August 2016 O&P Almanac

The Magazine for the Orthotics & Prosthetics Profession

AU G U ST 2016

Avoid Mistakes, Build Your Bottom Line

E! QU IZ M EARN

2

BUSINESS CE

P.16

CREDITS P.18

How Well Are You Protecting Electronic Health-Care Data?

P.32

Understanding Direct and Self-Pay Options

P.56

A Bridge TO THE

FUTURE

Join AOPA in Boston to reflect, engage, and help forge O&P’s path forward WWW.AOPANET.ORG

P.24

This Just In: The Growing Force of O&P Research P.20

YOUR CONNECTION TO

EVERYTHING O&P

Products & Services For Orthotic, Prosthetic & Pedorthic Professionals

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR

LAS VEGAS

EARN

NOVEMBER 14-15 | 2016

AOPA Coding Experts Are Coming to Las Vegas The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The Coding & Billing Seminar will teach you the most up-to-date information to advance the coding knowledge of O&P practitioners and billing staff.

The seminar features hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments. Breakouts are tailored specifically for practitioners and billing staff. Take part in this seminar and better your business, your staff, and your patients!

Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2016billing.

In this audit-heavy climate, can you afford not to attend?

14 CEs

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 2016 Coding & Billing Seminar!

Register online at bit.ly/2016billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

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contents

AUG UST 2016 | VOL. 65, NO. 8

FEATURES

DEPARTMENTS | COLUMNS

COVER STORY

Views From AOPA Leadership......... 4 Insights from Board Member Pam Lupo, CO

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

Numbers........................................................ 8

At-a-glance statistics and data

Happenings............................................... 10

Research, updates, and industry news

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

Transitions in the profession

24 | A Bridge to the Future When the AOPA National Assembly kicks off in Boston next month, attendees will celebrate the successes of the past and prepare for the changes of the future. They also will choose from exceptional business and clinical programming—including special presentations from medical professionals who treated Boston Marathon bombing survivors.

By Lia Dangelico

Avoiding claim submission mistakes

CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

Member Spotlight................................ 40 n

20 | This Just In

The Growing Force of O&P Research An increased dedication to O&P research by AOPA and other O&P stakeholders is paying off. Several significant initiatives are underway, including an agreement between AOPA and the RAND Corporation to study value-based purchasing in prosthetics; new data from CMS to expand and update the original Dobson-DaVanzo research on the value of O&P intervention; the funding of several new O&P-based grants; and more.

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

Don’t Give It Away

n

EastPoint Prosthetics & Orthotics Fusiform

AOPA News............................................... 44

AOPA meetings, announcements, member benefits, and more

Welcome New Members .................. 47 PAC Update .............................................. 47

P. 20

Marketplace............................................. 48

Careers......................................................... 52

32 | O&P Cybersecurity

Professional opportunities

Preventing breaches of data related to protected health information and payment information should be a priority for O&P facilities. In addition to leveraging antimalware, encryption, and intrusion detection tools, O&P businesses should consider investing in cyber liability insurance.

Upcoming meetings and events

By Christine Umbrell

Calendar...................................................... 54

Ad Index....................................................... 55 Ask AOPA................................................... 56 Expert answers to your questions about self-pay options

P. 32 O&P ALMANAC | AUGUST 2016

3

VIEWS FROM AOPA LEADERSHIP

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

AOPA’S Ardent Commitment to Its Membership

T

HE UNDERLYING CURRENT IN most board discussions is AOPA’s commitment to its members. It is palpable. “Are we meeting membership expectations?” is a common discussion point for the AOPA Board of Directors, AOPA Executive Director Tom Fise, and all AOPA staff. Imagine the task of trying to capture the expectations of our 2,000 member locations that can range in values, needs, wants, and vision for our organization and the future. The level of membership interaction and participation with AOPA varies widely.

In an effort to identify and conquer the questions we have regarding membership, AOPA engaged the talents of Tom Morrison at our most recent annual board meeting.

Morrison, a seasoned association management professional and consultant, tasked the board with taking a deeper look at AOPA’s current member benefits, services, and programs. The board was challenged to look with a fresh perspective at how AOPA might cultivate new services for its membership. As you can imagine, this exercise provoked much thought and engaging discussion.

We identified that AOPA has proven its real-time response to change and challenges as identified by our recent regulatory hurdles and the current health-care climate. Our AOPA staff shines in its knowledge base and response to member inquiries. Members can choose countless pathways for learning and education simply by logging on to the AOPA website. AOPA also excels in its opportunities for business support. And while it is too early to outline, the board also identified programs that will be rolled out and added to your vast membership benefits portfolio.

Efforts also are underway to use historical data to access membership trends, measure engagement in member programs, and guide AOPA in identifying which services are most valuable to its members (and consider eliminating those that have outlived their usefulness).

But as the saying goes, “You don’t know what you don’t know!”

AOPA will continue to communicate with you via the website, Twitter, the AOPA 365 app, the AOPA's Take reimbursement blog, and additional interactions. In response, we are seeking communication from you. We are your advocates and, as such, take the responsibility of meeting your membership expectations seriously.

AOPA members represent the best in class in our industry. We value your opinions and wisdom. Reach out to an AOPA board member or Executive Director Fise. Better yet, let AOPA know you are willing to actively participate on a committee or share your ideas when opportunities arise. AOPA strives to identify and develop individuals who are passionate about the future of our profession, and opening the door to communication is a great way to let yourself be known.

Whether you want to share your thoughts or are looking for more information, we’ll be waiting to hear from you!

Pam Lupo, CO, is a member of the AOPA Board of Directors, AOPA Coding and Reimbursement Committee member, Wright & Filippis and COP board member, and ABC facility accreditation surveyor.

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AUGUST 2016 | O&P ALMANAC

Board of Directors OFFICERS

President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX President-Elect Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Vice President James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Immediate Past President Charles H. Dankmeyer Jr., CPO Arnold, MD Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, BSPO, MPH, PhD Orthocare Innovations LLC, Mountain Lake Terrace, WA Maynard Carkhuff Freedom Innovations LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Ottobock, Austin, TX Bradley N. Ruhl Ottobock, Austin, TX

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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

Editorial Management Content Communicators LLC

Our Mission Statement The mission of the American Orthotic & Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation, and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.

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.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Tina Carlson, CMP, senior director of membership operations and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org SPECIAL PROJECTS Ashlie White, manager of projects, 571/431-0812, awhite@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org

Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com

Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org

Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com

AOPA Bookstore: 571/431-0865

Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

6

AUGUST 2016 | O&P ALMANAC

Publisher Thomas F. Fise, JD

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company 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 almanac@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.

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

Copyright © 2016 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.

COVER PHOTO: iStock.com/PeopleImages

Advertise With Us! Reach out to AOPA’s membership and more than 13,000 subscribers.

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

Visit bit.ly/aopamediakit for advertising options!

For us, it’s personal.

There’s a reason PEL was voted “Most Trusted O&P Distributor.” And it’s an honor we work hard to earn every day. Learn more at pelservice.com ©2015 PEL, LLC

NUMBERS

2016 Paralympic Games Thousands of competitors—including hundreds of amputee and limb-impaired athletes—will convene in Rio

Rio de Janeiro will become the first South American city to host the Paralympic Games when athletes who have disabilities compete September 7-18, in the same venues Olympic athletes visit in August.

Two Paralympic sports will debut in Rio: paracanoe and paratriathlon.

THOUSANDS OF COMPETITORS

INTERNATIONAL PARTICIPATION

HUNDREDS OF MEDALS

176 Countries to be represented.

11

Days of competition.

21 Venues where athletes will compete.

4,350

Athletes expected to compete.

23

16 Sports in which Team USA will compete.

528

FOURTH PARALYMPIC APPEARANCE

Medal events.

5 METERS RUN

M SWI AUGUST 2016 | O&P ALMANAC

BIKE

20 METERS

Swimmer Jessica Long, whose legs were amputated when she was 18 months, is expected to compete in her fourth Paralympic Games in Rio. She has won 17 medals at previous Games: 12 Gold, 3 Silver, and 2 Bronze. She won her first Paralympic title in 2004 at age 12.

Editor’s Note: Don’t miss the September issue of the O&P Almanac, where we will introduce you to several athletes competing in Rio, and hear from their O&P care providers about their preparations for the Games.

SOURCES: www.rio2016.com; www.teamusa.org.

The paratriathlon will feature competition among three classification divisions: men’s PT1 (wheelchair/handcycle) and men’s and women’s PT4 (limb deficiencies, impaired muscle power or range of movement).

The event will cover the following distances:

8

Female athletes competing—a 9.9 percent increase compared to London 2012.

Different sports in competition.

INAUGURAL PARALYMPIC PARATRIATHLON

750 METERS

1,650

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Happenings RESEARCH ROUNDUP

Russian Scientists Develop ‘Learning’ Prosthetic Arm

NIH To Monitor Paralympic Athletes for Zika Virus Hundreds of athletes from Team USA who will be participating in the 2016 Olympic and Paralympic Games have volunteered to take part in a Zika virus study. The virus spreads primarily through the bite of an infected Aedes species mosquito, as well as through intercourse with an infected man. The virus also can be passed from a pregnant woman through her fetus.

Zika virus is a cause of microcephaly and other brain malformations and disorders in babies born to women who were infected with the virus, according to scientific consensus.

The Olympic and Paralympic Games will take place in Rio de Janeiro, Brazil, this summer, where continuing transmissions of the virus have been reported. Brazil has seen the bulk of Zika-related fetal malformations reported globally—more than 8,100 suspected cases during the current outbreak, compared with seven in the United States. To gain a greater understanding of the virus, researchers at the National Institutes of Health will monitor study participants from Team USA for infection during the Rio competitions.

The researchers plan to include at least 1,000 volunteers, with the goal of studying the reproductive outcomes of any Zika-infected volunteers for up to one year. American athletes, coaches, and committee staff, as well as their spouses or sexual partners, have been asked to take part in the study.

“Participation in the study is completely voluntary,” says 10

AUGUST 2016 | O&P ALMANAC

Carrie L. Byington, MD, professor of pediatrics at the University of Utah and co-director of the Center for Clinical and Translational Science. Byington anticipates that the majority of those who travel to Rio for the games will not have been previously treated for Zika, which "will offer an opportunity for us to more fully evaluate the consequences of infection."

Byington and her team are seeking information on potential risk factors for infection, and plan to study where Zika persists in the body (blood, semen, vaginal secretions, or saliva), and for how long. Participants in the study will complete health surveys and submit bodily fluids that will be screened for Zika using test kits provided by the Centers for Disease Control and Prevention (CDC). Routine testing will help find anyone infected with the virus, which causes symptoms in about 20 percent of cases.

As of early July, approximately 200 volunteers had signed up to for the the study, with the enrollment period scheduled to end before the start of the Paralympic Games September 7.

The CDC recommends that pregnant women not travel to Brazil, and that anyone who does go waits at least eight weeks before trying to become pregnant, even in the absence of symptoms. Men with symptoms should wait at least six months, according to the CDC.

PHOTO: TPU © 2002-2016

Researchers at Tomsk Polytechnic University in Russia are developing a prototype prosthetic arm and a control algorithm using myoelectric signals. The prosthesis learns from the user’s brain signals and anticipates expected movements.

Led by Mikhail Grigoriev, Nikita Turushev, and Evgeniy Tarakanets at the Laboratory of Medical Instrument-Making, the researchers are designing the prototype to perform the full range of motions of a biological arm. “To date, there are quite [a number of] available traction prostheses,” Turushev says. “Their motions are carried out by means of traction belts, which are superimposed from the repaired arm across

the back and loop around the healthy shoulder. That is, the prosthesis performs by using motions of a healthy arm.”

