OP
The American Orthotic & Prosthetic Association
DECEMBER 2012
&
WWW.AOPANET.ORG
THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY
Survival
School Superstorm Sandy reminds facility owners the value of disaster planning
How military amputees advance R&D Answers to your questions regarding Medicare participation
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O&P Almanac CONTENTS
DECEMBER 2012, VOLUME 61, No. 12
departments
Cover Story
4 AOPA Contact Page
20 Survival School
By Adam Stone Superstorm Sandy left portions of the East Coast ravaged, with millions of homeowners and businesses affected in some way. Such a devastating natural disaster is a stark reminder of the necessity of developing and regularly updating a detailed disaster plan at your O&P facility.
Feature
How to reach staff
6 At a Glance
Statistics and O&P data
08
In the News Research, updates, and company announcements
38 AOPA Headlines
News about AOPA initiatives, meetings, and more
45 AOPA Membership 00 Applications
28 Striding Past “Status Quo�
By Lia Dangelico Veteran and active-duty military amputees, a relatively young and healthy population, demand prosthetic options that will help them return to active lifestyles. Manufacturers and prosthetists are responding with a progressive mindset, offering innovative treatment plans, and testing new products at military medical centers.
COLUMNS
46 Marketplace 50 Jobs
Opportunities for O&P professionals
54 Calendar 55 Ad Index 56 AOPA Answers
Expert answers to your FAQs
14 Reimbursement Page
When and how to appeal RAC overpayment decisions
34
Facility Spotlight East Coast Orthotic & Prosthetic Corp.
36 Ask the Expert
Medicare: The decision to become a participating provider
O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; 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. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com. DECEMBER 2012 O&P Almanac
3
AOPA IN THE Contact NEWS INFORMATION 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 EXECUTIVE OFFICES
MEMBERSHIP & Meetings
BOARD oF DIRECTORS
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org
Officers
directors
President Tom Kirk, PhD, Hanger Inc., Austin, TX
Jeff Collins, CPA, Cascade Orthopedic Supply Inc., Chico, CA
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org
Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org
Scott Schneider, Ottobock, Minneapolis, MN
O&p Almanac
Stephen Custer, coordinator, membership operations and meetings, 571/431-0876, scuster@AOPAnet.org
President-Elect Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI
Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com
Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, landerson@AOPAnet.org AOPA Bookstore: 571/431-0865 Communications Steffanie Housman, content strategist, 571/431-0835, shousman@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org
Stephen Custer, staff writer, 571/431-0876, scuster@AOPAnet.org
Government affairs
Lia K. Dangelico, contributing writer, 703/914-9200 x24, ldangelico@strattonpublishing.com
Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org
Christine Umbrell, editorial/production associate, 703/914-9200 x33, cumbrell@strattonpublishing.com
Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org
Vice President Charles H. Dankmeyer, Jr., CPO, Dankmeyer Inc., Linthicum Heights, MD Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA
Dave McGill, Ă–ssur Americas, Foothill Ranch, CA Ronald Manganiello, New England Orthotics & Prosthetics Systems LLC, Branford, CT Eileen Levis, Orthologix, LLC, Trevose, PA Michael Oros, CPO, Scheck and Siress O&P Inc., Oakbrook Terrace, IL Kel Bergmann, CPO, SCOPe Orthotics & Prosthetics Inc., San Diego, CA Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA
Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org
Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com
Mike Hamontree, Hamontree Associates, Newport Beach, CA
James Campbell, PhD, CO, Becker Orthopedic Appliance Co., Troy, MI
O&P Almanac Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales M.J. Mrvica Associates Inc. Design & Production Marinoff Design LLC Printing Dartmouth Printing Company
Copyright 2012 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 Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the 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.
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O&P Almanac DECEMBER 2012
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AT IN THE A GLANCE NEWS
Amputations on the Rise for U.S. Armed Forces The number of amputations undergone by active and reserve components in the U.S. Armed Forces dipped in 2008 and 2009, then rose significantly in 2010 and 2011, reflecting the recent surges in the extent and intensity of ground combat operations in Afghanistan…
Year
Amputations: Average Per Month Among U.S. Armed Forces
2003
6.8
2004
12.6 12.8 13.2
2005 2006 2007
17.2 8.9 7.6
2008 2009
16.8
2010
22.1
2011
Source: Armed Forces Surveillance Health Center: “Deployment-related conditions of special surveillance interest,” Medical Surveillance Monthly Report (MSMR). September 2012.
47%
313
Number of “major” lower-body amputations (i.e., loss of foot or more) among service members in 2011.
110
Number of bilateral lower-extremity amputations among service members in 2011.
70%
Percentage of amputations resulting from combat-specific occupations among service members in 2010 and 2011.
Percentage of major amputations in 2011 among service members in the Marine Corps (compared to 44% among service members in the Army).
248
5
Number of deployment-related amputations among service members in 2011.
Number of bilateral upper-extremity amputations among service members in 2010.
Sources: Armed Forces Surveillance Health Center: “Amputations of Upper and Lower Extremities, Active and Reserve Components, U.S. Armed Forces, 2000-2011,” Medical Surveillance Monthly Report (MSMR). June 2012. 6
O&P Almanac DECEMBER 2012
THE MOST CLINICALLY PROVEN OA BRACE WITH A NEW TWIST. The Unloader line of braces by Össur are clinically proven to reduce pain and improve function for patients who wear them. Recent clinical research* demonstrates that the Unloader One® provides decreased pain, improved function and reduction in pain medications for patients. * Briggs KK, Matheny LM, Steadman JR. Improvement in quality of life with use of an Unloader knee brace in active patients with OA: A prospective cohort study. J Knee Surg 2012; Advance online publication. Retrieved 23rd August 2012. DOI:10.1055/S-0032-1313748
SmartDosing™ now available. SmartDosing, powered by Boa® Technology, provides patients with a simplif ied, single-hand dosing dial for on-the-f ly adjustability of the dual Dynamic Force Straps (DFS), helping them better manage their unicompartmental OA knee pain.
Lightweight, low-profile and easy. Unloader One‘s lightweight, low-profile design is barely noticeable to the user and fits comfortably under clothing. And, by utilizing the new SmartDosing dial, users can easily adjust the dual DFS tension right through their clothes.
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IN THE NEWS
The Providence Veterans Affairs Medical Center (VAMC), Rhode Island, and Brown University, Providence, have announced the opening of a new research center, led by scientists jointly affiliated with Brown. The new Center of Excellence for Neurorestoration and Neurotechnology (CfNN) will develop and test technologies and therapies to help veterans with brain disorders, psychiatric conditions, and limb loss. The U.S. Department of Veterans Affairs (VA) Rehabilitation Research and Development Service funded CfNN with $4.5 million over five years. The CfNN involves more than 30 researchers overall. The CfNN is organized around two cores to support clinical trials and brain imaging, including Brown’s magnetic resonance imaging lab. It focuses on four areas of research: the BrainGate brain-computer interface (BCI) to help people with severe paralysis; advancing prostheses for individuals with upper-limb amputations; robotic- and computerassisted rehabilitation for patients with strokes, multiple sclerosis, and other disorders; and neuromodulation technologies, such as electrical and magnetic brain stimulation to
Photo: David Orenstein/Brown University
VA, Brown Dedicate Neurorestoration Center
A historic meeting: Two participants in the BrainGate research trials, Bob and Cathy (“T2” and “S3” in the literature), met for the first time at the dedication of the VA Center of Excellence for Neurorestoration and Neurotechnology.
treat chronic pain, depression, post-traumatic stress disorder, and other psychiatric disorders. All four research projects already are engaged in clinical trials where innovations are being tested and translated with real patients.
Amputee Coalition Guides Grey’s Anatomy Plotline The Amputee Coalition is working with ABC’s Grey’s Anatomy to provide insight into limb loss and the journey to recovery and readjustment. The producers of the television drama have written into its storyline the leg amputation of one of its main characters following an airplane crash—Dr. Arizona Robbins, played by actress Jessica Capshaw. “This is the first time on national television that viewers will be shown the arduous journey following amputation,” says Kendra Calhoun, president and CEO of the Amputee Coalition. “We applaud the producers of Grey’s Anatomy for raising awareness of limb loss by writing into its storyline the leg amputation of a main character, and for actively striving to ensure the portrayal is as realistic and authentic as possible.” According to Calhoun, the show’s producer contacted the Coalition this summer, asking for help in arranging what essentially amounted to an extended peer visit via phone with Capshaw. Since then, Capshaw has had regular conversations with Peggy Chenoweth, a transtibial amputee who is the Coalition’s social media coordinator, about what happens after limb loss and what to expect emotionally and physically. In addition, the show has interviewed Jeff Cain, MD, a past 8
O&P Almanac DECEMBER 2012
Coalition board member, who is a family practice physician and bilateral amputee. “More and more amputees are in the media, which is positive because it shows people living well with limb loss,” says Marshall J. Cohen, chairman of the board of directors for the Amputee Coalition. “The Coalition urges accurate portrayal of amputees in the media, and we are a strong advocate for amputees to play amputees in Hollywood and on Broadway. Of course, on Grey’s Anatomy Dr. Arizona Robbins is an established character and it would be unrealistic to expect the show to replace Jessica Capshaw with another actress who is an actual amputee.”
IN THE NEWS
PAD-Related Leg Amputations on the Decline The number of leg amputations among seniors with peripheral artery disease (PAD) has decreased over the past decade, according to a study published in the October 24 issue of the Journal of the American College of Cardiology. PAD causes blood vessels in the limbs to grow increasingly narrow due to cholesterol buildups. This reduces blood flow and may cause leg pain while walking, hard-to-heal ulcers, and eventually gangrene. Thousands of people with diseased blood vessels in their legs still lose a leg or part of one every year. According to W. Schuyler Jones, MD, lead author of the study and a cardiologist at Duke University Medical Center, treatments that allow patients to avoid amputation have improved significantly over the past 10 years, particularly procedures in which the buildups are broken up or removed. But until this research, it had not been clear if that development has been followed by a drop in amputations.
TRANSITIONS
To answer that question, the researchers tapped into data from Medicare. They identified nearly 3 million patients hospitalized for PAD between 2000 and 2008. More than 186,000 of the patients had a leg or part of it amputated. Most of the amputees were older than 75, and they were more likely to be black and have diabetes and kidney disease than were patients who kept their limbs. “There was a significant decline [in amputations] over time, so that is definitely encouraging,” says Jones, whose team is working to identify strategies to further drive down amputation rates.
people in the news
Steven Baxter, CO, has joined Hanger Clinic’s Houston, Texas, patient-care clinic.
Julie Hollimon, CP, has joined Hanger Clinic’s patient-care clinic in Overland Park, Kansas.
Rick Rentfrow, CPO, C.Ped, has joined Hanger Clinic’s Bowling Green, Kentucky, patient-care clinic.
Samuel Batista Jr., CPO, has joined Hanger Clinic’s patient-care clinic in Phoenix.
Megan Krause, CO, has joined Hanger Clinic’s patient-care clinic in Omaha.
Fillauer Companies has promoted Jack Richmond, CFO, to director of sales.
