contents

PRINCIPAL INVESTIGATOR

DEPARTMENTS

Robert “Bob” Gailey, PhD, PT....... 35

The researcher best known for developing the Amputee Mobility Predictor recalls his introduction to the O&P profession, describes his studies into energy expenditure and gait, and explains his latest research in the wearable technology space.

Views From AOPA Leadership..........5 AOPA Executive Director Eve Humphreys, MBA, CAE, welcomes the new year

AOPA Contacts.......................................... 6 How to reach staff

Numbers......................................................... 8 At-a-glance statistics and data

Happenings............................................... 10 Research, updates, and industry news

COLUMNS Reimbursement Page.......................... 16

Jump-Starting 2019

Revised codes, updated fees, and policy changes for 2019 CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

Compliance Page.................................... 32

ACCREDITATION

The Road to Orthotics and Prosthetics Enrollment

P.13

Tips from NSC for enrolling in Medicare CE Opportunity to earn up to two CE credits by taking the online quiz.

People & Places........................................14

CREDITS

Transitions in the profession

AOPA News.............................................. 42

Member Spotlight................................. 39 n

Syncor Ltd.

n

Utah Prosthetics and Orthotics

DMEPOS P.32

AOPA meetings, announcements, member benefits, and more

PAC Update.............................................. 46 AOPA New Members.......................... 48 Careers........................................................ 50 Professional opportunities

Marketplace..............................................52 Calendar......................................................54 Upcoming meetings and events

Ad Index...................................................... 55 Ask AOPA...................................................56 P.40

4

JANUARY 2019 | O&P ALMANAC

Monetary thresholds for appeals, interest on overpayments, and more

VIEWS FROM AOPA LEADERSHIP

Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.

Board of Directors OFFICERS President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO President-Elect Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Vice President Traci Dralle, CFM Fillauer Companies, Chattanooga, TN Immediate Past President Michael Oros, CPO, LPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Treasurer Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Executive Director/Secretary Eve Humphreys, MBA, CAE AOPA, Alexandria, VA DIRECTORS David A. Boone, BSPO, MPH, PhD Orthocare Innovations LLC, Edmonds, WA J. Douglas Call, CP Virginia Prosthetics & Orthotics Inc., Roanoke, VA Mitchell Dobson, CPO, FAAOP Hanger Clinic, Grain Valley, MO Elizabeth Ginzel, MHA, CPO NovaCare P&O, Fort Worth, TX Kimberly Hanson, CPRH Ottobock, Austin, TX Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Spring Lake Park, MN

Ready for the New Year

H

APPY NEW YEAR’S to our dear AOPA members and the O&P community! I am incredibly proud and honored to start off 2019 as AOPA’s new executive director. To kick off the new year, AOPA is hosting its fourth annual Leadership Conference in Scottsdale, Arizona, January 4-6. This is a great opportunity for O&P leaders to participate in executive-level discussions and be among the first to learn what’s happening in the O&P profession. Our speakers for the event include Elisabeth Rosenthal, MD, a constant contributor to the New York Times; Alison Cernich, PhD, ABPP-Cn, director of the National Center for Medical Rehabilitation Research in the National Institute for Child Health and Human Development at the National Institutes of Health; Bryce S. Sutton, PhD, of Avalere Health; Douglas G. Smith, MD, of Harborview Medical Center in Washington; and Kenton Kaufman, PhD, PE, research professor and director of the Motion Analysis Laboratory at Mayo Clinic. I am fortunate to have this opportunity to listen and learn more about and from the O&P field right at the start of my new role.

It is only fair for you to be as curious about me as I am about the O&P community. Although I am a “newbie” to the O&P field, my career is rooted in health care. Before AOPA, I previously served as executive director of the Society for Healthcare Epidemiology of America (SHEA), and in my five years in that position I provided guidance and management in representing physicians and other healthcare professionals in health-care epidemiology and infection prevention control.

Prior to SHEA, I held the role of senior director of membership at the American Academy of Otolaryngology—Head and Neck Surgery by strategizing domestic and international membership recruitment, retention, and engagement. I am hoping to thoroughly utilize my past experience to explore and gauge the needs of the O&P community.

One of the facets that drew me to AOPA is the responsibility to promote a patient-driven model, a dedicated focus on providing the best possible patient-centered care. AOPA’s members include a diverse group of O&P practitioners, researchers, manufacturers, suppliers, managers, engineers, technicians, etc., and all these groups of people tackle daily challenges and rigors to constantly improve the quality of patient care. I understand the complexities of legislative and regulatory advocacy that are integral to supporting these individuals and entities to better serve the public. A constant goal of AOPA is to gauge the ongoing needs and challenges of our members and support them by advocating for innovation in this ever-evolving field of practice. I look forward to serving you and this community; we may come from different disciplines, however, our focus is the same: optimal patient care. Thank you for all that you contribute to this community, and thank you for giving me the opportunity to learn and grow alongside you. Cheers to you and 2019!

Sincerely,

Rick Riley Thuasne USA, Bakersfield, CA Linda Wise WillowWood, Mount Sterling, OH

Eve Humphreys, MBA, CAE AOPA Executive Director

O&P ALMANAC | JANUARY 2019

5

AOPA CONTACTS

American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

Publisher Eve Humphreys, MBA, CAE Editorial Management Content Communicators LLC Advertising Sales RH Media LLC

Our Mission Statement Through advocacy, research, and education, AOPA improves patient access to quality orthotic and prosthetic care.

Printing Sheridan

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email ymazur@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices.

Eve Humphreys, MBA, CAE, executive director, 571/431-0807, ehumphreys@AOPAnet.org

Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@AOPAnet.org

ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314.

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org

Copyright © 2019 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide.

These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

Tina Carlson, CMP, chief operating officer, 571/431-0808, tcarlson@AOPAnet.org MEMBERSHIP & MEETINGS Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, kelly.oneill@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org

SPECIAL PROJECTS Ashlie White, MA, manager of advocacy, outreach, and special projects 571/431-0812, awhite@AOPAnet.org

Yelena Mazur, communications specialist, 571/431-0835, ymazur@AOPAnet.org

O&P ALMANAC

Ryan Gleeson, CMP, assistant manager of meetings, 571/431-0836, rgleeson@AOPAnet.org

Eve Humphreys, MBA, CAE, executive director, 571/431-0807, ehumphreys@AOPAnet.org

Kristen Bean, membership and meetings coordinator, 571/431-0876, kbean@AOPAnet.org AOPA Bookstore: 571/431-0876

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net

Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

6

Design & Production Marinoff Design LLC

JANUARY 2019 | O&P ALMANAC

Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

Advertise With Us! Reach out to AOPA’s membership and more than 11,400 subscribers.

Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/almanac19 for advertising options!

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NUMBERS O&P

The Rise of Female Clinicians More women are choosing the O&P career path

Nearly half of students in the O&P schools are women, and the number of female clinicians is at an all-time high, according to 2018 data supplied by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) and the National Commission on Orthotic and Prosthetic Education (NCOPE).

FEMALE ORTHOTISTS

ABC-certified orthotists who are women

Percentage of ABC-certified orthotists who are women

FEMALE CPOS

740

ABC-certified prosthetists/orthotists who are women

425

15 Percent

ABC-certified prosthetists who are women

221

26 Percent Percentage of ABC-certified prosthetists/orthotists who are women

Women Now Comprise 24 Percent of ABC-Certified Practitioners

Number of women who entered an NCOPEapproved residency in 2018

Total Number of ABC-Certified Practitioners

Number of Female ABC-Certified Practitioners

Percentage Female

2018

5,881

1,393

24%

2014

5,860

1,163

20%

2009

4,560

703

15%

2004

3,701

461

12%

JANUARY 2019 | O&P ALMANAC

48 Percent Percentage of women who entered an NCOPEapproved residency in 2018

O&P RESIDENTS OVER PAST 10 YEARS Women Now Comprise About Half of Individuals Entering NCOPE-Approved Residencies

SOURCE: American Board for Certification in Orthotics, Prosthetics, and Pedorthics

8

Percentage of ABC-certified prosthetists who are women

FEMALE O&P RESIDENTS

ABC-CERTIFIED PRACTITIONERS OVER PAST 15 YEARS

Year

29 Percent

Total Number of Individuals Who Entered a Residency

Number of Females Who Entered a Residency

Percentage Female

2018

458

221

48%

2014

327

164

50%

2009

304

122

40%

Year

SOURCE: National Commission on Orthotic and Prosthetic Education

SOURCES: American Board for Certification in Orthotics, Prosthetics, and Pedorthics; National Commission on Orthotic and Prosthetic Education

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Happenings RESEARCH ROUNDUP

Scientists Test Prototype for ‘Phantom Limb’ Control of Upper-Limb Prostheses

(Left) Global view of the experimental setup during one of the functional tasks of grasping an object (here, the foam tennis ball) and releasing it in the dedicated container, with the arm prosthesis controlled through the associated mobilization of the phantom limb. (Right) Photo of the setup being used with P2.

prototype, and are working with amputees who are wearing the prosthesis during testing. “While numerous limitations related to robustness of pattern recognition techniques and to the perturbations generated by actual wearing of the prosthesis remain to be solved, these preliminary results encourage further exploration and deeper understanding of the phenomenon of natural residual myoelectric activity related to phantom limb mobilization,” concluded the researchers, “since it could possibly be a viable option in some transhumeral amputees to extend their control abilities of functional upper-limb prosthetics with multiple active joints without undergoing muscular reinnervation surgery.”

Austrian First To Undergo Single-Operation Upper-Limb Osseointegration Procedure While many lower-limb amputees have completed osseointegration surgeries to receive implants for direct attachment of prostheses, the procedure is much less common among upper-limb amputees. Austria’s Edmund Rath recently became the first person to undergo a single operation to install a “click” prosthesis that the brain controls via signals on the missing hand.

Austrian surgeons implanted a metal rod into the bone of Rath’s residual limb in May 2018; the operation was projected live during an industry congress in Vienna, Austria. The rod features an external accessory that can anchor a prosthesis to the bone in the upper part of the 10

JANUARY 2019 | O&P ALMANAC

arm. During the operation, surgeons also located nerves that had been previously used to control the hand and connected them to the muscles of the upper arm, a procedure called “reinventing the directed muscle.”

It took six weeks for the implanted nerves to grow in the subject’s muscles to allow him to control six different functions of a robotic prosthetic arm, which was supplied by Ottobock.

Since the surgery, Rath has been learning to complete increasingly difficult tasks. He said the implant allows him to move his arm freely, compared to the restricted movement provided by a socket. Rath displayed his new abilities using an osseointegrated prosthesis during an Ottobock Media Day in October.

IMAGE:© N. Jarrassé 2018

French researchers are studying phantom-mobility-based prosthesis control in transhumeral amputees without surgical reinnervation. A preliminary study, published in the November 29 issue of Frontiers in Bioengineering and Biotechnology, found that amputee subjects could be trained to control their prostheses based on phantom limb mobilization and myoelectric pattern recognition techniques.

Researchers from the French National Center for Scientific Research (CNRS) and Aix-Marseille University developed a natural approach to prosthesis control stemming from the idea that many amputees can voluntarily move their “phantom,” or missing, limb. Previous studies had found that some arm amputees are able to engage in muscle contractions in the residual limb that would allow for finger pinching, making a fist, or rotating the wrist—contractions that are not connected with the joints used prior to amputation.

Building upon this phenomenon, the researchers, led

by Nathanael Jarrasse, PhD, and Jozina de Graaf, developed a prototype using algorithms capable of recognizing muscle activity generated by mobilization of the phantom limb and reproduction of the detected movement by the prosthesis, via “intuitive control.” Two amputee subjects tested the prototype, using a prosthesis placed near—but not attached to—the residual limb. After several minutes of acclimating to the system, both participants achieved the goal of controlling the prosthesis to perform specific grasping and releasing tasks.

The researchers are performing additional testing of the

HAPPENINGS

PHOTO: Institute of Systems and Robotics of the University of Coimbra, Portugal and College of Engineering, Carnegie Mellon University

Researchers Produce Electronic Tattoos for Wearable Computing A team of researchers has developed an economical method for producing thin-film tattoo-like circuits with integrated microelectronics with the potential for use in controlling a robotic arm. The circuits are designed to be applied with water in a manner similar to applying a temporary tattoo.

The researchers, from Carnegie Mellon University’s (CMU’s) College of Engineering and the University of Coimbra in Portugal, have established a detailed process to create the “skin” that involves patterning a circuit template onto a sheet of transfer tattoo paper using a laser printer; coding the template with silver paste that sticks to the printer toner ink; wiping away excess silver; depositing gallium indium liquid metal alloy on top of the silver paste to increase the flexibility and electrical conductivity of the circuit; and adding external electronics, such as microchips, using a silver epoxy or a conductive glue.

Using this method, the researchers can transfer the electronic tattoo to 3-D objects, such as a prosthetic hand.

The project is being led by Carmel Majidi, an associate professor of

mechanical engineering at CMU’s Soft Machines Lab, and Mahmoud Tavakoli, director of the Soft and Printed Mechatronics Laboratory at the University of Coimbra. They designed the tattoos to have mechanical properties similar to lightweight fabrics so that they remain functional even when subject to bending, folding, and twisting—much like human skin.

“This is a breakthrough in the printed electronics area,” Tavakoli said. “We showed for the first time that inkjet-printed patterns of silver nanoparticles can be sintered at room temperature using the gallium indium alloy. Removing the need for high-temperature sintering makes our technique compatible with thin-film and heat-sensitive substrates.”

ALTERNATIVE PAYMENTS

Does Your Facility Accept Online Payments?

Online payments are becoming much more common in the health-care industry, according to new research from BillingTree’s Healthcare Operations and Technology Survey. While traditional methods such as on-site, mail, and phone payments remain the most common payment methods, many facilities are now accepting newer methodologies in an effort to provide options for patients to pay their bills once they have left the facility. Patients have indicated a preference for 24/7 customer service options,

according to the BillingTree research.

Sixty-three percent of health-care providers currently accept web portal payments, and 27 percent have plans to implement text notifications for bill payments, according to the research.

The research also found that health-care companies most commonly select their payment providers based on their adherence to the Health Insurance Portability and Accountability Act. They also consider the price of payment processing.

NATIONAL ASSEMBLY NEWS

Plan Your Trip to

San Diego With the 2019 AOPA National Assembly just eight months away— September 25-28—it’s time to start planning your visit to “America’s Finest City.” Famous for its miles of white-sand beaches and beautiful weather, there will be many opportunities to enjoy the city before and after the conference.

The bayside San Diego Convention Center is just a short walk from award-winning dining venues, shopping, and nightlife in the historic Gaslamp Quarter. The convention center is surrounded by waterfront parks, the USS Midway, and PETCO Park—home of the San Diego Padres. And just a short drive away is the world-famous Balboa Park—a 1,200-acre urban cultural park that encompasses more than 16 museums, multiple performing arts venues, gardens, trails, and natural vegetation zones.

During the conference itself, experts and thought leaders from all aspects of business- and clinical-related O&P will preside over educational sessions, and hundreds of the top O&P manufacturing companies will share their newest products on the trade show floor.

With so much to see and do in San Diego, you won’t want to miss this year’s AOPA National Assembly.

O&P ALMANAC | JANUARY 2019

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HAPPENINGS

CONTRACT CONCERNS

Palmetto GBA Takes Over PDAC Contract

CMS awarded the Pricing, Data Analysis, and Coding (PDAC) contract to Palmetto GBA, effective Jan. 15, 2019. Palmetto GBA replaces Noridian Healthcare Solutions, which had held the PDAC contract since 2008.