The algorithm being developed by the Tomsk team will prevent amputees from having to wear traction belts, according to the researchers. Sensors on the prosthesis will pick up myoelectric signals. The researchers are developing an algorithm to analyze the myoelectric signals and anticipate the expected motion of the user. “Initially, the software will be universal, but we will adapt it to each specific artificial arm,” says Grigoriev. The learning algorithm is being designed to enable the arm to copy and recognize the myoelectric signals and patterns specific to its owner.

The researchers are in the process of “teaching” the algorithm the myoelectric signals used by more than 150 study participants to control their healthy limbs. The prototype is expected to be finalized in approximately two years.

HAPPENINGS

O&P ATHLETICS

LATEST ON THE LCD

University of Washington Students Host Three First Clinics Committee Issues Directive to CMS

PHOTOS: University of Washington

University of Washington (UW) orthotic and prosthetic students recently hosted three OPAF First Clinics on campus to promote health and wellness opportunities for those facing physical or mobility challenges. Led by Natalie Harold, MSOP, and a team of volunteers, the students hosted First Swing Learn to Golf, First Climb, and First Stride/First Things First on Saturday, May 14.

Participants were invited discover adaptive recreation opportunities by joining one, two, or all three clinics.

Dozens of participants joined the activities. First Swing offered instruction as well as both a Solo Rider and ParaGolfer golf cart to try on for size.

First Climb was held in the intramural center, where Tommy Lyon and a staff of climbing volunteers assisted participants, both adults and children, up the wall. First Stride/First Things First offered a new look at preparing for walking and gait, and focused on the aspect of falls and recovery as well as preparation.

The clinics were made possible through individual donations as well as financial support from GSPP and Trulife.

As a result of a series of meetings that took place during AOPA’s 2016 Policy Forum, which involved Sen. Bob Kerrey (D-Nebraska) and top members of the Senate and the Finance Committee, as well as through AOPA Past President Tom Watson’s intercession with Senate Majority Leader Mitch McConnell (R-Kentucky), important language relating to the July 2015 draft Local Coverage Determination (LCD) on lower-limb prosthetics was inserted into the committee report that has been prepared to explain the 2017 Senate Labor/ Department of Health and Human Services Appropriations Bill.

This is an important directive to CMS, essentially conveying that in light of reductions in Medicare prosthetic spend over 2012-2014, there seems no necessity for intervention to change the LCD, and instructing CMS to consult with clinicians, patients, and prosthetist groups before releasing any new or revised version of the LCD. The language included in the report is as follows: “The Committee recognizes that Medicare payments for all prosthetics, and especially the newer advanced technologies, have declined over each of the years 2010-2014. The committee encourages CMS to consult broadly with clinicians, patient groups, and the prosthetics field regarding revisions to the draft Local Coverage Determination, prior to publishing an updated draft policy for public comment.”

O&P ALMANAC | AUGUST 2016

11

HAPPENINGS

FDA FOLLOW-UP

Government Publishes Document Addressing 3D Printing

The U.S. Food and Drug Administration (FDA) in May released “Technical Considerations for Additive Manufactured Devices: Draft Guidance for Industry and Food and Drug Administration Staff.” The publication of this document marks the FDA’s first foray into potential regulation of devices that use additive manufacturing as a means of fabrication of medical devices.

Additive manufacturing is a broad term that encompasses 3D printing as a means of creating functional medical devices. The guidance document has been published to solicit public comment regarding the FDA’s current thinking on the topic of 3D printing and “is not intended to be a binding document on either the FDA or the public.”

Read more at bit.ly/medicarestatus.

12

AUGUST 2016 | O&P ALMANAC

CODING CORNER

Jurisdiction D Releases Prepayment Review Results for Orthoses Noridian, the Jurisdiction D durable medical equipment Medicare administrative contractor (DME MAC), has released quarterly results of its ongoing prepayment review of claims for several codes.

During the time period from December 2015 through March 2016, claims for ankle-foot orthoses (AFOs) described by Health-Care Common Procedure Coding System (HCPCS) codes L1960, L1970, and L4360 were reviewed. A total of 1,008 claims were reviewed, 855 of which were denied. Code L1960 had an error rate of 69 percent, code L1970 had an error rate of 70 percent, and code L4360 had an error rate of 99 percent (484 out of 488 claims were denied).

Noridian also released the results of its ongoing prepayment review of claims for L1833, which covers knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the-shelf. From September 2015 through December 2015, a total of 627 claims were reviewed, 607 of which were denied, for an overall claim error rate of 96 percent.

For spinal orthoses described by HCPCS codes L0631 and L0637, from December 2015 through March 2016, a total of 291 claims were reviewed and 284 were denied.

This represents a denial rate of 99 percent for L0631 and 94 percent for L0637.

Based on these results, Noridian will continue its prepayment review for all codes.

The full audit results, including common reasons for denials, are available on AOPA’s website at www.AOPAnet.org.

AOPA Updates Joint Statement on Orthopedic Shoe Inserts In 2013, AOPA, in conjunction with the American Podiatric Medical Association (APMA) and the Pedorthic Footcare Association (PFA), developed a joint statement on the interpretation of HCPCS codes L3000, L3010, L3020, and L3030. The joint statement was presented to AOPA leadership at the time and was approved for publication.

On May 13, 2016, a follow-up meeting of the three organizations was held and a slight revision to the joint statement was proposed, with the understanding that the leadership of AOPA, APMA, and PFA would have the opportunity to review and approve the revised document. The revised statement has been reviewed and approved by AOPA leadership, and is available on AOPA’s website at www.AOPAnet.org.

HAPPENINGS

MEETING MASHUP

AMPUTEE ACHIEVEMENTS

Record Numbers Convene for Amputee Coalition National Conference

Össur Announces Contest Winner, New Contest

PHOTOS: Amputee Coalition

More than 1,075 attendees took part in the Amputee Coalition National Conference in Greensboro, North Carolina, in June.

Participants benefitted from education offered at 95 sessions and toured 60 exhibits during the event.

“This was our most successful conference in our 30-year history,” says Susan Stout, president and CEO of the Amputee Coalition. “With more sessions offered than ever before and the largest conference and exhibit hall, it seems fitting that we also set an all-time attendance record. We are thrilled that so many people invested their valuable time to travel to our conference and actively participate in our many educational and social activities.”

Plans are underway for the 2017 National Conference, scheduled for August 5-7 at the Galt House Hotel in Louisville, Kentucky.

THE LIGHTER SIDE

Federica Maspero, a bilateral amputee from Como, Italy, is the winner of Össur’s inaugural #MyWinningMoment online contest celebrating amputees’ mobility. Maspero’s photo was chosen by an external jury of prosthetics community leaders from 10 finalists who had been featured on Össur’s Facebook page. The judges noted that the photo captured a winning moment for Maspero, an oncologist and runner who has overcome challenges after losing her legs and fingers due to meningitis.

Maspero has won a four-day, three-night trip for two people to Reykjavik, Iceland, home of Össur’s headquarters, for her submission depicting her and her husband in their wedding attire on a running track. Össur has launched a second #MyWinningMoment contest, currently underway. Individuals with lower-limb loss are invited to share their stories via photo or video, and eligibility has been expanded to include entries from children, as long as they are submitted by the child’s parent or legal guardian.

The grand prize for the new contest is a four-day, three-night, all-expense-paid trip for two people to attend the 2016 San Diego Triathlon Challenge in Southern California. Hosted by the Challenged Athletes Foundation, the event includes the Celebration of Abilities Awards, a half-day Össur Mobility Clinic, and the triathlon.

The contest deadline is Aug. 31, 2016. For details, visit www.mywinningmoment.com.

O&P ALMANAC | AUGUST 2016

13

PEOPLE & PLACES BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The 2016 Amputee Coalition Paddy Rossbach Youth Camp was held in July at the Joy Outdoor Education Center, located an hour northeast of Cincinnati. Taking part in the camp were a record 142 campers—children ages 10-17 with limb loss or limb difference, who attended the camp at no cost. The six-day camp offered a full range of activities, including fishing, swimming, zip lining, arts and crafts, canoeing, sitting volleyball, hiking, a high ropes course, dance, archery, and more. A unique aspect of the camp, according to Amputee Coalition President and CEO Susan Stout, is that campers are not accompanied by their parents, which inspires campers to take on new challenges, be independent, test themselves, and build new friendships in a supportive, caring environment.

PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Karen Lundquist has joined the Amputee Coalition’s strategic leadership team in the role of chief communications officer.

She will be responsible for translating the organization’s 2020 strategic goals into Karen Lundquist focused programs that include external and internal communications; brand and reputation management; and oversight of publications, media relations, and social media.

Since 2000, Lundquist has been regional director of communications at Otto Bock HealthCare in Minneapolis, where she made a significant impact on the organization’s communications, branding, social media, and website. Lundquist also is a former board member of the Orthotic & Prosthetic Activities Foundation, and a board member for AMAZE, a Minnesota-based diversity education nonprofit. “Karen is an outstanding addition to our team, and I know she will help us take the Amputee Coalition to the next level in our mission,” says Amputee Coalition Board Chair Jack Richmond.

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AUGUST 2016 | O&P ALMANAC

IN MEMORIAM

James Newberry Jr., BOCP, BOCO, BOCPD, longtime practitioner and board member for the Board of Certification/Accreditation (BOC), passed away on June 27.

Newberry began his career as an orthotist/ James Newberry Jr. prosthetist while serving in the U.S. Air Force after he graduated from New York University. Following his military service, he joined Mahnke’s Orthotics and Prosthetics in Oakland Park, Florida, where he spent more than 40 years as owner, practitioner, and director of orthotics/ prosthetics. He trained many orthotists, prosthetists, and technicians. He provided orthoses for athletes of all ages, including the Miami Dolphins, and supplied prop orthoses for Tom Selleck in the 1992 movie Folks, which was filmed in Boca Raton, Florida. Newberry’s longtime passion was improving the lives of children by providing them with scoliosis orthoses, prosthetic limbs, and cranial remolding helmets. He also established four pediatric orthopedic clinics.

For more than 30 years, Newberry served BOC in numerous capacities. He held many leadership positions for the BOC Board of Directors, including chair, and was interim executive director after the retirement of BOC’s founder, Donald O. Fedder, DrPH, MPH, BSP, FAPhA. Newberry was a facility accreditation site surveyor, a video practical exam reviewer, and a test development volunteer for BOC’s orthotist, prosthetist, and pedorthist exams.

Newberry also taught courses on therapeutic diabetic shoes, negative casting, anatomy, and gait analysis, and delivered presentations at events hosted by AOPA, the Florida Association of Orthotists & Prosthetists, the Pedorthic Footcare Association, and Medtrade.

“Jim was an advocate of BOC since we were founded, and his contributions to the O&P profession are immeasurable,” says BOC Chair L. Bradley “Brad” Watson, BOCO, BOCP, LPO. “I had the privilege of learning from him and serving with him on the board of directors, and I am grateful to have known him.”

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REIMBURSEMENT PAGE

By JOE MCTERNAN

Don’t Give It Away Protect your reimbursement by avoiding simple mistakes

E! QU IZ M EARN

2

BUSINESS CE

CREDITS P.18

T

HE O&P REIMBURSEMENT ENVIRONMENT is certainly not

getting any easier. With a seemingly endless parade of auditors reviewing— and rereviewing—your claims, a simple administrative oversight can mean the difference between your claim getting paid and getting denied.

