Breaking News: AOPA Succeeds in Pushing Congress to Approve Funding for O&P Outcomes Research
OP
The American Orthotic & Prosthetic Association
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FEBRUARY 2014
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W W W. A O PA n e t. O R G
Center Stage in
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Paralympic hopefuls and their prosthetists prepare, dream big for the 2014 Winter Games
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O&P FEBRUARY 2014, VOLUME 63, No. 2
CONTENTS Cover Story
18 Center Stage in Sochi Photo: Daniel Gale/Adaptive Action Sports
By Christine Umbrell Amputee athletes from across the globe will meet in Sochi, Russia, next month to compete in the 2014 Winter Paralympics and showcase their abilities in several winter sports. Three of these elite athletes and their prosthetists recount their journeys, explaining the role of prosthetics in their achievements and sharing their expectations for the Games.
Feature
24 Getting Down to Business
By Lia Dangelico In this challenging O&P climate of increasing documentation demands and declining reimbursements, facility owners and managers must streamline procedures and find ways to cut costs in order to stay afloat. Several O&P facility owners and executives highlight their biggest business management challenges and share strategies to overcome these common struggles.
departments
4
AOPA Contact Page How to reach staff
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At a Glance Statistics and O&P data
45 Jobs
In the News Research, updates, and company announcements
46 Calendar
08 COLUMNS
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Reimbursement Page Date of service vs. date of delivery
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Facility Spotlight Anchor Orthotics & Prosthetics
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AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more
41 AOPA Membership 00 Applications
43 Marketplace
Products and services for O&P Opportunities for O&P professionals
Upcoming meetings and events
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Ad Index
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AOPA Answers Expert answers to your FAQs
On the Cover––Photo: USA Hockey/Steve DeMeo
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 Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.
FEBRUARY 2014 O&P Almanac
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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
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org
Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA
Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org
President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI
O&p Almanac 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 Bob Heiman, director of sales, 856/673-4000 bob.rhmedia@comcast.net Lia K. Dangelico, managing editor and contributing writer, 703/914-9200 x24, ldangelico@strattonpublishing.com Stephen Custer, production manager, 571/431-0810, scuster@AOPAnet.org Christine Umbrell, editorial/production associate and contributing writer, 703/914-9200 x33, cumbrell@strattonpublishing.com
Stephen Custer, communications manager, 571/431-0810, scuster@AOPAnet.org Lauren Anderson, manager of membership services, 571/431-0843, landerson@AOPAnet.org Betty Leppin, project manager, 571/431-0876, bleppin@AOPAnet.org AOPA Bookstore: 571/431-0865 Government affairs Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org
President-Elect Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD Vice President James Campbell, PhD, CO Becker Orthopedic Appliance Co., Troy, MI Immediate Past President Tom Kirk, PhD Member of Hanger Inc. Board, Austin, TX Treasurer James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA
Devon Bernard, assistant director of coding reimbursement, programming and education, 571/431-0854, dbernard@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com
Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Alfred E. Kritter Jr., CPO FAAOP, Hanger, Inc., Savannah, GA Eileen Levis Orthologix LLC, Trevose, PA Ronald Manganiello New England Orthotics & Prosthetics Systems LLC, Branford, CT Dave McGill Ă–ssur Americas, Foothill Ranch, CA Michael Oros, CPO Scheck and Siress O&P Inc., Oakbrook Terrace, IL Scott Schneider Ottobock, Minneapolis, MN Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA
O&P Almanac Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company
Copyright 2014 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 FEBRUARY 2014
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AT IN THE A GLANCE NEWS
Countdown to Sochi The 2014 Winter Paralympic Games will take place in Sochi, Russia, March 7-16. The Games will be televised around the world, showcasing the accomplishments of athletes who have disabilities.
Nearly 700 Paralympic Athletes Worldwide Are Expected To Compete, a New Record:
77 U.S. Athletes Are Expected To Compete in the 2014 Winter Paralympics:
Alpine Skiing
28 10
Snowboarding Biathlon & CrossCountry Skiing
Sled Hockey
17 17
Wheelchair Curling
5
Sochi 2014 692 (expected)
Vancouver 2010 502
Torino 2006 474
Salt Lake 2002 416
Nagano 1998 561
Lillehammer 1994 471
Source: www.teamusa.org.
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Number of countries expected to send athletes to the 2014 Sochi Winter Games.
72
Sets of medals to be awarded at the Sochi Games.
1976
More than 1,000 Number of torchbearers who will carry the Paralympic torch between February 26 and March 7.
Friday, March 14, 2014 Date that snowboard cross will make its Paralympic debut.
9
Year the first Paralympic Winter Games were held, in Ornskoldsvik, Sweden.
Days of competition in the Sochi Games.
Sources: www.sochi2014.com; Sochi 2014 Official Spectator Guide; www.paralympic.org/sochi-2014; www.teamusa.org/paralympicgames.
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O&P Almanac FEBRUARY 2014
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IN THE NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS
Congress Approves New Funding for O&P Outcomes Research The U.S. Senate has adopted the essence of S 521, a bill apportioning money for outcomes research in O&P— legislation that AOPA has been working hard to advocate this congressional session. AOPA and its lobbyist, Catriona Macdonald of Linchpin Associates, worked with Sen. Dick Durbin (D-Illinois) toward developing funding support for both S 521 and S 522, a bill appropriating money to support educational advances for new O&P master’s programs and increased funding for existing O&P programs. The Senate has accepted the proposal by Durbin in S 521 and has included in recent Defense Appropriations legislation a provision instructing the Department of Defense (DoD) to invest up to $10 million in the coming fiscal year, to support new outcomes research initiatives on O&P research topics. The bill was signed into law by President Obama on Jan. 17, 2014.
In January, both houses of Congress passed a bill that would continue funding through the Department of Veterans Affairs for training the U.S. Paralympic team. Rep. Mike Coffman (R-Colorado) introduced HR 1402, the VA Expiring Authorities Extension Act, which extends until 2018 the yearly $2 million appropriated to the VA to pay a monthly assistance allowance to disabled veterans training or competing for the Paralympic team. The bill also appropriates $8 million for grants to U.S. Paralympics Inc. The bill passed in the House in a 353-0 vote. One week later, the Senate passed the measure through a unanimous consent agreement. President Obama subsequently signed the bill into law.
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O&P Almanac FEBRUARY 2014
Students Build Low-Cost Prostheses for Amputees in Vietnam Mercer University biomedical engineering professor Ha Vo, MD, PhD, DPM, is leading a group of students at the Georgia college in an effort to produce low-cost prosthetic legs for amputees in Vietnam. Under Vo’s leadership over the past five years, Mercer students have successfully manufactured, fitted, and deployed more than 400 prosthetic legs to amputees in Vietnam. The prostheses were developed in a laboratory on their Macon, Georgia, campus. Vo and other faculty are working with contractors in Vietnam to manufacture the limbs there, with an ultimate goal of launching a permanent clinic in the country. The Mercer team has created an economical prosthesis that features three main components: a socket, a pylon to serve as the leg bone, and a foot. Adjustable straps and clamps around the back of the leg sockets allow amputees to adjust the size of the socket opening. The devices cost approximately $120 each to manufacture, mainly because the sockets are made of polypropylene plastic instead of carbon fiber. The university works with several partner organizations and the Can Tho Orthopedics and Rehabilitation Center to identify patients and obtain necessary legal and medical clearances from the Vietnamese government.
Photo: www.muprosthetics.com
Congress Extends VA Funding for Paralympic Training
In the meantime, Macdonald is in conversations with congressional offices, DoD officials, and others to suggest some of the key areas where these funds would be particularly useful, and to ensure that DoD officials implement these funds in a manner that is consistent with the intent of S 521 and Durbin’s statements introducing and describing this provision. At press time, Durbin had successfully included language in the Department of Veterans Affairs appropriations bill that would fund provisions of S 522, with Senate passage expected soon.
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START HERE at Hanger.com/RAC
IN THE NEWS
Ottobock Relocates North American Operations, Headquarters Ottobock is moving its North America operations from Minnesota to Salt Lake City, Utah, (fabrication and service) and Louisville, Kentucky, (warehouse and logistics), according to a January 23 statement from Karen Lundquist, director of communications, North America. The company also is planning to relocate its regional headquarters to Austin, Texas. “Our first priority is the well-being of our employees and plans are in place to help them through the disruption that inevitably occurs during any corporate move,” said Lundquist. “We are also committed to continuing to provide our customers with the high level of service they have come to know and depend upon.” According to the statement, Ottobock “sought locations that will help us to best serve our customers in the decades
TRANSITIONS
The Amputee Coalition has announced its 2014 officers and board of directors: Dennis Strickland, chairman; Marshall J. Cohen, immediate past chair; Dan Berschinski, chair-elect; Jeff Lutz, vice chair; Mahesh Mansukhani, secretary; and Leslie Pitt Schneider, treasurer. Each officer will serve for a one-year term. Continuing on the board are Ron Drach, Michael Estrada, Col. Gregory D. Gadson, Terrence P. Sheehan, MD, and Charlie Steele. The Board of Certification/ Accreditation has announced leadership changes to its board of directors. James L. Hewlett, BOCO, has assumed the role of chair. Hewlett is owner of Yuma Brace and Splint.
O&P Almanac FEBRUARY 2014
to come. Regional expertise and an environment where our employees and the organization could flourish were our top considerations, as is our continuing commitment to improving patient outcomes and supporting clinical excellence.” While the transition is ongoing, the company does not anticipate problems or delays for the O&P community. “Ottobock carefully designed our moves to occur in phases to minimize disruption for our customers and to smooth transitions for our employees,” said Lundquist. O&P Almanac will provide more information on this relocation as details become available.
BUSINESSES in the news
In response to Typhoon Haiyan in the Philippines, a branch of Ability Prosthetics & Orthotics in Frederick, Maryland, has teamed up with Physicians for Peace and collected about $750,000 in prosthetic limbs to donate to residents there.
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Downtown Austin, Texas.