Palmetto GBA currently holds the contracts to serve as the National Supplier Clearinghouse contractor and the competitive bidding implementation contractor.

In addition, Palmetto GBA served as the contractor for the Statistical Analysis Durable Medical Equipment Regional Carrier, which was renamed the PDAC when the contract was awarded to Noridian in 2008.

Doran Edwards, MD, takes on the role of PDAC medical director under the new contract. Edwards is associate medical director for CGS, which serves as the Jurisdiction B and Jurisdiction C durable medical equipment Medicare administrative contractor.

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JANUARY 2019 | O&P ALMANAC

CODING CORNER

DME MACs Update Requirements for RT and LT Modifiers The durable medical equipment Medicare administrative contractors (DME MACs) have released a correct coding notification for the proper usage of the RT and LT modifiers when billing for bilateral items/services on the same date of service.

Current rules for billing bilaterally direct providers to use the RTLT modifier on the same claim line with two units of service. However, for claims with dates of service on or after March 1, 2019, providers must bill each item on two separate claim lines using the RT and LT modifiers, and one unit of service on each claim line. Bilateral claims with a date of service on or after March 1, 2019, billed with the RTLT on a single claim line will be rejected as incorrect coding.

APPLICATION DEADLINE

NAAOP Announces 2019 Fellowship on Public Policy and Advocacy The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) is soliciting applications for its annual health policy/advocacy fellowship. NAAOP is a national nonprofit association advocating for consumers and patients requiring orthotic and prosthetic care, as well as the providers who serve them.

The NAAOP fellowship is a paid, 10-week summer program based in Washington, D.C. The fellow will learn about O&P policy and advocacy, and how NAAOP and other O&P organizations function on behalf of the O&P community and within the broader rehabilitation and disability

policy and advocacy environment at the federal and state levels. The fellowship offers exposure to O&P clinical and business settings, and state-based public policy and advocacy. Two fellows will be selected for the summer of 2019 through a competitive process using the application on the NAAOP website, naaop.org.

The fellowship application is due via email to fellowship@naaop.org by Jan. 31, 2019. Finalists will be interviewed via videoconference and two will be selected, assuming high-quality candidates are identified. If the finalists selected cannot accept the fellowship for any reason, the next highest ranked fellow will be offered the position.

HAPPENINGS

AMPUTEE ATHLETICS

PHOTOS: OPAF First Swim Training and Clinic

Therapists and Amputees Take Part in Adaptive Swim Event in Ohio OPAF First Swim Training and Clinic returned to Dayton, Ohio, for an adaptive swim event, sponsored by Hanger Clinic, Bulldog Tools, and Endolite.

Hanger Clinic’s Jim Scharf, PTA, led a CE-eligible morning session featuring clinical education for therapists and swim coaches. In the afternoon, Mabio

Costa led the First Swim Clinic, assisted

by Rob Hendry and Emma Durante as well as the therapists and swim coaches from the morning session.

Clinic attendees came away with real and practical tips, techniques, and opportunities to improve in the pool, according to OPAF.

THE LIGHTER SIDE

FAST FACT

Most Americans Support Coverage of Pre-Existing Conditions

If the Affordable Care Act’s protections for people with pre-existing conditions are ruled unconstitutional, more than two thirds of Americans (70 percent) say they would want their home state to establish protections for people with pre-existing conditions—even if this means some healthy people may pay more for coverage.

SOURCE: Kaiser Family Foundation Health Tracking Poll, November 2018.

O&P ALMANAC | JANUARY 2019

13

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Sen. Tammy Duckworth (D-Illinois) has been honored with the Dole-Harkin Award by the U.S. International Council on Disabilities in recognition of her efforts to promote and expand rights for people with disabilities. The Sen. Tammy Duckworth Dole-Harkin Award honors U.S. policymakers (D-Illinois) for their service to the global disability community in advancing the rights, opportunities, and dignity of persons with disabilities. Sen. John McCain (R-Arizona) also received this year’s Dole-Harkin Award, posthumously.

Duckworth, a former U.S. Army lieutenant colonel who became a bilateral lower-limb amputee after the Black Hawk helicopter she was co-piloting was hit by a rocket-propelled grenade, is a champion for the rights for people with disabilities and a frequent advocate for O&P causes. In 2018, she led efforts to protect the Americans With Disabilities Act. Kinsey Herrin, MSPO, CPO, LPO, has joined the Handspring Clinical Services team as part of the organization’s expansion with a new office in Atlanta. Herrin will work with Director of Clinical Services Laura Katzenberger, CP, Kinsey Herrin, LP, to bring Handspring’s multidisciplinary MSPO, CPO, LPO, approach to patient care to the Atlanta office.

Herrin focused on patient care in Miami before joining the faculty at Georgia Institute of Technology’s Masters of Science in Prosthetics and Orthotics (MSPO) program. She has broad knowledge in prosthetic patient care, including long-term relationships with patients needing upper-limb prosthetic care. Herrin earned a bachelor’s degree in chemistry from the University of Georgia and an MSPO from Georgia Institute of Technology.

James “Jim” L. Hewlett, BOCO, has been named the 2018 recipient of the Jim Newberry Award for Extraordinary Service, presented by the Board of Certification/Accreditation (BOC).

A past member, secretary, vice chairman, and chairman of BOC’s Board of Directors, Hewlett played a key role in developing BOC's original accreditation standards and worked as a subject matter expert for certification exam development. He has served as an accreditation site surveyor for the past decade.

His work includes managing a facility for RX Positive Medical and Orthotics in Yuma, Arizona, and working as the director of operations for the Healthcare Independent Business Alliance in Tempe, Arizona. In 2009, Hewlett founded Consultants PRN/OandPEdu.com, where he serves as an author, educator, and consultant.

14

JANUARY 2019 | O&P ALMANAC

WillowWood has named Mahesh Mansukhani chief executive officer and Daniel Rubin executive vice president, strategy and corporate development. Ryan Arbogast, who previously held the chief executive officer Mahesh role, has become executive chairman of the Mansukhani board and will remain company president.

“Mahesh and I are aligned on a vision for WillowWood’s growth and expansion focused on enabling O&P practitioners to exceed the expectations of their patients,” said Arbogast.

“It’s an opportune time for Mahesh to bring Daniel Rubin his proven leadership ability back into our industry to help us realize this vision and our mission of leveling the playing field for those challenged with limb loss.”

Mansukhani brings more than 20 years of leadership experience, including five years at the helm at Össur. He has served in chief executive officer roles within the health-care and technology sectors, most recently as president and CEO of REPOWER America, a provider of residential solar power solutions.

Rubin brings experience to the executive vice president role, having served with Mansukhani at REPOWER America. He also led the global high-growth material science businesses at DuPont for more than 25 years.

OPAF & The First Clinics have announced officers for 2019: Lesleigh Sisson, CFm, president Lesleigh Sisson, Peggy Chenoweth Travis Young, CO CFm of consulting firm O&P Insight, returns for a second term as OPAF president.

Peggy Chenoweth, creator of online blog amputeemommy and co-founder of Amp’d, will serve as OPAF vice president. Travis Young, CO, a prosthetic resident at Advanced Prosthetics in Fresno, California, will serve as OPAF treasurer.

PEOPLE & PLACES

PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) has committed to a Goldlevel sponsorship of OPAF & The First Clinics for 2019.

OPAF’s corporate sponsorships fund the day-to-day business and operational expenses of the organization as well as fund future First Clinic development.

The Challenged Athletes Foundation (CAF) presented Össur with the 2018 Partner of the Year Award during its recent Celebration of Abilities Awards dinner.

“On behalf of everyone at Össur, we thank The Challenged Athletes Foundation for this honor. We think ‘partner’ perfectly describes the relationship we have mutually enjoyed over these two decades, and we are gratified that together, our

organizations have helped thousands of people pursue a life without limitations over the years,” said Olyfur Gylfason, executive vice president of sales and marketing for Össur. “We congratulate CAF on its 25th anniversary, and we look forward to many more years of partnership.”

WillowWood has secured a $2 million Department of Defense Clinical Translational Research Award to develop and validate a self-adapting myoelectrically controlled ankle utilizing continuously variable ankle stiffness.

The research grant will explore the myoelectric collection and application of lower-limb muscle contracture data that will be used to control the prosthetic device while determining the appropriate ankle stiffness for a user’s activity in real time.

Jim Colvin, WillowWood’s director or research and technology, serves as principal investigator for the grant.

WillowWood will team with its grant partners, Shirley Ryan AbilityLab, the University of Michigan, and the Louis Stokes Cleveland VA Medical Center, on this project.

The Source for Orthotic & Prosthetic Coding

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O&P ALMANAC | JANUARY 2019

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REIMBURSEMENT PAGE

By DEVON BERNARD

Jump-Starting 2019 Educate yourself on new codes, fees, and policies to prevent reimbursement headaches

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HE DECEMBER 2018 Reimburse-

Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits.

After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

ment Page explored what’s in store for 2019, and this month’s column offers some additional information to help you begin the new year on the right foot.

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Revised Code Lists

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The start of a new calendar year means it’s time to update your code lists.

In early November 2018, Medicare released the 2019 Health-Care Common Procedure Coding System (HCPCS) update, which featured three new O&P codes for implementation for dates of service on or after Jan. 1, 2019. The three new codes are the following: • A5514—For diabetics only, multipledensity inserts, made by direct carving with CAM technology from a rectified CAD model created from a digitized scan of the patient, total contact with patient’s foot, including arch, base layer minimum of 3/16-inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each • L8701—Powered upper-extremity range-of-motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated.

• L8702—Powered upper-extremity range-of-motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated.

The A5514 replaced the temporary code K0903, issued in early 2018. As of press time, the medical policy for

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JANUARY 2019 | O&P ALMANAC

Therapeutic Shoes for Persons With Diabetes Policy had not been updated to reflect this new code. However, the updated policy will most likely follow the current directions regarding the K0903—meaning the only inserts that may be billed using code A5514 are those that have been reviewed and approved by the Pricing, Data Analysis, and Coding contractor.

There is not a policy for upperextremity, and, as of press time, CMS and the durable medical equipment Medicare administrative contractors (DME MACs) had not provided guidance on the L8701 and L8702, so the items described by these codes should be based on individual consideration and medical necessity.

Updated Fees & Monetary Figures

For 2019, the estimated durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule update is 2.30 percent. As always, when the discussion about the fee schedule arises, there is always the question about sequestration, or the mandatory 2 percent reduction applied after the Medicare allowable amount.

Sequestration will remain in effect for 2019 and most likely will continue for the near future as it is scheduled to remain in effect until 2025. It may not be as important now, as many insurers may have caught up and renegotiated contracts, but remember that insurers may not automatically reduce their reimbursement by 2 percent because of sequestration, unless terms of your contracts involve some sort of reimbursement based on a percentage

REIMBURSEMENT PAGE

of Medicare payment amounts and not fee schedule amounts.

As the new year begins, in addition to verifying your patients’ insurance to ensure there have not been any changes during the open enrollment period—or any other changes—you should check whether there are any updated deductibles in your patients’ plans so you understand how much money to collect from patients before their insurance begins to pay. The 2019 Medicare deductible has been set at $185, an increase of $2 over last year’s deductible.

In addition to being aware of the new Medicare Part B deductible, including O&P services, you also should be aware of the updates to your patients’ Part A benefits—for hospitals and skilled nursing facilities (SNFs)—in case they have any questions. It is just one more way you can provide good customer service.

The Medicare Part A inpatient deductible, which includes the first 60 days of a Medicare inpatient hospital stay benefit period, is $1,364, which beneficiaries are expected to pay when

admitted to the hospital in 2019—an increase of $24 from 2018. For days 61 through 90 of the hospital stay, the beneficiary must pay a coinsurance amount of $341 per day, an increase of $6 from the 2018 coinsurance amount of $335. The lifetime reserve days— any time after the 90 days has been exhausted—is $682. For beneficiaries in SNFs, the daily coinsurance for days 21 through 100 in a benefit period will be $170.50 in 2019, an increase of $3.

You also should review the Medicare enrollment application fee, or the fee due when you enroll/open a new facility or when you revalidate a current facility. The fee does not apply to simple changes or updates, such as a changing phone number, a new billing address, a change in the name of the company, or similar updates—in these instances, an application fee will not be assessed since these would not constitute a new enrollment or revalidation.

To help determine if you are up for revalidation in 2019 and may have to pay the enrollment application fee, Medicare has established set due dates, on the

last day of the month, for all DMEPOS suppliers. These dates will be the same for all revalidation cycles (every three years). To determine your due date for revalidation, look at your last successful revalidation or initial enrollment and add three years, the revalidation timeframe for DMEPOS suppliers. You also may visit the Medicare revalidation website at go.cms.gov/MedicareRevalidation. The due date will be posted approximately six months prior to your established due date. In addition, you should receive a written and/or emailed revalidation notice two to three months prior to your revalidation due date.

The 2019 Medicare DMEPOS supplier enrollment application fee is $586, or an increase of 2.9 percent. The annual increase in the Medicare enrollment application fee is based on the change in the consumer pricing index for urban areas (CPI-U) from June to June of the previous year, June 2017-June 2018, and that change was a positive 2.9 percent.

This figure should look familiar as it also is used to help calculate the DMEPOS fee schedule increases and decreases.

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REIMBURSEMENT PAGE

Billing Privileges and Policy Changes

As a Medicare supplier, you must submit claims at least once within four consecutive quarters, or at least one claim a year, to keep your supplier number and associated billing privileges active. Since each location where you see Medicare beneficiaries is required to be enrolled separately and have its own Medicare supplier number, be sure each of your locations is submitting at least one claim a year. The start of a new year is a good time to take care of this—then you don’t have to worry about it for the rest of the year.

Failure to submit a claim from each location and supplier number can lead to your Medicare billing privileges being deactivated—and cause disruptions in your cash flow and in care for your patients. To reactivate your billing number, you will have to re-enroll with Medicare, including paying the application fee of $586 in 2019—unless you can demonstrate that you did submit a claim during the time period in question.

However, during the time your supplier number is deactivated, you will not have the ability to submit claims and be paid for any claims associated with that supplier number and location; in addition, you are prohibited from seeing Medicare patients at that facility.

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JANUARY 2019 | O&P ALMANAC

January also is a good time to review the previous year’s coding announcements and policy changes from Medicare, and any policy changes made by your company, and make sure they have been incorporated into your policies and procedures. If this has not been done, you should provide updated training to your staff and/or provide refresher courses to all employees. For example, have you updated your staff on the new Medicare guidelines for the use of the RT and LT modifiers starting on March 1, 2019? When you submit a claim for providing bilateral items with a date of service on or after March 1, 2019, you will no longer submit the claim on a single line with two units of service and the RTLT modifier combination. Instead, you must bill each item on a single line— one line with the LT modifier and one unit of service, and the other line with the RT modifier and one unit of service.