The simple fact that the O&P service you provided meets the needs of your patient and helps to restore his or her function is no longer enough.

As Medicare and other payors face pressures to reduce overall costs, they continue to look for new ways to justify denying payment on claims— regardless of whether the services are clinically appropriate for the patient.

This month’s Reimbursement Page discusses some basic strategies for avoiding simple mistakes that can severely impact your bottom line.

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AUGUST 2016 | O&P ALMANAC

Understand the Basic Requirements for Coverage

One of the most important—but often overlooked—issues regarding Medicare coverage of O&P devices is the basic coverage criteria. For all of the O&P services that are governed by a Local Coverage Determination (LCD) and Policy Article, the very first section of the policy addresses the general requirements for Medicare to consider coverage of the device. For example, for Medicare

Control the Things You Can Control

Two of the most common reasons for claim denials for O&P services are missing or incomplete proof of delivery documentation and missing or incomplete detailed written orders. These are both

PHOTO: iStock.com/Xijian

Editor’s Note—Readers of CREDITS Reimbursement Page are now 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.

CE

to consider coverage for any lower-limb prosthesis, there must be documentation that indicates the following: • The patient will reach or maintain a defined functional state within a reasonable period of time; and • The patient is motivated to ambulate.

While these two requirements seem like they should be understood, failure to document this information can immediately impact your ability to receive payment when you submit your claim. Leaving this information out of the patient’s medical record is a fairly common, yet completely avoidable, mistake.

Similarly, the LCD for ankle-foot orthoses and knee-ankle-foot orthoses states the following regarding coverage: “The item must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the function of a malformed body member.”

Without documentation that supports this basic but essential coverage requirement, the entire claim is placed at unnecessary risk.

REIMBURSEMENT PAGE

items over which you, as the provider of the device, have complete control. Taking a few minutes to ensure that these two pieces of documentation are completed properly could save thousands of dollars.

Medicare requires that proof of delivery documentation contain the following information: • Beneficiary name • Delivery address (actual location where the patient took possession of the item) • Detailed description of the item delivered • Quantity delivered • Date delivered • Beneficiary signature.

There has been a lot of recent discussion regarding what must be included in the detailed description of the item.

As of the publication of this article, the detailed description can be a detailed narrative of all separately billed components; a list of Health-Care Common Procedure Coding System (HCPCS) codes and complete descriptors; or a

listing of brand name, model number, or serial number of the devices delivered.

As a general rule, a member of the public should be able to read the proof of delivery document and understand what was specifically provided to the patient.

However you choose to document this section of the proof of delivery, you must be certain that you individually describe each component that will be billed with a separate HCPCS code. Since the proof of delivery documentation is almost always the responsibility of the provider of the device, failure to obtain a complete and valid proof of delivery is an

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avoidable, and often costly, error.

Like proof of delivery documentation, the provider of the O&P device is allowed to complete the detailed written order in preparation for the prescribing physician’s signature. The following elements are required to be included on a detailed written order: • Beneficiary name • Physician’s name • Date of the order • Detailed description of the item(s) • Physician’s signature and date of signature.

If you, as the provider of the device, are completing the detailed written order, it must contain both an order date, which you complete, and a physician signature date, which is applied next to the physician’s signature.

Taking extra efforts to ensure that proof of delivery documentation and detailed written orders are compliant with Medicare guidelines will result in a significant reduction in claim denial rates.

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O&P ALMANAC | AUGUST 2016

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REIMBURSEMENT PAGE

Don’t Forget Modifiers

Incorrect or missing modifiers are a very common and avoidable reason for claim denials. Modifiers are important pieces of the puzzle when communicating with Medicare and other payors, and failure to use them properly can lead to unnecessary claim denials.

Directional modifiers are required on all claims that involve either side of the body or, in some cases, bilateral services.

The LT modifier indicates that an item is worn on the left side of the body while the RT modifier indicates that an item is worn on the right side of the body.

In cases where the same device will be worn on both sides of the body (bilateral), the appropriate modifier is LTRT. Functional level modifiers are used exclusively on lower-limb prosthesis claims, specifically on HCPCS codes that describe prosthetic feet, ankles, knees, and hips. These modifiers range from K0 to K4 and are used to indicate the functional level of the patient as assigned by the prescribing physician and the prosthetist. Claims for prosthetic feet, ankles, knees, and hips that are not submitted with a functional level modifier will automatically be denied by Medicare.

The KX modifier is used in certain

circumstances to indicate that Medicare coverage criteria have been met and that required documentation is on file.

By including the KX modifier on your claim submission, you are attesting that the information above exists and is available upon request. Including the KX modifier on claims where you have not secured appropriate medical necessity documentation may lead to ramifications beyond a simple claim denial.

Gather Documentation Prior to Claim Submission

Medicare will allow you to deliver an O&P item based on a preliminary written or verbal order, but you must have your documentation gathered and prepared prior to claim submission.

While there is no requirement that you provide documentation of medical necessity unless it is requested, once you submit a claim, especially if it is for a service where policy requires the use of the KX modifier, you are expected to be able to produce the documentation that supports the medical necessity of the service you provided.

While it may be tempting to make quick claim submissions to alleviate the pressure to generate and book

revenue, it may be more prudent to delay claim submissions until all required documentation has been collected and reviewed for accuracy.

Educate, Educate, Educate

There are many actions you can take to reduce errors in your claim submission process, but there also are many things over which you have no direct control.

First and foremost among these is controlling how other providers document the medical need for the services they are providing. It can be very frustrating to request clinical notes from a referral source and be told there are none, or receive minimal information.

While you cannot directly control this situation, you can influence the documentation of others through education.

Taking a few minutes to sit down with your referral sources and explain what documentation you need from them— as well as why you need it—may save you tremendous time and effort in the future. It may be difficult to get access to these providers’ time, but if you present yourself efficiently and professionally, there is a good chance they will be willing to work with you. Proper documentation is always in everyone’s best interest.

While the list of avoidable claim submission mistakes is much larger than the space for this column allows, the issues highlighted above represent the great majority of avoidable mistakes that lead to unnecessary, and often costly, claim denials. Taking the time to make a few operational changes within your practice may ultimately prove to be a very profitable decision.

Joe McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@aopanet.org.

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This Just In

The Growing Force of O&P Research Recent research initiatives demonstrate the value of O&P intervention and propel the profession forward

T

HE PACE OF O&P research has

picked up over the past few months. As O&P professionals recognize the need for more significant research and outcomes studies to demonstrate the value of orthotic and prosthetic intervention to payors and regulators, several initiatives have arisen that will help grow the O&P research reservoir.

These initiatives include AOPA’s participation in a researchers’ conference June 9-10 facilitated by the O&P Alliance; recent approval from CMS to provide additional 2011-2014 Medicare services data and Part D drug information (2007-2014) to expand and update the original Dobson-DaVanzo research demonstrating that timely O&P intervention saves money for payors; an agreement between AOPA and the RAND Corporation for creating simulation models on the value proposition of prosthetics; and the awarding of pilot grants in response to the AOPA request for proposals issued in February.

The June researchers’ conference provided an opportunity for AOPA’s Jim Campbell, PhD, CO, Tom Fise, JD, and David Boone, BSPO, MPH, PhD, to meet with representatives from the National Science Foundation, National Institutes of Health (NIH), Department of Veterans Affairs,

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AUGUST 2016 | O&P ALMANAC

National Institute on Disability, and the U.S. Army Medical Research and Materiel Command. The O&P representatives were able to update the research funding agencies on the status of O&P research and to identify opportunities for collaborative efforts in the future. AOPA has taken steps with NIH for a follow-up meeting related to the patient registry, which could provide a collaborative opportunity for data to be generated by the registry that would be of interest to both payors and researchers.

AOPA has been notified that CMS will make the expanded Medicare beneficiary data available to AOPA so Dobson-DaVanzo can update its earlier cost-effectiveness study demonstrating that timely O&P intervention pays, not costs. The new data on Medicare beneficiaries includes the 2011-2014 claims years and is further augmented by Part D claims information for the 2007-2014 period, which will document overall cost of care related to O&P intervention. Including Part D information as part of the overall beneficiary Medicare costs may further demonstrate the cost effectiveness of O&P intervention. The Dobson-DaVanzo project is based on matched sets of cohorts—one without O&P intervention and the other receiving O&P care.

This Just In

The Dobson-DaVanzo data will be an important resource for the research project AOPA has retained the RAND Corporation to conduct. RAND will be providing a comprehensive analysis, report, and simulation model related to value-based purchasing in prosthetics and the comprehensive economic value of prosthetics. Conference calls with the Technical Advisory Workgroup were held July 15 and July 29 to coordinate the data points, review questions on data analysis, and provide the clinical guidance RAND needs to complete the work.

During the recent AOPA Board of Directors meeting, an update was given regarding Stream 2 of the Survival Imperatives, chaired

by Boone. There has been genuine progress in the systematic literature reviews, which can serve as the basis for standards of practice. The request for proposals for the 2016 small pilot grant elicited 27 submissions, with seven of the submissions scoring at a level to merit funding. These pilot grants are intended to be the basis for expanded research projects at much higher funding levels by government agencies or private funders.

The following researchers were notified of their selection for funding: • Walter Lee Childers, PhD, MSPO, CP, “Stumble Recovery Mechanisms Utilized by People Using Different Types of Microprocessor Knees” • Kenton Kaufman, PhD, PE, “Risk Factors and Costs Associated With Secondary Health Conditions of Individuals With Above-Knee Amputations”

22

Goeran Fiedler, PhD, CPO

AUGUST 2016 | O&P ALMANAC

Dennis E. Clark, CPO

Transfemoral Amputees” • Shane Wurdeman, PhD, MSPO, CP, FAAOP, “Improved Mobility With Lower-Limb Prostheses: The Establishment of a National Multisite Outcomes Database.”

All of the 2014-2015 grants associated with the Center for Orthotics and Prosthetics Learning and Outcomes/ Evidence-Based Practice, listed below, have been completed. The 2015-2016 grants are currently underway.

• Walter Lee Childers, PhD, MSPO, CP, “The World Is Not Flat: Justifying Prosthetic Feet With Multiaxial Features Being Used on Uneven Terrain” • Goeran Fiedler, PhD, CPO, “Physiologic Range of Step-byStep Variations in Lower-Limb Prosthesis Forces During Walking” • Dennis E. Clark, CPO, “Comparison of Postoperative Care Following Transtibial Amputation.”

AOPA’s research agenda is a growing force designed to help meet the needs of O&P providers and their patients as the transition continues from fee-for-service to value-based reimbursements, an expensive but necessary investment to help support the continued success of AOPA members.

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Walter Lee Childers, PhD, MSPO, CP

• Staci Shearin, PT, NCS, “Impact of Carbon Fiber Ankle-Foot Orthoses (AFOs) on Gait and Resulting Changes in Quality of Life Across Time in Persons With PD” • Nicholas LeCursi, CO, “Relative Influence of Orthotic Support Features Within an Open Frame AFO Versus a Total Contact AFO on Function, Endurance, and Activity Level in Patients With Spastic Equinovarus Secondary to Chronic Stroke” • Ignacio Gaunaurd, PhD, MSPT, “Utilizing an Innovative Timed-Upand-Go Test for Fall Risk Detection in People With Unilateral LowerLimb Loss” • Sai Vikas Yalla, PhD, “ActivityBased Quality Life Assessment To Compare Prostheses With and Without Microcontrollers in

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COVER STORY

A Bridge TO THE

FUTURE

Join AOPA in Boston to reflect, engage, and help forge O&P’s path forward

By LIA DANGELICO

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AUGUST 2016 | O&P ALMANAC

Boston Public Gardens

COVER STORY

B

oston is a city of firsts. It boasts the nation’s first public park in Boston

Common, as well as the first mail route, state constitution, police department, school for the blind—the list goes on. This storied town has played a central role in American history for 382 years, but it still manages to keep its edge. Today, with an eye to the future, the nearly 700,000 legislators, entrepreneurs, artists, and citizens that make up the city of Boston continue to drive advances in medicine, business, education, culture, and beyond.