Joining Hewlett on the board’s Executive Committee are R. Jeffrey Hedges, CDME, vice chair; William J. Powers, MBA, LFACHE, secretary; James Newberry Jr., BOCPO, BOCPD, treasurer; Mark L. Parris, PharmD, RPh, COF, member-at large; and John P. Kenney, MURP, BOCO, immediate past chair. New England Orthotic and Prosthetic Systems (NEOPS), headquartered in Branford, Connecticut, has secured funding to support NEOPS’ expansion throughout the Northeast. OPAF, the Orthotic & Prosthetic Activities Foundation, has announced the addition of two board members: Angela Courtade, CPO, LPO, an instructor at the J.E. Hanger College of Orthotics and Prosthetics at St. Petersburg College; and Reggie Showers, CEO of RS Group Motorsports in Philadelphia. OPAF officers for 2014 are Scott Williamson, president; James Young, CP, LP, FAAOP,
vice president; and Justina Shipley, CO, BOCPO, Med, FAAOP, treasurer. OPAF also announced it has been awarded a $4,000 grant from the U.S. Tennis Association Wheelchair Division for 2014. The Ottobock Michelangelo robotic prosthetic hand and the RSL Steeper bebionic3 myoelectric prosthetic hand received a British Healthcare Award in the Independent Living Design category. The awards were presented by the British Healthcare Trades Association. RH Media LLC has assumed advertising sales responsibilities for the O&P Almanac, published by AOPA. Bob Heiman, owner of RH Media, will be the key contact for further growing the magazine’s advertising reach and value to the O&P community. Tillges Certified Orthotic Prosthetic has announced the acquisition of Metropolitan Orthotic Laboratory in Minneapolis.
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IN THE NEWS
2014 Medicare DMEPOS Fee Schedule Released The CMS has released the 2014 Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule. The updated schedule will be implemented for claims with a date of service on or after Jan. 1, 2014. Existing Medicare fees for Healthcare Common Procedure Coding System (HCPCS) codes that describe orthotic and prosthetic devices have been increased by 1 percent, reflecting the 1.8 percent CPI-U annual update minus the annual productivity adjustment, which has been set at 0.08 percent for 2014. Of particular interest is the establishment of fee schedule amounts for the 23 new HCPCS codes created to describe off-the-shelf (OTS) orthoses, as well as the HCPCS codes whose descriptors were changed to indicate that they are either OTS or are required to be “trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise.” The fee schedule for these codes is the same regardless of whether they are classified as OTS or require specific fitting, and are consistent with the fee schedule amounts for 2013 subject to the 1 percent increase.
CMS Releases 2014 Medicare Premium and Deductible Amounts The CMS has released updated premium and deductible amounts for 2014. The 2014 Medicare Part B monthly premium is $104.90 per month, and the annual Medicare Part B deductible is $147. These amounts remain unchanged from 2013. AOPA members treating patients early in 2014 should ensure that patients have either met their 2014 deductible or understand that they must meet their deductible prior to Medicare paying for covered services.
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O&P Almanac FEBRUARY 2014
While the fee schedule is subject to change, the current fee schedule does not appear to include a reimbursement reduction for HCPCS codes that describe OTS orthoses. AOPA is monitoring this situation closely and will communicate any additional information as it becomes available. Contact AOPA’s Joe McTernan, jmcternan@aopanet.org, or Devon Bernard, dbernard@aopanet.org, with any questions. Visit www.cms.gov to access the 2014 Medicare DMEPOS Fee Schedule.
2014 ‘Amounts in Controversy’ Updated
PECOS Enforcement Now In Effect
CMS has published an update of the amount in controversy threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. Effective Jan. 1, 2014, the amount that must remain in controversy for ALJ requests is $140—there was no increase from 2013. The amount that must remain in controversy for judicial review appeals made on or after Jan. 1, 2014, is $1,430, up from $1,400 in 2013.
Claims with a date of service on or after Jan. 6, 2014, will be subject to edits that will ensure that the referring/ ordering physician has an active profile in the Provider Enrollment Chain Ownership System (PECOS). Claims where there is no PECOS record for the referring/ordering physician will be denied. The Affordable Care Act established the PECOS requirement for referring providers, but implementation has been delayed. Since 2009, claims that involved a non-PECOS enrolled physician have been processed with a warning message that the referring provider is not in PECOS. On or after Jan. 6, 2014, these claims will be denied.
IN THE NEWS
ACA Grace Period Could Be Problematic for O&P Under the Affordable Care Act, qualified health plans (QHPs) are prohibited from terminating coverage for enrollees receiving advance premium tax credits on the grounds of nonpayment of premiums during the grace period. Enrollees have a 90-day grace period after the initial nonpayment of the individual’s portion of the premium to pay past due premiums. After 90 days, the QHP is allowed to terminate coverage. That can be a problem for O&P and other providers. Providers may be told a patient is covered by the insurer prior to providing services, not realizing that the patient’s failure to pay the premium could leave providers holding the bag. QHPs must pay all appropriate claims for service rendered to the enrollee during the first month of the 90-day grace period, but the current Health and Human Services guidance only requires the QHP to notify providers of a lapsed enrollee after a provider has submitted a claim. QHPs may pend claims for services rendered to the enrollee in the second and third months of the grace period. For providers that accept patients and administer health-care services on the basis that the patient currently has QHP coverage at the time of service, this allowance for the “pending” of claims during the second and third months of the 90-day grace period presents serious concerns. A patient receiving advance payment tax credits with ongoing needs may be verified as appropriately insured when services are initially delivered, but if the patient fails to pay premiums during the grace period, the QHP may use its discretion as to when a “potentially affected” provider should be notified of a coverage lapse. The Medical Group Management Association asserts that a QHP should be required to provide an eligibility determination anytime a physician requests. But what about the rest of the provider world? Further complicating the situation is the widespread decision by many insurance companies to give consumers an extra 10 days to pay their first-month premium. With a coverage start date of January 1, a patient may be determined eligible for services delivered on January 5, but on January 11 that eligibility could end for patients not receiving advance premium tax credits. At this time, the best advice is “vigilance” and continued checking on any patient’s eligibility who is insured under a qualified health plan, according to AOPA experts.
TRANSITIONS
people
Hanger Inc. has announced that its board of directors has elected Christopher B. Begley, retired executive chairman of the board of directors and former chief executive officer of Hospira, to join the Hanger board as a director. Fred Lanier has been named sales manager for Comfort Products in Croydon, Pennsylvania. Jarryd Wallace was named the Para Male Athlete of the Year at the USA Track & Field annual meeting in Indianapolis.
IN MEMORIAM Grover Addison “Buddy” Jeffcoat III, CO Grover Addison Jeffcoat III, CO, passed away January 1, at the age of 61. Jeffcoat was owner of Savannah Orthotics and Prosthetics and founding president of the Georgia Society of Orthotics and Prosthetics. He was an active participant and supporter of the AOPA Policy Forum. Jeffcoat served in the Army at Walter Reed National Military Medical Center, Washington, D.C., during the Vietnam War. He received his formal education in orthotics at New York University and Northwestern University. His contributions to the O&P industry include helping to improve the national certification standards for orthotics and serving as an examiner for certification. Memorials may be made to the Georgia Amputee Golf Tournament, P.O. Box 343, Milledgeville, GA, 31601.
Richard Glabiszewski Richard Glabiszewski, known as “Glabi,” has passed away. Glabiszewski worked as department head and designer in the Otto Bock development group. One of the closest colleagues of Dr. Max Näder, Glabiszewski was actively involved in the development of contemporary prostheses throughout his career. His fundamental invention of the pyramid adapter, patented in 1969, was the key for modern modular lower-limb prosthetic systems. His development of the System Hand concept in the mid-1960s formed the basis for early Myobock myoelectric hands introduced in 1967. Glabiszewski also was instrumental in developing a complete, commercially available upper-extremity system including hooks, hands, wrists, and elbows for adults and children.
FEBRUARY 2014 O&P Almanac
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Reimbursement Page By Devon Bernard, AOPA government affairs department
Date Determinations How to understand and accommodate altered date of service
T
he requirement of a detailed written order and the requirement of a signed delivery slip are two core tenets of Medicare O&P billing that never change. However, other tenets—the date of service is always the date of delivery and the place of service is always home (POS 12)—while seemingly unchanging are not as set in stone as you may think. In this month’s Reimbursement Page, we will examine in detail three scenarios that alter your date of service—those times when the actual date of delivery will not be the same as the date of service.
The two-day rule states that you, as an O&P provider, may deliver an item to a Medicare beneficiary in a Part A hospital or skilled nursing facility stay within 48 hours of the patient’s anticipated discharge and bill Medicare instead of the facility where the item was delivered. 14
O&P Almanac FEBRUARY 2014
The Two-Day Rule The two-day rule states that you, as an O&P provider, may deliver an item to a Medicare beneficiary in a Part A hospital or skilled nursing facility (SNF) stay within 48 hours of the patient’s anticipated discharge and bill Medicare instead of the facility where the item was delivered. There are some criteria that must be met if you are to use and bill under the two-day rule. First, the item cannot be medically necessary during the remainder of the patient’s stay; in other words, the patient doesn’t need or doesn’t use the item during the last two days. If the patient uses the item for any reason, including physical therapy, during the last two days, then the first criterion has not been met. Second, the patient must be discharged to a location that qualifies as his or her home—the patient may not be discharged to a different hospital or SNF. Third, you must only be delivering the item in order to provide basic instruction on how to use and care for the device. The intent of the two-day rule is not to circumvent the responsibility of the hospital or SNF to provide its patients with medically necessary services. If an O&P device is needed as part of the patient’s recovery or rehabilitation in the facility, it must be paid for by the facility regardless of when it was delivered. O&P providers must be especially aware of this requirement as many inpatient facilities may utilize the two-day rule to avoid having to pay for medically necessary items provided to patients who are under their care.
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Reimbursement Page
If all of the criteria to bill under the two-day rule have been met, the date of service is the patient’s discharge date from the inpatient facility. Without this exception, the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) would improperly deny the claim as the responsibility of the inpatient facility. While the two-day rule allows you to use the date of discharge as your date of service, the actual date of delivery should be documented in the patient’s chart in case there are questions later on. It also is a wise idea to get verification in writing from the hospital or SNF of the patient’s anticipated discharge date—this will become handy, especially if the patient’s discharge date changes.
Refused Items/Services So what is a refused item, especially as it relates to Medicare billing? The simplest definition is that the patient just doesn’t want the item you are attempting to deliver and never comes back to your office to pick it up. An orthosis or prosthesis also may be considered “refused” if the patient no longer requires the item because the item is no longer medically necessary.