By now, everyone should be aware of the new Medicare identification (ID) cards. If you have not begun to transition, you should start now. By April 2019, all new and existing Medicare beneficiaries should have received their new Medicare ID cards featuring Medicare beneficiary identifiers (MBIs) to replace the old health insurance claim numbers (HCINs). After December 2019, only MBIs will be accepted for future

transactions. Currently, the DME MACs and CMS are in a transition period, and they will respond to your transactions with the identifier (HCIN or MBI) you use on your claims. For example, if you submit a claim using a patient’s HCIN, then the explanation of benefits/ remittance advice will use the HCIN. In addition, the DME MACS and CMS will provide you with the patient’s new MBI, if the patient has one. Beginning Jan. 1, 2020, however, you may no longer use HCINs; you will be required to use MBIs for all Medicare-covered transactions. Check with your patients to determine if they have received their new cards, and make sure you have updated the information in your records.

Finally, be sure to review your previous year’s breach logs in accordance with the Health Insurance Portability and Accountability Act and determine if you have any breaches that be must reported by the March 1, 2019, deadline. You are required to notify the U.S. Department of Health and Human Services of any breaches within 60 days of the end of the calendar year in which the breach was discovered. This means that any breaches—specifically those involving less than 500 individuals that occurred and were discovered in 2018— must be reported by March 1, 2019.

Following the recommendations described above will help you prepare your facility for 2019—and may help you avoid some potential headaches and pitfalls.

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming.

Reach him at dbernard@AOPAnet.org.

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This Just In

Speaking Out Against Competitive Bidding Why including OTS orthoses in competitive bidding will not benefit O&P patients or the Medicare program

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OPA ENDED 2018 BY submitting comments to CMS and to the Department of Veterans Affairs (VA) on issues that could affect the timing and the level of care Medicare beneficiaries and veterans receive.

CMS announced in November that it was soliciting comments on its proposed inclusion of off-the-shelf (OTS) spinal orthoses and OTS knee orthoses as product categories in the next round of Medicare competitive bidding. The announcement represented the first indication that OTS orthoses of any kind will be included in competitive bidding. Sixteen OTS spinal orthoses (L0450, L0455, L0457, L0467, L0469, L0621, L0623, L0625, L0628, L0641, L0642, L0643, L0648, L0649, L0650, and L0651) and eight OTS knee orthoses (L1812, L1830, L1833, L1836, L1848, L1850, L1851, and L1852) have been identified for possible inclusion in the competitive bidding program.

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JANUARY 2019 | O&P ALMANAC

AOPA immediately performed a preliminary analysis on the codes included in the proposal and determined that traditional O&P providers are responsible for less than 15 percent of overall claims submitted to Medicare for the codes in question.

While these 24 codes do not represent a large portion of a typical O&P practice’s business, AOPA continues to believe that no orthoses should be subject to competitive bidding. Thus, AOPA submitted comments to CMS, by the extended Dec. 17, 2018, deadline, indicating that competitive bidding for OTS orthoses is not in the best interest of patients or the Medicare program.

Some highlights of AOPA’s comments include the following: • All orthoses require clinical expertise and knowledge to ensure a proper fit and positive clinical outcome. Commoditizing spinal orthoses and knee orthoses through competitive bidding will not result in any benefit to Medicare beneficiaries.

• CMS has had multiple “false starts” on promulgating regulations to define the term “minimal selfadjustment” as it relates to OTS orthoses, implementing the qualified provider regulations legislated through Section 427 of Benefits Improvement and Protection Act of

This Just In

All orthoses require clinical expertise and knowledge to ensure:

POSITIVE CLINICAL OUTCOMES PROPER FIT

2000, and instituting the use of split code sets to set the stage for inclusion of OTS orthoses in competitive bidding for durable medical equipment, prosthetics, orthotics, and supplies.

• The U.S. Food and Drug Administration requires specific labeling of medical devices, including OTS orthoses. This labeling is intended for health professionals’ use, to be provided to the patient. Failure to provide proper instruction regarding the care and use of these orthoses not only renders the orthoses ineffective but could injure patients.

• Noteworthy data shows that 19 percent of patients who receive a Medicare-reimbursed OTS orthotic device subsequently receive a Medicare-reimbursed custom-fit or custom-fabricated device. Limiting the provision of OTS spinal and OTS knee orthoses to competitive bidding suppliers will have a profound impact on Medicare beneficiaries who are unable to achieve a successful clinical outcome with an OTS orthosis and require more advanced care.

• The implementation of competitive bidding for OTS orthoses will not result in a significant reduction in fraud and abuse. As confirmed

by the recent MedPAC report, the creation of split codes has led to a significant increase in the billing of OTS orthoses because of questionable relationships between unscrupulous providers and physicians using telemedicine strategies.

• Forcing OTS orthoses into a competitive bidding environment will result in the delivery of orthoses without any clinical care by properly trained and educated providers.

In addition to AOPA’s comments, which are available at http://bit.ly/ OTSComments, more than 200 O&P stakeholders submitted individual comments on this topic via AOPA’s legislative platform, AOPAVotes.

Even with this recent request for comments about implementation, CMS has announced a temporary ban on future rounds of competitive bidding until at least Jan. 1, 2021. AOPA will continue to monitor the situation and will provide guidance as new information arises.

Provider Choice for Veterans

In addition to providing comments on competitive bidding, AOPA has responded to the VA’s Supplemental Notice of Proposed Rulemaking (SNPRM), released on Nov. 28, 2018,

regarding the provisions of the October 2017 proposed rule that addresses veterans’ rights to choose their provider for provision of artificial limbs. The SNPRM was issued in response to the significant comments the VA received on these provisions in the original, but not-yet-to-be-finalized, proposed rule.

The main area of concern in the SNPRM is whether the VA has the right to determine whether veterans must receive prosthetic care within the confines of the VA medical center system or whether they have the right to choose to work with contracted providers within the community. For many years, this was not an issue as veterans, in most cases, were free to receive prosthetic care directly from the VA or from contracted providers.

However, the October 2017 proposed rule clearly indicated that the VA, and solely the VA, has the authority to determine where veterans receive prosthetic services. The SNPRM indicates that the VA still contends that it reserves the right to full discretion regarding how a veteran receives prosthetic services, including whether the veteran can seek care from community-based prosthetists.

The SNPRM addresses the comments it received on this issue and “seeks to clarify the intent of the proposed regulation, explain the VA’s current practices and processes relating to the provision, and request additional details on it.” While the SNPRM discusses the involvement and importance of community-based care in certain circumstances, it is AOPA’s position that the VA remains overly restrictive in the SNPRM and its authority to determine where a veteran receives prosthetic services.

In its comments on the SNPRM, AOPA once again strongly objected to the proposed change stating that the VA reserves the sole right regarding how a veteran receives prosthetic services, and AOPA insists that a veteran must have a say in his or her own care. To view the view set of comments, visit http://bit.ly/ VA1Comments.

O&P ALMANAC | JANUARY 2019

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COVER STORY

Achieving

Balance O&P professionals discuss the benefits of gender-balanced O&P facilities and share strategies for promoting women in the workplace

By CHRISTINE UMBRELL

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JANUARY 2019 | O&P ALMANAC

COVER STORY

Need To Know

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•

Diversity among O&P staff members is on the rise, especially among younger clinicians— with women comprising about half of O&P residents over the past five years.

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To ensure more women find opportunities for advancement, it’s important that established O&P professionals advocate for younger professionals and offer mentorship opportunities when possible.

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O&P facilities with more gender-balanced clinical staff may offer some benefits to patients, such as a broader choice of provider and more informed and collaborative decision making.

•

Looking toward the future, more parity is expected at higher levels as today’s young professionals advance in their careers—and as there is a more conscious effort to ensure women are promoted.

•

As greater numbers of females enter the profession, some companies are rethinking benefits to offer more flexible scheduling and part-time employment opportunities.

•

While many women have taken on leadership roles at O&P facilities, there is still an imbalance in the management structures at some companies.

ODAY’S O&P WORKPLACE HAS

in the field “is a positive, as diversity state of Michigan. Today, 24 percent can bring alternate means of probof clinicians certified by the American Board for Certification in Orthotics, lem-solving,” says Bailey, who became Prosthetics, and Pedorthics are female. the first female RVP at Hanger in 2009.

Diversity benefits any “We want our patientbusiness, according to care workforce to match Karen Edwards, senior our patients,” adds C. Leigh area manager, prosthetics, Davis, MSPO, CPO, FAAOP, for Össur and director of a clinician and assistant Össur Women’s Leadership manager at Children’s Initiative (OWLI). “Both Healthcare of Atlanta and Karen Edwards genders bring equal skills, president of the American

a vastly different look compared to 25 years ago. Facilities are hiring more diverse staff, seeking to be more reflective of the patients they serve.

And as the educational requirements have shifted, elevating the professionalism of the field, more women are actively choosing careers in orthotics and prosthetics.

In fact, women now comprise 48 percent of the individuals who but increasing diversity registered for orthotic or prosthetic brings new perspectives, new points residencies last year, according to of view, new solutions, and new abilidata from the National Commission on Orthotic and Prosthetic Education ties to relate to our diverse population (NCOPE). The rising number of female of patients,” she says. clinicians bode well for improved Jean Ann Bailey, regional vice patient care in particular and the future president (RVP) at Hanger Clinic, says of the profession in general. she has seen “more and more diver“The trends are exciting,” sity with clinicians in the says Pam Lupo, CO, a consulpast 20-plus years, which is incredible as so many tant in Michigan and chair patients are women, or of AOPA’s Women in O&P are parents or caregivers brunch in Vancouver. When bringing their children or she became an orthotist 37 elderly parents to be seen years ago, there were only four Pam Lupo, CO for care.” More women female clinicians in the entire

Academy of Orthotists and Prosthetists (the Academy). “We’ve made great strides in creating a more balanced male-female workforce—but we still have a long way to go” in terms of developing truly multicultural staffs.

Collaborative and Connected Patient Care

Successful clinical care relies on “clinician connections,” so facilities that employ practitioners of different genders and races are better positioned to meet patients’ needs, according to Davis, who was a founding member of the Academy’s Women O&P ALMANAC | JANUARY 2019

23

COVER STORY

Of course, many patients in O&P Committee 10 years seek practitioners with clinago and served as co-chair of the group for several ical acumen, whether male years. “Patients have the or female. “Patients typically right to be seen by someone want to work with the best they feel comfortable with,” clinician, irrespective of she says. gender,” says Bailey. But it’s Jean Ann Bailey “You bring different a benefit to be able to offer life experiences and can patients a choice. This is offer more commonalities with the particularly important for the segment patients” with a diverse practice, of the population for whom cultural adds Lissa Adams, MPT, CP, regional or religious differences may prevent a director of the Michigan market female patient from being treated by a for Hanger Clinic. “Men can empamale practitioner.

And it works both ways—in some thize with female patients—but they cases, male patients may prefer male haven’t necessarily lived their life clinicians. Adams recalls being called experiences.”

AOPA and O&P Alliance Publish Antiharassment and Nondiscrimination Policies During a meeting at the 2018 AOPA National Assembly in Vancouver, the AOPA Board of Directors unanimously adopted a statement to advance nondiscriminatory and antiharassment practices in O&P workplaces. The board determined to add a statement in the “AOPA Code of Interactions With Health Care Professionals” reminding AOPA member companies of Teri Kuffel, JD the necessity of complying with federal antidiscrimination laws.

“We felt it important to broaden the scope of sexual harassment/ misconduct to include discrimination and the federally protected classes of individuals listed in Title VII of the Civil Rights Act,” says Teri Kuffel, JD, a member of AOPA’s Board of Directors, who helped write the statement.

“This statement is important to our extended O&P community in that it reminds us to not only be civil to one another in our daily acts, but to operate in full compliance with all federal and state laws. It explicitly states, ‘Every employee is entitled to fair treatment in the workplace.’”

AOPA also provided input on this issue to the O&P Alliance at its meeting in Vancouver, which resulted in establishment of an O&P Alliance Subgroup on this topic; Kuffel serves as AOPA’s representative to the group.

On December 10, the O&P Alliance members, including AOPA, published an open letter to the O&P field condemning sexual misconduct, harassment, and discrimination in the workplace. The letter was intended to be a “clear message to the entire field that we support a zero-tolerance policy for sexual misconduct, harassment, and discrimination based on sex (including sexual orientation and gender identity), race, color, national origin, religion, age, disability, as well as retaliation for reporting of such conduct.”

The letter addresses where individuals can file a report and speaks to the commitment by each group to review and refine current policies, enhance education and training, and impose disciplinary actions where appropriate, says Kuffel. Follow http://bit.ly/InSupport to access the letter.

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JANUARY 2019 | O&P ALMANAC

to a hospital to treat a 17-year-old male with a very high upper-leg amputation. “I realized [examining] a patient at the hip disarticulation level is quite personal—especially for a teenage boy—so we made the decision” to have a male clinician treat him instead, she says. “If we can make someone more comfortable, he or she may be more willing to express their concerns” and, as a result, receive more informed care.

Plus, staffing a variety of genders and races leads to a diversity of opinion that results in more comprehensive and better informed decision making, according to Lupo. A 2018 Forbes study of 200 business teams that analyzed the Cloverpop decision-making database found that gender-diverse teams make better decisions 73 percent of the time, while teams that also include a range of ages and different geographic locations make better decisions 87 percent of the time.

“Women often bring improved communication to an organization,” adds Lupo. And “women bring a different perspective.”

Creating a More Welcoming Company Culture

While the number of women clinicians is on the rise, so, too, are the challenges associated with women joining a previously male-dominated profession.

“Sometimes, there just may be a lack of understanding of women’s priorities,” says Adams.

Anytime there is a large-scale change in a profession, there are bound to be challenges, says Edwards. “We know that women face sexual harassment far more frequently than men [in the general population]. That continues to be a challenge our profession faces, but I am very proud of the way the profession has stepped up across all our professional organizations to address and attempt to eliminate it,” she says. (See sidebar, AOPA and O&P Alliance Publish Antiharassment and Nondiscrimination Policies.)

Additionally, Edwards says issues like more favorable working conditions will become more prominent as women become a larger percentage of

COVER STORY

creative, you can find solutions to Many of the women who have the clinician population. She suggests barriers such as these, she adds. achieved success in the O&P profesthat companies re-evaluate their office policies to be more family friendly. sion have done so by self-advocating While many companies across and creating their own opportunities.

Learning To Lead corporate America have already “I learned early on to ask for what Today, many more women own O&P created policies that can be helpful to I want because, when I do, even if I businesses, and more companies are working women—such as generous don’t get exactly what I want, I usually hiring female managers, compared maternity leave policies, flexible get something,” says Edwards. She also to 20 years ago. “It is especially nice scheduling, and work-at-home encourages risk-taking to to see more women holding options—those perks are harder to help propel careers forward. higher roles on the business come by when employed by health“I consistently see women side, especially at the execcare facilities. “In our field, you have in O&P creating these utive director levels on our to balance taking care of your patients opportunities for themnational boards,” says Teri and your family,” says Davis. “If you Kuffel, JD, vice president of selves,” she says. “Women are out of the office unexpectedly, such Arise Orthotics & Prosthetics, are the ones raising their as with a sick child, you may have to who also is a member of the hands for leadership Leigh Davis, reschedule patients—which is difficult O&P Alliance Subgroup on roles on state chapters MSPO, CPO, for patients and employers, who are Harassment Policy. and national boards. I see FAAOP both counting on you.”