Dan Cox, an amputee athlete and golfer, has been elected to the OPAF Board of Directors.
Timothy Leist, CO, has joined Hanger Clinic’s Iowa City, Iowa, patient-care clinic.
Ted Rolling, CO, C.Ped, DAPWCA, has joined Innovative Prosthetics & Orthotics’ patient-care facility in Omaha.
Daniel Green, CP, BOCO, has joined Hanger Clinic’s Downey, California, patient-care clinic.
Karen Lundquist, director of communications for Ottobock, has been elected to the OPAF Board of Directors.
Pamela Hale, CPO, has joined Allard USA as director of clinical resources.
Tom Masters, CP, has joined Innovative Prosthetics & Orthotics’ patient-care facility in Omaha.
Teresa Hamm has been named director of marketing and education for American Orthopedics Manufacturing Corporation.
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O&P Almanac DECEMBER 2012
The Prosthetics Outreach Foundation has selected Marion McGowan as its new executive director.
Stan Sanderson, CPO, BOCO, LO, has joined Hanger Clinic’s Galveston, Texas, patient-care clinic. Tyler Seaver, CPO, has joined Hanger Clinic’s patient-care clinic in Zanesville, Ohio, as the clinic manager.
IN THE NEWS
White Paper Sets Standard for Limb Loss Prevention and Care The Limb Loss Task Force, which was convened by the Amputee Coalition, has issued a white paper called “Roadmap for Preventing Limb Loss in America: Recommendations From the 2012 Limb Loss Task Force.” The report sets a new standard for limb loss prevention and health care. The task force made two major recommendations in the report: The Amputee Coalition should partner with
TRANSITIONS
BUSINESSES in the news
Ekso Bionics, Berkeley, California, was named the World Technology Network’s 2012 Corporate Health & Medicine award winner. Ekso was honored at the World Technology Awards Gala and Ceremony in New York. Hanger has made Forbes’ 2012 list of “America’s Best Small Companies,” coming in at number 99. The company also was number 5 on Forbes’ list of “10 Hot Companies Hiring Like Crazy.” The magazine noted Hanger’s 46 percent increase in employees over the past three fiscal years. Hanger also announced it has completed the acquisition of 16 patientcare companies covering 15 states. The International Society for Prosthetics and Orthotics (ISPO) has announced the following individuals, named with the country/countries they represent, have been elected to its 2013–2015 executive board. Board members will take office immediately following the conclusion of the 14th ISPO World Congress in Hyderabad, India, which takes place Feb. 4–7, 2013. • President: Bengt Soderberg, Sweden/Thailand 12
O&P Almanac DECEMBER 2012
organizations to develop demonstration projects that seek to reduce the number of preventable amputations in the United States, and it should develop a media campaign to raise awareness about preventing amputations due to diabetesrelated complications and vascular disease.
• President-Elect: Rajiv Hanspal, United Kingdom • Immediate Past President: Jan Geertzen, Netherlands • Secretary: Friedbert Kohler, Australia • Treasurer: Nils-Odd Tonnevold, Norway • Member: Laura Burgess, United Kingdom • Member: Takaaki Chin, Japan • Member: Carson Harte, United Kingdom/South East Asia • Member: Rosie Jované C., Panama/ USA • Member: Harmen van der Linde, Netherlands • Member: Man-Sang Wong, China The National Commission on Orthotic and Prosthetic Education has announced the first centralized application service for O&P program applicants. The Pedorthic Footcare Association has announced the names of its 2012–2013 volunteer leadership team. Executive Committee • President: Jay Zaffater, C.Ped, BOCPed
• Vice President: Robert Sobel, C.Ped • Treasurer: Dean Mason, C.Ped, OST, BOCO, CO, BOCPed • Secretary: Christopher J. Costantini, C.Ped • Immediate Past President: Kristi Hayes, C.Ped Board of Directors, Class of 2013 (term ends November 2013) • Matthew Almeida, C.Ped, CPA • Tamara Daulton, C.Ped • Jeremy Long, C.Ped • Benjamin Nebroski, C.Ped • Stuart L. Pressman, C.Ped, CO Board of Directors, Class of 2014 (term ends November 2014) • Casper Ozinga, C.Ped, C.Ped (Au) • Althea Powell-Chandler, C.Ped • David M. Sparks, C.Ped Vendor/Manufacturer Member Liaison, Class of 2013 • Andrew B. Simonds Medical Advisor, Class of 2013 • James B. McGuire, DPM, C.Ped, PT
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Reimbursement Page By Joseph McTernan, AOPA government affairs department
RAC Audits and Appeals What to know for 2013
T
he Reimbursement Page article in the March 2010 issue of the O&P Almanac introduced a new player in the world of Medicare audits: Recovery Audit Contractors (RACs). The article provided an overview of RACs, including where they came from and what O&P providers could expect going forward. While it has been less than three years since the publication of that article, the impact of the RAC program has had a profound effect on the delivery of health care to Medicare beneficiaries. As millions of dollars in previously paid Medicare claims are being recouped through the efforts of the RACs, the time has come to take another look at the RAC program and its impact on the orthotics and prosthetics industry.
O&P and RACs The RAC program began in 2003 as a congressionally mandated demonstration project in five states (New York, Massachusetts, Florida, South Carolina, and California). As a result of the success of the demonstration project, which returned
14
O&P Almanac DECEMBER 2012
more than $900 million in recovered monies to the Medicare trust fund, the RAC program was established as a permanent national program in 2009. Since the expansion of the program, an estimated $2.5 billion in Medicare overpayments has been identified and recovered by the RACs. This is a staggering number that will continue to grow exponentially as the RACs focus and refine their efforts to identify potential Medicare overpayments. While orthotic and prosthetic services represent a miniscule portion (less than 1 percent) of annual Medicare expenditures, the RACs remain a very real and very dangerous threat to O&P companies. Several of the RACs have focused recovery efforts on O&P services since they represent a relatively high per service reimbursement rate. RACs are paid on a contingency basis, meaning they are paid a percentage of what they recover. Since O&P claims typically include codes with a relatively high reimbursement level, they represent “low-hanging fruit� to the RACs. As a business, the RACs are looking to recover the
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ABC is making all certification exams more readily available. Beginning January 2013 all Written and Written Simulation exams will be given every other month, and the Clinical Patient Management exams will be given three times a year. In addition, candidates for the Practitioner Certification exams will have 30 days after the application deadline to complete their residency requirements. For more information on exam dates and application deadlines go to abcop.org.
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Reimbursement Page
Documentation Is the Key The best way to position your appeal for success is to collect and record all of the necessary documentation to support your claim. This process begins with what you, as the O&P provider, can control: the documentation in your records. O&P practitioners are very good at documenting what they are providing, but the challenge lies in documenting why it is being provided. If you expect Medicare to pay your claim, you must document why a particular component or device is needed and how it is going to help the patient achieve a positive outcome.
highest amount of Medicare dollars at the lowest cost to the RAC, resulting in higher profit margins. At the end of the day, the RACs are for-profit businesses that are looking to keep revenue high and expenses low, resulting in higher profit margins.
The Numbers Tell the Story Recent statistics on the RAC program may prove useful in developing strategies to reduce the impact of RAC audits on your business. While there are no statistics available that are specific to O&P services, the general statistics provide valuable information that O&P companies can and should consider when dealing with RAC audits. In FY 2011, RACs identified a total of 903,372 Medicare overpayments. Of the claims identified as overpayments, a total of 56,620 were appealed. This represents an appeal rate of just over 6 percent, meaning that more than 93 percent of the identified overpayments were not appealed in any manner. What is even more telling is that of the claims that were appealed, 43 percent were eventually overturned in the provider’s favor. This represents an incredibly high success rate for providers who took the time to
16
O&P Almanac DECEMBER 2012
fight a RAC determination through the appeal process. At the end of the day, however, the Centers for Medicare and Medicaid Services (CMS) is able to accurately report that the percentage of claims identified by RACs as overpayments that are ultimately overturned on appeal is less than 3 percent, a number that supports the continued efforts by the RACs. While the statistics do not provide any O&P-specific information, there are separate statistics that discuss Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, also known as DMEPOS. These numbers closely mirror the overall statistics, with a total of 295,425 RAC-identified overpayments, of which only 9,056, or 3.1 percent, were appealed. Of the DMEPOS claims that were appealed, 3,930 were overturned, representing a success rate of 43 percent. The biggest lesson from these statistics is that there is value in pursuing the appeal process. CMS’s own statistics indicate there is almost a 50 percent chance of success when appealing a RAC overpayment decision. As the old adage states, “You have to play the game to win the game.” That being said, let’s discuss how to prepare for success when navigating an appeal.
CMS’s own statistics indicate there is almost a 50 percent chance of success when appealing a RAC overpayment decision. For example, Medicare’s Lower Limb Prosthesis Policy contains specific guidance regarding functionallevel assessment and coverage criteria for specific components. If you are providing a patient with K3 components, your records should contain specific documentation that discusses the patient’s ability to use the prosthesis at variable cadence, his or her ability to traverse most environmental barriers, and his or her need for vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion. These are the specific requirements in policy that must be met for Medicare to cover K3 components. Documenting this information in your own records will go a long way toward a successful appeal should the RACs seek to recover past Medicare payment.
n
Another important piece of the puzzle is a bit harder and often leads to frustration among O&P facilities: The collection of the documentation of others involved in the care of the patient can be difficult, and what the others provide may not be what Medicare or the RACs are looking for. Medicare expects that the documentation in the prescribing physician’s records will support the medical need for the device being prescribed. While you can never truly control how another health-care provider documents, you can try to educate the physician concerning what Medicare is looking for, and provide the resources to help the physician document in a way that supports your claim. This can be a very fine line to walk, as you want to educate but not offend. It’s a good idea to provide the referral source with a complete clinical assessment of your mutual patient’s orthotic and/or prosthetic needs; this may go a long way in getting the proper style of documentation from the physician’s records should your claim come under review. Also remember other health-care providers, such as physical and occupational therapists, may be involved in the care of the patient. Documentation in the files of these allied healthcare providers will prove useful to supporting your claim. They may be evaluating the patient using different methods and perspectives, and their observations often are just as valuable as those of the physician. In the current audit-heavy environment, there can never be too much documentation.
Persistence, Persistence, Persistence The single most positive piece of feedback AOPA has heard when talking to members about RAC audits is that persistence pays off. If you believe the RACs are unfairly recouping money for claims that were paid legitimately, you must be willing to fight for your reimbursement. AOPA is hearing that once appeals get onto the docket of an
Reimbursement Page
The Future of RAC Audits
The single most positive piece of feedback AOPA has heard when talking to members about RAC audits is that persistence pays off. administrative law judge, they usually are found in favor of the provider, and recoupments are being reversed. While this cannot be said for all claims that are denied by RACs, if your documentation is sound and you can provide reasonable arguments that you provided a clinically appropriate service in good faith, there is a good chance the judge will rule favorably regarding your appeal.