The change in medical necessity, or refusal, may be the result of a change in a patient’s condition. For example, you were going to provide a patient with a knee orthosis (KO), but before you were able to deliver the KO, the patient decided to have surgery. Since the patient chose a different means of treatment, the brace may no longer be needed, or medically necessary. The device has now just been refused. Similarly, if a patient dies before you are able to deliver the device, it is no longer medically necessary, and the device is refused. Once you are aware that a patient has refused a device, or the device is no longer medically necessary, ask yourself these three questions, which will help determine your course of action and also clarify if you have the right to bill Medicare: 1. Is the device you were to provide an off-the-shelf (OTS) item, or is it custom fabricated? If the item is an OTS product, you may not bill Medicare because you are able to return the item to stock and reuse it. 2. If you were providing a custom device, was the fabrication of the device completed, or were you still in the midst of fabrication? The answer
If a custom item is ordered while the patient is in a hospital and delivered to the patient in the SNF, the hospital will remain responsible for payment.
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O&P Almanac FEBRUARY 2014
to this question will determine how much you are able to bill. If you have completed fabrication, you may bill for the complete device—almost. You must first determine if any of the parts used in the fabrication may be salvaged and reused. This may be a rare situation, because most parts in a custom device are altered in a way that makes them only useful for one specific patient. However, if there are parts that can be salvaged and reused, you may not bill for those components. If you are providing a custom device and you have not finished fabrication when you learn of the refusal, you may only bill for the work that you have completed. You would submit your claim with an estimated cost of your services. Once again, you must subtract the cost of any parts that may be salvaged and reused. For prefabricated items, these devices may not necessarily be OTS items or custom items. You would follow the rules for a custom-fabricated device, only if you have altered components of the prefabricated device so that it can no longer be used for a different patient. If you did not alter the prefabricated device, treat it as an OTS item, return it to stock, and do not bill for the device. 3. When did you learn about the refusal? The date you learned about the refusal, or the date you learned the device was no longer medically necessary, will become your date of service when billing. If the patient has died, your date of service is the date of the patient’s death. If you use a date of service that is after the date of the patient’s death, your claim will be denied. If the patient truly refused the item and will not pick it up, your date of service would be the last day you attempted to make a delivery. There is no minimum or maximum number of attempts required to declare a device refused, but we recommend at least three attempts—and be sure to document all attempts. If the patient still refuses to pick up the item, you
n
may wish to notify him or her of your intent to bill for the item. It is not necessary, but you could use a certified letter to inform him or her of your intent to bill. A signed receipt of the letter can provide documentation confirming that you communicated about picking up the item in question and notified him or her that you are billing for the item. Once you have obtained the answers to the three questions above, submit your claim as if the item was not refused. There aren’t any special modifiers required to indicate the claim is being billed as a refused item, but you should note in your records that the device was refused and that is why you don’t have all the required documentation in your file (for example, delivery slip, detailed written order, etc.). It also is important to stress that you should not destroy an item if you are billing for it as a refused item. If the patient decides he or she wants the item, or it becomes medically necessary again, you must be able to provide the patient with the item since you have billed and collected payment for it.
Items Ordered Prior to SNF Stay There are times when an item is ordered when the patient is in a Part A hospital stay, but you are unable to deliver it until the patient is discharged to a Part A SNF stay; or when an item is ordered while the patient is at home, but is delivered while the patient is in a Part A SNF stay. In these scenarios, determining who is responsible for payment depends on when the medical necessity of the item is established. It is important to note that all of the following scenarios only apply to custom orthotic items and prosthetic items and do not apply to prefabricated items or diabetic shoes. The reason these scenarios only apply to custom items is because of the extra time required to fabricate and provide a custom item. For prefabricated items and diabetic shoes ordered in a
he e it t Vis websit S M C
hospital or at home and delivered to a patient in a Part A SNF stay, the normal billing procedures would apply. If a custom item is ordered while the patient is in a hospital and delivered to the patient in the SNF, the hospital will remain responsible for payment. When a patient requires an item and the item was ordered while the patient is at home, the medical need for the item has been established before the patient was admitted to the SNF. So, if
Reimbursement Page
the item was ordered while the patient was at home but it was delivered to the patient in SNF, you may bill Medicare. However, you must alter your date of service. If you use the date of delivery as your date of service, Medicare will deny the claim, stating that they are not the payer of record. Your date of service in this scenario would be the start date of the order or the date you began treating the patient. If you have questions about these scenarios or you are getting pushback from a hospital when you are seeking payment, you can review MLN Matters article SE0507 on the CMS website, www.cms.gov/Outreach-and-Education/ Outreach-and-Education.html. a
Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.
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COVER STORY By Christine Umbrell
Center Stage in
SOCHI
Photo: USA Hockey/Richard Lam
Paralympic hopefuls and their prosthetists share preparation plans, goals for the 2014 Winter Games
Captain of the U.S. Paralympic Sled Hockey Team, Andy Yohe.
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Photo: Steve DeMeo
here is perhaps no greater venue for amputee athletes to showcase their abilities than the Paralympic Games. The Sochi 2014 Paralympics will receive an unprecedented 50 hours of television coverage by NBC and NBCSN, beginning on March 7 with the Opening Ceremony and followed by daily coverage of all five Paralympic sports in the Sochi program, then the Closing Ceremony on March 16. The U.S. Olympic Committee will provide online coverage of the Games at www.TeamUSA.org. The stage is set for members of Team USA to compete on the highest level—to demonstrate their athletic abilities in the sports of alpine skiing, cross-country skiing, ice sledge hockey, wheelchair curling, and biathlon. As the athletes race the clock to complete their final training regimens and prepare for the long trip to Russia next month, O&P Almanac caught up with three U.S. Paralympic hopefuls and their prosthetists to find out what it took to get this far—and what they hope the future will bring.
—JARED Larson, CPO
The Full-Time Athlete: Keith Gabel When Keith Gabel, 29, arrives in Sochi, he will be representing the United States in a sport that makes its debut at the Games: para-snowboarding. Part of the alpine skiing competition, parasnowboarding challenges athletes to compete in a timed trial version of the snowboard-cross event. Each competitor will perform two or three timed runs, with only one rider on the course at a time. The course will feature banked turns, rollers, and jumps. Gabel’s love for snowboarding pre-dates his amputation. He adopted the sport as a teenager, when he first moved to Utah. Over the past 14 years, Gabel has never missed a season, although he did miss three months of “pre-season” in 2004—the three months after his foot was crushed beyond repair in an industrial accident. After undergoing multiple blood transfusions and surgeries, he lost his left leg below the knee. Defying medical professionals’ predictions that it could take several years to return to his favorite sport, Gabel was back on snow in three months. “I pretty much just strapped in and went. I had a lot of confidence in my recovery,” Gabel recalls.
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Jared Larson, CPO, has been Gabel’s prosthetist since his amputation. He recalls Gabel’s recovery: “It has been an evolutionary process. Initially, it was getting Keith back to recreational snowboarding. As he progressed to competitive snowboarding, the impact on his residual limb and the prosthetic componentry increased significantly,” says Larson, who works at Shields Orthotic Prosthetic Services Inc., in Salt Lake City, Utah. In the years immediately following his amputation, Gabel snowboarded as a hobby. But once he became educated about the World Cup Circuit, it took only two weeks for Gabel to obtain an expedited passport and arrive in France for his first competition. “I went to my first World Cup and took third,” he recalls. Since then, he has been a medalist in the World Cup six more times, and he earned a Gold medal at the 2012 Winter X Games. He is currently in a three-way tie for the number 1 ranking in the world. This past summer, Gabel made the U.S. National A Team and decided to train full-time. He relocated to Winter Park, Colorado, and has intensified his workouts. “If you want to be the best athlete in the world, you have to train like the best athlete in the world,” he says.
Over the years, Gabel has used different types of prostheses. “There have been times when Keith has had snowboard-specific prostheses, and times when the prosthesis has had to serve multiple purposes,” Larson explains. “When the prosthesis has to serve multiple purposes, then you have to find a balance of function and durability. At times, Keith has had to deal with a stiffer foot for walking in order to get the durability needed to withstand the forces of extreme snowboarding. When we have been able to make snowboard-specific prostheses, or have a dedicated snowboarding foot, then we can be more precise on foot stiffness and snowboarding-specific alignment. You still have to find the right stiffness for durability, but maintain the function. “The most important aspect of the prosthesis, though, is the fit of the socket,” adds Larson. “The socket has to distribute the forces over Keith’s residual limb well enough to keep him comfortable under repetitive, high-impact stresses. Keith needs the socket to transmit subtle inputs from his residual limb to the prosthetic foot and snowboard, so it isn’t a matter of simply putting on a thick gel liner and allowing it to absorb the forces. There has to be an intimate fit of his anatomy.”
Photo: Edwin Stee
“The most important aspect of the prosthesis... is the fit of the socket. The socket has to distribute the forces over [Keith Gabel’s] residual limb well enough to keep him comfortable under repetitive, high-impact stresses.”
Photo: Courtesy of Keith Gabel
Pictured here and below: Team USA Paralympic Snowboarding hopeful, Keith Gabel.
loftier goals for the inaugural parasnowboarding event. “Snowboarding was created in the United States; it’s a sport that’s from home. Team USA is a dominating force.” But ultimately, “I want to help the sport grow. I want to put on a good show. And I want it to help open doors so I can continue to give back. “At the end of the day, it’s not about the medal—it’s about progression, and reaching goals.”
The Veteran: Andy Yohe Andy Yohe, the 35-year-old captain of the U.S. Paralympic Sled Hockey Team, is looking to repeat. He brought home Gold as part of Team USA in Vancouver four years ago, and he expects no less in Sochi.