That’s why it is the perfect place

to host the 2016 AOPA National Assembly, held September 8-11, at the Hynes Convention Center. As the O&P profession faces unprecedented challenges and change, it also is experiencing a surge of innovation and collaboration that will help pave the way forward. O&P stakeholders will come together and find a way to connect the successes of our past with the reality of our future. Combined with an expansive and interactive exhibit hall; a robust, multitrack business and clinical education program; and an array of impactful events and attractions, this year’s Assembly is most certainly the place to be—especially as AOPA is poised to kick off its 2017 centennial celebration.

Downtown Boston

O&P ALMANAC | AUGUST 2016

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COVER STORY

Raising the Bar for O&P’s Future AOPA is committed to recognizing members who work diligently to bring about a more prosperous future for O&P through its annual awards program. This year’s awards will be presented during the Assembly’s Annual Business Meeting, held Saturday, September 10, 7:30 to 8:45 a.m.

For his many contributions and lifetime of dedication to the O&P community, AOPA will present a Lifetime Achievement Award to: Thomas H. Watson, CP: Owner and President of Tom Watson’s Prosthetics & Orthotics Lab of Owensboro, Kentucky, Watson is a graduate of Northwestern University and the Rehabilitation Institute of Chicago. He has a long history of community engagement, from his time as mayor of Owensboro, to his long support of programs helping people with physical disabilities, such as the Kentucky and Indiana Commission for Children With Special Health Needs and Veterans Affairs.

For their many contributions to the O&P profession in regard to legislative advocacy, especially their continual participation in the annual Policy Forum, AOPA will present Legislative Advocacy Awards to the following individuals:

Ralph W. Nobbe, CPO, of Nobbe Orthopedics, Santa Barbara, California

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AUGUST 2016 | O&P ALMANAC

Scott Schneider, of OttoBock Healthcare, Austin, Texas

James O. Young Jr., CP, LP, FAAOP, of Amputee Prosthetic Clinic, Macon, Georgia

Hynes Convention Center

Reimagined Exhibit Hall

At the center of the action is the exhibit hall, where attendees can mix and mingle with their colleagues as well as the industry’s leading vendors and innovations. Navigate the show floor using the AOPA Passport, a fun competition where visiting booths and answering trivia questions enters you to win all sorts of prizes, offers you the chance to earn CE credits—and, of course, introduces you to the latest products and offerings.

After Thursday’s reenergized Welcome Reception and “Friday Night Lights” sportsthemed happy hour, the Assembly will host its first-ever Expo Day on Saturday, from 10:00 a.m. to 2:00 p.m. Expo Day will feature special deals from vendors, door prizes awarded on the half hour, and can’t-miss events and guests. One such event is a book signing with Boston Marathon bombing survivor Jeff Bauman, whose identification of one of the bombers kicked off the statewide manhunt. Bauman, who lost his legs in the bombing and is a bilateral prosthesis user, wrote about his experience in the 2014 book Stronger. The book is being made into a movie starring Jake Gyllenhaal and is scheduled to premiere in 2017.

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COVER STORY

“We are very excited about Expo Day,” says Traci Dralle, director of marketing at Fillauer and 2016 National Assembly Planning Committee member. “This will be the first time we will have had this much unopposed time in the exhibit all, which will allow attendees and exhibitors more time to interact without being rushed to the next course or meeting.”

Of course, one of the challenges of attending a conference jam-packed with specialty programming and exhibitors is taking the time to explore the host city. But by bringing a bit of the sights and sounds of Boston inside Hynes Convention Center, attendees can experience the best of both worlds. AOPA has put a spin on the city’s Freedom Trail with its “Trail of Freedom,” a fun and interactive game that doubles as a mini tour of Boston.

All 16 stops—including Faneuil Hall, Bunker Hill, the Paul Revere House, the U.S.S. Constitution, and others— will be represented throughout the hall, providing attendees a chance to engage with key historical facts and landmarks, win prizes, and even take a selfie or two. Thanks to complimentary WiFi, this mobile-friendly experience enables attendees to access

dynamic video and other content using QR codes, links, and the mobile app, AOPA365 (available on Google Play and the App Store).

When you’ve had your fill of networking and fun, check out the Technical Fabrication Contest, hosted next to the lab at the front of the AOPA booth. Watch technicians work against the clock to assemble a below-knee socket or an articulating ankle-foot orthosis (AFO) joint. And if you need to unwind, wander over to the Relaxation Station for a complimentary massage courtesy of Cailor Fleming.

Getting Down to Business

Outside of the exhibit hall, get ready to build your business acumen. This year, AOPA is offering a wide range of business programming tailored to owners, managers, clinicians, and those looking to prepare for future challenges and put their newly acquired knowledge to use immediately. These are just a few of the can’t-miss sessions on the agenda: • Business Certificate Programming: Advance your career by earning a certificate in O&P Business Management. Kick off the process during the Assembly’s Business

Faneuil Hall Marketplace

Certificate Program, covering topics from human resources to marketing and operations. Complete four core and four elective courses and pass the accompanying quizzes to earn the certificate. —Thursday, 1:005:00 p.m.

• “Today’s World of O&P,” led by Peter Thomas, JD: This informative session will give attendees a muchneeded update on several key issues affecting the O&P community now and in the future, including prior authorization, Medicare competitive bidding, BIPA Section 427, proposed rule, Office of the Inspector General WorkPlan, the Local Coverage of Determination, and O&P care definition in private insurance.—Friday, 11:00 a.m.-noon.

• “DME MAC Medicare Update Session,” led by Michael Hanna, MPA, CDME: Curious about what’s new with the DME MACs? Be sure to join this panel of DME MAC Provider Outreach and Education representatives as they discuss need-to-know changes and updates.

There will be time for questions immediately following, so make sure you come prepared.—Saturday, 3:00-4:00 p.m.

• “DME CERT Outreach and Education Task Force: Process and Errors,” led by Michael Hanna, MPA, CDME: Hear from DME CERT Outreach and Education Task Force members as they provide an overview of the CERT process and outline the most common errors with O&P categories. Have your notepad ready as they parallel those errors with Medicare’s requirements and answer your most-pressing questions.—Saturday, 2:00-3:15 p.m.

• “Preparing for Prior Authorization,” led by Joe McTernan, director of reimbursement services for AOPA: Take advantage of this opportunity to gain a better understanding of the Medicare prior authorization

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AUGUST 2016 | O&P ALMANAC

COVER STORY

Let’s Get Technical Make some time to get technical on Sunday with a variety of informative, interactive sessions on the latest developments in CAD/CAM, 3D printing technology, and more. Here are some of the top technical track sessions to check out:

process. Learn what O&P products are eligible for inclusion, and how to prepare your business to operate in a Medicare prior authorization environment. Come away with insightful tips on how to get prior authorization approval the first time, encourage patient involvement, avoid delays in patient care, and more.—Sunday, 10:00-10:45 a.m.

Meeting of the Clinical Minds

The theme of past and present has been heavily woven into this year’s clinical programming, which seeks to acknowledge O&P’s past while pioneering its future. And this, in addition to the appeal of Boston, is a big draw for attendees, according to Jim Krupa, MEd, CO, clinical director for Massachusetts General Hospital Department of Orthotics and Prosthetics, president of the New England Chapter of the American Academy for Orthotists and Prosthetists, and member of the 2016 National Assembly Planning Committee. “We wanted to build a program that reflects what our profession is trying to do… while addressing common questions, such as: How can we go about becoming better at what we do? What challenges do we face?

How can we work within the variables that face our industry?”

• “CAD/CAM Modification Design Essentials,” led by the HOPE Careers Consortium, a partnership of five institutions of higher education. These highly informational hands-on workshops examine how computer-aided design and computeraided manufacturing (CAD/CAM) technology enables orthotic and prosthetic technicians, assistants, and practitioners to easily modify scanned images in preparation for fabrication.

Computers, associated software, and materials will be provided.

Four separate workshops will be offered, with the “Transtibial” workshop offered twice. Each workshop is offered as a standalone option, enabling conference participants to select the topics that best fit their professional needs.

8:00–10:00 a.m.: “CAD/CAM Modification Design Essentials—Transtibial” 10:00 a.m.-Noon: “CAD/CAM Modification Design Essentials—Ankle-Foot Orthosis” 1:00–3:00 p.m.:

“CAD/CAM Modification Design Essentials—Transtibial” (Repeat)

3:00–5:00 p.m.:

“CAD/CAM Modification Design Essentials—Transfemoral” • “3D Printing,” led by Jeff Erenstone, CPO; Roger Chin, CPO; Joe Fairly, MS; and Daniel Kelleher, MS. This interactive session, scheduled for 1:00 to 5:00 p.m., will highlight many aspects of using 3D printing in O&P, giving attendees a better understanding of this innovative technology through hands-on experience. Printers and parts will be available for participant use.

O&P ALMANAC | AUGUST 2016

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COVER STORY

Lots of mementos lefts by locals and tourists at one of the several improvised memorials along the blocked Boylston Street in Boston, Massachusetts, on April 21, 2013.

The result is a number of clinical sessions that are consistent with the day-to-day challenges practitioners face, from the latest innovations in upper- and lower-extremity prostheses, to treatment for scoliosis in adults, to new approaches with AFOs. This year’s program also features more medical doctors (MDs) and allied health providers than ever before. This decision also hints at O&P’s evolving landscape. “As our industry moves forward, we need to recognize that the best possible care and outcome requires a multidisciplinary effort,” says Krupa. A more collaborative effort between MDs, physical therapists, orthotists, prosthetists, and others will be essential. And there is no better place to come together than Boston—one of the top medical cities in the country and home to some of the health-care community’s best and brightest.

Those top medical professionals were tested like never before on April 15, 2013, when bombs exploded near the finish line of the Boston Marathon, killing three people and wounding more than 264 others— many of whom experienced limb loss as a result of their injuries. The city’s medical community was thrust into

Reserve Your Room Today!

AOPA has reserved a block of rooms exclusively for Assembly attendees. Don’t miss this chance to stay in these prime locations—book your room ASAP before they sell out!

• To book a room at the Sheraton Boston Hotel, go to http://bit.ly/sheratonboston or call 800/325-3535 or 617/236-2000.

• To book a room at the Hilton Boston Back Bay, call 800/774-1500 or 617/236-1100.

Questions? Contact Assembly@AOPAnet.org or 571/431-0876.

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AUGUST 2016 | O&P ALMANAC

Lia Dangelico is a contributing writer to O&P Almanac. Reach her at ldangelico@contentcommunicators.com.

PHOTO: iStock.com/Marcio Silva

• To book a room at the Boston Marriott Copley Place, go to http://bit.ly/marriottbostoncopleyplace or call 888/2362427 or 617/236-5800.

the spotlight as its first responders, hospitals, surgeons, nurses, and others rushed to the aid of victims. So, too, was the O&P community, as practitioners played an integral role in helping these patients reclaim their mobility and quality of life in the months and years that followed. In recognition of these events and the responses, the Assembly’s two-part Boston Strong Program gives attendees a chance to mourn those who lost their lives and also learn from survivors. The first part of the program will highlight key events that transpired during and immediately following that tragic day, and allow survivors and their caregivers to share their personal perspectives and the biggest lessons learned in managing their recovery. The second part is a Grand Rounds session that will include the prosthetists, physical therapists, and surgeons who managed three of the survivors—all presented in a classic grand rounds case study format. One member of the session is Eric M. Bluman, MD, PhD, a medical director and director of research, Brigham & Women’s Foot and Ankle Center; assistant professor of surgery, Uniformed Services University of the Health Sciences; and assistant professor of orthopedics, Harvard Medical School.