The RACs are here to stay. While the numbers are significantly skewed by the fact that most providers simply do not pursue their appeal rights, the bottom line remains that less than 3 percent of all RAC recoveries end up being overturned in the provider’s favor. This number alone represents a successful RAC program in the eyes of CMS. Through persistence and proper documentation, however, you can avoid being part of the 97 percent, and significantly reduce the financial impact the RACs will have on your bottom line. a Joe McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmternan@ AOPAnet.org.
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O&P Almanac DECEMBER 2012
COVER STORY By Adam Stone
Superstorm Sandy reminds facility owners the value of disaster planning
T
he events of October 29 serve as a stark reminder: Natural disasters can strike anywhere, anytime, and they can have a devastating impact on
individuals and businesses alike. Although the full cost of Superstorm Sandy’s damage to
the U.S. East Coast has yet to be determined, early estimates by IHS Global Insight point toward total economic losses of around $30-$50 billion, and $10-$30 billion for businesses alone. Even more telling, up to 40 percent of businesses affected by natural or human-caused catastrophes never reopen, according to the Federal Emergency Management Administration (FEMA). What’s the difference between those businesses that bounce right back from disaster and those that never open their doors again? The survivors typically have a detailed disaster plan in hand well in advance of any event. Yet an Ad Council survey found that nearly two thirds (62 percent) of businesses do not have an emergency plan. Is your facility one of them?
DECEMBER 2012 O&P Almanac
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Knowing the Basics First and foremost, disaster readiness means communicating with employees. That begins by knowing where they are and how they can be reached. “This is incredibly important, and it’s probably one of the first things nonclinical people think of,” says Julie Dooling, a health information management solutions director with the American Health Information Management Association.
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O&P Almanac DECEMBER 2012
A solid plan includes not only phone/cell numbers, but also friendand-family contact information, and even Facebook pages and Twitter handles. “If you want to find out whether your employees are safe, social media is something you can use if you can’t get hold of them any other way,” Dooling says. In the midst of chaos, employees will likely be hit on all sides by the need to secure the office, ensure their own personal safety, and attend to the needs of their own families. And business owners should be aware of their needs, advises Peter Lucash, a former medical practice administrator and author of Medical Practice Business Plan Workbook, Third Edition. “Do what you can to pay your staff, whether it is using a payroll service or going to the ATM before the ATMs run out,” says Lucash. “They are the ones who make your practice run. They enable your practice to earn an income. They know things you may not necessarily know, and you don’t want to lose all that once the storm has passed.” Once you have a plan to ensure the safety and wellbeing of staff, it’s time to address the bigger picture. “The question before you is: What would you do if you couldn’t operate in your location?” says Lucash. “What if you can’t get to your office? What if your office is gone? What if the office is there, but police barricades won’t let you get there?”
Such questions fall broadly under the heading of business continuity, and they lie at the heart of disaster planning. It’s not just a question of what to do with the computers when the water is rising (though that is critically important) but, rather, how will the practice continue when the lights come back on? “In principle, you want to protect your business so that you could pick up and function at another location,” says Lucash. “It may be a temporary matter, but what would happen if a piece of your practice was entirely destroyed or made unavailable for weeks?” O&P business owners obviously will be concerned with the status of their patient records. Experts suggest keeping a backup set of electronic files offsite, perhaps on the internet via a cloud vendor, and hiring local IT support to come in and physically remove servers, desktop machines, and electronic storage devices. A comprehensive disaster plan also should include assignments for employees to secure all files needed to keep the business running, such as patient registrations, scheduling, and billing. Dooling recommends storing nonessential paper documents offsite with a secure document management vendor. It helps, too, to forge early ties with local authorities such as FEMA and an emergency response team. Likewise, a practice may want to have connections to other practitioners and hospitals. It makes sense to have plans for mutual support in place, should patients be in need of care or attention.
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The final crucial element in a successful emergency plan is practice. “It is great to have all these plans, but if you don’t practice, it is not going to turn out the way you’d hoped,” Dooling says. “You have to drill, you have to practice, and you have to remember that a real event is going to be even more chaotic than what you’ve practiced.”
Learning the Hard Way When Superstorm Sandy tore through New York and New Jersey, Marc Klemmt, CPO, FAAOP, experienced a personal twinge of pain for his downstate neighbors. “We really feel for all those people with all their belongings on the curbs. It immediately reminds us of what we went through,” he says. In September 2011, Klemmt’s small O&P practice in Johnson City, New York, got swamped by Tropical Storm Lee. Established in 1965, the practice found itself under nine feet of water and sustained some $400,000 in damages, including the loss of a new server. Klemmt admits he had been complacent. The facility had suffered no damage in a 2006 flood, so he figured he was safe. He had only a bare-bones disaster plan in place when Lee hit: an evacuation plan in case of fire. It’s a mistake he won’t make again. Now, he has a detailed emergency procedure in hand—just in case. “Now all it has to do is rain, and we
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O&P Almanac DECEMBER 2012
are talking about it,” he says. “This is something you don’t forget.” The company’s disaster plan begins with a commitment to patients. They’re likely caught in the storm, too, and they’ll want to know where they stand in terms of upcoming appointments and the availability of their prostheses. So when word of a possible event comes in, staff immediately prints off a list of the next three days’ appointments, along with all contact information, to make cancellations, if necessary.
safety. While the move to digital records has lightened the load some, patient notes still need to be transported, as well as the digital recording equipment itself. For anything electronic that’s too big to move, staff pulls the plug before they shut the door. The plan also calls for immediately securing all insurance-related information—something Klemmt didn’t do prior to Lee. “The last time, I had no access to the building; it was all under water, including information on my insurance agent, my insurance
“It is great to have all these plans, but if you don’t practice, it is not going to turn out the way you’d hoped.” ––Julie Dooling
All employees also have assigned responsibilities in the office. First, each person is responsible for his or her own desk, packing up computers, supplies, and other vitals. Specific individuals are designated to inventory items that are in fabrication as well as those on the shelves. Klemmt may have it easier than some. He occupies the ground floor of a two-story building, and he owns the upper floor. That means his computers and critical materials only have to travel up a flight of stairs to reach presumed
documents, and the underwriter. Right now that is the first thing that we pick up when we leave,” he says. Klemmt also learned a bit about predatory practices, especially by cleanup crews whose services are in high demand in the wake of a storm. “They will take you for everything they can if you let them. Don’t tell them what your insurance level is because that is what they will bill you for. Get everything in writing,” he advises. “But until this happens to you, you don’t know that.”
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Lee taught Klemmt and his staff a lot about planning: what goes, what stays, and who does what. Perhaps the most significant lesson, however, tackles the fundamental disasterscenario question: When do you pack your bags and run? “You have to know when to initiate, and that’s a hard one,” he says. “That decision to disconnect everything, when it may be a false alarm—that’s a tough one. But I would say don’t take the chance. It’s not worth it. It’s better to lose a day or two and use it as a drill.”
Doing Your Homework Ted Drygas, CPO, FAAOP, wasn’t happy to see Superstorm Sandy barreling down on his town, but at least he felt ready, should the worst occur. Care Crafters Prosthetics & Orthotics Inc. is located in Nanuet, New York, a Manhattan suburb that sat square in the path of the storm. While Drygas was concerned, he believed he had laid out in advance
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O&P Almanac DECEMBER 2012
the groundwork that would help his practice ride out the storm. “We have an extensive plan in place,” he says. “Our computer files are our number one concern. The day before the hurricane, my computer guy did a secure close-down, physically shutting down the system, taking a backup off site,” Drygas explains. If flooding should become a significant threat, the server also would be removed from the premises. In case those backups became unavailable, office staff would take with them printouts of files on recent patients as well as information on all upcoming appointments. Procedurally, many of the actions that took place during the storm and preparation were laid out in the employee manual. For instance, it was understood that the office would close if a state of emergency were declared. The manual also details the specifics of a phone tree, laying out the order of contact among practitioner, office manager, and staff, along with contact information, including backup contacts such as friends and relatives,
should employees be displaced from their homes. Past flooding had taught the practice to keep all major parts and equipment a couple of inches off the ground. Because the practice sits on high ground, and has withstood many tests since its construction in 1975, Drygas deems this to be sufficient protection. It has taken a lot of time and effort over the years to put this plan in place. Insurance likely would cover any loss in the event of a disaster, but Drygas considers it worth the effort to make his emergency preparations. “Even if you are covered for it, you don’t want to go through all that. We would rather deal with it preventatively,” he says. In the end, Sandy was gentle with Care Crafters P&O. While towns along the coast got battered, the practice only lost power for a couple of hours. Reviewing his team’s actions as the storm rolled in, Drygas says that having a plan in place no doubt saved them a lot of grief. “I came back in, I turned the computer on, and we were able to come right back to work.” a Adam Stone is a contributing writer for O&P Almanac. Reach him at adam. stone@newsroom42.com.
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By Lia Dangelico
Striding Past
“Status Quo” Veteran and active-duty military amputees inspire innovation in patient care and prosthetic design
I
n the 11 years spanning wars in both Afghanistan and Iraq, more than 1,500 American combat soldiers have suffered major limb amputations, and almost 500 have experienced multiple amputations. Eighty-three percent of those individuals have lost one or both legs, according to a recent casualty report from the U.S. Army Surgeon General’s Office. With a steady influx of both active-duty military and veteran amputee patients, the prosthetic industry—from manufacturers and product researchers to prosthetists—has faced unprecedented challenges, as well as unique opportunities for innovation in patient care and prosthetic design.
Specialist Euard Lychik runs in the Austin Army Ten-Miler in 2012 28
O&P Almanac DECEMBER 2012
A Common Interest When they return home, these amputee soldiers receive treatment and rehabilitation at some of the best care centers in the world, including Walter Reed National Military Medical Center (WRNMMC) in Bethesda, Maryland. WRNMMC has a state-ofthe-art gait lab, a prosthetic physical therapy program, rehab physicians, and a couple hundred participants who are “not happy with just the status quo,” says Mike Corcoran, CP, who has worked with Össur on its Power Knee prosthesis and treats some of WRNMMC’s most complex cases, including hemipelvectomy and hip-disarticulation amputees. Some of these patients will evolve beyond just receiving care to partner with clinicians, manufacturers, and product developers to wear and test the latest prosthetic products and technology. “There is this acute need here at Walter Reed and the other military treatment facilities to try and bring some type of normalcy back to these patients’ lives,” says Corcoran, “and technology enables us to get there more quickly.” For example, powered
devices normalize a transfemoral amputee’s gait far quicker than assisted devices and reduce wear and tear on the remaining joints. So, initially fitting that patient with Össur’s Power Knee will get him or her up and walking with a reciprocal gait almost immediately. “We’ve put these guys through the gait lab, and their gait analysis is closer to a normal, intact individual than any other prosthetic device. So we see the benefits immediately,” says Corcoran. Peter Nohre, director of marketing, technical orthopedics and mobility solutions, for Ottobock, works with active-duty military amputees to develop and improve the products that will join the company’s offerings. Nohre, who has been working on the development of Ottobock’s X3 and Genium offerings since their inception, says sometimes collaboration is initiated just as much by the military as it is by companies looking Lychik with his prosthetist, Robert Kuenzi, MS, CP
“There is this acute need here at Walter Reed and the other military treatment facilities to try and bring some type of normalcy back to these patients’ lives and technology enables us to get there more quickly.” Power Knee
—Mike Corcoran, CP
to create new products. In the case of these products, “this was a need that the military had, and obviously it fit really well with our intentions to create that next generation of microprocessor knees. So it was combining our two projects into one.” Another appealing benefit for companies like Össur, iWalk, Ottobock, and others that conduct product research with military amputees is “access to a large number of patients, being able to try products on a number of them in a short period of time, and receive feedback almost immediately,” says Nohre. Unlike the civilian patients who frequently move, military patients often reside at the medical center or on base and remain in one place for a long time. “Companies have their ears open; they want to partner with us,” says Corcoran. Plus, he says, the opportunity gives patients hope, which also helps to mitigate the psychological and emotional effects of losing a limb or multiple limbs. “We can tell them ‘Look, you have an effect, an input on what the engineers develop, making these products—and lives—better.’”