Photo: Edwin Stee
Gabel currently switches between two feet: a regular “walking foot” for everyday use, which he also uses for training at the gym, and a “snowboarding foot,” a low-profile action foot. This component attaches at the foot as well as at the socket, meaning “you can have as strong a pylon as you want,” Gabel says. This is critical given the cold temperatures and high-impact activities the prosthesis endures. “I use aircraft aluminum pylons, because carbon fiber can get brittle and break” in extreme conditions, he says. Gabel has been grateful for support from Ottobock, which has been a “valuable supporter” to him, and has helped supply some of his componentry. Gabel also appreciates the time Larson has dedicated to fitting him with the right devices. “Jared listens to me, and then thinks outside the box to fix me,” says Gabel. Larson believes that prosthetics have played a significant role in helping Keith achieve his goal of competing in the Paralympics. “At the highest level, a few tenths of a second can make a huge difference,” Larson explains. However, he emphasizes that it is Gabel’s drive and determination that have gotten him to an elite level. While Gabel hopes to return home with Paralympic Gold, he has even
Yohe, who lost both legs in a train mishap as a teenager—one above knee and the other below knee—plays defense on Team USA. But in life, he has learned to play offense—to do what it takes to achieve his goals despite his disability. After a rocky start at rehabilitation after his accident, Yohe switched to a new prosthetist, Ken Meier, CPO, FAAOP, and never looked back. Meier has treated Yohe since he was 17, eventually hiring him as a technician at his facility, Miller-Meier Limb and Brace in Bettendorf, Iowa. Yohe, who eventually earned a business degree, now serves as the facility’s office manager—his day job. Evenings and weekends, he trains for Sochi. Yohe’s progression to elite athlete was slow and steady. As a hobby, he played wheelchair basketball for several years, then switched to hockey—a sport he enjoyed as a child. After finding success on a recreational team, he tried out for and made the RIC Blackhawks Sled Hockey team. “I enjoyed the sport—how fast and hard-hitting it is,” Yohe recalls. He made the U.S. National Team for the 2004-2005 season; and was part of the 2006 U.S. Team in Torino, which took home Bronze; then was captain in 2010 for the successful Vancouver Games. After Vancouver, Yohe retired from sled hockey to spend more time with his family. But last year the lure of another Gold convinced him to rejoin Team USA. “If you ever get to compete in the Paralympic Games, it’s pretty
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Photo: USA Hockey/Richard Lam
Pictured right: Yohe on the ice.
addictive,” he explains. “Being in the Opening Ceremony of the Paralympic Games, and being part of Athlete Village” are experiences that beg to be repeated, Yohe says. In sled hockey, players use the same equipment as in “stand-up” hockey with the exception of skates; instead, they use a sled, which consists of a cushioned seat mounted on a tubular sled that has skate blades and a center pivot underneath. Two shortened hockey sticks are used to handle the puck as well as propel the player across the ice. Though Yohe doesn’t wear prostheses during competition, his artificial limbs are critical to his training. To prepare for Sochi, Yohe spends time on the ice at least three days a week, and trains off-ice the rest of the week: “I ride my hand-cycle, I lift weights, I use a skiing ergometer, and I go cross-country skiing for cardio and endurance training.” He wears prostheses for all of his workouts. Since Yohe spent 10 years as an O&P technician, he has “a pretty good idea of what I need, and I make my own adjustments.” But when he requires more comprehensive care, he relies on Meier to make his sockets.
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Part of Yohe’s path to becoming an elite athlete was believing in his own ability to ambulate and set high goals. As a prosthetist, says Meier, “I wouldn’t accept from Andy anything other than complete mobility and independence.” Over the years, Yohe progressed quickly, and became one of the first patients at his facility to be fit with a computer-controlled knee. “The things he gets that knee to do are amazing,” says Meier. “People don’t know he’s a bilateral amputee.”
Meier attributes a portion of Yohe’s success as an athlete to his prostheses: “Prosthetic devices give him the self-esteem and motivation to say, ‘I’m normal, I just play the game a little differently.’ It motivates him to achieve on very high levels. He’s an individual who stands out there and becomes the face of the sled hockey team. Prosthetics help him feel comfortable out in the public eye.”
“Prosthetic devices give [Andy Yohe] the self-esteem and motivation to say, ‘I’m normal, I just play the game a little differently.’ It motivates him to achieve on very high levels. He’s an individual who stands out there and becomes the face of the sled hockey team. Prosthetics help him feel comfortable out in the public eye.” —Ken Meier, CPO, FAAOP
The Advocate: Amy Purdy Amy Purdy’s participation in the Paralympics next month will be an accomplishment not just because she is one of the most accomplished female snowboarders, but also because she was a driving force behind adding para-snowboarding to the list of sports featured at the Games. More than a snowboarder, Purdy also describes herself as an actress, model, makeup artist, massage therapist, and businesswoman. But it is her efforts to elevate the sport of para-snowboarding that led to its inclusion in both the X Games and this year’s Paralympics. Though Purdy was given less than a 2 percent chance of living when she contracted bacterial meningitis at age 19, she eventually pulled through, though she lost both legs below the knee. An avid snowboarder before her illness, she was unsure if she would be able to return to the sport. But seven months later, she was back on her board, and has since earned several national titles and three World Cup medals. In 2005, Purdy and her boyfriend Daniel Gale co-founded Adaptive Action Sports, a California-based nonprofit organization. The organization develops adaptive snowboard- and skateboard-specific programs for youth, young adults, and wounded vets who have permanent disabilities.
Photo: Daniel Gale/Adaptive Action Sports
Team USA Paralympic Snowboarding hopeful and advocate, Amy Purdy.
“Prosthetists would like to say we help athletes [achieve their goals], but so many of them would find a way to do it themselves without us. We just give them a socket that won’t break down and components that will help them accomplish their goals.” —Stan Patterson, CP
Purdy’s ambition and competitiveness have been instrumental in bringing her to the precipice of stardom in Sochi, according to Stan Patterson, CP, Purdy’s prosthetist, and founder of Prosthetic & Orthotic Associates in Orlando, Florida. Patterson’s philosophy in treating Purdy and other elite athletes is to avoid putting all patients in the same box: “We try to optimize treatment for each individual,” he explains. “There are a lot of differences based upon each amputee’s residual limb.” Patterson uses a baseball analogy: “Just as each player chooses different bats and gloves based on their abilities and preferences, so too must amputees be fit with different devices.”
Because Purdy has long residual limbs and her tissue coverage is taut, she has more options than individuals with shorter residual limbs—but she is limited on the type of feet she can use since she needs to maintain a low center of gravity and flex in the toe during snowboarding, Patterson explains. Treating athletic patients drives prosthetists to be creative, Patterson adds. “Prosthetists would like to say we help athletes [achieve their goals], but so many of them would find a way to do it themselves without us,” says Patterson. “We just give them a socket that won’t break down and components that will help them accomplish their goals.” Patterson is a strong advocate of involving the patient in his or her treatment. “These athletes are very knowledgeable about their prostheses. We teach amputees what changes we are making with angles on prostheses and other tweaks. We want them to know and understand how their devices work.” As Sochi 2014 approaches, this spirit of cooperation is sure to shine through among the U.S. athletes who compete on an international stage, demonstrating their abilities for the whole world to see. a Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@strattonpublishing.com.
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By Lia Dangelico
Getting Down to Business As the industry transitions, O&P facilities must embrace efficiency to boost the bottom line
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K
athryn Davis, administrator at OPA 1 Ltd. in Bellaire, Texas, has seen the benefits of streamlining business management efforts firsthand. Working at a large, Texas-based O&P facility in the early 2000s, she recalls how the practice used a physical paper scheduling book, and members of the staff leafed through, page by page, whenever appointments needed to be found. “It would often be determined at date of delivery that an order had not been opened,” says Davis. “The administrative answer was invariably ‘I did not get the chart.’ Customer service failures were a normal course of business that really needed a solution.” Davis worked to build a strong administrative team with simple tools, starting with business management software that allowed for “visit types” and the option to auto-generate orders. “It began from there,” she says. “Organization. Automation. Assigning auto-generation of orders based on casting or evaluation appointments removed the need for the ‘chart’ to alert the administrative professional to the existence of an order to open. At the same time, our scheduling became automated.”
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Perhaps the scenario sounds familiar. Many O&P facility owners and practitioners have business savvy—but are not necessarily good business people, according to Jonathan Naft, CPO, LPO, founder of Geauga Rehabilitation Engineering Orthotics & Prosthetics based in Ohio. “We are good with O&P patients,
O&P technology, but when it comes to the big scope of things, like profit and loss statements and forecasting cash flow, our time has always been focused on the patients and the devices,” he says. In today’s O&P environment, with increasing demands for documentation and decreasing
reimbursements, facility owners and managers must reassess their procedures and implement cost-saving strategies in order to stay afloat. Here, O&P executives, clinicians, and administrators share their biggest, day-to-day business management challenges—as well as their solutions.
How Can Software Address These Challenges? O&P Almanac asked three popular business management software companies how they address some of O&P business owners’ biggest challenges. Here’s what they said:
How does your product help streamline documentation?
FUTURA www.futuraintl.com
MEDFLEX
www.medflex.com
Terry Long, Vice President, Futura: “Our new practitioner portal [available on mobile devices] is a huge part of helping secure proper documentation because it allows practitioners to be remote and have all of the documentation that they need available for each service… The portal also offers video capture capability, so if a practitioner is doing a clinical assessment with a patient, he or she can check off each item in that [subjective, objective, assessment, and plan] (SOAP) note in the iPad, and it will image drop that item right back to the patient’s account… We are seeing practitioners using the portal for clinical assessments, measurement forms for manufacturing, delivery receipts, acknowledgements, everything.” John Mason, President, Medflex: “MedFlex supports the creation of Work in Progress tracking templates, which can vary by both the insurance and by the device being created. These tracking templates define each step to be done, each required piece of documentation, and both tracks and assigns this work to appropriate parties. Jobs can be placed automatically in a hold state, preventing purchasing of material or beginning of fabrication until certain tasks or documentation are done or received. This whole process is managed on a unique tool we call the Whiteboard. The Whiteboard allows easy filtering of open jobs and updating of tasks and attachments of any electronic documents.”
Mark Ford, Director of Business Development, OPIE: “[Our software] creates processes that provide you with opportunities to document probably more than most clinicians have been documenting, but the result is that the OPIE Software auto-creates this SOAP note that you could send to any doctor, and they’re going to think, ‘This guy is a medical professional,’ based on the level of information that’s incorporated into that OPIE clinician’s notes. This improvement in a clinician’s documentation can help to make a huge change in the perception of how the medical profession sees orthotists and prosthetists.”