Bluman was involved in the care of the most severely injured survivors of the Boston Marathon bombing.

For Krupa, a Massachusetts native, this session—and this year’s Assembly as a whole—is not only deeply personal but also a seminal moment in the changing world of O&P. For four days this September, leaders from countless disciplines, walks of life, and cities across the globe will come together in one place to share ideas, listen and learn from one another, and take steps toward a brighter tomorrow. You definitely don’t want to miss it.

O&P

CYBERSECURITY

By CHRISTINE UMBRELL

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I PROTECT YOUR PATIENTS AND YOUR BUSINESS FROM COSTLY DATA BREACHES BY IMPLEMENTING CYBERSECURITY MEASURES NEED TO KNOW • O&P business owners and managers should be aware that data breaches are occurring at health-care facilities at an unprecedented pace: Nearly 90 percent of health-care organizations and 60 percent of their business associates have experienced data breaches during the past two years.

• O&P facilities are required to safeguard electronic files to protect against breaches, and they must comply with regulations set forth by both the Health Insurance Portability and Accountability Act and the Payments Card Industry.

• Businesses should implement a cybersecurity strategic plan that includes assigning oversight duties to a trusted staff member and installing updated antimalware software, whole drive encryption, and intrusion detection tools.

• Because even the most stringent security controls are not guaranteed to prevent all intrusions, O&P facilities should consider purchasing cyber liability insurance.

• A well-written, comprehensive policy should offer coverage for liability; first-party expenses; cyber extortion; forensic, audit, restoration, and notification costs; and business interruption coverage.

T SEEMS YOU CAN’T look at the

news these days without hearing of a data breach. Wendy’s, Target, Anthem, CareFirst, the Office of Personnel Management, eBay, Starbucks, and many more have all been casualties of expensive and well-publicized exposure of confidential data. While those scenarios may seem far removed from the world of O&P, it is very likely that a data breach could happen at your facility—or may even be happening without your knowledge.

Understanding cybersecurity—and what you need to do to prevent and protect against data exposures—is an important responsibility for O&P business owners and managers.

Nearly 90 percent of various sized health-care organizations and 60 percent of their business associates have experienced data breaches during the past two years, according to the “Sixth Annual Benchmark Study on Privacy & Security of Health-Care Data,” conducted by Ponemon Institute and sponsored by ID Experts. And 79 percent of health-care organizations experienced multiple data breaches (two or more) in that time period—up 20 percent since 2010.

Looking specifically at 2016 data is even more troubling: During the first three months of this year, 3.5 million medical records were compromised, according to data from the U.S. Department of Health and Human Services. Health-care businesses experienced nearly four data breaches per week during that time period.

O&P ALMANAC | AUGUST 2016

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Criminal attacks are the leading cause of data breaches in the healthcare arena, responsible for half of all breaches. Internal problems such as mistakes (e.g., unintentional employee actions, third-party snafus, and stolen computing devices) account for the other half of data breaches, says the Ponemon report. While the majority of breaches are small (fewer than 500 records), the financial impact on those health-care businesses is significant.

All health-care companies— including O&P facilities—are required to safeguard electronic files to protect against breaches. Whereas typical retailers must comply with regulations put in place by the Payments Card Industry (PCI) to protect credit and debit card payments data, health-care companies must comply with not only PCI but also the Health Insurance Portability and Accountability Act (HIPAA), which requires covered entities to implement reasonable safeguards to limit incidental, and avoid prohibited, uses and disclosure of protected health information (PHI).

Assessing the Threats

Health-care records represent an attractive target for cyber criminals. Data thieves are increasingly focusing on the U.S. health-care Ross Koppel, PhD, FACMI industry—particularly those health-care companies that continue to rely on aging computer systems that do not use the latest security features, say security experts.

At a typical O&P facility, a criminal who gains illegal access to patient records might find himself in possession of large batches of personal data he could sell for profit. The data for sale could include names, birth dates, policy numbers, diagnosis codes, and billing information. Experts who have investigated cyberattacks on healthcare organizations say that fraudsters could use this data to create fake IDs to buy medical equipment or drugs that could be resold, or they could 34

AUGUST 2016 | O&P ALMANAC

combine a patient number with a false provider number and file made-up claims with insurers.

The risks in health care are “massive,” says Ross Koppel, PhD, FACMI, adjunct professor of sociology at the University of Pennsylvania and affiliate professor of medicine specializing in research on how health information technology influences society. “Medical data is 15 times more valuable than credit card data,” he says, because you can get so much more information from a medical record— including Social Security numbers and credit card information, as well as information that can be used to blackmail individuals. In addition, medical data can be used by fraudulent healthcare facilities to “bilk Medicare and other payors out of millions of dollars.

“There’s the criminal risk. The HIPAA-related risk. There is civil suit risk as patients have data exposed,” Koppel continues. “O&P providers who are not aware of the risks may not be doing what they need to be doing” to protect data.

“Medical data is 15 times more valuable than credit card data.”

—ROSS KOPPEL, PHD, FACMI

“Data breaches and cyberattacks are becoming more common and have increased 62 percent in the last year alone,” says Donald Foley, principal/program specialist at Cailor Donald Foley Fleming Insurance, citing statistics from Travelers Insurance as well as the Ponemon Institute. “The average cost of a data breach has risen to almost $6 million and includes costs related to business disruption, revenue loss, equipment damages, legal fees, public relations expenses, and forensic analysis, as well as notification costs.” The costs associated with a data breach average $201 per compromised record, according to Foley.

Minimizing Breach Risks

O&P professionals can begin to protect their patients by putting cybersecurity measures in place. In broad terms, cybersecurity means “protecting patient data,” says Paul Turek, director of information technology for Wright & Filippis. In more granular terms, he says, cybersecurity means protecting all electronic medical record data, in the cloud and in the physical building, and protecting both data at rest and data in motion. Turek points out that because HIPAA is in play with O&P facility medical records, data breaches at O&P facilities “may be regarded as criminal negligence, which could lead to criminal charges,” as well as steep fines.

To protect both patients and their businesses, O&P professionals should take the first step in implementing a cybersecurity strategic plan by assigning oversight duties to a staff member. “You have to have someone whose job it is to make sure you’re checking all of the boxes,” says Turek.

This involves ensuring every piece of equipment is compliant, security procedures are up to date, and your facility is keeping abreast of emerging threats.

Next, Turek recommends that O&P businesses develop a three-pronged strategy for cybersecurity, by installing

updated antimalware software, whole drive encryption, and intrusion detection tools. But even if all of those strategies are in play, they “may be trumped by the most important part—the human element,” he says. For example, laptops that are brought home then stolen could lead to massive data breaches. “And clinicians taping passwords to computers pose a huge security concern.”

While there’s no one foolproof solution, putting security protocols in place should be a priority for O&P facilities. Rather than rely solely on in-house staff, some facilities opt to hire a Paul Turek third-party company that can manage data security and a firewall. For example, Wright & Filippis uses a combination of in-house oversight and an outside vendor.

“Our in-house IT staff monitor the day-to-day activities,” Turek says. “On the infrastructure side, we contract with a third party that handles our firewall and physical infrastructure.”

Foley also suggests that O&P businesses work with an IT company that can ensure a company has updated firewalls, antivirus protection, and data encryption for medical insurance.

Whether managing cybersecurity with in-house expertise or choosing to outsource this function, securing data is important for O&P facilities of all sizes. The idea that some O&P facilities may be too small to be breached is faulty thinking, says Turek: “It’s not a matter of if you will be breached, but when,” he says.

Cyber Insurance

With new cyber threats arising every day, security experts recommend that O&P businesses’ cybersecurity strategic plans also include cyber liability insurance. Kevin Mendizabal, a commercial insurance broker with Frates Insurance & Risk Management in Oklahoma City, Oklahoma, defines a cyber liability risk as “a loss to a company as a result of a security failure.” If a company is hacked

Does Your Facility Qualify for Cyber Liability Insurance?

Many insurers ask that a business seeking cyber liability insurance submit an application detailing the cybersecurity strategies already in place at the facility, and require that certain safeguards be in place in order for that business to purchase insurance, or to purchase insurance at favorable rates, says Donald Foley, principal/program specialist at Cailor Fleming Insurance.

Cailor Fleming recommends that the following security measures be implemented at all applicant businesses: • up-to-date, active firewall technology • updated antivirus software active on all computers and networks • patch management procedures • intrusion detection software • multifactor login for privileged access • valuable/sensitive data backup procedures • remote access limited to virtual private network • procedure to test or audit network security controls.

In addition, Cailor Fleming recommends that employee training be conducted regarding security issues and procedures, that procedures are in place regarding the creation and periodic updating of passwords, and that background checks be conducted of prospective employees, among other suggestions.

and breached, and its data is compromised, says Mendizabal, “it could trigger a substantial loss.”

While the term “cyber liability insurance” may be new to some O&P business Kevin Mendizabal owners, the insurance has actually been available for several years—and is now “becoming a part of every discussion with insurance companies,” says Mendizabal. Medical records are “very valuable to someone

who wants to inflict harm,” he says.

“If a data breach is traced back to your company, you’re liable for costs the patient or the physician’s office incurred, attorney fees, HIPAA fines, and more—one incident can snowball and even lead to bankruptcy” for your O&P facility, he says.

Every O&P company should “have a separate cyber liability policy to cover the costs of a computer breach or hacking and to make you whole again,” agrees Foley. “Most people have no idea how expensive, how inconvenient, and how damaging a breach will O&P ALMANAC | AUGUST 2016

35

Protecting Against Employee Theft In addition to implementing cybersecurity measures, O&P businesses must protect against a number of other threats to their profitability—including occupational fraud.

Defined as the use of one’s occupation for personal enrichment through the deliberate misuse or misapplication of the employing organization’s resources of assets, occupational fraud happens more often than you may think, and it can occur in a number of ways. Asset misappropriations are the most common type of occupational fraud, accounting for approximately 85 percent, according to the “Report to the Nations on Occupational Fraud and Abuse,” published by the Association of Certified Fraud Examiners (ACFE). Financial statement fraud and corruption schemes also account for a significant portion of occupational fraud.

In the health-care sector specifically, the ACFE report showed that billing schemes and corruption schemes each accounted for 31 percent of occupational fraud, with expense reimbursement schemes accounting for another 20 percent.

Organizations with fewer than 100 employees— like many O&P businesses— face different fraud risks than larger organizations. For example, check tampering schemes occurred in 22 percent of small business cases, but only in 7 percent of larger organizations, according to ACFE. What’s more, payroll and cash larceny schemes were found to occur twice as often in small businesses.

“When it comes to fighting fraud, many small businesses face an uphill battle.

These entities not only incur losses as large as bigger organizations, but they typically have fewer resources with which to combat this threat,” says the report.

“The combination of these factors leaves small businesses particularly vulnerable to occupational fraud. In addition, the working environment and limited staff size in many small businesses often relies upon, and even requires, an increased level of trust among the individuals performing daily operational tasks. As most antifraud professionals know, trust is not an internal control. In fact, trust in the wrong person can lead to disaster.”