DECEMBER 2012 O&P Almanac
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“It’s a progressive mindset of patients and clinicians to try anything for the sake of trying to get something that’s the best.”
—Peter Nohre
Vanguards of the Future Even after their service and sacrifices, these amputee patients are willing to bring their insight and feedback to the table when it comes to prosthetic advancements. “A large percentage of them have lost more than one limb. Some of them are double, triple, quadruple amputees,” says Corcoran, “so providing more efficient prosthetic knees, feet, hip joints, powered knees, and ankles—there’s a great need for that technology in this patient population.” As most were wounded in combat, these patients tend to be young, aged 19 to 40, but the average is mid-20s or younger. Most are in good physical shape, and they are not afraid to try new technology. “They’re soldiers, they’ve been shot at,” says Corcoran. Consequently, they don’t see falling on the ground while practicing with a device as dangerous, whereas an older diabetic amputee or a vehicular trauma patient might have some reservations. “So that attitude makes these guys the best candidates, not only to take chances, but to observe and give feedback.”
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O&P Almanac DECEMBER 2012
This patient population also is extremely motivated, which is a major benefit, says Nohre. “It’s a progressive mindset of patients and clinicians to try anything for the sake of trying to get something that’s the best.” That level of patient motivation often drives prosthetists to think outside the box when it comes to patient care. And that was the case when Robert Kuenzi, MS, CP, of the Center for the Intrepid in San Antonio, met U.S. Army Specialist Eduard Lychik, a hip disarticulation patient who was injured on duty in Afghanistan in the fall of 2011. From their first meeting, Lychik was emphatic that he wanted to run, despite the fact that there was little to no precedent for making a running prosthesis for a hip disarticulation patient. He began walking in December of 2011, and walked 300,000 steps in just six months. So Kuenzi began piecing together several different components—“I got more of a hinge hip joint and decided not to include an articulating knee,” he says. But after Lychik started running, he wanted to be able to run instead of skip as most amputee runners do, so Kuenzi took the hip joint out, too. Within the first two weeks of running, Lychik was able to run one mile stepover-step in just over nine minutes. Creating Lychik’s prosthesis has “really been an evolution,” says Kuenzi, who engineered the device based on Lychik’s feedback and Kuenzi’s own knowledge of prosthetic principles. He used plaster casting to create an intimate-fitting socket that enables Lychik to take a more natural step. “It’s not one of these low-profile or suction designs,” he says. Lychik has completed a Tough Mudder, an Army Ten-Miler in 1:38 without stopping, and most recently, the Rock and Roll San Antonio Half Marathon in 2:09. Next up, he has set his sights on another half-marathon in Hawaii—all less than a year from when he first began walking with a prosthesis.
“He pretty much forced me to do [the work] and I’m glad about that,” says Kuenzi.
The “Trickle Down” Effect Working with military amputees also comes with challenges, especially when the intent is application for the general population. These patients are prone to “pervasive damage to the body, and residual effects that affect fitting and quick, positive outcomes,” says Corcoran. “Sometimes the body doesn’t respond … and there is a plethora of other issues going on— family, relationship, confidence. There is a lot of coming to terms with limb loss and body image involved.” The young, fit, and active nature of the military population is not quite an accurate reflection of the overall amputee population at large, says Nohre. “Most civilian amputees are mobility grade 3, 2, or 1, while these military individuals are gait level 3 or 4. If a product is going to be used for the larger population as well, there’s still some consideration [as] to how to adjust to the lower activity levels of the majority.” As with any patient, military amputees also have certain expectations of their prosthetic devices. While the ability to walk and run is highly sought-after, they also are looking for durability and adaptability—“to be able to do one activity and then do another one without really having to think much or do anything differently than they normally would,” says Nohre. That feedback guided the development of Ottobock’s X3 and Genium products. Both products are the result of a seven-year development program from the Military Amputee Research Program, sponsored by the U.S. Army Medical Research and Materiel Command, to make a suitable prosthetic device for transfemoral military amputees who wish to remain on active duty. The “final deliverable” is now identified as the Genium—designed more for the civilian population—and the X3, which
Lychik carries the Wounded Warrior Project flag in a Tough Mudder competition
features a running mode for serious, long-distance running, and is fully waterproof and sealed. “It’s a big jump forward in order to take an electronic microprocessor-controlled device under water, a big hurdle to cross,” he says. It’s that level of adaptability—to easily transition from a run on the beach, to a swim in the ocean—that amputee patients requested from this project and ultimately received. But creating the right device and fitting these patients isn’t the end of care, says Corcoran: “They are going to be members of the community and prosthetics users for many years to come, so they can essentially be vanguards of the future. As the war winds down, this window of opportunity to really drive prosthetic technology is closing.” While the goal for these prosthetists, researchers, and manufacturers is to improve the quality of life for their military patients, their work also is intended to benefit the greater good. “These patients have sacrificed life and limb,” says Corcoran, “and that accentuates the need to bring prosthetic advancements, but it also trickles down to civilian amputees.” Although the majority of civilian amputees are not pursuing longdistance running or swimming, says Nohre, “it’s safe to assume that if it is bringing clinical benefit to the user—who is highly active—some of that is going to translate to virtually
every amputee, no matter what their mobility level.” Success becomes more about the degree to which the user will be able to use the device’s features. This also is why therapy becomes such an important aspect of the fitting process, so patients, both military and civilian, can be taught and practice how to use all of the different features. Taking a cue from military medical centers that have developed significant physical therapy protocol, several manufacturers have developed therapy protocols to accompany their more advanced products. The progression of care is another benefit to civilians. “We are able to fit civilian trauma patients more quickly
with better prostheses initially, like the Power Knee,” says Corcoran, “and that would never happen if we didn’t have the experience of fitting a brand-new amputee with a powered device.” It may happen with military patients first, but “the technology that’s developed from the military, and all the testing and projects from all sorts of companies, does go on to the civilian market as well,” says Nohre. “It spurs innovation and helps a broader group—it helps everyone.” a Lia Dangelico is a contributing writer to O&P Almanac. Reach her at ldangelico@strattonpublishing.com.
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Facility Spotlight
By Deborah Conn
Facility:
East Coast Orthotic & Prosthetic Corp. staff
East Coast Orthotic & Prosthetic Corp.
Location: Based in Deer Park, NY, with 4 main offices and 25 satellites located in New York and New Jersey
OwnerS: Vincent A. Benenati, CO, and Lawrence Benenati
HISTORY: 15 years in business
Vincent A. Benenati, Lawrence Benenati, CO, CEO president
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O&P Almanac DECEMBER 2012
Shining in the Spotlight Despite a large staff and recent media attention, East Coast Orthotic & Prosthetic Corp. maintains a patient-by-patient focus
F
rom its start in 1997 in a one-room office with four employees, East Coast Orthotic & Prosthetic Corp. has grown to be one of the largest privately owned O&P practices in New York State, with multiple locations and more than 100 employees. Founded by Vincent A. Benenati, CO, and his brother, Lawrence, the practice sees a wide range of patients, with satellite offices located everywhere from rural areas in western New York to inner city sites, pediatric hospitals, and trauma centers. The firm’s corporate headquarters in Deer Park, New York, are a 20,000-square-foot building including
a warehouse, patient area, and laboratory. Another lab is located at the Buffalo office, and East Coast O&P handles all fabrication in house. Orthotic work accounts for roughly two thirds of the company’s business, prosthetics about one third, as well as some durable medical equipment. “One thing that is unique about our organization is that we have accounts where we are on site 24 hours a day,” notes Vincent J. Benenati, East Coast’s human resources manager and the son of co-owner Vincent A. “Not just on call, but physically there, where we have someone fitting devices at 3 a.m. so that an in-patient can be taken care of or an out-patient can be released.”
n
CO and Prosthetist Glenn Barman
Deer Park Lab Supervisor Alex Ramirex
Facility Spotlight
Buffalo lab work
Chris Berger, CPO
He emphasizes the importance of the facility’s diverse, committed staff. “Many companies can provide quality devices, but it is our service and the people who provide the service that make us unique as an organization.” East Coast O&P found itself in the midst of an ongoing news story last year when it began to treat Shannon Smith, a young pregnant woman who developed septic shock and subsequently lost the baby and all four of her limbs. A Buffalo native, Smith became ill and was initially treated in Las Vegas, but after about a year she returned to Buffalo for rehabilitation at the Erie County Medical Center. East Coast O&P fitted her with lowerextremity prostheses and eventually upper-extremity devices. Smith’s ongoing progress received much media attention, and she recently appeared on The Doctors television show, as well as Inside Edition and several local news outlets. Dealing with that level of publicity was a new experience for Benenati. “We’d been in the news before,” he says. “The local station had done stories on our facility. But never to this extent.” Benenati wanted to avoid sensationalism, so he contracted with an outside public relations firm to handle media inquiries and opportunities. “We had
CPOs Andy Weingartner and Lou McCabe
so much press, but all the pieces were tastefully done,” he says. East Coast O&P’s business continues to grow. The media blitz generated a number of new patients, not only from neighboring areas, says Benenati, but throughout the country, and the facility recently signed a major contract with the city of New York and brought on 10 new hires. In addition to patient care, East Coast has expanded to technical innovation. The company has a biomedical engineer on staff and is working on two patents. The inspiration for one of them struck Benenati on a humanitarian trip to China. “I started thinking about a certain type of bracing, something that could be used all over the world,” he says. Benenati participates in one or two O&P missions each year, working through the Children of China Foundation, which brings a wide range of medical specialists to orphans in that country. Benenati enjoys the benefits of growth, including the ability to
Buffalo lab and practitioner staff
delegate certain areas of the business. “I can do some things a small company doesn’t have the resources to do,” he says. “We have two people in human resources, a controller. My vision is that as long as we can take care of patients, I want to be able to grow. But all our offices are local. We do it patient by patient, and the way to get tomorrow’s patient is to do a good job with today’s.” a Deborah Conn is a contributing writer to O&P Almanac. Reach her at debconn@ cox.net.