OPIE www.opiesoftware.com
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Editor’s Note: Brightree was contacted for this article but was unable to participate. O&P Almanac FEBRUARY 2014
Considering Cost One key area where facilities can streamline their efforts to save is in scheduling. After hearing a session on productivity at a recent AOPA annual conference, Naft reviewed his processes and found his facility was losing time and money by not scheduling the typical 8:30 a.m. to 5
p.m. day with a revenue-based model. For example, O&P practitioners have to be mobile, able to hop in the car and drive to the hospital or rehabilitation clinic to meet patients, so Naft’s facility schedules those out-of-office appointments at the end of the day to cut down on driving time during productive hours.
How does it help facilities stay on top of compliance?
In the same vein, facilities must prioritize financially viable appointments and cases. “In O&P, we have a hierarchy of patients and O&P devices,” says Naft, “and [as the business owner,] you should be prioritizing and creating a hierarchy with your schedule and patient management to be able to maximize your business
What sets it apart from the rest?
“[Futura] helps achieve compliance through the use of electronic records, as well as portable tools so that the practitioner can do his or her clinical assessments and appointments by way of hand-held devices. For example, if a practitioner is managing his appointment schedule local on his smartphone via Google calendar, that’s not compliant. And sending emails back and forth about patient information is not compliant, either. Futura’s practitioner portal helps keep facilities in compliance because nothing is stored on local devices, so practitioners can do documentation, collect digital signatures from the patient, manage their schedules, upload video and images, and more, no matter where they are.”
“Futura not only has a billing system in patient management but it also has a purchasing and inventory piece of the application that is used by some facilities and not by others… In addition to that, what we see more and more is integrating that purchasing side with the vendors to then have online ordering built into our application to the vendors… It’s a complete application; whether or not facilities choose to use all of the pieces is up to them, but it’s all there, all-in-one.”
“Typically, if an organization lets practitioners initiate billing, these go into MedFlex as an order subject to review. Properly trained and competent billing staff review the billing initiated by the practitioner and review the job before the job moves forward. This process is typically integrated in the Work in Progress and Whiteboard tools. Additionally, there are statistical reports that can be generated by inputters or office staff to study the combinations of base and add-on codes to make sure people are coding properly. Combinations that are repetitive that show up in these statistical reports can often be set up as ‘combination codes,’ where a single combination code populates the order with the appropriate parts and billing codes.”
“The three areas of difference between Medflex and our competitors are the philosophical, technical, and completeness levels. Philosophically, we encourage our clients to work with whomever they want in terms of distributors of O&P parts and electronic clearinghouses… At the technical level, in the actual database design, we use full 3rd Normal Form relational structures. We do not have flat file structure trip points that other systems have. This is a foundational difference that limits the types of reporting that can be done as well as flexibility and accuracy in implementing the patient’s electronic record… At the completeness level, MedFlex has always been fully integrated in a single system for all aspects the business owner must deal with.”
“Medicare, individual payers, and state Medicare systems are constantly making updates and changes that affect compliance, and OPIE is constantly keeping up with those changes being forced on the O&P profession. Our Support and Training Teams are continually monitoring what they hear from our clients and the payers to understand what changes have been made to the compliance rules. This information is then passed on to our Development Team so that they can make changes to the software to help manage those differences in compliance requirements. For example, we have had a system that allows facilities to track Provider Enrollment, Chain and Ownership System (PECOS) enrollment in place for several years. [After CMS announced big changes in fall of 2013], we further enhanced the OPIE Software so that users are automatically notified whenever they try to use a physician who isn’t PECOS enrolled. We also recently worked cooperatively with Quality Outcomes to create a new Policies and Procedures Manual that is expressly designed for OPIE practices. This unique effort was a further step to provide OPIE practices with a customized tool to help with the compliance issues related to accreditation of an O&P practice.”
“OPIE is about creating a workflow process that standardizes the daily routines within all of the functional areas of an O&P practice—so every step from when the patient first calls to when the practice gets paid and the money is in the bank, is all processed and tracked through the OPIE system. By providing a single, comprehensive software that addresses every part of a clinical operation, an O&P independent practice owner has an easy-to-use system that incorporates all of the tools that they need to run a successful, efficient organization. When the OPIE system is being utilized fully, practice owners and managers can understand where every patient is throughout the patient-care process and can be certain that things don’t fall through the cracks.”
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sense.” Another example: Typically, prosthetics are high-dollar items; orthotics are medium-dollar; and pedorthics are low-dollar. So it’s important to find a balance at your facility that best serves the bottom line and your patients’ needs—such as allocating 60 percent of a clinician’s time to prosthetics, 30 percent to orthotics, and 10 percent to pedorthics. That way, something like an annual check-up that is low in need and cost can be scheduled around higher-value and higher-need appointments that stand to balance your facility’s revenue stream. These cost-conscious decisions also play out in the realm of purchasing. First, clinicians assess a patient on the clinical level to determine the most appropriate device or component, and then they must find the most costeffective offering for that device, says Michael Oros, CPO, LPO, FAAOP, president of Scheck and Siress based in Illinois. It can be very challenging to align the best clinical fit with what’s
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most cost-effective for practice and patient, agrees Naft. Naft looks forward to software developments down the road that will audit the purchasing process, allowing clinicians to view all of the available products side-by-side to choose the most cost-effective option. “While the clinical element is subjective—you and I might never agree on [the right device],” he says, “the pricing, fee structures, and insurance company contracts—those are all uniform.”
Driving Outcomes with Documentation Maintaining accurate and comprehensive clinical documentation is another big struggle for O&P practitioners at a time when increasingly more documentation is required with less reimbursement than ever before, says Oros. Of course, documenting patient outcomes more clearly could lead to better reimbursement, but it also can help quantify outcomes for the future. The challenge is determining what kind of outcomes matter to insurance companies, says Oros, noting an absence of direction from the federal government and insurance companies themselves on exactly what and how to document these elements. This lack of direction is forcing the industry’s hand, so to speak, he says. The industry needs to step up and say, “Here’s what we, as practitioners, can deliver.” What will help this process is standardizing clinical documentation, and several of the business management software products on the market can deliver on that front. These tools generate data that can be assessed and tracked over long periods of time, and in some cases, create medically validated clinical notes. Everyone in the industry is looking for the magic process for increasing efficiency in clinical documentation, adds Davis, but few things can replace “the need to know how to document with a focus on compliancy adherence.”
Compliance Concerns In O&P, the challenge with compliance is that there’s a very large difference between what practitioners think is covered and submit in their documentation for coverage, versus what is required documentation from an insurance company, according to Naft. In an effort to standardize their documentation, many O&P clinicians use templates to document all of the elements that Medicare requires, but it can be a challenge to customize them according to each patient’s care. According to Naft, Medicare has taken the position that it does not like templates, suggesting that each encounter should be a unique, documentary response. Naft’s facility established a happy medium, purchasing voice recognition software so clinicians can record their detailed notes easily while using an internal template as a guide. Many facilities also use AOPA’s www.L-CodeSearch.com resource, which provides a sort-able list of the majority of available O&P products on the market and gives their appropriate L-code. Free to all AOPA members, the tool defaults to Pricing, Data, Coding, and Analysis (PDAC), and AOPA Coding and Reimbursement second, so users can be confident they are getting the most up-to-date information. Additionally, warns Naft, practitioners should be accessing the Medicare and PDAC websites directly to look up products and stay on top of current policies. Another valuable AOPA resource is Coding Pro, a Windows-based resource that provides a sample illustration for each of the L-codes, along with up-to-date fee schedule information and relevant excerpts from current medical policy. Coding Pro also contains a prescription generation feature that allows users to select specific L-codes and incorporate them into a Medicare-compliant prescription that may be presented to the referring physician for signature and date.
Beyond that, one of the biggest keys to compliance is educating staff, offering the necessary guidance and training, says Davis. “No [tool or software] program is going to do the thinking for you and isolate every possibility… Compliance is only assured when research is performed prior to action, and customized for the patient.”
Industry in Transition O&P is facing an unprecedented period of change—what some see as growing pains as the industry transitions from being a trade group to a medically relevant clinical profession. “Medicare and CMS see us as suppliers,” says Oros. “We do provide devices as our modality, but that’s only part of our practice. We need recognition for the clinical aspects of our work, in addition to device fabrication.” As an ideal to strive toward, Oros points to the dental and chiropractic
space, where established practice models drive standardization and efficiency. O&P is getting there, especially with the recent introduction of master’s level education offerings, but it’s not there yet. Adopting practice models will deliver more consistent outcomes and help boost the bottom line for O&P facilities across the country. “It makes sense, from a business
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perspective, to create different tiers of providers [within the O&P practice model],” says Oros, “with clinicians providing initial patient assessment and high-level care, and para-professionals taking care of other necessary tasks.” a Lia Dangelico is a contributing writer to O&P Almanac. Reach her at ldangelico@strattonpublishing.com.
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The Ferrier Coupler provides you with options never before possible:
Enables a complete disconnect immediately below the socket in seconds without the removal of garments. Can be used where only the upper (above the Coupler) or lower (below the Coupler) portion of limb needs to be changed. Also allows for temporary limb replacement. All aluminum couplers are hard coated for enhanced durability. All models are interchangeable.
Model A5
Model F5
Model P5
The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.
The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component. The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.
Model FA5
Model FF5
Model FP5
NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern. Female portion of coupler accepts a pyramid.
Model T5
NEW! The FF5 has a female pyramid receiver on both male and female portions of the coupler for easy connection to male pyramids.
NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.
The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb. The unit is waterproof and has a traction base pad.
FEBRUARY 2014 O&P Almanac
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Facility Spotlight By Deborah Conn
The Anchor Orthotics & Prosthetics team.
Closing the Gap A California-based facility takes pride in its broad patient demographic— from amputees to family pets Owner Terry McDonald, CO.