Edwards also is happy to women speaking at national But companies can be creative see female O&P professionals in highermeetings and leading the way.” and receptive to alternative staffing Kuffel notes that she, too, charted level positions today: “Women are now solutions, suggests Adams. Recalling an practice owners and managers. Women her own path in the industry. She made AOPA National Assembly she attended a conscious decision to put “family first” now serve on the boards of the professeveral years ago, Adams mentions and work at the family O&P business, sional organizations.” She believes meeting two unemployed female then embraced her role as vice presithat women in leadership have had a clinicians who were no longer working positive effect on overcoming some dent—creating her own opportunities to because they wanted part-time posiof the reimbursement challenges of become more involved. “No one asked the past decade.

With more stringent me to go to the AOPA Policy Forum in tions—arrangements that had not been requirements, “everyone DC nine years ago—I was drawn to it. presented as an opportunity has had to change the way No one asked me to bring amputees at their former employers. they document, and think into congressional offices to show the They were at the Assembly more closely about costs reality of our concerns—I just did it. No to earn continuing education and about how they make one asked me to help write a licensure credits and maintain their their money,” says Edwards. bill for the state of Minnesota—I just certification despite being “Women as a larger realized there were only a few people unemployed. Adams helped Lissa Adams, percentage of the clinician around who could do it,” she says. facilitate introductions with MPT, CO population have been part Additionally, leadership roles come potential employers, and they of that evolution. Not only in many different forms, according both eventually were hired do we have exponentially to Edwards. “Not everyone wants to

by Hanger Clinic as part-time more women, women are taking on serve on a board or lead their state clinicians. “Now they’re phenomenal more leadership roles within industry chapter, but they can still lead in the employees,” she says. groups, actively leading the profession role they have. Women are stepping At smaller facilities in particular, it into the future, and taking the lead on up and leading with patient educacan be difficult to offer flexible schedaddressing and eliminating potential uling. But companies can try to find tion and advocacy, education to their issues, such as harassment.” arrangements to accommodate both colleagues, etc.”

At larger O&P companies, women female and male staff members. For Despite there being more female sometimes find more opportunities example, Adams suggests creating supervisors and managers, there’s still for advancement. “I’ve been lucky to a “job share” option to allow two some work to do in ensuring enough work with a lot of women in the field,” clinicians who prefer part-time status women advance through the ranks, says Adams, who says that women to work as the equivalent of one according to Lupo and Davis. “The clinicians and women managers are clinician. Such an arrangement can numbers [of women in the profession] commonplace at Hanger. And Davis, at result in “engaged, highly motivated have been on the rise for a while, but Children’s Healthcare of Atlanta, says employees,” Adams says, although she we have not been escalating in managethat women outnumber men on staff, admits “it does create some challenges ment,” says Lupo. She suggests it’s time and the culture is open to the advanceregarding participation in all-staff for companies to take a hard look at meetings on a day off.” But by being their hiring and promoting practices. ment of women.

O&P ALMANAC | JANUARY 2019

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COVER STORY

2019:

The Year of the Woman in O&P Organizations

This year, five of the O&P professional organizations have female executive directors: Eve Humphreys, MBA, CAE AOPA Chellie Hollis Blondes American Academy of Orthotists and Prosthetists Catherine Carter American Board for Certification in Orthotics, Prosthetics, and Pedorthics

www.bocusa.org

Claudia Zacharias, MBA, CAE Board of Certification/Accreditation Robin Seabrook National Commission on Orthotic and Prosthetic Education

In addition, five of the 13 members of AOPA’s current board of directors are women: Traci Dralle, CFM, who is vice president, and four board members: Elizabeth Ginzel, MHA, CPO; Kimberly Hanson, CPRH; Teri Kuffel, JD; and Linda Wise.

For women to push forward and feel encouraged to advance both in their careers and in professional organizations, it’s important that women in higher positions “reach back” and propel others forward, says Davis.

She credits senior women in the field with helping to facilitate her own rise through the ranks. “As people advance in their careers, they should be looking for people they can pull along behind them—and this is especially true of women,” says Davis. She encourages female clinicians to become mentors to up-and-coming professionals and to share their myriad experiences and success stories.

“It’s important for established professionals—both male and female—to speak up for and advocate 26

JANUARY 2019 | O&P ALMANAC

for younger professionals,” agrees Edwards. “We can support and lift up women by speaking up for them in group situations, reinforcing their ideas to colleagues, advocating for their ideas to those in higher positions, and by coaching and mentoring them. It’s sometimes hard to establish a mentor/mentee relationship, but we can all mentor, coach, and support other women. It doesn’t have to be a formal mentorship.”

“Provide the opportunities, and let them know that their aspirations are achievable,” says Bailey, “though it takes work and focus.”

Davis thinks it’s important for women in positions of power to make sure all of the voices are being heard.

“As women, we don’t always get our

points across the way we want to, and sometimes it takes some courage” to offer opinions and ask for advancement opportunities. “Maybe those in leadership roles can help others find their voice.”

Women in senior roles should make an effort to advocate for women to be included in hiring and advancement discussions, says Adams. They can “let recruiting teams know you are looking to put forward a slate of candidates to choose from”—and the slate should be inclusive of different genders and races.

“Qualifications come first and foremost” when making O&P hiring decisions, but it’s important to pull from a diverse pool, agrees Lupo.

Female O&P professionals seeking support and camaraderie also can turn to industry events and organizations, such as AOPA’s Women in Leadership breakfast, the Academy’s Women in O&P Committee, and OWLI, which was launched by Össur in 2015 to support women in the profession as they enter and move up in their careers. “OWLI also strives to contribute to gender equality and the elimination of gender biases within the profession through professional education,” and offers a monthly blog, quarterly educational webinars, and an annual Women’s Leadership Conference, explains Edwards, whose work as director of OWLI led to her recognition as 2018 O&P Woman of the Year Award by OPGA. Looking toward the future, more parity is expected with the maturation of young professionals and as there is a more conscious effort to ensure women are promoted. “The trend is here, but we haven’t arrived,” says Lupo.

“I fully believe women have made O&P a stronger, more viable profession,” adds Edwards, “and that ultimately means we can continue to take care of our patients well into the future.”

Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

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By MICHAEL COLEMAN

High Scores O&P facilities embrace new strategies for measuring and boosting patient satisfaction

NEED TO KNOW • In today’s competitive market, many O&P facilities are looking for ways to improve their patient satisfaction initiatives to ensure they are capturing accurate and relevant feedback they can use to make changes to provide optimal patient care.

• Some companies are working directly with patients, via patient councils or more informal interactions, to determine what information to include on redesigned patient satisfaction surveys.

• One university-affiliated O&P medical center has begun using an iPad-enabled survey instrument that is designed to capture patient-reported outcomes in three distinct categories during each visit.

• Some facilities are creative in how they administer surveys, seeking to be flexible to drive a healthy participation rate. Many surveys are administered during patient visits while others are distributed via email, or even on paper.

• Once patient feedback is collected, it’s important that facilities analyze the data and read through comments to determine ways to improve device fit, function, and comfort; ensure clinicians are providing optimal care; and decide how to improve the patient appointment process.

• Capturing immediate patient feedback from as many patients as possible is especially important in the age of Yelp and other social forums. Facilities that acknowledge and respond to patient complaints are best positioned to solve any problems while preventing negative reviews.

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JANUARY 2019 | O&P ALMANAC

T

HOMAS PASSERO, CP, FOUNDER

and owner of Prosthetic and Orthotic Associates in upstate New York, has a very personal reason for prioritizing patient satisfaction at his facility: His own experiences as a prosthetic patient decades ago were substandard—but his dissatisfaction went unnoticed.

“There was no patient satisfaction metric 40-some years ago when I was injured [in a motor vehicle accident], and it’s what motivated me to get into the business,” he says. “I was frankly disappointed and, in some ways, shocked.”

Long tracked by the medical profession, measuring patient satisfaction is becoming a high priority among O&P practitioners. And some, like Passero, are adopting innovative approaches that go well beyond typical, rote software programs that collect patient feedback in part to comply with federal law.

Many O&P facilities have implemented O&P-specific customer satisfaction software that assists in compliance with requirements from CMS and the Facility Accreditation Program of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics. While these programs can be extremely helpful, some clinics are developing their own surveys, leveraging medical feedback tools, and modifying in-clinic routines to boost feedback from patients about their satisfaction—and inform decisions to improve care at their facilities.

Patient-Driven Queries

While the O&P profession has become increasingly focused on patient satisfaction, more work still needs to be done, according to Passero.

“This process of measuring patient satisfaction hasn’t really been addressed as comprehensively as it could, but it’s becoming more important—not just to satisfy patients, but to demonstrate uniqueness in the marketing of your company,” he says.

A division of Passero’s company— an offshoot called Handspring that specializes in upper-limb prosthetic rehabilitation—has developed a more refined approach than the typical Q&A patient satisfaction survey.

The McGann Client Feedback Form, introduced in 2015, is named after an ingenious patient who came to a Handspring clinic for treatment, says Laura Katzenberger, CP, the company’s director of clinical services.

“Mr. McGann created a questionnaire for himself to help him express how he felt about the prosthesis when he would come to his appointments to make sure that he communicated all of his experience with the prosthesis in between his appointments,” Katzenberger explains. “Our occupational therapist, Debra Latour, MEd, OTR/L, realized the power of the questions he was asking himself, and that led Handspring to develop the form we currently use.”

The survey, which Handspring shares with O&P professionals upon request, features 22 sections

of frequent concerns to the user of prosthetic technology. The user ranks each section on a simple three-tier “severity scale.” The survey, administered by the clinician during the visit, addresses the ease of donning and doffing the prosthesis, its weight, comfort of the socket, battery life, reliability, satisfaction with appearance, endurance with use of the device, and other factors. The user ranks each section on a simple threetier severity scale of red, yellow, or green, with red being most problematic and green being satisfactory.

The survey addresses many aspects of prosthetic care. “It can be anything from how well it fits, to the aesthetics of it, to the comfort of their gait, to the control of the device,” Katzenberger says. “When we’re in the fitting process, [implementing the survey] puts them more into the driver’s seat to get quality outcomes, and it gives them a voice at the next appointment, or at that specific appointment.”

Examining Patient Care

Jeffrey Brandt, CPO, chief executive officer and founder of Ability Prosthetics & Orthotics, headquartered in Exton, Pennsylvania, also uses industry standard software to deliver surveys and gauge satisfaction. But his facility has begun developing a

more specialized set of questions for patients. Brandt says traditional O&P patient satisfaction surveys seem to be more “about checking boxes for Medicare purposes, and not about informing” the practitioner.

Ability’s new survey, still in development, is the result of the feedback from the company’s recently established Patient Advocacy Council, which played a key role not only in contributing to the company's "Best Practices," but also in the refinement process of the patient satisfaction questions Ability P&O is piloting.

Brandt and his team also relied on informal patient comments. “We went through the patient rooms at all stages of the process and asked patients what they need to hear from us,” he recalls. “We learned a lot.” The new survey is being designed to be shorter and more informative than previous surveys. “We are piloting improvements. … We’re using it right now as a pilot in one of our clinics.”

The new pilot survey asks patients to share how strongly they agree or disagree with several statements corresponding to their care. Some questions relate to fit, comfort, donning/doffing, durability, information and courtesy offered by clinical staff, financial obligations, risks and benefits, and follow-up services, among others.

O&P ALMANAC | JANUARY 2019

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“

This process of measuring patient satisfaction hasn’t really been addressed as comprehensively as it could, but it’s becoming more important—not just to satisfy patients, but to demonstrate uniqueness in the marketing of your company.”

—THOMAS PASSERO, CP

After convening the Patient Advocacy Council and talking with patients, Ability has noted improvements in the quality of care, Brandt says. One of the sentiments Ability practitioners heard from patients was that they hoped to be better informed about potential side effects, such as rashes, from their devices in advance.

“When you’ve shared with them what could happen, they don’t ultimately react to those situations as extremely as they would if they hadn’t heard about it,” Brandt explains, describing it as “anticipatory guidance.”

Findings from the Patient Advocacy Council also revealed that many Ability patients would like to know more about why the clinic’s practitioners guide them to a specific prosthesis or brace design, say a specific foot or arm, in a market that might offer hundreds of choices.

“Clinically, patients wanted to know why they were ruled out of or into certain devices,” Brandt explains.

“They ask what made you choose the one you finally chose. Patients asked us for more transparency in that decision. They wanted more engagement.”

So, clinicians at Ability are making more of an effort to explain their clinical decisions. “We, as practitioners, can reference articles and show there has been a clinical efficacy test done 30

JANUARY 2019 | O&P ALMANAC

[that] shows that this [particular device will work] better for them. It isn’t just because a sales rep came in yesterday and offered me a better price on this foot. Our new patient satisfaction survey questions can capture whether these best practices are being practiced.”

Of course, convincing clients to participate is one of the most important—but sometimes challenging—keys to getting the most out of patient satisfaction surveys.

“We’ve put a great deal of emphasis on making sure our practitioners and the front desk staff are very thorough at explaining the survey and emphasizing the importance of receiving it back,” Brandt says. “We are trying to drive higher response rates for patient satisfaction and get more meaningful results.”

Capturing Physical and Emotional Satisfaction

Two years ago, clinicians at the University of Rochester Medical Center in New York started using a data collection system called PROMIS—short for Patient-Reported Outcomes Measurement Information System—with good results, according to Sean Zeller, MBA, MSPO, CPO, chief of orthotics and prosthetics.

The tool, developed by Northwestern

University using National Institutes of Health funding, is a statistically validated, computer-driven survey that uses computer adaptive technology and item-response theory for highly detailed, accurate results.

The tool is designed to capture patient-reported outcomes in “three default domains: physical function, mood, and pain interference,” Zeller explains. The survey asks questions about each of those domains, and scores are based on patient responses.

Those domains allow clinicians to study patient progress over the course of several appointments, with common assessment values used on the same patient for comparisons over time.

“PROMIS is a great tool to be able to talk to patients about how they are responding to things within a clinic visit,” Zeller says. “We’ve modified the instrument to be used on an iPad. As patients come in, they are given an iPad to answer questions. This is relatively new to O&P here. We’ve only been collecting data for 15 to 18 months now.”

The tool is designed to be minimally disruptive to clinic flow, with less than three minutes required to complete the questions each visit. Results can be visualized on a dashboard in real time, allowing clinicians to address areas of concern immediately.

Leveraging Data—and Informal Feedback

As the owner of LimBionics, a growing O&P practice that includes four clinics in North Carolina, Brittany Stresing, CPO, FAAOP, spends a lot of time thinking about patient satisfaction. Like many business owners, Stresing relies on software from OPIE to manage her business paperwork, and to distribute and collect patient satisfaction surveys.

But Stresing goes one step further in the patient satisfaction process.

Her team uses the information they collect—as well as feedback gleaned through more intuitive methods—to determine how to improve the patient experience and reach better outcomes for everyone they fit with a device.

“We do analyze each [survey], so if there is any fault at all—a lack of communication with the patient, education, wait times—we’re aware of it,” Stresing says. “We have monthly staff meetings and we go through all of it. If we realize we had somebody who was unhappy with their wait time, we dig into that chart—all of us together— to figure out what went on. Is it something we can improve on or was it a misunderstanding of the paperwork?

We all look at that to figure out what we could have done better.”

Stresing also makes a concerted effort to get feedback from as many patients as possible. While most LimBionics patients receive their questionnaires via email, there are some—many of whom are elderly— who opt to receive it by snail mail.

“Our geriatric patients aren’t as likely to email it back or have an email at all,” she says. “If they don’t have email, we’ll print off a copy of the survey and hand it to them, along with a stamped envelope, so it’s just easy for them. The geriatric population has a little more time generally—and a lot of times they are kind of excited to participate.