DECEMBER 2012 O&P Almanac
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n
Ask the Expert By Joseph McTernan, AOPA government affairs department
The Participation Puzzle Make sure all of the pieces fit before changing your Medicare participation status
As the end of the year approaches, it is time once again to decide your company’s Medicare participation status for 2013. This month’s Ask the Expert will address some of the frequent questions AOPA receives regarding Medicare participation.
Q:
If we are nonparticipating providers with Medicare and we are not accepting assignment on a claim, do we still have to obtain all of the required documentation before we can submit a claim for payment?
A:
Yes, you are still required to adhere to all Medicare policies and procedures, and this includes making sure you have the proper documentation to support medical necessity. The choice of being a participating or nonparticipating provider and accepting or not accepting assignment only relates to how you bill the patient and how much you may collect from the patient.
Q: A:
How do I change my participation status with Medicare?
The decision to be a participating or nonparticipating provider is an annual one. Once your election is made, it remains in effect for the full calendar year and can only be changed during the open enrollment period; any changes you make will not take effect until the start of the next calendar year. The Medicare open enrollment period is typically mid-November to the end of December. If you want to change your status from a participating provider to a nonparticipating provider, during the open enrollment period send a letter to the National Supplier Clearinghouse
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O&P Almanac DECEMBER 2012
(NSC) indicating that you no longer wish to be a participating provider. The letter must be sent before the end of the year (December 31) and must be signed by a recognized authorized official of your company. If you want to change your status from a nonparticipating provider to a participating provider, during the open enrollment period you must complete a Medicare participating provider agreement, CMS form 460, and submit it to the NSC before the end of the year (December 31). If you take no action, your current participation status will remain the same for the upcoming year.
Q:
Can some of our locations/ facilities be participating providers and some of our locations/facilities be nonparticipating providers?
A:
The answer will depend on how many Taxpayer Identification Numbers (TINs) you have. The decision to be a participating provider or nonparticipating provider is tied to the TIN of a company and not to its locations or facilities. So, if you have multiple locations under one TIN, you may not have some locations be participating and some locations be nonparticipating providers. However, facilities with different TINs can have different participation statuses.
n
Q: A:
If my company is a nonparticipating provider, are we still required to submit claims to Medicare?
Q: A:
What are the advantages of being a Medicare participating provider?
Yes. Whether you are participating or nonparticipating, you remain obligated to submit claims to Medicare on behalf of the beneficiary. If you are nonparticipating and chose to submit the claim on an unassigned basis, you may collect up to your full usual and customary charge from the patient at the time of delivery. If Medicare deems the claim to be medically necessary, it will reimburse the patient 80 percent of the Medicare allowable.
If you elect to be a Medicare participating provider, your information will be published in the Medicare participating provider directory. In addition, since you are agreeing in advance to Medicare participation, all of your claims will be submitted on an assigned basis, meaning Medicare will pay directly to you 80 percent of the Medicare allowable.
Q: A:
What are the disadvantages of being a participating provider?
Q: A:
Ask the Expert
Will Medicare pay less on claims that are submitted on a nonassigned basis?
No. The assignment decision only dictates who Medicare will pay. For nonassigned claims, 80 percent of the Medicare allowed amount is sent directly to the patient and you must separately negotiate payment terms with the patient. There is no reduction in Medicare reimbursement when a DMEPOS claim is submitted on an unassigned basis.
Q:
If I submit a claim on a nonassigned basis, and collect my full usual and customary charge from the patient, and Medicare denies the claim, am I required to refund the patient?
A:
Yes. The decision to accept assignment or not is a financial decision only and does not relieve you from liability should the claim be denied as not medically necessary. a
Joseph McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmternan@AOPAnet.org.
If you decide to be a Medicare participating provider, you agree in advance to accept assignment on all Medicare claims. This does not allow you to choose, on a claim-by-claim basis, whether or not to accept assignment.
DECEMBER 2012 O&P Almanac
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AOPA HEADLINES
AOPA WORKING FOR YOU
AOPA Annual Business Meeting Update 2013 Officers
New board, new bylaws, and new Survival Imperatives
Tom Kirk, PhD President
Anita Liberman-Lampear, MA, President Elect
D
Thomas V. DiBello, CO, FAAOP, Immediate Past President, speaks at the Past President’s Luncheon on Sept. 8, 2012.
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O&P Almanac DECEMBER 2012
Thomas V. DiBello, CO, FAAOP, Immediate Past President
Charles Dankmeyer, CPO Vice President
ecember 1 each year marks AOPA’s changing of the guard. On that date, the new officers and board members elected at that year’s Annual Business Meeting officially take office. This year’s changeover is especially significant as it reflects amendments to AOPA’s bylaws, which were approved during the National Assembly’s September 8 Annual Business Meeting in Boston. The changes ratified at this year’s Annual Business Meeting brought AOPA into the 21st century by authorizing electronic voting and refining the composition of the board of directors to more directly reflect the membership’s mix and needs. The governance changes provide for two supplier directors (instead of the current one), condense the number of designated directors based on the number of locations to three categories (rather than the current five), and reduce the number of at-large director seats from three to two. Additional expertise was added to the board by creating a clinical
Jim Weber, MBA Treasurer
director seat and a health-care director position, each serving a two-year term, who need not be members of AOPA. The health-care director may be a compensated seat, recognizing there may be competition to recruit the type of “world view” health-care expert sought for that position. The AOPA Board selects the health-care director under the new bylaws, but members continue to elect all other directors. After a transition period allowing for current board members’ expiring terms, the size of the board will remain at 14 beginning December 2014. Tom Kirk, PhD, was elevated to AOPA president, succeeding Thomas DiBello, CO, FAAOP, who becomes immediate past president and will serve one more year on the board after serving two one-year terms as president. The extraordinary circumstances that prompted DiBello’s two one-year terms rather than the traditional one term was triggered by the departure of the then president-elect from the O&P industry just weeks before the 2011
Kel Bergmann, CPO
Alfred E. Kritter Jr., CPO, FAAOP
Eileen Levis
Ronald Manganiello
Michael Oros, CPO
SPECIAL THANKS // RETIRING
CONTINUING
Mike Hamontree
AOPA HEADLINES
James Kaiser, CP, Immediate Russ Hornfisher, MBA, MSOD Past President
Mahesh Mansukhani, MBA
NEW
2013 AOPA Board MEMBERS
AOPA WORKING FOR YOU
Frank Vero, CPO
2013 Jeff Collins, CPA Supplier Director
Scott Schneider Supplier Director
Annual Business Meeting election. The continuity of leadership issue was resolved by Jim Kaiser, CP, and DiBello, then immediate past president and president, respectively, agreeing to serve one more year. Anita LibermanLampear, MA, becomes president-elect and Jim Weber, MBA, was elected to his second two-year term as treasurer. New faces on the board include Charles Dankmeyer, CPO, who was elected vice president and will be in line to succeed President-Elect Liberman-Lampear next year. Jeff Collins, CPA, and Scott Schneider were elected to fill the two supplier seats, and Dave McGill was named to the vacant at-large director seat. James Campbell, PhD, CO, is the new clinical director for a two-year term, and the health-care director seat is currently vacant although an effort is being made to recruit an appropriate candidate as soon as possible. Continuing their service on the AOPA Board are Mike Hamontree; Ronald Manganiello; Eileen Levis; Michael Oros, CPO; Kel Bergmann,
Dave McGill At-Large Director
James Campbell, PhD, CO Clinical At-Large Director
CPO; and Alfred E. Kritter Jr., CPO, FAAOP. Departures from the board in addition to Kaiser are Supplier Director Russ Hornfisher, MBA, MSOD; At-Large Director Mahesh Mansukhani, MBA; and Frank Vero, CPO, who served as a 1-3 facility director. The 2013 AOPA $5.6 million revenue budget was approved during the September 5 board meeting at the National Assembly. The approval came with a caution that the newly developed Survival Imperatives agenda may require further budget adjustments at the January 2013 board meeting to accommodate significant resource requirements. Survival Imperatives identified at the summer board meeting fall into four broad categories: outcomes, education, alliances, and risk. Outcomes include three significant areas, each involving substantial research dollars: a national patient registry that would be housed with a third party, a review and expansion of cost-effective and comparative-effectiveness studies,
and the development of standards and protocols. The education imperative primarily targets payers and how best to inform them of the efficacy of O&P care and share research from the outcomes imperative on cost and comparative effectiveness. Building relationships with other provider groups is a key factor of the alliances imperative to begin O&P participation in accountable care organizations, which will be a centerpiece of the Affordable Care Act’s (ACA) implementation. The risk imperative refers to examining the different payment methodologies under the ACA and helping bring about the option or options that best ensures members their ability to provide continued O&P quality patient care. Three separate planning and implementation sessions are scheduled for each of the four imperatives during the next few months, with a goal of trying to launch the major elements of each in 2013. a
DECEMBER 2012 O&P Almanac
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AOPA HEADLINES
Log On to AOPAversity Online Meeting Place for Free Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you. For a limited time, AOPA members can learn and earn for FREE at the new AOPAversity Online Meeting Place: www.AOPAnetonline.org/education. Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn CE credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis. AOPA also offers two sets of webcasts: Mastering Medicare and Practice Management.
Coding Questions Answered 24/7 AOPA members can take advantage of a “click-of-the-mouse” solution available at LCode-Search.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways––by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.
24/7 40
O&P Almanac DECEMBER 2012
• Mastering Medicare: Coding & Billing Basics: These courses are designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare. • Practice Management: Getting Started Series: These courses are designed for those establishing a new O&P practice. Register online by visiting http://bit.ly/AOPAwebcasts.
If You’re Paying More Than 1.9%, You’re Paying Too Much AOPA has partnered with Bank of America Merchant Services to offer credit card processing rates as low as 1.9 percent to AOPA members. Many members are paying more than 2.5 percent, and if you’re handling $500,000 a year in credit card transactions, the 0.6 percent savings is like getting a 200 percent return on your membership dues investment. To enroll, contact 888/317-5402 or email tellmemore@bankofamericamerchant.com. AOPA encourages members to request an audit of a recent processing statement to identify the savings they would enjoy.
Discover Employment Opportunities at AOPA’s Online Career Center As an O&P professional, you can make a difference every day. Job opportunities abound throughout the country, and the need for O&P professionals is increasing rapidly. Currently, 100 percent of O&P program graduates find employment, and most choose to make it a lifelong profession. If you’re seeking employment, access the most recent jobs available. If you’re recruiting, reach the most qualified candidates by posting your job on AOPA’s Online Career Center. Visit http://jobs.AOPAnet.org, or email Stephen Custer at scuster@ AOPAnet.org with questions.
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AOPA HEADLINES
Follow AOPA on Facebook and Twitter Follow AOPA on Facebook and Twitter to keep on top of latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities. Like us on Facebook at: www.facebook. com/AmericanOandP with your personal account and your organization’s account! Follow us on twitter: @americanoandp, and we’ll follow you, too! Contact Steffanie Housman at shousman@ AOPAnet.org or 571/431-0835 with social media and content questions.
Top 5 Reasons to Follow AOPA: • Be the first to find out about training opportunities, jobs, and news from the field. • Build relationships with others working in the O&P field. •
Stay in touch with the latest research, legislative issues, guides, blogs, and articles—all of the hot topics in the community.