Facility: Anchor Orthotics & Prosthetics Location: Sacramento, California, with satellite office in Auburn, California Owner: Terry McDonald, CO History: 9 years in business 30
O&P Almanac FEBRUARY 2014
N
ine years ago, certified orthotist Terry McDonald launched Anchor Orthotics & Prosthetics. Today, the practice has four practitioners, two fitters, a certified technician, and three administrative employees operating out of its main office in Sacramento, California, and a part-time satellite office in Auburn, California. The facility serves a broad demographic, with about 60 percent of its work in prosthetics and 40 percent in orthotics. It has its own lab that handles most fabrication. McDonald is proud of his practice’s commitment to customer service. “We work really hard to close the gap as
patients move through the health-care system,” he says. Anchor practitioners who first encounter patients in a hospital trauma unit will follow them to a step-down unit, skilled nursing facility, or rehabilitation center, and then continue care after they go home. “This has been a challenge,” says McDonald. “When patients come out of the acute phase and need adjustments, they may move to different providers. We try to follow them, to make ourselves available to them and their physicians to ensure flow and coordination of care.” Another point of pride for McDonald is offering coaching services to prosthetic patients. Anchor’s
Matt Ditritch, CPO, measures material for use with an AFO product.
Cruz Ochoa, a fitter, is an amputee himself who makes peer visits to help other amputees work through their frustration, depression, coping skills, and other issues. “It makes a big difference to address the psychological side,” says McDonald. “It improves our results throughout the whole process. Depressed patients are less likely to be as engaged in their own care—they may not participate in physical therapy or listen to what their doctor says about diet and other factors. Cruz is able to get them really motivated, to put the effort in, and it makes for a better outcome all around.”
Coaching services are offered free as part of Anchor’s care, as is a support group Ochoa organized. The group, which is open to patients from any O&P facility, meets regularly, goes on field trips and sports outings, and holds an annual Christmas toy drive. The group is open to family members as well, who meet separately to share their own experiences. “It’s a totally different environment for family members,” McDonald notes. “Many of them don’t feel comfortable saying some things in front of the amputee, so this gives them the space to work through their own issues.” At McDonald’s invitation, a local
Facility Spotlight
physical therapy practice opened a clinic just down the hall from Anchor nearly five years ago. Their collaboration is useful for both patients and practitioners, he says. “If a patient is receiving physical therapy services and the device isn’t right, we can tweak things then and there, avoiding a waste of valuable therapy time. And patients can schedule appointments with both facilities so they don’t need to drive to separate locations.” Anchor O&P offers another, less common service: prosthetics and orthotics for animals. McDonald first worked with a pony at the University of California, Davis, more than 20 years ago. He has since treated cats, dogs, alpacas, sheep, and horses, devising prosthetic limbs and specialized braces for short- and long-term use. According to McDonald, the biomechanics of animals may differ from those of humans, but the principles remain the same. “It’s definitely different in that the patient can’t talk to you,” he says. “And I have to train the owners. Many think once they get the device, everything will be fixed. But just like with humans, these devices need to be monitored, and the animals will need ongoing care.” As for the future, McDonald says he is always looking for new opportunities to expand, but only if the situation is right. His focus right now is on collaborating with area hospitals in coordinating care so that patients “don’t fall through the cracks” or experience a delay in care. “Early intervention is good for patients and outcomes,” he says. “Our other goal is to streamline our processes and procedures to fend off RAC audits, maximize reimbursement, and manage new regulations and documentation requirements,” he says. “Improvements in this area will create opportunity.” a Deborah Conn is a contributing writer to O&P Almanac. Reach her at debconn@ cox.net. FEBRUARY 2014 O&P Almanac
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Photos: Anchor Orthotics and Prosthetics
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AOPA HEADLINES
AOPA WORKING FOR YOU
AOPA’s Biggest Actions in 2013 Reviewing key endeavors to support members and the industry last year
W
hat happens in Washington has always played an important role in the daily work of O&P, but never before have these events demanded such an incredible amount of resources and resourcefulness—simply to survive. AOPA members’ support provides the wherewithal, so every year we try to summarize the most important actions conducted on your behalf over the past year. AOPA worked diligently and accomplished much in 2013, including the following key efforts: Filed a lawsuit on May 13, 2013, against the Centers for Medicare and Medicaid Services (CMS) seeking relief from the unfair and unauthorized actions of CMS and its Recovery Audit Contractor (RAC) auditors and Durable Medical Equipment Medicare Administrative Contractors (DME MACs), relating to physician documentation requirements and the change in policy resulting from the “Dear Physician” letter.
1.
Aggressively continued seeking common sense solutions to disruptive RAC and other CMS audit practices through frequent meetings, testimony, letters, and “Calls to Action” to address specific problems. Each day, AOPA’s experts fielded dozens of member calls for help on the audits and other CMS issues.
2.
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O&P Almanac FEBRUARY 2014
Convinced Congressional leadership to introduce the Medicare Orthotics and Prosthetics Improvement Act in the House (HR 3112), which, if enacted, would save $250 million annually through fraud-prevention provisions. The bi-partisan sponsors and co-sponsors are helping the O&P community take a proactive approach to combating fraud.
3.
Funded ground-breaking research commissioned by the Amputee Coalition that proved the cost-effectiveness of O&P intervention. The study, conducted by the noted DobsonDaVanzo consulting firm, used Medicare’s own data to demonstrate that patients who receive timely O&P intervention experienced better health outcomes and reduced costs to Medicare, compared to patients with the same diagnoses who did not receive O&P care.
4.
Worked with the Amputee Coalition to introduce the Insurance Fairness for Amputees Act (HR 3020), which would require insurance companies that offer O&P coverage to provide benefits equal to other surgical and medical benefits provided by the insurer with no separate caps, arbitrary exclusions, or lifetime limits.
5.
AOPA WORKING FOR YOU
Challenged the Pricing, Data Analysis and Coding’s (PDAC) authority to propose medical device labeling requirements, citing the FDA’s exclusive authority on medical device labeling. The Unique Device Identifier (UDI) final rule establishes the requirement for UDI on most medical devices, but AOPA previously provided specific comments supporting the continued exemption of most O&P Class I devices from the Good Manufacturing Practice requirements. PDAC tabled its proposal, and the new UDI regulations have minimal short-term effects on O&P devices.
6.
Achieved a limit on the number of CMS’s Additional Documentation Requests. CMS acknowledged AOPA’s concerns about the harm caused by RAC audits and modified the number of ADR requests to no more than 10 over a 45-day period.
7.
Testified twice during U.S. Small Business Administration Regulatory Fairness hearings held by the National Ombudsman to assist small businesses with unfair and excessive regulatory enforcement by federal agencies. AOPA’s testimony detailed the unfair and unauthorized actions of CMS, primarily via the actions of its RACs and DME MACs, relating to audit practices and physician documentation requirements.
8.
AOPA HEADLINES
revisions issued by CMS did not reflect AOPA’s concerns but instead introduced a new wrinkle, by exploding 23 codes into those that can be furnished with or without clinical care and assigned each individual codes. The question of who decides under which circumstances the with- or withoutclinical care device can be used remains unanswered. in the CMS Special Open Door Forum 11. Participated calls that solicited feedback for the proposed electronic physician documentation template for lower-limb prostheses. AOPA ensured that the interests of its members were properly represented during the calls, and urged that CMS follow a formal rulemaking process to ensure that all stakeholders are heard and that a proper record exists. AOPA convinced the Department of Treasury 12. After in 2012 that O&P qualified for the “retail exemption” from the new, 2.3 percent federal excise tax on medical devices—no tax this year or any year—AOPA educated its members on how to understand this exemption and benefits. Much progress is being made in an effort to understand who our patients are and to track the progress and outcomes they experience with O&P treatment. Through AOPA’s efforts, the O&P community was able to convince the Treasury and IRS that O&P qualified for this exemption.
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Requested the DME MAC medical directors to remove the height requirement that was established and implemented for ankle-foot orthoses (AFOs) that were provided on or after Jan. 1, 2013. Medicare responded favorably for patients and providers and revised the AFO/ KAFO Policy Article after AOPA disagreed with the requirement detailed in its first announcement.
9.
Introducing our NEWEST Study Guide in PEDORTHICS
its participation in the O&P Alliance, AOPA 10. Through met with high-ranking CMS officials, regarding the “final list” of orthoses that were considered to be “off the shelf” and, therefore, eligible for future rounds of competitive bidding. The meeting challenged the CMS proposal of the creation of split codes that would differentiate those services that required professional fitting and follow-up care and those services that did not require professional fitting and follow-up care. AOPA continues to challenge the CMS expansion of the statutory definition of the term “minimal self adjustment” by the patient to also include adjustments provided by caregivers or suppliers. Sadly, the 2014 Healthcare Common Procedure Coding System code
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FEBRUARY 2014 O&P Almanac
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AOPA HEADLINES
AOPA WORKING FOR YOU
introduction of the Wounded Warrior 13. Achieved Research Enhancement Act (S 521), which would provide $30 million in research funds based on an agenda developed with O&P industry input from the Department of Defense and the Department of Veterans Affairs. Achieved introduction of the Wounded Warrior 14. Workforce Enhancement Act (S 522), which would provide funding to support the expansion of existing and the opening of new education facilities to train and prepare O&P practitioners to serve the needs of tomorrow’s expanding patient base, by providing $15 million in short-term, competitive grants. and remained an active participant in each of 15. Joined the four DME MAC Advisory Councils. This is a group of providers and association representatives who meet with the DME MAC medical directors and staff on a regular basis to address specific issues within each of the DME MACs. AOPA participation in the DME MAC Advisory Councils has provided unprecedented access to high-level staff within each of the DME MACs and has proven very valuable in establishing strong relationships to advance AOPA’s efforts to assure common sense solutions.
Performers during the Opening Ceremony at the 2013 O&P World Congress.
four pilot studies through the Center for 16. Funded Orthotic & Prosthetic Learning for important research topics: vacuum-assisted suspension on clinical outcomes in lower-limb amputees; efficacy of dynamic response prosthetic feet in K-level 3; functional performance and evaluation of dynamic response feet; and gait for persons wearing either a SACH or a dynamic response foot.
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Manufacturers: Get your products in front of AOPA members! Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811. 34
O&P Almanac FEBRUARY 2014
AOPA WORKING FOR YOU
AOPA HEADLINES
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Hosted a global O&P World Congress that brought together more than 2,500 orthotic, prosthetic, and pedorthic professionals from 43 countries in Orlando, Florida—the first global O&P event in the western hemisphere. Highlights included Rep. Tammy Duckworth’s (D-Illinois) keynote, the 200 exhibiting companies providing the biggest product and services display in the western hemisphere, the unprecedented clinical and business programming, and incredible networking opportunities. Rep. Duckworth is a co-sponsor of HR 3112 (see #3).