While O&P facilities have much to lose if an employee engages in fraudulent activity, implementing antifraud controls is associated with reduced fraud losses and shorter fraud duration, according to the report. Tasking a staff member with oversight responsibilities, encouraging employees to question practices that don’t make sense, implementing checks and balances in the accounting department, and instituting a regular third-party auditing process are all steps an O&P facility can take to prevent occupational fraud. And, as with cybersecurity, O&P businesses should consider purchasing an insurance policy that covers occupational fraud to protect your company should employee theft occur.

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usually be. “When a small company has a serious breach, it will cost a minimum of $75,000 to hire a forensic IT specialist to walk through your door,” says Foley. “The average cyber liability claim for small businesses will run about $300,000, and without cyber liability insurance, or a large line of credit, this could bankrupt most small companies.”

Cyber insurance plans vary according to company and plan type.

In general terms, cyber liability insurance should cover the losses your company incurs as the result of a security breach. But in practice, this type of insurance is relatively new, so there is no “standard” coverage—each cyber liability policy offered by different companies may cover different things.

“There may be two policies, each called cyber insurance, but one could offer just bare-bones coverage, and the other could be comprehensive— and there may not be much variance in costs,” says Mendizabal. For that reason, O&P business owners evaluating insurance plans must be very clear on what a potential plan covers.

Foley suggests that O&P business owners look for a plan that protects against unlawful intrusion by unauthorized third parties, such as hackers, and also covers breach of confidential information, such as a HIPAA violation. “Look for a reputable independent insurance agent who understands cyber liability thoroughly,” he says. “Then, make sure they are quoting comprehensive coverage.” Foley says the main three coverages needed are notification coverage, forensics coverage, and crisis management.

A well-written, comprehensive policy should offer the following specific types of coverage, says Mendizabal: liability coverage, which protects the facility against claims for damages due to losses caused by unauthorized disclosure of information; first-party expenses, including regulatory fines and penalties coverage, which covers regulatory fines related to HIPAA, the Health Information Technology for Economic and Clinical Health (HITECH) Act, and state regulators; cyber extortion to cover monetary demands; forensic, audit,

restoration, and notification costs to determine the cause and severity of a breach, and notify and restore any affected parties; and business interruption coverage, which covers expenses caused by a facility being unable to participate in normal business due to damaged databases or loss of network use. Mendizabal encourages O&P professionals “lookSlater for a policy —Quote bytoKelly written specifically for the industry you’re in.”

Turek cautions O&P professionals to look carefully at how an insurance policy is worded. Some insurers will cover everything “under certain circumstances”—but those circumstances can be very narrow.

“Remember there are emerging threats, and try to get coverage that will cover new threats,” he says. “Look for a very comprehensive plan that covers a wide range of breach types.”

Mendizabal also cautions against relying on third parties who promise that their coverage extends to your facility. For example, “a lot of payments processors say they offer breach insurance—but this is not true. They are only offering a limited indemnity to a

company for HIPAA and PCI fines that come up,” says Mendizabal. But if your facility gets sued, there are many more expenses that need to be covered.

It can be difficult to pinpoint the necessary amount of coverage for an O&P facility: “It’s very hard to quantify how much, in terms of limits, you need,” says Mendizabal. “There are so many unknowns about the severity of the theft of medical records.”

Fortunately, some insurers may offer lower premiums if your facility has implemented security measures to prevent breaches. For example, if your business has antivirus software and a dependable firewall, that could bring down your rates. “The more a company does to minimize risks, the more favorable the terms of the insurance policy,” says Mendizabal.

“It’s all about where your mind’s at.”

Taking a Strategic Approach

Unfortunately, cybersecurity experts agree that no amount of security is guaranteed to prevent all intrusions.

Foley shares the wisdom of John Chambers, the recently retired CEO from Cisco, who says there are only two kinds of companies: those that have been hacked, and those that don’t know they’ve been hacked.

To ensure your O&P business is prepared when a cybercriminal decides to target your data, make sure you have implemented strategies to deter hackers and protect both your patients and your facility should a breach occur.

EDITOR’S NOTE: For more information about this topic, read “Safe and Secure in the Digital Age” in the February 2016 O&P Almanac, or access the article online at bit.ly/ securityissue.

Attend the session Cyber Liability—the #1 Coverage Not on O&P Facility Owners Radar, Friday, September 9 in Boston.

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

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AUGUST 2016 | O&P ALMANAC

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EastPoint Prosthetics & Orthotics

By DEBORAH CONN

O&P on the Road North Carolina facility engages a fleet of mobile vans to serve a wide region

Brett Decker, CP, adjusts a patient’s prosthesis on one of EastPoint’s mobile units.

P

AUL SUGG, CPED, CPO,

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AUGUST 2016 | O&P ALMANAC

Louis Brown, CPO, uses a structure scanner attached to an iPad to scan a patient’s leg for a new prosthesis.

FACILITY: EastPoint Prosthetics & Orthotics OWNER: Paul Sugg, CPed, CPO, FAAOP LOCATIONS: Kinston and Raleigh, North Carolina HISTORY: Eight years

Paul Sugg, CPed, CPO, FAAOP, adjusts a prosthesis from the recessed observation pit in EastPoint’s gait room.

Emily, founded EP Legacy, a nonprofit to aid amputees in developing countries. The team partners with other companies around the world to provide prosthetic limbs to impoverished areas. Currently, the EP Legacy team attends and supports clinical work in El Salvador, Guatamala, Ivory Coast, and Latvia. They just returned from the Ivory Coast, where they delivered 16 prosthetic legs. The nonprofit has a Facebook page with photos and videos of the trips.

Sugg relies on his clinicians to market the business, and they do so via education and awareness. The facility hosts seminars that provide continuing education credits to physical and occupational therapists, nurses, and other medical care givers, and clinicians often hold continuing education sessions at nursing homes, doctors’ offices, and rehabilitation facilities.

“We think it’s important to help medical professionals understand what we do from a

clinical perspective,” says Sugg.

“As we do that, we try to solve their problems. What are the issues they’ve had before with O&P? We want to make it as easy as possible for them.”

With 24 years’ experience in the field, Sugg might be considered an old timer—but he eagerly embraces new technologies. He is thoughtful about the way different industries cross boundaries to become new players in O&P. For example, the aerospace industry has a presence in Kinston. “They work with advanced carbon composites, and we hope to be able to tap into that to make extremely lightweight prostheses in the future,” Sugg says. “There are lots of other industries that never thought about using their products in O&P, and it’s exciting to see what we can use from different sources.”

Sugg also looks forward to the advent of even smaller, lighter scanners, and greater use of 3D printing.

“We have four residents with us right now,” he says. “It would be foolish to keep my old-school mentality. We are willing to change, and we want to bring on young people who want to work here and make it their company as well. We like the word ‘legacy’—and welcoming new technology is a good way to ensure the legacy of EastPoint P&O.”

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

PHOTOS: EastPoint Prosthetics & Orthotics

FAAOP, spent much of his career working for large national O&P providers. In 2008, he launched his own business, EastPoint Prosthetics & Orthotics, in Kinston, North Carolina. Since then, his facility has grown to employ 19 full-time and four part-time workers, including 12 clinicians, and has a second office in Raleigh.

Between the two offices, and a fleet of mobile vans, EastPoint covers most of the central and eastern part of the state.

The company’s Kinston headquarters occupies about 5,000 square feet, with roughly one third devoted to fabrication.

“I designed it myself,” says Sugg. “I’ve been in a lot of different offices, so I knew how I wanted to lay it out.” The space includes three patient rooms, a gait room with a recessed floor, and administrative and corporate offices. The Raleigh office is just 600 square feet, but its clinicians work out of mobile vans so the space is primarily administrative.

The vans, Ford Transits, contain workbenches, mini carvers, and other equipment that enables practitioners to create custom-made devices on the road. EastPoint uses a software platform with mobile capabilities so clinicians can follow cases, take notes, and conduct other business while traveling.

The Kinston facility and six vans based in eastern North Carolina primarily work with prosthetics patients, while Raleigh’s four vans do about 90 percent pediatric orthotics.

In addition to his business responsibilities, Sugg and his wife,

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Fusiform

By DEBORAH CONN

Imagining a New O&P Ecosystem Baltimore company develops collaborative platform to streamline fabrication process

P

ARAM SHAH, A COMPUTER

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COMPANY: Fusiform OWNERS: Param Shah and Alex Mathews LOCATION: Baltimore, Maryland HISTORY: 1.5 years WEBSITE: www.fusiform.co

Alex Mathews applies computer-integrated surgery principles to provide powerful visualization of 3D scans.

In addition to Shah, who serves as chief executive officer, and Mathews, who serves as chief technical officer, the company has 10 employees—all Johns Hopkins undergrads, graduate students, or alumni. The company mainly utilizes software to provide its services, and is exploring fabrication opportunities. Fusiform’s board of advisors includes orthopedic specialists, and the company has been working with Dankmeyer Prosthetics & Orthotics and other clinics in the Maryland area.

Fusiform’s first product is FusiformCAST, a digital collaborative platform that creates a common interface for clinics to use when ordering from any central fabrication facility. “Each fabricator has its own specific order form, making clinics use five different ordering methods for five different fabricators. To simplify the process for clinics, CAST allows you to choose the device and fabricator you want and fill out a standardized online form with the necessary information. From

that, we can generate order forms customized to each manufacturer or communicate directly with one already on the platform,” explains Shah. “Clinics can scan a patient in 10 minutes, upload the files and other pertinent information, and then use a consistent process to order the device.”

Currently, Fusiform offers FusiformCAST free of charge to O&P providers. Shah hopes that CAST will become the center of a new ecosystem, where all O&P business will be conducted through digital technology. When clinics accept the system, custom fabricators will be encouraged to join the platform as well.

Once they do so, they can work directly with O&P providers through the software, to view scans, annotate them, make modifications, or coordinate orders through messages.

The software is versatile, enabling clinics to track patients and orders and receive notifications of any updates to cases.

Additional integrations will allow automatic payment processing and invoicing, CAD design software, and direct connection with electronic medical record systems.

As Fusiform continues to develop products aimed at streamlining the fabrication process, future O&P patients stand to benefit from quicker turnaround times, as well as increased functionality.

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

PHOTOS: Fusiform

science undergraduate student at Johns Hopkins University in Baltimore, traveled to India several years ago as part of a service trip to improve sanitation and health in rural villages. He was struck by the many children he encountered there with disabilities, an experience that led him to create a nonprofit: the Lotus Life Foundation. Among other educational and medical intervention activities, the organization provides orthotic and prosthetic services to children in rural parts of India.

In the course of his foundation’s work, Shah was distressed by the amount of time it took to get from patient assessment to delivery of a finished device; often a month passed before a child received a prosthesis or orthosis.

Back in the United States, he found a similar timeframe in this country, as many O&P facilities continued to use time-consuming hand-fabrication techniques.

These concerns helped drive Shah as he and Alex Mathews, a biomedical engineering student at Hopkins, launched Fusiform in 2015. “Our mission is to deliver devices exponentially faster, as well as ease the process for O&P facilities and make devices both more accessible and comfortable,” says Shah. Fusiform’s ultimate solution is to move to a fully digital supply chain of fitting and manufacturing orthotic and prosthetic devices, which could shorten delivery time from a month to a few hours.

James E. West, PhD (center), Alex Mathews (left), and Yunus Sevimli (right) discuss patient accessibility.

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Fill in the Blanks: Know Your Forms

Register for the September 14 Webinar Are you filling out all of your forms correctly? Join AOPA experts for the September 14 webinar and get answers to these questions: • Are your prescriptions compliant with Medicare?