• Hear from thought leaders and experts. • Take advantage of special social media follower discounts, perks, and giveaways.
Take This BOAT for a Ride
Create your own secure and confidential web pages on the BOAT—a tool specifically tailored to help O&P business owners manage their businesses for greater profit and quality patient care. By using this tool, you not only will examine the financial fitness of your business, you also will be pushed to identify and better understand your competition, market conditions, referral sources, and internal effectiveness. Use the BOAT to create budgets, track your finances, and participate in the annual Operating Performance and Compensation surveys. The new AOPA Patient Satisfaction Survey (required by certifying bodies) will be accessed through the BOAT site, which will be free to those firms using electronic data capture devices. All information is confidential and secure. Members can sign up for the BOAT website by going to www.AOPA-BOAT.com and clicking on the orange “Register for BOAT” button on the bottom right-hand section of the screen. The direct link for the registration page is www.iisecure.com/ BOAT/Register.asp. Once you have registered and logged in, visit the tutorial video on the landing page.
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O&P Almanac DECEMBER 2012
AOPA 2012 Operating Performance Report Available Now Are you curious about how your business compares to others? This updated survey will help you see the big picture. The Operating Performance Report provides a comprehensive financial profile of the O&P industry, including balance sheet, income statement, and payer information organized by total revenue size, community size, and profitability. The data was submitted by more than 130 patient-care companies, representing 1,050 full-time facilities and 68 part-time facilities. The report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2011 operations. Purchase the 2012 Operating Performance Report at the AOPA Bookstore, www.aopanetonline.org/store.
AOPA HEADLINES
2013 AOPA Audio Conferences Announced AOPA has confirmed the dates and topics for its 2013 series of audio conferences. Educate yourself and your staff during one-hour sessions in the comfort of your office on the second Wednesday of each month at 1 p.m. EDT. This series provides an outstanding opportunity for you and your staff to stay abreast of the latest hot topics in O&P, as well as gain clarification and ask questions.
Buy the Series and Get Two FREE!
www.savewithups.com/aopa
Visit the AOPA Bookstore, buy the series, and get two audio conferences free. AOPA members pay $990 to participate in all 12 sessions ($1,990 for nonmembers). If you purchase the entire year’s worth of conferences, all conferences from months prior to your purchase of the set will be sent to you as CDs. Seminars are priced at just $99 per line for members ($199 for nonmembers).
2013 Topics January 9:
Secrets to a Successful Audit
February 13: Understanding the LSO/TLSO Medicare Policy March 13:
Contracting With the VA: Hints for Landing the Contract
April 10:
Handling Adversity: Coping With Difficult Patients
May 8:
Navigate the Maze: Get to Know the Appeals Process
June 12:
Clinical Documentation: Dos & Don’ts
July 10:
Networking for the Future: Building Relationships With Referrals
August 14:
Don’t Get Stuck With the Bill: Medicare Inpatient Billing
September 11: Read Between the Lines: The Medicare Lower-Limb Prosthetic Policy October 9:
What’s the Word: A Health-Care Reform Update and What You Can Expect
November 13: Advocacy: A Potent Weapon for Change December 11: What’s on the Horizon: New Codes for 2014
UPS Savings Program AOPA Members now save up to 30% on UPS Next Day Air® & International shipping! Sign up today at www.savewithups.com/aopa! Take advantage of special savings on UPS shipping offered to you as an AOPA Member. Through our extensive network, UPS offers you access to solutions that help you meet the special shipping and handling needs, putting your products to market faster. AOPA members enjoy discounts for all shipping needs and a host of shipping technologies. Members save: • Up to 30% off UPS Next Day Air® • Up to 30% off International Export/Import • Up to 23% off UPS 2nd Day Air®
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DECEMBER 2012 O&P Almanac
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AOPA HEADLINES
Be part of the greatest clinical education event for O&P!
September 18-21, 2013
O r l a n d o, F lo r i da , U S A G ay l o r d Pa l m s r e so r t a n d Convention Center
Call for Papers Announcement
T
he American Orthotic and Prosthetic Association (AOPA) and its partners, The U.S. National Member Society of the International Society for Prosthetics and Orthotics (USISPO) and the German Association of Orthopaedic Technology/Con.fair.med, are pleased to announce this call for papers for the 2013 World Congress to be held Sept. 18-21, 2013, at the Gaylord Palms Resort in Orlando. The World Congress program committee has made a commitment to having a strong scientific program and is soliciting scientific and clinical case study abstracts for the congress. The committee invites you to submit an abstract to be considered for presentation at the congress. Strong scientific and clinical case study submissions are expected from the world over. The format of the conference will provide a substantial audience for novel research focused on orthotics and prosthetics. The committee anticipates more than 400 abstract submissions. The AOPA-hosted World Congress will bring together prosthetists, orthotists, physicians, scientists, researchers, engineers, programmers, clinicians, and other professionals. The organization also has made
a commitment to have extraordinary plenary sessions with invited speakers who are leading experts from the world over. This diverse community of professionals focusing on different aspects of orthotics and prosthetics will provide a unique and powerful environment to advance the field forward. Before submitting a paper, we ask that you review the model for the abstract format, which provides additional information about the submission process. The model abstract is available at http://bit.ly/V6amc9. Papers are being accepted for podium, poster, and symposium sessions. For more information or to submit a paper, use this convenient link: http://bit.ly/VdUjhY. For general information about the congress, we invite you to visit www.opworldcongressusa.org, email opworldcongress@AOPAnet.org, or contact Tina Moran at 571/431-0808. We look forward to seeing you in Orlando for the largest and most significant event for orthotics, prosthetics, and pedorthics in the Western Hemisphere.
Visit www.opworldcongressusa.org or email worldcongress@AOPAnet.org.
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O&P Almanac DECEMBER 2012
AOPA Applications
Welcome new members!
ADAPT Prosthetics & Orthotics LLC
Peeples Orthotics & Prosthetics
2204 Ironwood Place Coeur D’Alene, ID 83814 208/765-0597 Fax: 208/765-0598 Category: Patient-Care Facility Chris Moore, CPO, LP, LO
7570 W. 21st Street, Bldg. 1026-B Wichita, KS 67205 316/773-5511 Fax: 316/773-5587 Category: Affiliate Parent Company: Peeples Orthotics & Prosthetics LLC, Wichita, KS
Advanced Brace & Limb Inc. The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or 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: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million.
4140 Ferncreek Drive Fayetteville, NC 28314 910/483-5737 Fax: 910/483-2327 Category: Patient-Care Facility Rose Ward
Arnold O&P Lab Inc. 619 Jordan Street Shreveport, LA 71101 918/425-2400 Fax: 318/425-2405 Category: Affiliate Parent Company: Premier Hope Orthotics & Prosthetics Enterprises LLC, Monrose, LA
AtlanticProCare 1274 Congress Street Portland, ME 04102 207/774-1002 Category: Patient-Care Facility Cathy Le Shane
Chladek Orthotic & Prosthetic Associates Inc. 1300 Keo Way Des Moines, IA 50309 515/244-4040 Fax: 515/244-5455 Category: Patient-Care Facility Amber Chladek
Hawaiian Orthotics Prosthetics Enterprises (HOPE)
Membership in AOPA is one of the best investments that you can make in the future
Pioneer Valley Orthotics & Prosthetics Inc. 138 Doty Circle West Springfield, MA 01089 413/788-9655 Fax: 413/732-0828 Category: Patient-Care Facility Debbie Lamoureux
Premier Hope Orthotics & Prosthetics Enterprises LLC 1209 Royal Avenue Monroe, LA 71201 318/812-0119 Fax: 318/812-0136 Category: Patient-Care Facility Kim Lindsley
St. Croix Orthopaedics Center 1715 Tower Drive W., Ste. 100 Stillwater, MN 55082 651/275-4180 Fax: 651/430-8164 Category: Patient-Care Facility Julie Theobald
Texoma Orthotics & Prosthetics, PLLC/dba Texoma O&P 719 NW Heinzwood Circle Lawton, OK 73505 580/678-9458 Category: Patient-Care Facility Connie Chelenza, CO, LO a
P.O. Box 1156 Honoka’a, HI 96727 808/775-0814 Fax: 808/775-0645 Category: Patient-Care Facility Tina McGill
of your company.
DECEMBER 2012 O&P Almanac
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Marketplace
WillowWood’s New Sleeve for Elevated Vacuum
Friddle’s is now offering the FC2 Flexion Control Ankle Joint
Our new LimbLogic® Sleeve works with the LimbLogic controller to ensure an airtight, secure system. This fabric-covered silicone sleeve comes with a separate silicone cuff. The cuff is placed directly over the socket’s trim line for extra protection from wear and impact. The sleeve is then donned over the cuff. This clever, yet simple, design allows the cuff to be repositioned. Should a patient puncture their sleeve, they can immediately rotate the cuff and regain an airtight seal. Additionally, the fabric used on the Sleeve enhances knee flexibility for ease and comfort of movement. For more information, call 800/848-4930 or visit www. willowwoodco.com.
FC2 Flexion Control Ankle Joint features: • Patented, spherical-axis FC2 Ankle • FC2 provides up to 70 degrees of anterior-posterior range of motion using plantar-/ dorsiflexion-stop set screws • Unique design made of high-quality, heat-treated stainless steel • Allows for adjustments to be made while patient is wearing orthosis • FC2 precontoured design saves fabrication time while facilitating a low-profile finish • Availability of self-squaring molding dummy to reduce fabrication time. Contact Friddle’s today at 864/369-2328, fax 864/3691149, or visit www.friddles.com.
Total Knee® by Össur®. Totally versatile. With K2, K3, and K4 models to choose from, Total Knee enables a broad range of amputees to walk with a smooth, more natural, energy-efficient gait, enhancing their confidence and stability. Key features include geometric locking for stability, plus mid-swing shortening designed to prevent hip-hiking and reduce the chances of tripping. Each model fits a wide range of amputees and is lightweight and easy to cosmetically finish. To learn more about Total Knee by Össur, call 800/2336263 or visit www.ossur.com today.
Patented KISS® Superhero™ Reusable Test Socket Plate The unique design of this plate allows for easy casting tape removal, without damage. Damage-free casting tape removal allows this plate to be reused, saving costs. Visit www.kiss-suspension. com or call 410/663-KISS for more information.
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O&P Almanac DECEMBER 2012
Prepreg from Ottobock Give your patients the most advanced KAFO technology combined with the most advanced fabrication! Ottobock’s line of KAFOs is now available in prepreg, creating KAFOs up to 40 percent lighter than laminated alternatives. Prepreg also creates more consistent fabrication outcomes that avoid unwanted buildups. Ottobock Fabrication Services offers decades of expertise, exceptional customer service, and an unparalleled reputation for quality. Our expert services include water transfer, lamination, and prepreg carbon fiber. You can count on timely turnaround delivering the results you want. Visit www.ottobockus.com or call 800/795-8846.