“We get a good amount of participation overall—it’s over 50 percent,” Stresing says. “The easier you make it for the patients, the more likely they are to do it.”

“

Capturing patient feedback from as many patients as possible is especially important in the age of Yelp, Google reviews, and ZocDoc, according to Brittany Stresing, CPO, FAAOP.

Capturing patient feedback from as many patients as possible is especially important in the age of Yelp, Google reviews, and ZocDoc, according to Stresing. It’s much better to hear any complaints directly from patients— and have the chance to address them immediately—rather than reading them online in a public forum. “[It] can be quite frustrating to have all those [public complaint] options out there,” Stresing says. “All it takes is someone to be unhappy that their insurance didn’t pay for something, and they end up venting about that.”

And even as more facilities implement surveys and e-tools to measure patient satisfaction, the value of human interaction should never be discounted. Clinicians at Barber Prosthetics in Vancouver, Canada, are ramping up use of client satisfaction surveys with good results—but they can’t replace good old-fashioned faceto-face communication, says Brittany Pousett, CP(C), a clinician and head of research at the facility.

“Talking gives you more information because you can delve into specific things,” Pousett says. “If someone really values aesthetics, you may hear about that. But at the same time, the survey asks such a wide variety of questions, you may learn things you have not thought to ask them.” In addition, one-on-one discussions can make patients aware of some of the services provided that perhaps the patient had not been aware of, she says.

Every O&P practitioner wants happy and satisfied patients, and increasingly, they’re realizing that achieving that goal means asking the right questions—and listening to the feedback.

“Without the patients, we’re nothing,” Stresing says. “Honestly, there is nothing more critical than understanding what the patient sees, what their issues are, and [whether] there is anything we can do to improve.”

Michael Coleman is a contributing writer to O&P Almanac.

O&P ALMANAC | JANUARY 2019

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COMPLIANCE CORNER

By MICHAEL HOLOMAN

The Road to Orthotics and Prosthetics Enrollment

E! QU IZ M EARN

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BUSINESS CE

CREDITS P.34

Follow these steps to ensure a smooth Medicare enrollment process

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 34 to take the Compliance Corner quiz.

Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

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This month’s Compliance Corner was written by Michael Holoman of the National Supplier Clearinghouse.

CREDITS

ACCREDITATION

DMEPOS

T

HE MOMENT FINALLY ARRIVES.

Your pen hovers over the page, or your mouse pointer sits on the “Submit Application” button in the Provider Enrollment and Chain/Ownership System (PECOS), and your heart pounds a little harder. The question we all ask ourselves arrives: “Have I included everything?”

The enrollment process for Medicare can be an arduous, stressful process.

Did you fill out all of the appropriate sections of the application? Did you include all of the appropriate documentation? Are you exempt from accreditation? Is this the correct application? Wait … there’s a fee?

Do any of these questions sound familiar as you go to ink your signature or click the “Submit Application” button?

Removing that angst during Medicare enrollment is possible. As an orthotic or prosthetic supplier, it’s possible you may make some common errors throughout the enrollment process—but you can adopt strategies to help reduce errors and ease that angst. Before you begin to traverse the path of durable medical equipment Medicare enrollment, slip off those trail boots for a moment and rest your feet, and we will guide you safely down the application road.

Tools

Before any trail hike, we need to be sure we have all of the necessary tools for the journey to be a success and 32

JANUARY 2019 | O&P ALMANAC

to prevent any unnecessary stops.

The website of the National Supplier Clearinghouse (NSC) is where you’ll want to begin. Specifically, you’ll want to use the New Supplier Enrollment document, which will explain all of the documentation and steps you should complete before even considering putting anything on the application.

First Bump in the Road: The infamous, “Do I have to be accredited?” question always comes up among the O&P community. The answer is simple. You do not have to be accredited—you are exempt.

How about, “Do I need to have a surety bond?” This is another question that O&P suppliers often ponder. This answer is not quite as simple. You are exempt if you meet some criteria: • The orthotic or prosthetic personnel are in private practice; • The business is making custommade orthotics and/or prosthetics; • The business is solely owned and operated by the orthotic or prosthetic personnel; and • The business is only billing for orthotics, prosthetics, and supplies.

There isn’t any interpretation of the criteria. If you meet all of the criteria, then you are exempt from the surety bond requirement and can put the money you save into something else.

COMPLIANCE CORNER

The Journey Continues

Not so bad so far, is it? As we continue down the path of gathering information, you’ll find that having the appropriate documentation will make the actual application process far easier and less stressful. At any point along the way, you can stop and reference your New Supplier Enrollment document, which offers detailed guidance if you find yourself a bit lost.

Does your state require you to have a license? If so, you’ll be required to submit that license with your application. If you are not sure, you can always reference the licensure information on the NSC website.

Second Bump in the Road: Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers are required to adhere to the Medicare DMEPOS Supplier Standards. One of the most common delays in processing applications is failure to show proof of

meeting Standard 10: “A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier’s place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations.”

NSC requires suppliers to submit a certificate of insurance with NSC as the certificate holder as proof of this insurance. This requirement is commonly overlooked with the application documentation. As an added note, the declaration page is not acceptable, nor is submitting the entire policy book:The one-page certificate of insurance is what is required. It is likely that your agent can produce a copy for you. Remember that submitting the professional insurance is not an alternative. This is not acceptable for DME enrollment. Submission of anything other than the certificate of insurance for general liability will delay the processing of your application.

Moving Right Along

As the path winds and twists down the application road, we come to a stop sign at Standard 30: “A supplier must remain open to the public for a minimum of 30 hours per week except physicians (as defined in section 1848(j)(3) of the Act) or physical and occupational therapists or a DMEPOS supplier working with custom-made orthotics and prosthetics.”

If you are an O&P supplier doing custom work, then you are exempt from the 30-hour requirement. You cannot be an O&P supplier and only sell off-the-shelf items and still be exempt.

As the journey to application completion continues, let’s remind ourselves that no one is exempt from the application fee for DMEPOS. You will need to pay the application fee for a first-time enrollee, adding additional locations, revalidations (once every three years), and reactivations. The application fee changes every year. Not sure what the fee is? Visit the cms.gov website.

O&P ALMANAC | JANUARY 2019

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COMPLIANCE CORNER

Third Bump in the Road: Moving along down the road, we take a quick inventory of all of the things we’ve collected and learned along the way. We revisit the New Supplier Enrollment document to review the checklist. You have a National Provider Identifier? (Check.)

You verified if you need to be accredited, and if so, you have accreditation?

(Check.) You verified if you need to have a surety bond—and that you have one if needed? (Check.) You have the required licensure for the states that you will bill in? (Check.) You have the appropriate insurance? (Check.) You are adhering to all of the supplier standards? (Check.)

You paid the application fee, or prepared to pay the application fee? (Check.)

As a reminder, the items discussed above are just a few of the most common mistakes we see during the application process.

This is not an exhaustive list of the documentation required. You still will need to submit documents for the Internal Revenue Service, electronic funds transfer forms, etc.

Once you have everything you need for your application submission, the question becomes, should you use paper or PECOS? The CMS 855s form is the paper application for submitting your application to NSC. Sure—you can go download a copy, print it, fill out the form (typewritten or in the preferred blue ink), make copies of all of your documents, gather them up, place them all in an envelope, make a trip to the post office, pay your postage, and just wait. This is what we are very accustomed to doing.

This process works, but it is fading.

As an alternative, CMS has created the Internet-based PECOS system for online application submittals. This system can be used to submit an initial Medicare enrollment application, view or change enrollment information, track an enrollment application through the web submission, add or change a reassignment of benefits, submit changes to existing Medicare enrollment information, reactivate an existing enrollment record, withdraw from the Medicare program, and submit a change of ownership of the Medicare-enrolled provider.

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JANUARY 2019 | O&P ALMANAC

Using the PECOS system offers some advantages: It’s faster than paper-based enrollment, a tailored application process means you only supply information relevant to your application, it gives you more control over your enrollment information, it’s easy to check and update your information for accuracy, and it requires less staff time and administrative costs to complete and submit enrollment to Medicare. In addition, you can upload all of your required documentation to submit, along with your application, and electronically sign your application. Zero paper is needed.

My recommendation? Use PECOS. When the system was initially created, it was easier to submit your application with paper. But today, the use of PECOS is far easier than paper, and the electronic system allows you more control over what’s happening with your application—plus, it’s easier to track the progress of your application. You can even go online at any time and verify exactly what’s on your application in the system. What you see on your side of a completed application is the exact same information that NSC has in its system because it is the same, shared system. And when it’s time to revalidate your application, you do not have to re-enter all of your information; you can just verify that the information is up to date, attach the needed documentation, and submit it. The time you save on just that process is worth it.

The Home Stretch

At this point, your application journey is just about complete. If you are using paper, mail it in; if you are using PECOS, click the “Submit” button.

Now the hardest part of the process is upon you—the wait. The application is no longer in your hands, and NSC has control over what happens with your application. No worries—you have followed the road to enrollment so your processing should go quickly and smoothly. And as you wait, you can always track your application status with the online NSC Application Status Tool.

Remember that your application process involves a site visit. An inspector from NSC, or an individual representing

NSC, will come unannounced to your facility to check your compliance with the 30 Supplier Standards. Don’t fret—when the inspector shows, you are almost done waiting for the completion of your application as this is the last major function of the application process before you are assigned a Provider Transaction Access Number.

Is the process of submitting your application for your DMEPOS supplier number simple? The answer is, “Yes.” Is the process easy? If you know what to do, the answer is, “Yes.” You do not have to guess or remain in the dark during the enrollment process. NSC has tools to help make your road to enrollment a much easier process.

OK, it’s time to take your feet down and pull those trail boots back on—time to begin your journey.

If your questions are too specific for the tools that are readily available on NSC’s website, contact the customer service line, 866/238-9652. The representatives who answer the phone lines are the same people who process enrollment applications. If you prefer to communicate via email, contact medicare.nsc@palmettogba.com.

Happy trails!

Michael Holoman is senior provider relations representative at the National Supplier Clearinghouse or, as he prefers, “the ombudsman.” Holoman has almost a decade of service within the ranks of NSC. DISCLAIMER: This information is accurate as of Dec. 21, 2018.

The content of the article is subject to change based on CMS policy changes and/or updates.

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PRINCIPAL INVESTIGATOR

Questions and Answers For Robert “Bob” Gailey, PhD, PT, O&P research means uncovering truths and going back for more

Fulfilling AOPA’s mission to advance research in the profession, O&P Almanac introduces individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and health-care professionals who have carried out studies and gathered quantitative and/ or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.

PHOTOS: Robert Gailey, PhD, PT

Robert “Bob” Gailey, PhD, PT, with his wife, Ann, and their golden retriever, Murray, in Washington, DC

“R

ESEARCH” IS SIMPLY THE

process of answering a question, according to Robert “Bob” Gailey, PhD, PT, a pre-eminent O&P researcher perhaps best known for developing the Amputee Mobility Predictor. “Funny thing—once you find the answer to one question, you often also realize that you now have several more questions,” he says. “If you get the bug for research, you quickly develop the passion—and before long, many scientists find themselves in the middle of a career of seeking the truth through a series of systematic investigations.”

That’s exactly where Gailey, a professor in the Physical Therapy Department at the University of Miami (UM), finds himself these days. After spending years studying energy expenditure and gait and developing outcome measures to demonstrate the functional capabilities of people with and without prostheses, Gailey is now working in the wearable technology space.

“At the UM Functional Outcomes Research Evaluation (FORE) Center, we have developed wireless sensors that can assess gait with a prosthesis, monitor exercises and physical therapy training, and provide audio feedback with music and verbal commands. In short, we have developed the ability for amputees to have a physical therapist in their pocket,” says Gailey. The goal is to help amputees walk better with their prosthesis and

reduce gait deviations, which could result in a reduction in secondary health conditions such as degenerative joint disease, back pain, and ulcers on the contralateral limb. “Basically, we are enhancing the use of outcomes with the use of wearable technologies so that we can gather more practical data.”

Inspired by Athletes With Limb Loss

Gailey says he was first drawn to the O&P profession after witnessing the determination and dedication of amputee athletes. After earning his bachelor’s degree in physical therapy (PT) in the very first class of PT students at UM in 1982, he began graduate studies. “While I was working on my master’s degree, I was freelancing as a physical therapist with a local prosthetic facility,” he recalls.

He attended an amputee basketball game during the U.S. Amputee Athletic Association’s National Summer Games in Nashville, where he watched an athlete with a transtibial amputation limping to the bench during a time-out.

“When the young man took off his prosthesis, I noticed his residual limb was bleeding from abrasions to the skin.

As the young man cleaned the skin, I suggested that he stop playing to avoid further injury to his skin. As he donned his prosthesis, he looked at me and said, ‘Are you kidding? We’re down four points!’

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PRINCIPAL INVESTIGATOR

monograph, Prosthetic Gait Training for Lower-Extremity Amputees, and shortly after I published on amputee sports.”

Gailey went on to produce videos and other publications on the topic.

He has educated hundreds of PTs and prosthetists on how to teach people to run with a prosthesis, “not so amputees can compete in the Paralympics, but rather, so they could exercise or move quickly at any time they feel the need,” he says. “In 1987, there were probably less than 20 amputees in the world who could run competitively. Working with Össur and Challenged Athletes Foundation (CAF) running clinics in 2018, we taught 450 people to run or improve their running performance.”

Gailey at a Challenged Athletes Foundation (CAF) running clinic After the game, the young athlete took off his prosthesis and grabbed his crutches from behind the bench.

Because the prostheses of the time were unforgiving and not designed for sports, the physical cost for one game of basketball for this young athlete was several days on crutches to allow his skin to heal.

But, for the young man to be an athlete again, if only for an hour, it was worth it.”

Gailey also attended a track competition at the Nashville Games, where he observed athletes taping metal to the bottom of their wood-and-rubber

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While aiding individuals with limb loss in their athletic endeavors has been a fulfilling part of his career, Gailey’s contributions as a faculty member of UM since 1986 also have been significant. Throughout the years, he has been involved in countless research endeavors; published hundreds of articles, monographs, and books; and spoken at conferences around the world.

In the late 1990s, when ultralight prosthetics came on the scene, Gailey studied the relationship of weight to energy expenditure. At the time, conventional wisdom was that the lighter the prosthesis, the greater the reduction in energy expenditure. “So, we investigated and found that was not true, and, in fact, prosthetic weight has little influence in energy expenditure, which turned out to be an advantage with today’s bionic prostheses that are a little heavier than mechanical prostheses,” he explains. “We also produced the first publication comparing quad sockets with ischial containment sockets and received the 1995 International Society for Prosthetics and Orthotics Forcheimer Prize for Research for our work.”

Of course, Gailey is widely known for his contributions to amputee measurement tools, which have been a game changer for the provision of O&P services. While employed by UM, he also took time to study at the University of Strathclyde, Glasgow,

PHOTOS: Robert Gailey, PhD, PT

Gailey and a participant at a CAF running clinic

prosthetic feet to improve their performance, with the transfemoral amputees running “with an inefficient hop-skip running style, and none of the amputee athletes used their prostheses effectively,” he recalls. “Very simply, sports for amputees was just emerging, and there were few people with knowledge about sports and prosthetics to help them.” Leveraging his background in sports biomechanics, he spent the next three days working with athletes to make simple changes in their running form that dramatically improved their performance. “During my time in Nashville, I learned that amputees were a neglected population of athletes, and that all they were looking for was the training and prosthetic equipment that would enable them to compete on an even playing field with other athletes.”