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Knee Orthosis Policy: The ABCs of the Local Coverage Determination and Policy Article

Register for the October 12 Webinar

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit. ly/2016webinars. Contact Ryan Gleeson at rgleeson@ AOPAnet.org or 571/431-0876 with questions.

Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2016billing.

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AUGUST 2016 | O&P ALMANAC

Join AOPA experts for the October 12 webinar, and find out everything you need to know about the proposed Local Coverage Determination (LCD) and Policy Article for knee orthoses: • Examine which addition codes can be used with each base code.

• Determine what documentation is needed for each type of knee orthosis.

• Determine when you may use the KX modifier on a KO claim.

• Review all other pertinent information found in the LCD and Policy Article.

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit. ly/2016webinars. Contact Ryan Gleeson at rgleeson@ AOPAnet.org or 571/431-0876 with questions.

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The Study that Started MobilitySaves.org

The Results

A major study, commissioned by the Amputee Coalition with support from the American Orthotic & Prosthetic Association, shows that Medicare pays more over the long term in most cases when Medicare patients are not provided with replacement lower limbs. O&P professionals have learned the positive outcomes from the Dobson DaVanzo study, which proves that timely O&P intervention results in fewer co-morbidities and lower total healthcare costs for both patients and payers. Share this significant news by using the educational tools provided at MobilitySaves.org. Mobility Saves Lives And Money!

The lower limb prosthetic patients could experience better quality of life and increased independence compared to patients who did not receive the prosthesis at essentially no additional cost to Medicare (or other payers), and patients using spinal orthoses and lower limb orthoses had lower overall costs.

O&P CARE IS A SAVER, NOT AN EXPENSE TO INSURERS! Visit MobilitySaves.org.

Follow us on social media!

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

WELCOME 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 publiwww.AOPAnet.org cation, 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 state-licensed 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.

Anatomi Metrix Inc. 365 McCaffrey Montreal, QC, Canada H4T 127 514/882-9676 Category: Supplier Level 1 Apex 360 Systems LLC P.O. Box 1031 Tipp City, OH 45371 800/396-2480 Category: Supplier Level 1

Is Your Facility Celebrating a Special Milestone in 2016?

O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email cumbrell@ contentcommunicators.com.

O&P PAC UPDATE

T

HE O&P PAC IS AOPA’s federally registered political action committee (PAC), AOPA’s lobbying branch, representing the O&P profession on Capitol Hill to ensure that your voice is heard during pertinent discussions and /or debates on legislation that may have an effect on the future of O&P. The O&P PAC is bipartisan and does not support one political party over the other, but instead the O&P PAC focuses on seeking out key legislators on key committees, who have demonstrated an interest and concern for the issues facing the O&P community. The O&P PAC then supports these legislators and their election efforts with a donation to their campaign funds and/or will help sponsor a fund raising event for these candidates.

Since the O&P PAC is federally registered, it must comply with all of the rules and regulations of the Federal Election Committee (FEC). The FEC has very specific rules on who may contribute to a trade association’s political action committee. All O&P PAC contributions must be voluntary and come from eligible employees of AOPA member companies, including O&P practitioners, executive and

The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to the O&P PAC*:

administrative personnel, board of directors, stockholders, and their family members.

All contributions from these eligible individuals must be made with personal funds. The O&P PAC may not accept contributions from corporate accounts. Also, monies collected by the O&P PAC cannot be used for government relations administrative functions, those things funded by Capitol Connection; they may only be used for direct or indirect support of federal candidates.

To participate in and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: https://aopa.wufoo. com/forms/op-pac-authorization.

• Jeffery Brandt, CPO • J. Martin Carlson, CPO • Rick Fleetwood, MPA • Pam Lupo, CO

*Due to publishing deadlines this list was created on June 30, 2016, and includes only donations/contributions made/ received between May 24, 2016, and June 30, 2016.

Any donations/contributions made/ received on/or after June 30, 2016will be published in the next issue of the O&P Almanac.

O&P ALMANAC | AUGUST 2016

47

MARKETPLACE

Feature your product or service in Marketplace.

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

Visit bit.ly/aopamedia for advertising options.

New AFO Gauntlets, Part of ACOR PRIME! A custom AFO gauntlet is prescribed to assist in stability and allow functional mobility without demanding excessive energy. For 2016 Acor is now offering our refined-design AFO gauntlets hand-made in our Cleveland, Ohio, facility as part of our new ACOR PRIME services.

ACOR PRIME is designed to eliminate pricing and shipping hassles, with free shipping both ways and standard orthotics mods included at no additional charge!

See our ad in this issue for information regarding our new ACOR PRIME services or just call Acor at 800/237-2267.

PDAC Approved A5513 Diabetic Insoles Custom-milled, not molded, EVA and approved for Medicare billing by PDAC. Submit foam/crush boxes or Amfit digital orders for fabrication in three to five business days of receipt. Program pricing includes shipping to keep your costs low. Standard Bi-Lam and Tri-Lam plus toe fillers and Charcot foot styles. Do your office a favor and outsource your diabetic orthotic orders.

Program services start with FootPrinter Foam Boxes where no equipment is placed at your office. For lower fabrication pricing and more control over the orthotic design, talk with us about FreeScan and lease purchase requirements.

For complete details, please email sales@amfit.com or call toll-free 800/356-FOOT/3668, x266 or x264.

ALPS EasyLiner™ ALPS EasyLiner is formulated with EasyGel, which contains an antioxidant blend that is an effective hydroxyl scavenger and has been reported to have beneficial effects to the skin. It features a flat encapsulation for additional comfort, and high performance fabric for more durability. The EasyLiner is available in 3-mm and 6-mm uniform thickness, or tapered 6/3-mm distal to proximal.

For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.

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AUGUST 2016 | O&P ALMANAC

Amfit Contact LT 3D Digital Casting The Contact LT retains all the accuracy and automatic off-loading of the original Contact Pro Digitizer.

Flash-Scan speed for casting and contour display in less than 10 seconds, thanks to eliminating the sensor lock. One button operates pins up, scan, and release but sensor pressure is still adjustable to fit your preferred casting and treatment methodology.

Offered in the FreeScan Program, the Contact LT is a great addition to clinic offices and mobile service providers. As with all Amfit equipment, the LT is designed and built in the USA. For complete details on the Contact LT and FreeScan please email sales@amfit.com or call 800/356-FOOT/3668, x266 or x264, today.

Peak Scoliosis Bracing System Winner of the 2015 Spine Technology Award, the Peak Scoliosis Bracing System is a revolutionary new bracing system from Aspen Medical Products.

This innovative new concept in bracing is the only brace specifically designed for adults with scoliosis and has been shown to: • Significantly reduce pain • Increase mobility • Promote better posture • Improve the quality of life.

Code L1005 approved. Visit www.aspenmp.com.

Sure Stance K3 Knee by DAW Industries THK-4PSC This ultralight, true variable cadence, multiaxis knee is the world’s first nonmicroprocessor, four-bar stance-control knee. The positive lock of the stance control activates up to 35 degrees of flexion! The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K3 patients not qualifying for a microprocessor knee.

For more information, call DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

MARKETPLACE Cool Liner 2.0 Vertical Stretch Control (VSC) by DAW Industries Cool Liner 2.0 VSC DAW, the world’s leading manufacturer in prosthetic socket interface (DAW Sheath/ Sock) has improved upon our unbelievably advanced Cool Liner™ technology to create a thermoformable gel socket liner that provides a level of socket comfort beyond what is thought possible. You will never go back after using our new and improved Cool Liner with patented Vertical Stretch Control (VSC)—no other liner provides total elimination of Vertical Stretch with this level of comfort.

For more information, call DAW Industries Inc. at 800/2522828, email info@daw-usa.com, or visit www.daw-usa.com.

Child Variable Cadence Multiaxis Knee TK-4POC Never heard of before: This ultralight miniaturized knee provides the ultimate in function and dependability for the active above-knee child amputee or smaller petite adults. Designed as a four-bar Pneumatic Polycentric, the knee’s instantaneous center of rotation isprojected proximally to the paitent’s residual limb.

The specially engineered alloy construction accommodates the most active child amputee or lightweight adult with uncompromising strength and durability.

For more information, contact DAW Industries Inc. at 800/2522828, email info@daw-usa.com, or visit www.daw-usa.com.

Fusiform FusiformCAST FusiformCAST is a software application that makes ordering your O&P devices much more easy and simple. Clinicians can create a patient and add any media they’d like, including 3D scans, pictures, and videos. They can select a vendor and device through the platform and fill out a digital consistent form, which will overlay on the custom fabrication form.

If the fabricator is on the system, it can communicate directly with each of its clinics through messaging, and media annotations. CAST will forge the way to make a fully digital O&P ecosystem. For more information, call 714/623-3711 or visit www.fusiform.co.

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 at 800/301-8275 or visit www.hersco.com.

Infinite TT The Infinite TT is a custom-molded, modular, and adjustable socket system for transtibial amputees. The thermoplastic carbon-fiber frame, hinging posterior strut, and BOA closure system draw in the medial and lateral walls to improve biomechanical control. The advanced pressure distribution system incorporates height adjustment and air bladders, designed in response to activity demands, pressure areas, and shape change. The colorful range of soft shell covers allows patients to choose the right style for them.

If you are interested in attending our Infinite TT AOPA workshop, please RSVP to RSVP@LIMInnovations.com.

Infinite Socket TF The Infinite Socket TF is a custom-molded, modular, and adjustable socket system for transfemoral amputees. It is a blend of advanced textiles and structural components, enabling transfemoral amputees to live beyond the limits of their prosthesis. It is made of a modular four-strut configuration, base-plate, and an adjustable brim designed to adapt and conform to limb fluctuation. The Infinite Socket is the first truly adjustable socket that the patient and clinician can fine tune on the fly.

If you are interested in attending our Infinite Socket AOPA workshop, please RSVP to RSVP@LIMInnovations.com.

O&P ALMANAC | AUGUST 2016

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MARKETPLACE Silicone, Urethane, and Copolymer Liners The Skeo family of silicone liners includes an internal matrix to reduce pistoning plus a slick outer surface to aid in donning and doffing.

Choose from a variety of options that include preflexed for enhanced fit, and SkinGuard protection to reduce odor. Our copolymer liners are ideal for lower activity patients, and our Anatomic 3D Urethane liner is preferred for Harmony vacuum or valve systems. Whether your patients need a silicone, urethane, or copolymer solution, Ottobock can help you find the right fit.

Call your local sales rep to find out more. Ottobock: 800/328-4058 or visit www.professionals.ottobockus.com.

DVS- Dynamic Vacuum The DVS- Dynamic Vacuum is bridging the gap between valve and Harmony socket technology.

Integrating innovative design with simplicity, the DVS reduces the movement between the limb and socket associated with limb volume fluctuations. Lightweight and low profile, the DVS can easily be fabricated into a socket using traditional fabrication techniques with no additional certification.

Now available; call your local sales rep to find out more.

Ottobock: 800/328-4058 or visit www.professionals.ottobockus.com.

Touch Bionics QR Codes Allow for Easy Access to Key Grips Designed to help maximize the use of the i-limb™ prosthesis, QR codes enable users to quickly download or share custom my grips among the fast-growing user community.

For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit: www.touchbionics.com/resources/qr-codes.