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Marketplace
The NEW Triton Low Profile (LP) Foot from Ottobock
Becker Stride4 Stance Control Knee Joint from PEL Supply
We’ve added a new low-profile carbon fiber foot to the popular Triton family! Now patients with lower clearance (2.5 in) can take advantage of the same smooth rollover and robust function as the original Triton. The multiaxial Triton LP provides excellent dynamics and flexibility for above- or below-knee individuals. A titanium adapter makes the foot waterproof and especially robust (maximum weight 330 lbs, up to K4). With a split toe design for safety, stability, and control, the Triton LP is ideal for all your active patients. Contact your sales representative at 800/328-4058.
The new Stride4 Stance Control Knee Joint from Becker is the next generation of the Stride family. Comprised of a four-bar linkage mechanism, the Stride4 allows for better rotation and closer mimicking of anatomical knee motion. The Stride4 offers three specific modes of operation: stance control, free motion, and locked with stance phase flexion, allowing the practitioner to make easy adjustments while in each state. At the simple push of a button, the Stride4 allows the patient to easily switch between locked and stance control modes, which provide the joint with approximately 3 degrees of flexion and shock absorption, when the lock option is engaged. For more information on the Stride4 Stance Control Knee Joint or any of Becker’s other high-quality, stance control system components, call PEL Supply 800/321-1264, or email customerservice@pelsupply.com. Registered customers may order online at www.pelsupply.com. a
www.LCodeSearch.com
24/7 Expert Coding Advice 24/7
• The O&P coding expertise you’ve come to rely on is now available whenever you need it. • Match products to L codes and manufacturers—anywhere you connect to the Internet. • This exclusive service is available only for AOPA members.
Log on to LCodeSearch.com and start today. Not an AOPA member? GET CONNECTED
Contact Lauren Anderson at 571/431-0843 or landerson@AOPAnet.org. Visit AOPA at www.AOPAnet.org.
Manufacturers: Get your products in front of AOPA members! Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811.
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O&P Almanac DECEMBER 2012
JOBS
Find your region on the map to locate jobs in your area.
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color
$482 $678 $634 $830
Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to srybicki@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge.
Mid-Atlantic Prosthetics and Orthotics Faculty Position Pittsburgh Tenure-stream prosthetics and orthotics faculty position now open at the University of Pittsburgh. Qualifications: ABC certification and PhD related to orthotics and/or prosthetics. Minimum of three years of teaching, clinical, and/or research experience. Prior experience in teaching and/or research preferred. Evidence of and/or potential for productivity in scholarly activity, as shown through publications, research grants, and presentations. Responsibilities: Responsible for teaching, service, and research in MS in O&P program, including/not limited to program/curriculum development, evaluation, accreditation, clinical education, student recruitment, and developing/ expanding a research and development program. Participate in scholarly activity and secure independent research funding. Participate in professional service within the orthotics and prosthetics profession, service to RST, and university at large. Participate in teaching, and serve as a mentor to students. As part of the University of Pittsburgh, the School of Health and Rehabilitation Sciences is an affirmative action institution and welcomes applications from military veterans, people from unrepresented minorities, people with disabilities, and other categories of underrepresented persons. People from throughout the world are encouraged to apply. To apply, send curriculum vitae to:
Rory A. Cooper, PhD Chair, Department of Rehabilitation Science and Technology School of Health and Rehabilitation Sciences University of Pittsburgh 5044 Forbes Tower Sennott and Atwood Streets Pittsburgh, PA 15260
Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140
Increase exposure and save! Place your classified ad in the O&P Almanac and online on the O&P Job Board at jobs.AOPAnet.org and save 5 percent on your order. BONUS! Online listings highlighted in yellow in the O&P Almanac.
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O&P Almanac DECEMBER 2012
www.AOPAnet.org YOUR resource for the O&P Community
JOBS
North Central
Northeast
CPO/CP/CO
Certified Orthotist
Urbana, Illinois A well-established and reputable central Illinois O&P practice is seeking an energetic and motivated practitioner who demonstrates strong O&P clinical skills and experience to conduct comprehensive patient evaluations to determine orthotic and/or prosthetic needs, formulate and provide treatments, perform necessary protocols to deliver the best possible O&P services, and provide follow-up patient care. The ideal candidate has excellent communication, patientcare, and interpersonal skills and adheres to the ABC Canons of Ethical Conduct. We offer full-time employees benefits and a competitive salary commensurate with experience. Send resume to:
Vermont Yankee Medical, providing orthotic and prosthetic services for over 65 years, is looking for a certified orthotist ready to locate to Vermont. With five locations in some of the most scenic areas of the country, Yankee Medical offers a lifestyle that attracts professionals. Send your resume to:
Email: pandoresume@gmail.com
Attn: John Ficociello Yankee Medical 276 North Avenue Burlington, VT 05401 Email: jnf@yankeemedical.com
Pedorthic Business for Sale Beachwood, New Jersey Mom & Pop business for 21 years, providing diabetic shoes and orthopedic braces. Good highway location, great potential to grow and expand. Interested? Call:
Phone: 908/692-5310
“ Six doctors came walking in my room, surrounded my bed and they told me I would not get up again.” Tina Mann Tina Mann
Today Tina Mann walks, hikes, rock climbs, bikes and lives life fully thanks to Hanger Clinic. She was so inspired by her experience that she became an orthotic resident with us.
Clinic Manager
Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all are part of Hanger Clinic career offerings. • 1,000,000+ patients treated annually • 270,000+ orthotic and prosthetic products • 4,500+ employees Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state or local law. Residency Program Info, contact: Robert S Lin, MEd, CPO, FAAOP Director of Residency Training and Academic Programs, Hanger Clinic, Ph. 860.667.5304; Fax 860.666.5386.
View our current positions and apply online at: www.hanger.com/careers or scan the QR code.
150 YEARS
700 CLINICS
Available Positions:
Clinic Manager Waterville, ME Burnsville, MN Akron, OH Bartlesville, OK
Olympia, WA Seattle, WA Tacoma, WA
Orthotist Mesa, AZ Parker, CO Waterbury, CT Jacksonville, FL Tallahassee, FL Aurora, IL Springfield, IL Urbana, IL Methuen, MA
Portland, ME Columbia, MO Jackson, MS Lancaster, PA Philadelphia, PA Beaufort, SC Spartanburg, SC Waukesha, WI
Prosthetist / Orthotist Montrose, CO Buffalo, NY Kissimmee, FL Johnson City, NY Pensacola, FL Portland, OR Tamarac, FL Wilkes Barre, PA Lawrenceville, GA San Antonio, TX Des Moines, IA Longview, WA Springfield, IL Morgantown, WV Mayfield Heights, OH Prosthetist Los Angeles, CA Johnson City, NY
1 VISION
DECEMBER 2012 O&P Almanac
51
JOBS
Southeast CPO Rome, Georgia Walker O&P is a privately owned, 10-year-old practice in Rome, Georgia, located one hour northwest of Atlanta. We have an immediate opening for a CPO in our expanding facility. We are seeking a hard-working and self-motivated practitioner with good clinical and interpersonal skills. A minimum of three years of clinical experience is preferred. We offer a competitive salary and growth potential based on experience and benefits, including health insurance, vacation and personal time, and 401k. Forward your resume, in confidence, to:
CPO/CO/CFO/Technician—Multiple Positions Miami We are a growing company looking to add two to three positions to our office. We are a well-established, ABC-accredited facility in Miami, seeking self-motivated CPO/CO/CFO and/or technicians who have or are eligible for Florida licensure. This is a great opportunity to join a fast-growing, private company in an excellent location. Candidates must have excellent interpersonal and communication skills to provide optimal patient care. CPO position must be bilingual in English/Spanish. We offer a competitive compensation package based on experience. Email your confidential resume to:
Email: pandomiami@gmail.com
Director of Education and Technical Support
Walker Orthotics & Prosthetics 205 Redmond Road Rome, GA 30165 Phone: 706/232-4383 Fax: 706/232-4667 Email: lolowalker@att.net
CO/BOCO or CPO/BOCOP Jackson, Mississippi Methodist Orthotics and Prosthetics, a division of Methodist Rehabilitation Center, is looking for a certified orthotist or certified prosthetist-orthotist for our facility in Meridian, Mississippi. Located only minutes from the Alabama line, Meridian is a growing town with three major hospitals within a half-mile of our office. Meridian offers many outdoor activities and is only three hours from the Gulf Coast. The ideal candidate should be a self-starter with solid fabrication skills who wants professional growth with an exciting orthotics and prosthetics company. Clinical skills in office and hospital environments as well as the ability to function as a team player are vital. Methodist Rehabilitation Center is a progressive orthotics and prosthetics facility with five locations throughout Mississippi and Louisiana. Competitive salary and benefits including 403b retirement with employer matching, continuing education, paid vacation, and more. Please forward resumes in confidence to:
Chris Wallace, CPO, FAAOP Director, Department of Orthotics and Prosthetics 1 Layfair Drive, Suite 300 Jackson, MS 39232 Fax: 601/936-8896 Email: cwallace@mmrcrehab.org
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O&P Almanac DECEMBER 2012
Chattanooga, Tennessee Fillauer Companies Inc., with corporate offices in Chattanooga, Tennessee, is seeking a director of education and technical support. Fillauer is a worldwide leader in orthotics, prosthetics, and fabrication equipment. Candidate should be an ABC-certified CPO or CP with experience in formulating and teaching educational programs. Excellent company benefits. M/F/D/V Equal Opportunity Company Tennessee Drug-Free Workplace Send resume to:
Email: humanresources@fillauer.com
Certified Orthotist/Prosthetist Chattanooga, Tennessee Fillauer O&P, a Chattanooga, Tennessee-based patient-care facility, is seeking a certified or board-eligible CPO practitioner. We offer competitive salary, bonus opportunity, and a comprehensive benefit package. M/F/D/V Equal Opportunity Company Tennessee Drug-Free Workplace Send resume to:
Email: humanresources@fillauer.com
Inter-Mountain Certified Practitioners and Technicians 75 degrees and sunshine. We are looking for certified practitioners and technicians in our offices. Send resume to O&P Ad 1112 and we will call you to discuss this great opportunity in the Southwest.
O&P Ad 1112 C/O: O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899
JOBS
Pacific CO/CPO San Diego Do you want to work for an established, growing company in an environment that values clinical excellence and work/life balance? Do you want to live in one of the most desired and diverse areas in the country, beautiful Southern California? SCOPe has a career opportunity for you. We are a leading orthotics & prosthetics company looking for an energetic and motivated CO and/or CPO to provide comprehensive assessment, treatment, and follow-up for our patients. SCOPe offers competitive salaries as well as an excellent benefits package for full-time employees. Salary is commensurate with experience. Interested parties can send resumes via email to:
Certified Prosthetist-Orthotist, Certified Prosthetist, Certified Orthotist Orange, Riverside, and San Bernardino Counties, California A reputable, well-established, multi-office, Southern California O&P company is looking for energetic and motivated individuals who possess strong orthotic/ prosthetic clinical skills and experience to provide comprehensive patient assessments to determine orthotic/prosthetic needs, formulate and provide treatments, perform necessary protocols to ultimately deliver the best orthotic/prosthetic services, and provide follow-up patient care. Candidates must have excellent communication, patient-care, and interpersonal interaction skills, and always abide by the Canons of Ethical Conduct instilled by ABC. We offer competitive salaries and benefits to full-time employees. Salary is commensurate with experience. Send resume to:
Attention: Human Resources Inland Artificial Limb & Brace Inc. Fax: 951/734.1538 E-mail: ialb720@hotmail.com
Fax: 858/292-5496 Email: jobs@scop.net www.scop.net All communications will be held in the strictest confidence.