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Commissioned a systematic literature review on post-stroke orthotic management. This review is being used as a component of the clinical practice guidelines that are currently being constructed by orthotic experts as a tool for practitioners, patients, and teachers to help reduce errors of omission, inform payers, and elevate practice standards in the field.
18.
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a systematic literature review of 19. Commissioned prosthetic management following transtibial amputation. This also is being used as part of the clinical practice guidelines being drafted by prosthetic experts. a pilot testing of a patient registry 20. Sponsored database to collect demographic information and,
•
•
The mission of the American Orthotic and Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.
Expert Reimbursement and
•
Cost-Effectiveness Research. The
changing of health is Coding Guidance. AOPA’s Membership inreim-AOPA is climate one ofcarethe moving to a patient driven process bursement specialists provide
Your Survival Advocacy in Washington. AOPA’s staff and the lobbying team bring years of healthcare knowledge and experience to the issues of O&P. AOPA’s efforts help assure equitable reimbursement policies in these uncertain financial times to ensure quality patient care.
coding advice and keep you up-to-date on the latest Medicare quality standards, RAC and other audits, billing rules and regulations. Answers to all of your questions related to O&P coding, reimbursement and compliance—via telephone or email. Members have unlimited access to AOPA staff experts.
and is demanding more and more
of cost-effectiveness to best investments that evidence yououtcomes. canAOPAmake measure has
21.
Making Your Voice Connect. AOPA’s Annual Policy Forum brings O&P leaders to Washington to receive high level briefings and to E E GUIDdeliver the O&P story personally to MEMBER VALU rg/join their members of Congress. www.AOPAnet.o
& PROST HETIC
ASSO CIATIO
•
LCodeSearch.com, AOPA’s online coding resource, provides members with a one-stop, up-to-the minute coding reference available 24/7, from anywhere you connect to the Internet.
N (AOPA )
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n Orthotic services; audit of the America regulation and RAC and CERT The mission Challenging business in laws, ented by overly of the O&P to e treatment policies implem contractors is g skills; and for favorabl and marketin CMS aggressive management one priority. ion. s improve their the associat AOPA’s number to help member industry and litigation against unfair nding of the We have filed relief from the CMS, ss and understa of CMS seeking raise awarene rized actions MACs and unautho h. The , and DME ectiveness Researccare is its RAC auditors n documenta• Cost-Eff health g climate of t and relating to physiciaand the change process changin rsemen driven ents, Reimbu patient tion requirem • Expert moving to a ing more and more e. AOPA’s reimfrom the “Dear Coding Guidanc ts provide in policy resulting s to and is demand cost-effectivenes bursement specialis Physician” letter. evidence of and keep you s. AOPA has coding advice the latest Medicare measure outcome Advocacy in study by health up-to-date on s, RAC and other • Your Survival funded a major -DaVanzo proving ons. team Washington. quality standard care firm Dobsons of timely O&P rules and regulati and the lobbying AOPA’s staff healthcare knowlaudits, billing of your questions the same cost-effectivenes of all sepatients with bring years Answers to ce to the issues did treatment of coding, reimbur patients who can assure edge and experien related to O&P nce—via telephone diagnoses as efforts help t. AOPA treatmen of O&P. AOPA’s sement policies ment and complia s have unlimited the field not receive to resources of equitable reimbur or email. Member aggregate the vital research that n financial times staff experts. in these uncertai access to AOPA to conduct this cannot conduct. patient care. rms ensure quality AOPA’s online s individual fi earch.com, • LCodeS Connect. , provides member Your Voice coding resource, up-to-the minute • Making Policy Forum ton AOPA’s Annual with a one-stop e available 24/7, leaders to Washing (Continued) and to brings O&P coding referenc you connect to the level briefings re to receive high story personally to from anywhe deliver the O&Pof Congress. Internet. s their member
MIS SIO N
•
funded a major study by health care firm Dobson-DaVanzo proving
cost-effectiveness of timely O&P in the future of your company. treatment of patients with the same
•
AMER ICAN
Twenty-one is a great number, but the list does go on and on. This annual summary represents a report card, in a sense, about what we trust our members perceive as a great value for their annual investment in AOPA. We offer our sincere thanks to all AOPA members—those special individuals running their companies who believe continued support for AOPA remains their lifeline to the future and their guidepost for the present. a
Challenging RAC and CERT audit policies implemented by overly aggressive CMS contractors is AOPA’s number one priority. We have filed litigation against CMS seeking relief from the unfair and unauthorized actions of CMS, its RAC auditors, and DME MACs relating to physician documentation requirements, and the change in policy resulting from the “Dear Physician” letter.
MISSION
•
eventually, outcome measures for O&P patients. Much progress is being made in an effort to understand who our patients are and to track the progress and outcomes they experience with O&P treatment. Reached out to the payer community through a sophisticated survey process to understand their view of O&P. Thirty top private payers participated as part of a long-term initiative to educate payers about who we are and the important role O&P plays in patients’ lives.
Experience the Benefits of AOPA Membership
Experience the Benefits of AOPA Membership
diagnoses as patients who did not receive treatment. AOPA can aggregate the resources of the field to conduct this vital research that individual firms cannot conduct.
2014 AOPA Annual Membership enrollment(Continued) is now open. Call 571/431-0876 to request an application form, or visit www.AOPAnet.org.
Join today! FEBRUARY 2014 O&P Almanac
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AOPA HEADLINES
Become a Presenter at the 2014 AOPA National Assembly in Las Vegas! AOPA invites you to become a presenter at the 2014 AOPA National Assembly, to be held September 4-7 at the Mandalay Bay Resort in Las Vegas. Your clinical submissions, based on sound research and strong empirical data, will set the stage for a broad curriculum of highly valued business, technical, and scientific offerings. All interested presenters must submit an abstract of their proposed scientific paper or description of their proposed business or technical paper using an electronic submission form. To submit a free paper abstract, use the electronic submission form found at https://aopa.wufoo.com/ forms/2014-call-for-free-papers/. To organize a scientific symposium, use the electronic submission form found at https://aopa.wufoo.com/ forms/2014-call-for-symposia/.
The Review Committee will grade each submission based on the following criteria: • Relevance, level of interest in topic • Quality of scientific content • Quality of clinical content Important Dates Monday, March 10 Deadline for abstract and symposia submissions Tuesday, April 10
Notice of acceptance or rejection
Friday, August 1 Electronic version of handouts due Thursday, Sept 4
AOPA National Assembly begins
Contact AOPA Headquarters with questions, 571/4310876 or tmoran@AOPAnet.org, or visit www.AOPAnet.org.
Mastering Medicare: AOPA’s Advanced Coding & Billing Techniques Royal Sonesta | Feb. 10-11, 2014 New Orleans, LA Join your colleagues February 10-11 at the Royal Sonesta in New Orleans for AOPA’s Mastering Medicare: Advanced Coding & Billing Techniques seminar. AOPA experts will provide up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage. Register online for the Mastering Medicare: Advanced Coding & Billing Techniques seminar in New Orleans at http://bit.ly/aopa2014neworleans. Questions? Contact Devon Bernard at dbernard@aopanet.org or 571/431-0854.
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O&P Almanac FEBRUARY 2014
AOPA HEADLINES
Mastering Medicare: AOPA’s Advanced Coding & Billing Techniques Bally’s Las Vegas Hotel & Casino April 7-8, 2014 • Las Vegas, NV Join your colleagues April 7-8 at Bally’s Las Vegas Hotel & Casino for AOPA’s Mastering Medicare: Advanced Coding & Billing Techniques seminar. AOPA experts will provide up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage. Register online for the Mastering Medicare: Advanced Coding & Billing Techniques seminar in Las Vegas at http://bit.ly/aopa2014lasvegas. Questions? Contact Devon Bernard at dbernard@aopanet.org or 571/431-0854.
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Survive and Thrive—Bottom-line, profit-oriented business programs for O&P If you missed the 2013 O&P World Congress, don’t let this opportunity to participate in these important programs pass you by: • Everything You Need to Know to Survive RAC and Prepayment Audits in a Desperate Environment • Competitive Bidding: Devastation to Orthotic Patient Care, Or Just a Passing Storm? • Food and Drug Administration Compliance for Patient-Care Facilities, Manufacturers, and Distributors • Your Mock Audit: Are You Ready for the Auditor to Examine Your Claims Record?
You and your staff can now have a private viewing of business saving strategies and earn CE credits at the same time. Learn more about each session by visiting www.aopanet.org/Need%20CE%20Credits%20 Promo.pdf. AOPA members just $59 per session ($99 per session for nonmembers), and the price covers your entire staff. Take advantage of a special offer to buy three, get one free. Review the videos as many times as you like. Register at http://bit.ly/aopabusiness. Contact Betty Leppin at bleppin@AOPAnet. org or 571/431-0876 with any questions.
FEBRUARY 2014 O&P Almanac
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AOPA HEADLINES
Save the Dates: 2014 AOPA Audio Conferences Announced Mark your calendar now for the audio conferences in 2014. AOPA has confirmed the dates and topics for its 2014 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 1:00 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! Visit the AOPA website, buy the series, and get two audio conferences free. AOPA members pay $990 to participate in all 12 sessions (nonmembers pay $1,990). If you purchase the entire year’s worth of conferences, all conferences from the months prior to your purchase of the set will be sent to you in the form of an MP3. Individual seminars are priced at just $99 per line for members ($199 for nonmembers).
Register online at http://bit.ly/aopa2014audio. Questions? Contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876.