Over the next decade, Gailey focused on the biomechanics of prosthetic and amputee movement. He developed a systematic method of training and began working with various organizations to host multiday training camps designed to teach running and sports for amputee athletes. “I realized during the camps that before someone could run with a prosthesis, they needed to learn to walk properly,” he recalls.

“The sports camps also included gait training. After two years of intense work, in 1989, I published my first

Monumental Contributions

PRINCIPAL INVESTIGATOR

PHOTO: Robert Gailey, PhD, PT

Scotland, where he earned his PhD in Prosthetics and Orthotics in 2000. In Glasgow, he recognized that the recently introduced K levels were confusing and noted that U.S. insurance companies were asking for evidence to objectively determine K levels—and were even denying claims for newer technologies.

So, he set out to develop a measure that would detect differences in function with lower-limb amputees and provide clinicians with an objective measure for K-level assignment. “The test had to be administered with and without a prosthesis, appropriate for all levels of unilateral lower-limb amputees, be performed in less than 10 minutes, and use very little equipment,” Gailey recalls.

The result was the Amputee Mobility Predictor (AMP), an easily administered assessment tool designed to measure functional status of lower-limb amputees with (AMPRO) and without (AMPnoPRO) the use of a prosthesis.

The AMP is now used worldwide, translated in numerous languages, and a standard for many clinical practices.

“The AMP, for over two decades, has assisted countless clinicians justify K level and functional capabilities of people seeking to be fitted with microprocessor knees and feet.” Even more important “is the ability for clinicians to demonstrate the value of their interventions,” he says. Physicians, prosthetists, and therapists have the ability to quantify the change over time of a patient and link that change to the interventions they administered. “Today, the need to justify our interventions has never been greater, access to the health-care dollars has never been more competitive, and the need to document our clinical care has become vital to every profession,” he says. “If you look across the body of work from UM during my tenure, every publication and educational program has been focused on improving the care of our patients and quantifying the interventions we choose. In fact, several publications clearly stated the people classified as lower-functioning prosthetic users would benefit from more advanced prosthetic devices. In turn, the measures we developed, the products we compared, and interventions we

introduced all were focused on justifying need for improved prosthetic devices, socket designs, targeted physical therapy, and the need for access to care.

“Many people make the mistake that an outcome measure provides a number—that is the very minimum an outcome measure should provide,” he adds. “A well-designed outcome measure should be able to guide treatment and identify what exercises or prosthetic components a patient needs.”

Gailey teaches a new exercise to a subject.

Impacting All Aspects

Since the debut of the AMP tool, Gailey has continued to develop outcome measures and focus on other areas of study. Currently, he and his team at the UM FORE Center are working on the application of wearable technologies to detect gait deviations, predict injuries, and provide real-time feedback, so patients can receive a continuum of care in the home and community throughout the lifespan, he says. His team is currently in clinical trials with the U.S. Departments of Defense and Veterans Affairs, working with subjects

involved in the Rehabilitative LowerLimb Orthopedic Accommodatingfeedback Device (ReLOAD) program.

“This technology is not designed to eliminate or reduce the need for prosthetic care and physical therapy but rather enhance care, improve function, and reduce gait deviations that can lead to secondary health effects,” he explains. “The overwhelming majority of participants enrolled with ReLOAD have been found to walk better, have been more active, and have requested more from the program because they can see the difference.” The program is simple, according to Gailey: After someone receives a prosthesis, he or she is taught how to use the ReLOAD app. When they go home, they have an iPad that offers exercises with videos.

“If they wear the two knee sleeves with sensors, we can see how well they walk.

They can use the audio feedback system, where the system detects if they deviate from their ‘best’ walking pattern; when they do, the music they are listening to warps, [so] they quickly return to the preferred walking pattern, and the music is restored to normal. People respond much better to the music than verbal commands, and, after a short period of time, they maintain a more natural gait.”

The ReLOAD program is designed to be used in conjunction with a clinician, who can pull up the patient’s file at the end of the day to monitor progress with their exercise program, walking, daily activities, and more. “The clinician can modify their home program—or if a problem does occur, have the patient schedule an appointment at the clinic for further evaluation.

Clinicians can now prevent small problems from becoming major complications. And the patients love it!”

The use of applied technology is happening across all aspects of health care, says Gailey. “Today, O&P has to be more than just another widget or product; the expectation is complete care … which would include in-depth assessment, outcomes, documentation, and referrals,” he says. “The use of technology can help reduce the burden of these demands and will be imperative as clinical practice and the future of O&P changes.”

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PRINCIPAL INVESTIGATOR

Driven To Help

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Gailey with members of Team Zaryen; Jason Miller, PT; and Adam Finnieston, CPO devices were fit with 400 adult prosthetics; plus 275 prosthetics for children and 510 pediatric orthotics,” he says.

“The Knights of Columbus generously agreed to support Team Zaryen, the amputee soccer team that rallied the people of Port au Prince after the earthquake with games in the national stadium. Team Zaryen also traveled to Walter Reed National Medical Center to introduce amputee soccer to the military amputees and to say thank you for their support immediately after the earthquake.” On the fifth anniversary of the earthquake, Gailey was invited with select members of the rehabilitation team and Team Zaryen to meet with Pope Francis in the Vatican—an experience he will never forget.

When he is able to steal some spare time away from O&P work, Gailey spends time with his wife, Ann, and their sons, Rob and Max. “Ann is my best friend who has traveled with me, collaborated with me, and put up with me,” he says. “The long hours of work, weekends

devoted to meeting deadlines, and extensive time away from home over the years can be difficult; however, Ann has always been there.” And although they are based in Miami most of the year, the couple enjoys summers in Camden, Maine, where they hike, sail, and golf.

In addition, Gailey engages in an extremely unique pastime—collecting prostheses. His collection includes a prosthesis from every war fought by the United States since and including the Revolutionary War. “I have been collecting prosthetic legs since the 1980s and continue to be on the hunt for unique vintage prosthetic arms and legs,” he says.

Circling back to his work, Gailey notes that he gets tremendous joy from his investigations. “The absolute fun part of research in O&P is going to meetings and having discussions with other researchers who know the literature and can have in-depth conversations,” he says. “I always walk away with more questions than when the conversation started.”

PHOTOS: Robert Gailey, PhD, PT

Going forward, Gailey believes the most pressing question regarding O&P is the value of O&P interventions—“not so much comparing one product to another, but rather what is the change over time after receiving prosthetic care?” More clinicians are integrating outcome measures into their practices, which bodes well for the profession. “If more prosthetists were to use [outcome measures] as a baseline with their patients and repeat the measures at the time of final fitting and, more importantly, some time in the future after they are familiar with the new prosthesis, then they could demonstrate the value of appropriate prosthetic care over time,” says Gailey.

“The even larger question is the long-term effects of appropriate prosthetic care with respect to a reduction in secondary conditions such as back pain, degenerative joint disease, falls, and ulcers to the contralateral limbs,” he adds. Satisfying these questions will be important to establishing prosthetic care, “not as the replacement of a missing limb, but rather a medical appliance to restore function and reduce the risk of further adversity.”

Gailey stays focused on the goal of improving life for O&P patients—and he believes that interacting with the subjects in his studies is one of the most enjoyable aspects of his research.

“When research participants share their thoughts, they are invested stakeholders conveying well-thought-out observations from their life with the intention we will use the information to help others.

That can be powerful information.”

Gailey also enjoys interactions with younger researchers, including the many PhD students, PTs, engineers, and prosthetists he has advised over the years.

Despite his busy schedule, Gailey has made time for volunteer initiatives, including important work in Haiti.

Days after the 2010 Haiti earthquake, he headed the rehabilitation team for Project Medishare and UM in Port au Prince. “During the six years of services, and with funding from the Knights of Columbus, we treated over 20,000 patients; 1,750 prosthetic and orthotic

MEMBER SPOTLIGHT

Syncor Ltd.

By DEBORAH CONN

Lower-Limb Innovators Wisconsin company got its start as a manufacturer of suspension products

S

UCCESSFUL INVENTORS

PHOTOS: Syncor Ltd.

notice a need and then figure out a way to fill it. The need for a better way to suspend an aboveknee prosthesis turned out to be the impetus behind the invention of new prosthetic suspension products—and the creation of Syncor Ltd. back in 1985.

David Jolly, CP(E), and his wife, Debra, were working at an O&P facility in Houston, Texas, when David and the facility owner saw the need for an improved device.

They developed a total elastic suspension (TES) system that would support a transfemoral prosthesis. “Up to that point, the only method was to use a belt of webbing that had to be riveted onto the socket,” says Debra. “It was difficult to change and to launder. We wanted our TES belt as an alternative.”

The Syncor auxiliary suspension is made of neoprene with nylon on the inside. It has a low-profile, anti-roll panel that doesn’t bunch to ensure ease of application and comfort.

“Our belt uses a Silesian, or diagonal, design that evens out the stress and eliminates any ‘pull-down’ feeling,” Debra explains. “At the time, it was revolutionary—a unique item that was much appreciated, and we had a hard time keeping them in stock.

Even now, with all the new ways of attaching a socket, we [continue to serve] a niche market.”

The Jollys moved to Wisconsin in 1988, where they maintain a warehouse stocking their products—which are made to their specifications

by U.S. manufacturers.

Bilateral total elastic suspension (TES) belt

COMPANY: Syncor Ltd. OWNER: David Jolly, CP, and Debra Jolly LOCATION: Abrams, Wisconsin HISTORY: 33 years

In addition to the standard belt, which has a triangular opening at the hip joint, Syncor offers a model without the opening that offers slightly more control for rotation problems and an improved fit for many women. The company makes the TES belt in sizes ranging from infant to double extralarge. It offers custom work for individuals who may need a belt with a smaller waist or a longer cuff, for example.

Syncor also developed the Durasleeve, a neoprene sleeve suspension product for belowknee prostheses that creates an air-tight, hypobaric suction environment. The sleeve is made in a preflexed knee design to eliminate bunching and is seamless for additional comfort.

The design also incorporates a Lycra panel fitting over the socket edge area to minimize wear. “It’s a washable, easyto-wear product,” says Debra.

The sleeve is made in standard neoprene as well as a more heavy-duty version for active

amputees. Another option uses EZ neoprene, which is hypoallergenic as well as softer and more easily donned, she says, making it a good choice for less active amputees who may have hand mobility issues.

Debra notes that the raw materials are sourced from Japan and Taiwan because neoprene rubber is not manufactured in the United States. “We have to have the sleeve assembled in Mexico because of gluing regulations in the United States, for the inner Lycra panel,” she says.

“Otherwise, all our products are manufactured in this country.”

Syncor handles no direct sales and has no presence on the Internet. The company sells through six distributors in North America and eight serving an international market that includes India, France, the Netherlands, Japan, Australia, Great Britain, Spain, and Pakistan.

In the past, Debra says, distributors would maintain relatively strong inventories of the belt, but improvements in shipping have made it easier to fulfill small orders on demand.

David Jolly retired in 2013, and Debra is thinking about doing the same. Their daughter, Elizabeth, is learning the business and is considering taking it over at some point. Debra and David are proud of what they have accomplished. “We saw a need, and we’re glad we were able to fill it,” Debra says.

Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

O&P ALMANAC | JANUARY 2019

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MEMBER SPOTLIGHT

Utah Prosthetics and Orthotics

Serving His Home State— and a U.S. Territory Utah facility owner spends several weeks each year providing care in American Samoa

M

ATTHEW BRACKEN, CPO,

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JANUARY 2019 | O&P ALMANAC

Matthew Bracken, CPO, started a triathlon in American Samoa to promote health.

FACILITY: Utah Prosthetics and Orthotics OWNER: Matthew Bracken, CPO LOCATION: Cedar City, Utah HISTORY: 13 years

Matthew Bracken, CPO

Utah Prosthetics and Orthotics

orthotist. “This whole-person approach helps patients return to independent living,” he says.

Utah P&O has adopted a philosophy of helping underserved patients. Matt has a long history of volunteer work in such areas as the Philippines, the Republic of Georgia, and Haiti. In Haiti, he volunteered with Healing Hands for Haiti, an organization that teaches local residents how to fabricate basic prostheses. The organization also donates physical medicine and rehabilitative services to people of that country.

In 2013, the government of Western Samoa asked the Church of Jesus Christ of Latter-Day Saints, of which Matt is a member, to help open a prosthetics office on the island. The Brackens decided to fly to Western Samoa to check out the situation, but just before they left, they learned that the Australian government had already submitted a successful proposal to set up a prosthetics program there. Matt and his wife proceeded with their trip

to evaluate conditions there, and on their way back, they stopped in American Samoa.

The Brackens connected with a local physical therapist, Sandy Scanlan, who proved instrumental in helping them decide where to focus their efforts.

“The need for prosthetic care is somewhat hidden in the American Samoa community,” Matt explains. “There are few sidewalks, and the driveways are made of crushed coral and volcanic rock, which means patients in wheelchairs are pretty much confined to their homes. I ended up building a prosthesis for one of [Scanlan’s] patients, and by the time it was finished, she had lined up 17 other amputees.

Clearly, amputees there want to have access to prosthetic care.”

Another local, Joe Tavale, helped Matt navigate the red tape involved in getting Medicare reimbursement in American Samoa—a process that has taken years—but, today, Matt has a repair facility on the island and sees patients in their homes.

He and Nylene visit American Samoa for 10 days at a time about four times a year. In addition to treating Medicare patients, Matt works with those without funds, making low-cost propylene sockets with donated materials.

Back in Cedar City, he takes an unusual approach to social media marketing, which has paid off. Matt says, “I encourage my patients to get their kids on Facebook and on other sites to spread the word. It’s a great way to publicize our services and successes.”

Wherever he practices—in Cedar City or American Samoa—Matt’s underlying mission is constant. “I love helping people,” he says.

Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Utah Prosthetics and Orthotics

has worked as a certified prosthetist/orthotist in Utah for more than 33 years. In 2005, he opened a facility in St. George, Utah, and in 2008, he moved to Cedar City, where he turned the existing satellite office into a full-time facility. He is now in the process of spinning off the St. George facility to another prosthetist, Peter Fjeldsted.

Utah P&O’s Cedar City location is staffed by Matt; his wife, Nylene, who handles administrative duties; a receptionist; and a billing secretary.

Matt serves a wide range of patients, including Native Americans, with nearly 75 percent of his business focused on prosthetics. “Most amputations are the result of diabetes,” he says, although he also works with trauma patients, including several military veterans. Matt sees patients in office but frequently makes home visits.

The facility is “set apart” from other O&P practices in Utah due to Matt’s training in a specialized solution for brain injury and stroke patients: He is the only approved orthotist in the state to cast patients for the Neuro-IFRAH (Neuro-Integrated Function Rehabilitation and Habilitation) approach, according to Matt.

Neuro-IFRAH involves a team of practitioners, including a physician, an occupational and/ or physical therapist, and an

By DEBORAH CONN

www.amďŹ t.com

800-356-3668 * p l u s S / H , l i m i t o n e p e r c u s t o m e r, o f f e r e x p i r e s 1 / 3 1 / 1 9

AOPA NEWS

AOPAversity: Webinar Series Subscription During the one-hour monthly webinars, AOPA experts provide the most up-to-date information on a specific topic.