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AUGUST 2016 | O&P ALMANAC

How PEL Contributes To a Better Patient Experience A growing number of health-care business strategists are redefining their definition of value-based health-care delivery by placing greater emphasis on patient experiences. A study by The American Journal of Managed Care revealed the quality of care is strongly correlated with the amount of time clinicians spend with patients. PEL has a tradition of offering superior personal service that allows O&P practitioners to spend more time focusing on patients. The 2015 Independent O&P Practitioner Study results rated PEL highest in customer service, easiest distributor with which to work, and best overall value of service and price. If you desire a better distributor experience, try PEL. For more information, visit www.pelservice.com.

2016 AOPA Coding Products 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 2016 AOPA coding products. Ensure each member of your staff has a 2016 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors.

• Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • Illustrated Guide: $185 AOPA members, $425 nonmembers $30 off sale until August 31 while we celebrate the Illustrated Guide's 30th birthday! $155 for AOPA members and $395 for nonmembers.

• Quick Coder: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or by calling AOPA at 571/431-0876.

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Pacific

Job location key:

CO/CPO

- 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 landerson@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.

Fresno/Sacramento, California Portland, Oregon Established in 1987, Pacific Medical Prosthetics and Orthotics has become a tenured company in the industry for patientcare products and services. With the heart of the company dedicated to helping and serving others, we are currently seeking an certified orthotist or a certified prosthetist/ orthotist in Fresno/Sacramento, California, and Portland, Oregon, that is a seasoned practitioner with experience in practice management; clinical expertise in outpatient and inpatient settings; organization and maintenance of an O&P facility; fabrication; fitting; and a willingness to work within a dynamic team. This position is an excellent opportunity for a candidate who is self-driven/motivated with an entrepreneurial spirit, and who is looking to produce results in an expanding market. Competitive salary, benefits, and profit sharing offered based on experience. Interested candidates should email inquiries/résumé to:

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

Member $482 $634

Nonmember $678 $830

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

Pacific Medical Prosthetics and Orthotics Email: careers@pacmedical.com Fax: 209/834-0690

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

Job Board

Member Nonmember $85 $150

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

FOR SALE Orthotics/Prosthetics Practice Eastern North Carolina

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.

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AUGUST 2016 | O&P ALMANAC

ABC-credentialed, successful, well-established O&P practice available. Excellent reputation.

Please respond to: Business Opportunity 62016 Email: info@aopanet.org O&P Almanac 330 John Carlyle St., Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

CAREERS

Pacific CPO, CP, or Board-Eligible CPO/CP and Prosthetic/Orthotic Technician or Assistant

Portland, Oregon Expanded contract base has created the need for additional patient-care and fabrication staff. Our growing patientcentered practice seeks energetic, skilled team players to provide primarily prosthetic care. BOC-accredited facility.

Enjoy work/life balance with no on-call duties. Positions provide competitive salary and bonus program, fully paid medical benefits, and vacation.

All inquires will be held in strict confidence.

Send résumé to:

BUILD A

Better BUSINESS WITH AOPA

Visit www.AOPAnet.org/join today!

Learn how AOPA can help you transform your business into a world class provider of O&P Services with: Coding, Billing and Audit Resources

Diane Daybreak, President Oregon Artificial Limb Company Confidential email: Diane_daybreak@yahoo.com

Education, Networking, and CE Opportunities Advocacy Research and Publications Business Discounts

The Source for Orthotic & Prosthetic Coding

Morning, noon, or night— LCodeSearch.com allows you access to expert coding advice—24 hours a day, 7 days a week.

T

HE O&P CODING EXPERTISE the profession has come to rely on is available online 24/7! LCodeSearch.com allows users to search for information that matches L Codes with products in the orthotic and prosthetic industry. Users rely on it to search for L Codes and manufacturers, and to select appropriate codes for specific products. This exclusive service is available only for AOPA members.

Log on to LCodeSearch.com and start today.

Need to renew your membership?

Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

Manufacturers: AOPA is now offering Enhanced Listings on LCodeSearch.com. Don’t miss out on this great opportunity for buyers to see your product information! Contact Betty Leppin for more information at 571/431-0876.

SPECIA16L! for 20

www.AOPAnet.org

O&P ALMANAC | AUGUST 2016

53

CALENDAR

2016

August 18-20

Virginia Orthotic & Prosthetic Association. Hyatt Regency Reston, Reston, VA. For more information, visit www.vopainfo.com.

August 10

The Supplier Standards: Are You Compliant? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

August 11-12

Orthomerica Whole Limb Solutions Seminar. Milwaukee. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Milwaukee. Tuition is $495. Each attendee receives a $200 coupon. For more information, visit www.orthomerica.com/education and register today as seating is limited.

September 1

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

September 8-11

99th AOPA National Assembly. Boston. For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org.

For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

August 12-13

ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg College—Caruth Health Education Center, Pinellas Park, FL. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

August 12-13

Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting.

Grand Hyatt on the Riverwalk, San Antonio. Contact Leslie Gray at 214/648-1006, email secretary-treasurer@txaaop.org, or visit www.txaaop.org.

September 12-17

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

September 14

Fill in the Blanks: Know Your Forms.

Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

No Application Deadlines BOC offers year-round testing with no deadlines. COF and CMF candidates can apply – test when ready and receive their results instantly.

Existing BOCO, BOCP, BOCPD candidates still have 3 years to take their exams. To learn more about our nationally recognized, in-demand credentials, or to apply now visit www.bocusa.org.

www.bocusa.org

SHARE

your next event!

54

Cascade Dafo Inc. Cascade Dafo Institute. Now offering a series of six free ABC-approved online courses, designed for pediatric practitioners. Visit www.cascadedafo.com or call 800/848-7332.

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

Questions? Email landerson@AOPAnet.org.

Calendar Rates Let us

Online Training

CREDITS

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 landerson@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.

AUGUST 2016 | O&P ALMANAC

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR

September 23-24

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. LaGuardia Airport Plaza Hotel, New York. Contact Drew Shreter at 800/946-9170, ext. 101, or email dshreter@pomac.com.

December 14

New Codes and What Lies Ahead for 2017. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

October 1

ABC: Application Deadline for ABC/OPERF Student Award for Academic Achievement. Ten exceptional students will be selected to win $1,000 to cover educational expenses. For more info or to apply, go to operf.org.

October 12

Download the app today:

KO Policy: The ABCs of the LCD and Policy Article. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

November 9

Don’t Miss Out: Are You Billing for Everything You Can? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Webinar Conference

for the latest news and information!

November 14-15

AOPA Mastering Medicare: Essential Coding & Billing Techniques Seminar.

The Tropicana, Las Vegas. Register online at bit.ly/2016billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Seminar

ADVERTISERS INDEX Company

Page Phone

ABCOP—American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc. ACOR Orthopedics Inc. Amputee Coalition ALPS South LLC Amfit Aspen Medical Board of Certification/Accreditation Cailor Fleming Insurance Custom Composite DAW Ferrier Coupler Inc. Fusiform Medical Hersco LIM Innovations Ottobock PEL Touch Bionics

37 19 43 15 27 23 41 39 21 1, 51 17 31 2 5 C4 7 9

Website

703/886-7114 www.abcop.org 800/237-2276 www.acor.com 888/267-5669 www.amputee-coalition.org//lled 800/574-5426 www.easyliner.com 800/356-3668 www.amfit.com 800/295-2776 www.aspenmp.com 877/776-2200 www.bocusa.org 800/796-8495 www.cailorfleming.com 866/273-2230 www.cc-mfg.com 800/252-2828 www.daw-usa.com 810/688-4292 www.ferrier.coupler.com 714/623-3711 www.fusiform.co 800/301-8275 www.hersco.com 844-888-8LIM www.liminnovations.com 800/328-4058 www.professionals.ottobockus.com 800/321-1264 www.pelsupply.com 855/694-5462 www.touchbionics.com O&P ALMANAC | AUGUST 2016

55

ASK AOPA CALENDAR

Payment Perplexities Billing patients directly, self-pay discounts, and more

AOPA receives hundreds of queries from readers Q 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.

If a patient requests that I bill him or her directly rather than bill his or her insurance, must I comply with the request?

Q/

The easy answer is yes. Under the Health Insurance Portability and Accountability Act of 1996, if an individual has paid for a service out of pocket, in full, and the individual requests a nondisclosure to his or her health plan, you must accommodate the request. In previous years you were not obligated to follow the patient’s request, but now you are obligated—especially when the patient makes a payment directly to you.

A/

If a patient wishes to pay out of pocket for a service or item, am I required to have a prescription/ order on file?

Q/

In short, the answer is no.

However, you must take into account liability issues and how such a scenario could affect your accreditation standing or local licensure rules. For example, your accrediting body or state licensing board may require you to have prescriptions on file for all services, even if they are cash pay. So, before you provide a service without obtaining a prescription, verify the rules with your accrediting body and/or your state boards.

A/

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AUGUST 2016 | O&P ALMANAC

If a patient wishes to self-pay for an item, am I able to offer a discount?

Q/

It is acceptable to provide a discount for cash pay or prompt pay. However, according to the Office of the Inspector General, there are five things you should be aware of when offering a cash discount:

A/

• The discount program should not be advertised.

• Patients should be informed of the discount through the ordinary billing process.

• The discount should apply and be available to all payors (not just Medicare patients).

• The costs associated with providing the discount must be absorbed by you.

• The discount should have a reasonable relationship to the amount saved by you, or should be a justifiable discount (usually in the 5 to 15 percent range).

May I submit a claim to Medicare and receive payment if I don’t have a physician’s order on file?

Q/

Yes, you may submit a claim if you did not receive or if you do not have a valid physician’s order on file; however, you must submit the claim using the EY modifier. The EY modifier indicates that you do not have an order on file, and will cause your claim to be denied. The denial will result in a “not medically necessary” denial, meaning you have the ability and right to file an appeal and seek payment if you are able to document the medical necessity of the item or service you provided.

A/

The premier meeting for orthotic, prosthetic, and pedorthic professionals.

#AOPA2016

AOPAnet.org

LIGHTING the FUTURE SEPTEMBER 8-11, 2016 | BOSTON

Earn more than

35 CE

REGISTER TODAY!

CREDITS

Join us September 8-11, 2016, for the 2016 AOPA National Assembly at the Hynes Convention Center in Boston, MA.  PLOT A COURSE FOR FUTURE SUCCESS with 5 concurrent sessions for Orthotists, Prosthetists, Pedorthists, Technicians, Business Owners and Managers

The O&P community has experienced stormy seas for the past several years with legislative challenges, rising costs, and reimbursement pressures. If you are looking for a lighthouse in the storm—join us at the 2016 Assembly.

Our goal is to bring our profession together to build a strong future through clinical and business education, networking and the support of a strong supplier community.

 Cruise through the stormy seas of REGULATORY RULES with answers you can only get from AOPA  Navigate the country’s LARGEST O&P EXHIBIT HALL  Sail through spectacular general sessions with inspiring KEYNOTE PRESENTERS

 Partake in FUN NETWORKING EVENTS  Enjoy exciting and HISTORIC BOSTON BACK BAY  Catch up with the ALUMNI CONNECTION  Maneuver your way with CASE STUDIES AND SYMPOSIA  GET ONBOARD with MDs, PhDs, Wound Care Specialists, Research Scientists, Attorneys, Business Experts and Top-Notch Practitioners.

Questions?

Contact AOPA at 571/431-0876 or email at info@AOPAnet.org.

For information about the show, scan the QR code with a code reader on your smartphone

Visit www.AOPAnet.org to learn more, register, or to exhibit.

1E91 Runner 1E93 Runner Jr Ready, set, go!

Adjust the stiffness level for high intensity or long distance

Stability when making tight turns

Interchangeable foot soles for on and off the track

www.ottobockus.com www.ottobock.ca