O&P Board Study Resources
Orthotic & Prosthetic Technician
We can help you PASS your BOARDS All products updated to 2012 test standards.
Sumner, Washington Independent Tech Service is an established O&P fabrication facility in Sumner, Washington. We are seeking a technician with a minimum of two years’ experience to be a part of our team. The technician will work with CAD, plastics, laminations, metal, and leather using the latest technology in both equipment and componentry. Competitive salary based on ability. Benefits package and paid vacation included. Email resume to:
Introducing our NEWEST Study Guide in PEDORTHICS Chad Eberhart, CPOA, CTPO Phone: 253/891-1976 Email: Chad@itsfabrication.com & Prosthetic
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DECEMBER 2012 O&P Almanac
53
CALENDAR
■■ YEAR-ROUND TESTING Multiple Choice Examinations. BOC has yearround testing for Multiple Choice Examinations; candidates can apply and test when ready. Orthotist and prosthetist candidates can take the Clinical Simulation Examination in February, May, August, and November. Applications are accepted any time, although seating is limited. For more information, visit www.bocusa.org or email cert@bocusa.org.
ON-SITE TRAINING Motion Control, Inc. On-site Training Course is focused on the expedited fitting of your first patient. Course Length: 3 days, CEUs: 19.5 hours (estimated). Recommended for prosthetists with a patient ready to be fit immediately. For more information, call 888/696-2767 or visit www. UtahArm.com. ■■
■■
2012 DECEMBER 4-6 WillowWood: OMEGA® Tracer® Training. Mt. Sterling, OH. This hands-on class covers both orthotic and prosthetic software tools, scanner applications and tasks, ‘by measurement’ shape creation, advanced tool usage, and creating custom liners. Attendees work with patient models. Must be current OMEGA Tracer facility to attend. Credits: 18.5 ABC/18.5 BOC. Visit www.willowwoodco.com. ■■
■■ DECEMBER 8 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 9–10 AM ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™)
PROMOTE Events in the O&P Almanac
CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Words Member Rate Nonmember Rate 25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$3.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email srybicki@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. For information on continuing education credits, contact the sponsor. Questions? Email scuster@AOPAnet.org. 54
O&P Almanac DECEMBER 2012
technology. Presenter: Keith Smith, CO, LO, FAAOP. Register at www. ultraflexsystems.com or call 800/220-6670. ■■ DECEMBER 12 AOPAversity Audio Conference–Are You Ready for the New Year? 2013 New Codes and Policies. For more information, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org.
■■ DECEMBER 12 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 5–6 PM ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length. Presenter: Keith Smith, CO, LO, FAAOP. Register at www. ultraflexsystems.com or call 800/220-6670. ■■ DECEMBER 20 Ultraflex: Adult UltraSafeStep® Continuing Education Course, via WebEx, 12–1 PM ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology. Presenter: Marc Kaufman, CPO. Register at www. ultraflexsystems.com or call 800/220-6670. ■■ DECEMBER 27 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, 12–1 PM ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function. Presenter: Jim Rogers, CPO, FAAOP. Register at www.ultraflexsystems.com or call 800/220-6670.
2013 ■■ JANUARY 10 WillowWood: LimbLogic® VS for Technicians via WebEx, 1:30 PM ET. Learn essentials of elevated vacuum socket fabrication using available socket adaptors with LimbLogic VS. Learn how to deal with airtight issues, unit operation, and diagnostics that will keep the system optimal for patient use. Credits: 2.5 ABC/2.5 BOC. Visit www.willowwoodco.com. ■■ FEBRUARY 20-23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org. ■■ FEBRUARY 28 WillowWood: LimbLogic® VS Applications Practitioners Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.0 ABC/7.0 BOC. Registration deadline is Feb. 8, 2013. Contact 877/665-5443 or visit www.willowwoodco.com. ■■ MARCH 1 WillowWood: LimbLogic® VS Applications Technicians Course. Mt. Sterling, OH. Learn all aspects of fabricating LimbLogic VS for various applications: socket materials, controller configurations and care, fob operation, troubleshooting. Fabricate sockets following recommended techniques for airtight socket designs. Credits: 9.75 ABC/9.75 BOC. Registration deadline is Feb. 8, 2013. Contact 877/665-5443 or visit www.willowwoodco.com.
CALENDAR
■■ MARCH 1-2 Oklahoma Association for O&P Annual Meeting. Tulsa, OK. Marriott Southern Hills. For more information, visit www.okaop.org, contact Jane Edwards at 888/388-5243 or email jledwards88@att.net. ■■ MARCH 15-16 PrimeFare West Regional Scientific Symposium 2013. New Location. Denver, CO. Denver Marriott City Center. Contact Jane Edwards at 888/388-5243 or visit www.primecareop.com. ■■ MARCH 21-23 2013 Annual Meeting of the International AfricanAmerican Prosthetic Orthotic Coalition. Atlanta. Georgia Tech Hotel and Conference Center. Contact Tony Thaxton Jr. at 404/8750066 or thaxton.jr@comcast. net. Visit www.iaapoc.org for more information.
2014
■■ APRIL 4-6 Rehabilitation Institute of Chicago: Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago. Featuring Elaine Owen. 21.25 ABC Credits. Contact Melissa Kolski at 312/238-7731 or visit www.ric.org/education. ■■ MAY 16-18 PA Chapter AAOP Spring Conference. Pittsburgh. Sheraton Station Square Hotel. Contact Beth Cornelius at 814/455-5383 or Joseph Carter Jr. at 814/455-5383. ■■ SEPTEMBER 18-21 O&P World Congress. Orlando. Gaylord Palms Resort and Convention Center. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org.
■■ FEBRUARY 26 - MARCH 1 40th Academy Annual Meeting & Scientific Symposium. Chicago. Hyatt Regency Chicago. For more information, contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.
SEPTEMBER 3-6 97th AOPA National Assembly. Las Vegas. Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@AOPAnet.org.
■■ OCTOBER 7-10 98th AOPA National Assembly. San Antonio. Henry B. Gonzales Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org.
2016
■■
2015 ■■ FEBRUARY 18-21 41st Academy Annual Meeting & Scientific Symposium. New Orleans. Hyatt Regency New Orleans. For more information, contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.
■■ MARCH 9-12 42nd Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. For more information, contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org. ■■ SEPTEMBER 15-18 99th AOPA National Assembly. Orlando. Gaylord Palms Resort and Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org. a
AD INDEX Company Allard USA Inc. ALPS American Board for Certification in Orthotics, Prosthetics & Pedorthics BOC International Cailor Fleming Insurance College Park Industries Inc. DAW Industries Dr. Comfort Friddle’s Orthopedic Appliances KISS Technologies LLC Motion Control OPTEC Orthotic and Prosthetic Study and Review Guide Össur® Americas Inc. Otto Bock HealthCare PEL Supply Provel Inc.
Page 23 1, C4
Phone 888/678-6548 800/574-5426
Website www.allardusa.com www.easyliner.com
15 27 9 25 49 5, C3 11 13, 47 41 18, 19, 32, 33
703/836-7114 877/776-2200 800/796-8495 800/728-7950 800/252-2828 800/556-5572 800/369-2328 410/663-5477 888/696-2767 888/982-8181
www.abcop.org www.bocinternational.org www.cailorfleming.com www.college-park.com www.daw-usa.com www.drcomfortdpm.com www.friddles.com www.kiss-suspension.com www.utaharm.com www.optecusa.com
53 7 C2 2 17
800/233-6263 800/328-4058 800/321-1264 509/857-2009
ww.oandpstudyguide.com www.ossur.com www.ottobockus.com www.pelsupply.com www.provel.us DECEMBER 2012 O&P Almanac
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AOPA Answers
To Gift or Not To Gift? Answers to your questions regarding holiday gift-giving
AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.
Q.
I want to thank some of my regular patients for their loyalty and support over the years. Can I send them a holiday gift to say “thank you”?
A.
The Office of Inspector General (OIG) published a Special Fraud Alert in August 2002 that addresses the practice of Medicare beneficiary inducement. In the alert, the OIG reiterated that the provision of any remuneration that the provider believes will encourage the beneficiary to choose them over another provider is illegal. “Remuneration” means “anything of value” and includes the waiver of copayments and/or deductibles, as well as the offering of anything for free or at a cost less than fair market value. There is a general exception to the rule that allows for gifts of minimal value, as long as they are offered without conditions. Minimal value is defined as noncash items of $10 or less per episode and $50 or less on an aggregate basis per Medicare beneficiary, per calendar year. In short, you may offer a Medicare beneficiary a small token of your appreciation for his or her business, but it cannot be cash, and cannot exceed a value of $10 per gift and $50 per year. Also, the gift must be given without any condition, especially one that involves requiring the patient to continue to choose you as his or her provider.
Q. A.
What about gifts to referral sources? Do the same rules apply?
The rules surrounding gifts to referral sources are even more stringent than those involving patients. Federal Anti-Kickback Regulations set severe penalties for individuals who, “knowingly and willfully offer, pay, solicit, or receive remuneration in order to induce business reimbursed under the Medicare or State health-care programs.” You must be very careful to avoid even the appearance of providing what could be classified as a kickback. To help understand what is acceptable and not acceptable,
56
O&P Almanac DECEMBER 2012
AOPA has created a Code of Interactions with Health-Care Professionals, which may be downloaded from the AOPA website at www.aopanet.org/AOPA_Code_of_Interactions_with_ Healthcare_Professionals.pdf. This document outlines when it is appropriate to provide anything of value, no matter how small, to a current or potential referral source. As a general rule, the only time you may provide a referral source with anything of value is when it is provided as part of a program that provides scientific or educational value. For example, you may provide an in-service to a physician’s office during the work day and provide the staff with a modest lunch. You may not, however, provide the staff with tickets to a sporting or other recreational event, even if you intend to discuss new products and technologies during the event. The key difference between the two scenarios described above is that the second scenario involves a recreational activity outside of the typical workplace environment.
Q.
If I am not allowed to provide gifts to my referral sources at the holidays, how can I thank them for their business throughout the previous year?
A.
Often, a simple “thank you” will do the trick. Let your referral sources know how much you appreciate their trust in your ability to provide excellent service to their patients. There is no prohibition on sending holiday cards to referral sources or even stopping by to personally thank them for their referrals. While everyone likes to receive gifts, especially during the holidays, a personal note or a brief visit often will go further than a tin of cookies or a fruit basket. The business of providing health care is one that often is centered on the value of personal and professional relationships. Taking the time to nurture and grow the relationship between your office and its referral sources may prove to be more valuable than a generic gift. a
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