Webinars are held the second Wednesday of each month at 1 p.m. EST. One registration is all it takes to provide the most reliable business information and CE credits for your entire staff. If you’ve missed a webinar, AOPA will send you a recording of the webinar and quiz for CE credits, so you can still take advantage of the series discount and the valuable learning opportunities.

Sign Up for the 2019 Full Year Series & Save!

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* Includes an unlimited number of participants per telephone line. AOPA members may use code “member” when registering for the $99 price.

Earn 1.5 Business CEs each by returning the provided quiz within 30 days and scoring at least 80 percent. All webinars begin at 1 p.m. EST. Webinar registration fees are nonrefundable. AOPA can provide the webinar recording if registrants cannot make the scheduled webinar.

FEBRUARY 13

MARCH 13

Patient Outcomes: Best Practices & How To Use Them

Advanced Beneficiary Notice: Get To Know the ABN Form

The February 13 webinar will focus on the principles of developing and using patient outcomes in your practice.

AOPA experts will address the following questions:

The advanced beneficiary notice (ABN) can be a valuable tool in protecting your financial liability. Take part in the March 13 AOPAversity webinar, when AOPA experts will examine proper usage of the ABN form:

• • • •

42

What exactly are “patient outcomes”?

Why should you pay attention to patient outcomes?

What are best practices for tracking patient outcomes?

How can you leverage patient outcomes to improve care and your business?

JANUARY 2019 | O&P ALMANAC

• Learn when use of an ABN is appropriate.

• Examine common scenarios regarding proper ABN usage.

• Determine how to use the ABN when billing for upgraded features.

• Find out how the ABN can ensure a partial payment for services rendered.

• Avoid the most common mistakes that can render an ABN invalid.

• Understand all of the modifiers associated with an ABN.

AOPA NEWS

2019 WEBINARS

2019 Webinar Topics Announced Mark your calendars for AOPA’s 2019 monthly webinars. These informative sessions take place on the second Wednesday of each month at 1 p.m. EST. 2019 Webinars • January 9: Understanding the Knee Orthosis Policy • February 13: Patient Outcomes: Best Practices & How To Use Them • March 13: Advanced Beneficiary Notice (ABN): Get To Know the ABN Form • April 10: Shoes, External Breast Prostheses, Surgical Dressings, and Other Policies • May 8: Are You Compliant? Know the Supplier Standards • June 12: Documentation—Understanding Your Role • July 10: Target, Probe, Educate—Get To Know the Program & What the Results Are Telling You • August 14: Are You Ready for the Worst? Contingency Planning • September 11: Veterans Affairs Updates: Contracting, Special Reports, and Other News

AOPA Announces 2019 Call for Papers Submissions Due March 25

AOPA is seeking high-quality educational and research content for the 2019 AOPA National Assembly, which will be held September 25-28, 2019, in San Diego, California. All submissions are due March 25, 2019.

Your submissions will set the stage for a broad curriculum of high-value clinical and scientific offerings at the National Assembly. All free paper abstracts must be submitted electronically. Abstracts submitted by email or fax will not be considered. All abstracts will be considered for both podium and poster presentations. The review committee will grade each submission via a blind review process and reach a decision regarding acceptance of abstracts.

AOPA is seeking submissions for the clinical free paper sessions, symposia/instructional courses, technician program, or business education program. Contact AOPA Headquarters at 571/431-0876 or rgleeson@AOPAnet.org with questions about the submission process or the AOPA National Assembly in general.

Visit the AOPA website for more information and to see full submission guidelines for the 2019 AOPA National Assembly.

• October 9: Performance Reviews: How Is Your Staff Doing?

• November 13: The Holiday Season— How To Provide Compliant Gifts • December 11: New Codes for 2020, Other Updates, and Yearly Roundup During these one-hour sessions, AOPA experts provide the most up-to-date information on a specific topic.

Webinars are perfect for the entire staff—they’re a great team-building, money-saving, and educational experience!

Sign up for the entire series and get two conferences free.

Entire Series ($990 Members/$1,990 Nonmembers).

Register at bit.ly/2019webinars.

O&P ALMANAC | JANUARY 2019

43

AOPA NEWS

Are you curious about how your O&P business is performing compared to others? Have you been asking questions like these:

NOW AVAILABLE:

‘2018 Operating Performance Report’ AOPA Releases Results From Member Benchmarking Survey

• How does our spending on materials, advertising, or other expenses compare with other companies similar to ours?

• Is our gross margin better or worse than other facilities of the same size?

• Are our employees generating enough sales?

Copies of the “2018 Operating Performance Report” are now available. The annual report provides a comprehensive financial profile of the O&P industry, including balance sheet, income statement, and payor information organized by total revenue size, community size, and profitability. This year’s data was submitted by more than 90 patient-care companies representing 1,022 full-time facilities and 191 part-time facilities.

Copies of the “2018 Operating Performance Report” are available electronically or print in AOPA’s bookstore: • “2018 Operating Performance Report” (Electronic)—Member/Nonmember: $185/$325

Realize the facts. O&P care improves quality of life and is cost effective!

Learn more at MobilitySaves.org.

Reasons to visit MobilitySaves.org

O&P CARE IS A SAVER, NOT AN EXPENSE TO INSURERS!

Visit MobilitySaves.org MobilitySaves.org.

Follow us on social media!

“Search Mobility Saves” on Facebook, Twitter, and LinkedIn

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JANUARY 2019 | O&P ALMANAC

Learn about the study proving orthotic and prosthetic care saves money

See how amputees rallied when their prosthetic care was threatened

Find supporting data to get your device paid for

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O&P PAC UPDATE

Special Thanks to the

2018 PAC Contributors

AOPA would like to thank the following individuals for their contributions in 2018 to the O&P PAC:

PRESIDENT’S CIRCLE ($1,000-$5,000) David Boone, BSPO, PhD, MPH Jeffrey Brandt, CPO Maynard Carkhuff Rick Fleetwood, MPA Michael Oros, CPO, FAAOP Rick Riley

CHAIRMAN’S TABLE ($100-$499) Lisa Arbogast Vinit Asar Gerald Bernar Jr., COA, CP, LP Dale Berry, CP Frank Bostock, CO George Breece Luke Brewer, CPO Jim Campbell, PhD, CO, FAAOP Edward De La Torre

SENATOR’S TABLE ($500-$999) Ryan Arbogast Curt Bertram, CPO Michael Fillauer, CPO Eddy Gosschalk, CPO Dan Jones Curt Kowalczyk, CO Jeffrey Lutz, CPO Ann Mantelmacher

Mitchell Dobson, CPO, FAAOP Traci Dralle, CFm Brian Franklin Elizabeth Ginzel, CPO, LPO Paul Gudonis Sheri Hassler Denise Hoffman Michele Hogan Jim Kingsley Charles Kuffel, CPO, FAAOP

Teri Kuffel, Esq. Eileen Levis Sam Liang F. Daniel Luitjohan, CP, LP Pam Lupo, CO Stuart Marquette, CO Dave McGill Jonathan Naft, CPO Scott Ranson Cathy Rubel Scott Sabolich, CP William Snell, CPO Wanda Stephans Sarah Stilley Terry Supan, CPO, FAAOP Jason Wening, CPO, FAAOP Chris Wilson Jon Wilson, CP llly Woodard Shane Wurdeman, CP, FAAOP, PhD, MSPO

Brian Mayle Paul Prusakowski, CPO Jack Richmond, CPOA

1917 Club (Up to $99)

John Roberts, CPO Bradley Ruhl Scott Schneider Ed Sisson, CPO Chris Snell, BOCP Ted Snell, CP Jim Weber, MBA

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JANUARY 2019 | O&P ALMANAC

Devon Bernard Tina Carlson, CMP Don DeBolt Thomas Fise, JD Ryan Gleeson, CMP Betty Leppin

Yelena Mazur Joe McTernan Kelly O’Neill, CEM Ashlie White

O&P PAC UPDATE

2018 PAC Supporters These individuals have generously contributed directly to a political candidate’s fundraiser and/or have donated to an O&P PAC-sponsored event.

Peter Allard

Traci Dralle, CFm

Jack Richmond, CPOA

Wendy Beattie, CPO, FAAOP

Steve Filippis, CP

Rick Riley

Rudy Becker

Tom Fise, JD

Manuel Rivera, CP

Rick Fleetwood, MPA

Scott Schneider

Jim Kaiser, CP

Chris Snell, BOCP

Teri Kuffel, JD

Clint Snell, CPO

Dave McGill

Frank Snell, CPO, FAAOP

Michael Oros, CPO, FAAOP

Peter Thomas, JD

Curt Bertram, CPO, FAAOP Amit Bhanti, CPO David Boone, BSPO, PhD, MPH Jeffrey Brandt, CPO Charlie Dankmeyer, CPO

Melanie Perry

Jim Weber, MBA

In 2018 the O&P PAC made contributions to the following members of Congress: Sen. Ben Cardin (D-Maryland) Sen. Claire McCaskill (D-Missouri)

Rep. Dutch Ruppersberger (D-Maryland)

Rep. Mike Bishop (R-Michigan)

Rep. Glenn Thompson

Rep. Brett Guthrie (R-Kentucky)

(R-Pennsylvania)

Rep. Ann Kuster (D-New Hampshire)

Rep. Brad Wenstrup (R-Ohio)

Rep. Brian Mast (R-Florida) Rep. Richard Neal (D-Massachusetts) Rep. Erik Paulsen (R-Minnesota) Sen. Ben Cardin (D-Maryland)

Rep. Peter Roskam (R-Illinois)

* Due to publishing deadlines this list was created on Nov. 27, 2018, and includes only donations and contributions made or received between Jan. 1, 2018, and Nov. 27, 2018. Any donations or contributions made or received after Nov. 27, 2018, will be published in the next issue of O&P Almanac.

O&P ALMANAC | JANUARY 2019

47

NEW MEMBERS

T

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or statelicensed practitioner to be eligible for membership.

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

ACTRA Rehabilitation Associates Inc. 10700 W. Burleigh Street Milwaukee, WI 53222-3310 414/778-4500 Affiliate ACTRA Rehabilitation Associates Inc. 1931 S. Washburn Street Oshkosh, WI 54904-7865 920/426-1231 Affiliate ACTRA Rehabilitation Associates Inc. 7201 Green Bay Road Kenosha, WI 53142-3532 262/697-1160 Affiliate ACTRA Rehabilitation Associates Inc. 6514 Odana Road Madison, WI 53719-1124 608/833-9660 Affiliate

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JANUARY 2019 | O&P ALMANAC

Benchmark Orthotics & Prosthetics Inc. 1944 Lincoln Highway E., Ste. 4 Lancaster, PA 17602-5903 717/295-3073 Affiliate Benchmark Orthotics & Prosthetics Inc. 808 East Oldtown Road Cumberland, MD 215024034 301/759-4944 Affiliate Benchmark Orthotics & Prosthetics Inc. 351 West Beau Street, Ste. A Washington, PA 153019998 724/825-4200 Affiliate Benchmark Orthotics & Prosthetics Inc. 12100 West Center Road, Ste. 524 Omaha, NE 68144-3969 402/932-1070 Affiliate

Benchmark Orthotics & Prosthetics Inc. 56 West Main Street, Ste. C Westminster, MD 211574844 410/857-2805 Affiliate

David A. Yates & Associates Inc. / dba Jonesboro P&O Lab 820 Professional Acres Jonesboro, AR 72401 870/932-6436 Affiliate

Cape ProstheticsOrthotics Inc. 118 Airway Drive Marion, IL 62959-5841 618/993-9779 Affiliate

Eastpoint Prosthetics & Orthotics Inc. 2149 Stumbo Road Mansfield, OH 44906 419/512-9841 Affiliate

Cape ProstheticsOrthotics Inc. 2232 Broadway Street Paducah, KY 42001-7112 270/575-3223 Affiliate

Fountain Orthotics & Prosthetics 3650 South Street, Ste. 110B Lakewood, CA 90712-1502 Affiliate

Cape ProstheticsOrthotics Inc. 912 Ida Street Poplar Bluff, MO 639014210 573/778-9093 Affiliate Cape ProstheticsOrthotics Inc. 1904 Olive Street St. Louis, MO 63103-1626 314/231-1156 Affiliate Cape ProstheticsOrthotics Inc. 728 Sunset Drive Farmington, MO 636401988 573/747-1144 Affiliate David A. Yates & Associates Inc. / dba Jonesboro P&O Lab 2103 S. 54th Street, Unit 1 Rogers, AR 72758 479/319-4543 Affiliate

Freedom Management Services 440 Horsham Road, Ste. 2 Horsham, PA 19044 214/328-9111 Affiliate Horton’s Orthotics & Prosthetics 635 Dave Ward Drive, Ste. 103 Conway, AR 72034 501/406-8510 Affiliate Orthopaedic Specialties of Atlanta Inc./dba Georgia Brace & Spine 331 Curie Drive Alpharetta, GA 30324 770/619-0615 Company

NEW MEMBERS

Orthotic Prosthetic Solutions LLC 2425 S. Colorado Blvd., Ste. 100 Denver, CO 80222 303/346-1906 Affiliate

Victory Orthotics & Prosthetics LLC 2333 Knob Creek Road, Ste. 14 Johnson City, TN 37604 423/461-3320 Affiliate

Rhode Island Limb Co. Inc. 26 Valley Road, Unit 101 Middleton, RI 02842 401/619-4639 Affiliate

Victory Orthotics & Prosthetics LLC 166 D. Market Place Blvd.

Knoxville, TN 37922 865/249-8852 Affiliate

Wisconsin Prosthetics & Orthotics Inc. 1105 Wittman Drive Menasha, WI 54952-3607 920/725-6200 Affiliate Wisconsin Prosthetics & Orthotics Inc. 1845 Velp Avenue, Ste. A Green Bay, WI 543036594 920/497-5911 Affiliate

Wisconsin Prosthetics & Orthotics Inc. 1344 N. Taylor Drive Sheboygan, WI 530813042 920/803-9610 Affiliate SRT Prosthetics & Orthotics LLC 408 E. Washington Street Butler, IN 46721 419/633-3961 Affiliate

Richey FAS LLC 1023 Emmet Street N. Charlottesville, VA 22903 434/245-0208 Affiliate

NE

W

Make Your First Impressions Count

!

With Customized Polo shirts, Scrub tops and Lab Coats for your O&P staff

Create an attractive business image, promote your brand, and foster team spirit with AOPA’s new Apparel Program.

To order your apparel, go to

iconscrubs.com Enter access code: ICON-AOPA Enter your AOPA member id Create your user profile

AOPA is partnering with Encompass Group, a leading provider of health care apparel, to offer members special prices on customized polos, scrub tops, and lab coats.

AOPA Polo Shirts–Now for Sale Celebrate AOPA’s Centennial with us by ordering AOPA polo shirts for your office! The shirts are black with a white AOPA logo. Moisture wick, 100 percent polyester. Rib knit collar, hemmed sleeves, and side vents. The polos are unisex but the sizes are men’s M-2XXL. $25 plus shipping. Order in the bookstore at bit.ly/aopastore.

POLO TS SHIR

B SCRU P O T S

LAB COAT

O&P ALMANAC | JANUARY 2019

49

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge.

Include your company logo with your listing free of charge.

Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to ymazur@AOPAnet.org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.

O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Listing Word Count 50 or less 51-75 76-120 121+

Member Nonmember $140 $280 $190 $380 $260 $520 $2.25 per word $5 per word

Nonmember $678 $830

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org.

Member Nonmember $85 $150

For more opportunities, visit: http://jobs.aopanet.org.

SUBSCRIBE

A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.

50

Certified Prosthetist/Orthotist (CPO)

Job location key:

Job Board

Mid-Atlantic

JANUARY 2019 | O&P ALMANAC

Central Virginia The Prosthetics and Orthotics Division in the University of Virginia’s School of Medicine seeks a certified prosthetist and orthotist (CPO) to consult, provide, and fabricate orthotic and prosthetic devices for adults and children with musculoskeletal impairments throughout Central Virginia.

The successful candidate will be responsible for managing comprehensive orthotic and/or prosthetic patient care. This includes patient assessment, formulation of a treatment plan, implementation of the treatment plan, and follow-up care and practice management.

Candidates for the position should have either a bachelor’s degree with completion of an NCOPE-affiliated certificate program and completion of NCOPE-affiliated residency program; or an associate degree with at least 10 years of direct P&O experience. Qualified candidates must be certified through the American Board for Certification in Prosthetics and Orthotics and have one year of post-certification experience. Some experience with foot/ankle and pediatrics is required. Also, candidates should be knowledgeable with DME billing codes, insurance compliance, and current trends in the prosthetic and orthotic industry.

Successful candidates for the position should also possess interpersonal skills to help build referral bases. A history of prior practice management is preferred, and supervisory and office management skills are a plus.

Applicants should complete a staff application through the Jobs@UVa website, and provide a cover letter, résumé, and a list of three references. To apply for either position, visit https://jobs.virginia.edu, click on University Staff, and search for posting # 0622645 for the Certified Prosthetist/Orthotist.

For more information about the division, please visit https:// med.virginia.edu/orthopaedic-surgery/orthopaedic-divisions/ orthotics-and-prosthetics/.

This position is restricted and contingent upon continued funding.

University of Virginia Website: https://jobs.virginia.edu The University of Virginia is an equal opportunity and affirmative action employer. Women, minorities, veterans, and persons with disabilities are encouraged to apply.

CAREERS

WANTED!

Southeast

Certified Prosthetist/Orthotist (CPO) and P&O Technician

South Carolina, North Carolina Are you a compassionate, experienced professional who enjoys a challenging position and thrives on providing excellent patient care? If so, you are who we are looking for.

As health care continues to change and large corporations treat patients like a number, we at Advanced Prosthetics continue to make patient care our #1 priority. We are Amputees Serving Amputees. Consider joining our team and making a difference! Competitive salary and benefits package offered. Visit www.advancedpro.biz.

A few good businesses for sale.

Lloyds Capital Inc. has sold over 150 practices in the last 26 years.

If you want to sell your business or just need to know its worth, please contact me in confidence.

Barry Smith Telephone: (O) 323-722-4880 • (C) 213-379-2397 e-mail: loyds@ix.netcom.com

CONTACT: Carol Baker, Director of Human Resources Advanced Prosthetics Inc. Fax: 864/622-0592 Email: carol@advancedpro.biz

AOPA’s O&P Career Center

Connecting highly qualified O&P talent with career opportunities

EMPLOYEE

• Research who is hiring • Apply online for job openings • Free résumé review

EMPLOYER

• Post your job in front of the most qualified group of O&P professionals • Search anonymous résumé database to find qualified candidates • Manage your posted jobs and applicant activity easily on this user-friendly site.

LOG ON TODAY!

Recruitment

https://jobs.aopanet.org O&P ALMANAC | JANUARY 2019

51

MARKETPLACE

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/almanac19 for advertising options.

ALPS Smart Seal Liner Break into the New Year with ALPS Smart Seal Liner!

Our Smart Seal Liner features raised bands that grip to the socket wall to form a secure interface. The bands are coated with a special material to ensure longer life and extra security for a smarter seal. The Smart Seal Liner has a new seamless knitted construction with a modern look and is available in locking and cushion suspension. The locking version features a new distal construction to control distal distraction with no matrix.

The Smart Seal Liner is just what you need to start off to a great New Year!

Call us or visit www.easyliner.com for more details.

Apis Footwear Apis Footwear is proud to introduce all new additions to our premier collection of shoes under Mt. Emey—six new styles to revamp and reenergize our already impressive collection. These new styles offer a highly demanded lightweight fit with more options. All new shoes are made of quality materials to ensure fit and comfort. They come with removable insoles for flexible fitting and elongated counters for superior support. Our goal is to put a smile on your patients’ faces and maximize your bottom line.

Please call us at 888/937-2747 for current catalogs and free display samples.

The Original Pre-Flexed Suspension Sleeve ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Pre-flexed at 43 degrees for maximum comfort and natural unrestricted movement.

For more information, call ESP LLC at 888/932-7377 or visit www.wearesp.com.

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JANUARY 2019 | O&P ALMANAC

Sutti Bounders Store and Return Energy— Mimicking Normal Muscle Function New “Sutti Bounders” modular pediatric dynamic elastomers are a patent-pending elastomer technology that offer two progressive solutions.

Sutti Bounders store and return energy—mimicking normal muscle function to produce both eccentric and concentric contractions and, if needed, a ground-reaction force. Smart and simple modular design, standardized sizes, and three levels of performance to choose from add up to an easy-to-use expandable dynamic system to treat your pediatric and young adult patient base.

For more information, visit www.fabtechsystems.com/ bounders or call 1-800/322-8234.

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue.

For more information, call 800/301-8275 or visit www.hersco.com.

Naked Prosthetics Naked Prosthetics designs and manufactures high-quality prosthetic devices specifically for finger loss. Our mission is to assist people with digit amputation(s) and positively impact their lives with fully articulating, custom finger prostheses.

Our product aims to restore the ability to perform most tasks, supporting job retention and an active lifestyle. Our customers have lost fingers to power tools, equipment malfunctions, injury in the line of military service, random accidents, and infections; in some cases, multiple digits have been lost. NP provides a viable functional prosthesis, as opposed to a passive cosmetic solution. Our design mimics finger motion and utilizes the remainder of an amputee’s digit to power the device.

For more information, visit www.npdevices.com.

MARKETPLACE Pro-Flex® LP Align Pro-Flex LP Align combines functionality, comfort, and aesthetic design. It allows users the freedom to choose footwear that best suits their activities, without having to compromise alignment, posture, dynamics, or functionality.

The heel height adjustment feature is quick and easy to use.

Visit ossur.com/proflex or ask your Össur representative about Pro-Flex® today!

MyoBock Accessory Kits From Ottobock

With the new MyoBock Accessory Kits, we have simplified ordering an upper-limb prosthesis. By combining our best myoelectric accessories into a single purchase, we’ve taken the guesswork out of choosing componentry. Visit professionals.ottobockus.com or speak with your sales rep to order.

For more information, contact Ottobock at 800/328-4058.

JAWS Prehensor JAWS is an innovative, versatile, heavy duty, voluntary opening prehensor that can be used with and without a cable-harness system.

Powerful and adjustable with four grip settings, easily “shiftcontrolled” by wearer. Perfect for yard, ranch, and farm tools with special capability at handling handlebars for ATVs , snowmobiles, and watercraft. Truly a “cross-over” terminal device with multiple functions and capabilities. Crafted at 5 inches long with aircraft aluminum, stainless steel, and high-performance gripping polymer rubbers. L code 6721.

Order now for delivery in February/March 2019.

Technical description and video on the website.

JAWS IS THE ANSWER For more information, email trsprosthetics.com or call 800/279-1865

2019 AOPA Quick Coder

New DVS Liner for Improved Sealing We know you’ve been waiting for this, and we’re pleased to announce that the new Ottobock 6Y94 DVS Partial Covered Liner is now available. With magnetic integration, this updated liner keeps an even better seal, while the DVS pump helps stabilize limb volume fluctuations, creating a great connection through both swing and stance phases of gait.

Ask your sales representative or visit professionals.ottobockus.com for more details.

For more information, contact Ottobock at 800/328-4058.

Get your facility up to speed, fast, on all of the O&P Health-Care Common Procedure Coding System (HCPCS) code changes with an array of 2019 AOPA coding products. Ensure each member of your staff has a 2019 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors.

• 2019 Quick Coders: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

O&P ALMANAC | JANUARY 2019

53

CALENDAR

APPLY ANYTIME! BOC Certification. Apply anytime and www.bocusa.org test when ready for the orthotic fitter, mastectomy fitter, and DME specialist certifications. To learn more about BOC’s nationally recognized, in-demand credentials and to apply today, visit www.bocusa.org.

NEW DATES: February 15–16

PrimeFare Central Regional Scientific Symposium 2019. Renaissance Hotel, Tulsa, OK. Contact Cathie Pruitt at 901/359-3936, email primecarepruitt@gmail.com; or Jane Edwards at 888/388-5243, email jledwards88@att.net; or visit www.primecareop.com.

March 1

Free Online Training

Cascade Dafo Institute offers eight free ABC-approved online continuing education courses for pediatric practitioners.

Earn up to 11.75 CE credits. Visit cascadedafo.com or call 800/848-7332.

2019 January 25–26

ABC: Prosthetic Clinical Patient Management (CPM) Exam. ABC Testing Center, Tampa, FL. Contact 703/8367114, email certification@abcop.org, or visit www.abcop.org/certification.

January 28–29

2019 Mastering Medicare: Essential Coding & Billing Techniques Seminar.

Orlando. Register online at bit.ly/2019billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Coding & Billing Seminar

February 1

ABC: Application Deadline for Certification Exams.

Applications must be received by February 1 for individuals seeking to take the April Written and Written Simulation certification exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

February 4–9

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic, and prosthetic assistants and technicians in 300 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

February 13

Patient Outcomes: Best Practices & How To Use Them. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

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JANUARY 2019 | O&P ALMANAC

ABC: Application Deadline for Spring CPM Exams.

All practitioner candidates have an additional 30 days after the application deadline to complete their residency.

Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

March 1

ABC: Practitioner Residency Completion Deadline for April Written & Written Simulation Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

March 13

Advanced Beneficiary Notice (ABN): Get To Know the ABN Form. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

April 1

ABC: Application Deadline for June Certification Exams. Applications must be received by April 1 for individuals seeking to take the June Written and Written Simulation certification exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

April 1

ABC: Practitioner Residency Completion Deadline for Spring CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

April 8–13

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants and technicians in 300 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

April 10

Shoes, External Breast Prostheses, Surgical Dressings, and Other Policies.

Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

CALENDAR

April 18–20

International African-American Prosthetic Orthotic Coalition Annual Meeting. Texas Scottish Rite Hospital for Children, Dallas, TX. Contact Tony Thaxton Jr. at 404/875-0066, email thaxton.ir@comcast.net, or visit www.iaapoc.org.

August 14

Are You Ready for the Worst?

Contingency Planning. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

May 8

Are You Compliant? Know the Supplier Standards. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

September 11

Veterans Affairs Updates: Contracting, Special Reports, and Other News.

Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

June 12

Documentation—Understanding Your Role. Register online at bit.ly/2019webinars.

For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

July 10

Target, Probe, Educate—Get To Know the Program & What the Results Are Telling You. Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

Calendar Rates CE For information on continuing education credits, contact the sponsor.

Questions? Email ymazur@AOPAnet.org.

CREDITS

September 25–28

AOPA National Assembly. San Diego Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0836 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

October 9

Performance Reviews: How Is Your Staff Doing? Register online at bit.ly/2019webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

Let us share your next event!

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email ymazur@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

Words/Rate 25 or less 26-50 51+

Member

Nonmember

$40

$50

$50 $60 $2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

AD INDEX

Advertisers Index Company ALPS South LLC Amfit Apis Footwear Company ESP LLC Fabtech Systems LLC Hersco Naked Prosthetics Össur Ottobock TRS Prosthetics

Page

Phone Website

19 800/574-5426 41 800/356-3668 17 888/937-2747 9 888/WEAR-ESP 7 800/FABTECH 1 800/301-8275 27 888/977-6693 3 800/233-6263 C4 800/328-4058 33 800/279-1865

www.easyliner.com www.amfit.com www.apisfootwear.com www.wearesp.com www.fabtechsystems.com www.hersco.com www.npdevices.com www.ossur.com www.professionals.ottobockus.com www.trsprosthetics.com O&P ALMANAC | JANUARY 2019

55

ASK AOPA CALENDAR

Appeals Requirements Monetary thresholds for appeals, interest on overpayments, and more AOPA receives hundreds Q of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

Q/

Did the amounts in controversy (AIC) increase for 2019?

Yes and no. There are new AIC amounts, or monetary thresholds that must be met if you plan to file an appeal at the administrative law judge (ALJ) level (third level of appeal) or judicial review level (fifth level of appeal).

The AIC for the ALJ will remain the same as in 2018, which is $160. The AIC for the judicial review will increase by $30, and the new threshold is $1,630.

These new AICs are in play for any appeals filed on or after Jan. 1, 2019.

A/

If I am successful in my appeal at the ALJ level and Medicare owes me interest, how do I know which rate is applied?

Q/

The interest rate used to calculate any interest owed to you on overpayments is based on the interest rate that is effective at the time of the ALJ decision, and not at the time

A/

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JANUARY 2019 | O&P ALMANAC

the money was originally recouped from you. The current rate is 10.125 percent, and the rate is updated on a quarterly basis. The next update will be in mid-January.

Q/

When are we able to collect interest from Medicare?

You have the possibility to collect interest from Medicare under two specific scenarios.

Scenario one is if the Medicare contractor does not pay/repay you within 30 days of a favorable outcome.

For example, if you have a claim that adjudicated in your favor—on initial submission—and you are not paid within 30 days, you may collect interest.

The second, and most common, scenario is if you repaid CMS through nonvoluntary means, such as automatic offsets, and you were successful in your appeal at the ALJ level or higher.

A/

AOPA Coding Experts Are Coming to

Orlando

January 28-29, 2019

ATLANTA

FEB. 26-27 | 2018

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR Join AOPA January 28-29, 2019, in Orlando to advance 14 CEs your O&P practitioners’ and billing staff ’s coding knowledge. Join AOPA for this two-day event, where you will earn 14 CEs and get up-to-date on all the hot topics.

EARN

AOPA experts provide the most up-todate information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions with AOPA experts, your colleagues, and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups, to ensure concentration on material appropriate to each group.

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more at bit.ly/2019billing.

The DoubleTree by Hilton Orlando at SeaWorld 10100 International Drive Orlando, Florida 32821 Cutoff Date: January 11, 2019 Room Rate: $149 Individuals can book their room by calling (407) 352–1100.

Top 10 reasons to attend: 1.

Get your claims paid.

2.

Increase your company’s bottom line.

3.

Stay up-to-date on billing Medicare.

4.

Code complex devices.

5.

Earn 14 CE credits.

6.

Learn about audit updates.

7.

Overturn denials.

8.

Submit your specific questions ahead of time.

9.

Advance your career.

10. AOPA coding and billing experts have more than 70 years of combined experience.

Find the best practices to help you manage your business.

Participate in the 2019 Coding & Billing Seminar!

Register online at bit.ly/2019billing.

For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

The new ® C-Brace

10/18 ©2018 Ottobock HealthCare LP. All rights reserved.

Step into your future.™

professionals.ottobockus.com