2014 Topics • February 12: Billing for Diabetic and Orthopedic Shoes, Mastectomy Services, and Surgical Dressings • March 12: The ABCs of Audits: What to Expect and How to Respond • April 9: How To Use Advanced Beneficiary Notices (ABNs) Effectively • May 14: Modifiers: How and When to Use Them • June 11: The Self-Audit: A Useful Tool • July 9: The OIG: Who Are They and Why Are They Important? • August 13: AFO/KAFO Policy: Understanding the Rules • September 10: Urban Legends in O&P: What To Believe • October 8: Medicare Enrollment, Revalidation, and Participation • November 12: Gifts: Showing Appreciation Without Violating the Law • December 10: New Codes and Changes for 2015
The ABC’s of Audits: What To Expect and How To Respond Join the Audio Conference March 12 Join AOPA on March 12 for an AOPAversity Mastering Medicare Audio Conference that will focus on meeting new Medicare supplier standards and why it’s an important part of your business operation. An AOPA expert will address the following issues during the audio conference. Audits have arrived and they are here to stay. An auditor’s job is to seek out questionable Medicare payments made in the past and recoup as much money for the Medicare program as they can. But where did they come from? How do they work? To answer these questions and many more, including how to prepare for an audit, attend the audio conference. • Learn who is auditing your claims and why • How do audits work 38
O&P Almanac FEBRUARY 2014
• What restrictions do the auditors have • How to identify potential problems • How to handle an audit (documentation, timely responses, etc.) The cost of participating is always just $99 for AOPA members ($199 for nonmembers) and any number of employees may listen on a given line. Listeners can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Register online at http://bit.ly/aopa2014audio. Contact Betty Leppin at bleppin@ AOPAnet.org or 571/431-0876 with registration questions.
AOPA HEADLINES
Billing for Diabetic and Orthopedic Shoes, Mastectomy Services, and Surgical Dressings Join the Audio Conference February 12 Having a hard time billing properly for shoes, dressings, and external prostheses? Join AOPA February 12 for an AOPAversity Mastering Medicare Audio Conference that will focus on Medicare policies and correct billing opportunities for diabetic and orthopedic shoes, mastectomy services, and surgical dressings. The following topics will be covered: • How to bill for split shoe sizes • How to bill for diabetic shoes attached to braces • How many bras may be dispensed at one time • How and when compression garments are considered medically necessary.
O&P Almanac Magazine If you aren’t receiving and reading AOPA’s official magazine every month, you don’t know what you’re missing. The O&P Almanac is the most respected source for industry insight and association news in the O&P industry. Featured topics include emerging technologies, coding and reimbursement education, premier meetings, people and businesses in the news, and industry modernization. As a member of AOPA, or a credentialed practitioner with ABC or BOC, you receive a print copy of the O&P Almanac monthly. A digital version of each issue also is available on AOPA’s website at www.aopanet.org under “Publications.” If you are not a member of AOPA, or a credentialed practitioner with ABC or BOC, you may purchase an annual subscription of the O&P Almanac at AOPA’s Online Bookstore, www.aopanetonline.org/store. www.bocusa.org
AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@ AOPAnet.org or 571/431-0854 with content questions. Register online at http://bit.ly/aopa2014audio. Contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876 with registration questions.
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.
Coding Questions Answered 24/7 AOPA members can take advantage of a “click-of-the-mouse” solution available at LCodeSearch.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 FEBRUARY 2014 O&P Almanac
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AOPA HEADLINES
AOPA’s 2014 Coding Products Available for Pre-Order! Pre-Order Your 2014 Coding Products Today AOPA PRODUCTS
COMPREHENSIVE GUIDE The Most Popular Orthotic and Prosthetic Illustrated Reference!
A M E R I C A N O R T H O T I C & P R O S T H E T I C A S S O C I AT I O N ( A O PA )
2014ILLUSTRATED GUIDE UPDATED MEDICARE CODES for Orthotics and Prosthetics
2014 Illustrated Guide This easy-to-use reference manual provides an illustrated guide to the coding system in use for orthotics, prosthetics, and shoes, including HCPCS codes, official Medicare descriptors, and illustrations.
reference to the HCPCS orthotic, shoe, and prosthetic codes and modifiers. These laminated cards are durable, longlasting, and convenient to store.
2014 Coding Suite Save $50 when you purchase the newly updated 2014ILLUSTRATED GUIDE Coding Suite, which includes all of the coding products discussed above: 2014 Illustrated Guide, 2014 Coding Pro (Single-User CD Software), and the 2014 Quick Coder. AOPA PRODUCTS
COMPREHENSIVE GUIDE The Most Popular Orthotic and Prosthetic Illustrated Reference!
2014 Coding Pro The Coding Pro is O&P’s comprehensive guide to Medicare codes, reimbursement, and medical policies. This is the single-source reference for all of your coding needs! The Coding Pro CD-ROM provides updated Medicare fee schedules for all 50 states and allows you to customize and import other fee schedules used by your office. Illustrations of the codes allow you to quickly sort codes. And writing prescriptions just got easier with the prescription writing tool. Network Version for use on multiple office terminals.
A M E R I C A N O R T H O T I C & P R O S T H E T I C A S S O C I AT I O N ( A O PA )
UPDATED MEDICARE CODES for Orthotics and Prosthetics
Anticipated delivery is March 1, 2014. Visit the AOPA Bookstore to pre-order your Coding Products today: http://bit.ly/BookStoreAOPA.
2014 Quick Coder Stop searching through numerous pages to find a code! AOPA’s redesigned Quick Coder provides a speedy
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.
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O&P Almanac FEBRUARY 2014
AOPA also offers two sets of webcasts: Mastering Medicare and Practice Management. • 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.
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!
Top 5 Reasons To Follow AOPA:
Contact Steve Custer at scuster@AOPAnet.org or 571/4310835 with social media and content questions.
• Take advantage of special social media follower discounts, perks, and giveaways.
•
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.
AOPA Applications Welcome new members! 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.
Alabama Artificial Limb & Orthopedic Service
Bulow Orthotic and Prosthetic Solutions
720 Alabama Avenue Selma, AL 36701 334/284-0250 Fax: 334/280-2853 Category: Affiliate Member Parent Company: Alabama Artificial Limb & Orthopedic Service Inc., Montgomery, AL
503 Spruce Street, P.O. Box 25049 Nashville, TN 37203 615/327-9343 Fax: 615/329-4871 Category: Affiliate Member Parent Company: Bulow Orthotic and Prosthetic Solutions, Nashville, TN
AOPM CORP 145 Pine Haven Shores Road, Ste. 3100 Shelburne, VT 05482-7815 877/490-2676 Fax: 514/448-5614 Category: Supplier Eniko Mitrea
Cranial Technologies Inc. 495 Central Park Avenue, Ste. 207 Scarsdale, NY 10583 480/505-1840 Fax: 480/505-1842 Category: Affiliate Member Parent Company: Cranial Technologies Inc., Tempe, AZ
Cranial Technologies Inc. 1905 Clint More Road Boca Raton, FL 33496 561/994-7506 Fax: 561/994-1471 Category: Affiliate Member Parent Company: Cranial Technologies Inc., Tempe, AZ
Pro Tec Orthotics 3625 W. Main, Ste. 108 Norman, OK 73072 405/570-4790 Category: Patient-Care Member John Brigance a
Is Your Facility Celebrating a Special Milestone This Year? O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email o&palmanac@ strattonpublishing.com.
FEBRUARY 2014 O&P Almanac
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There’s a new TW IST to lower-limb prosthetics Dycor introduces “Spiralon”1, a triple helix dynamic response pylon used to add a dynamic dimension to relatively unresponsive feet. Sprialon is recommended for use with Dycor’s flexible keel K2A (L5972) and energy storing K3U9 (L5981) “K Series” feet and energy storing FDS feet because the foot attachment is forward and low as possible and the “rocker” forefoot is posterior as possible 2. Spiralon is now available in both geriatric and non-geriatric versions. The geriatric version orientates the bi-directional carbon fibers at a 45/45 deg. to the longitudinal axis and the non-geriatric unidirectional fibers orientates at O deg. Recommended L coding for the open-ended version is L5985. L coding for the single- and double-ended versions are L5984 plus L5940. For product selection and alignment consideration, contact Dycor’s technical service at 1-800-794-6099 or visit our website at www.dycormfg.com. 1
Patented and patent pending.
2
Not recommended for use with OTS pen suspension liners.
Double-ended geriatric Spiral attached to Dycor’s K3U foot
www.dycormfg.com
Marketplace
New College Park Shelltread
Horizon™ Lower Spine Bracing from PEL
College Park is known for high-quality and durable foot shells. Now your highest impact patients can increase that durability, and everyone can enjoy walking barefoot safely. The College Park Shelltread is made from abrasion-resistant styrenebutadiene rubber with a cross hatch design for enhanced non-skid. Easy to install and affordable, they are available in neutral and black for every size and type of College Park foot shell. For more information, call 800/728-7950 or visit www. college-park.com.
Horizon Lower Spine Line from Aspen Medical Products is designed to provide needed support, motion restriction, and pain relief. Four brace configurations ensure the right brace for every condition. Each brace can be stepped down to Horizon PRO (Pain Relief Orthosis) for treatment of recurring low back pain. • Simple adjustable sizing allows braces to comfortably fit 24-in to 70-in waists • Unique independent upper/lower tightening system allows patients to localize compression for customized pain relief • Easy to fit and adjust sizes • Tri-Bane technology system and integrated vertical stays provide stability and comfort • Ergonomic, low-profile design may be comfortably worn under clothing • PDAC approved. Contact PEL at 800/321-1264 or www.pelsupply.com. a
Job Opportunity CPO/BOCPO
Provel Cad/CAM A complete system for cost-effective automation in facilities of all sizes. Scan, modify, carve, and thermoform. The cordless S1 Scanner allows fast, accurate three-dimensional shape capture with unmatched ease of use and low cost. Newly released ProvelCAD modification software is easy to use and template based. The C7 Carver is not only fast and precise, its self-contained dust collection system is extremely quiet. The T7 Thermoformer, now with IR sensing, consistently produces high-quality thermoplastic sockets from industry standard preforms. AOP, OBJ, and STL file compatible. Provel Inc. can be contacted at 509/857-2009 or visit www.provel.us.
At Center for Orthotic & Prosthetic Care (COPC) our staff of orthotic and prosthetic professionals is committed to our mission of providing the highest level of patient care possible. COPC is a private partnership that enjoys the privilege and challenge of serving in leading and renowned medical centers in KY, IN, NC, and NY. Due to an opening at a new patient-care facility in Paducah, Kentucky, we are seeking a CPO, or KY licensed BOCPO, with a minimum of 5 years’ clinical experience. Candidates must possess excellent communication, organizational, and interpersonal skills, and the demonstrated ability to provide the highest quality patient care. This position offers a competitive salary, relocation assistance, and excellent benefits including medical, dental, disability, 401K, certification and licensure fees, and continuing education expenses. If you meet these requirements and have an interest, please submit your resume, in confidence, to: via fax at 502/451-5354 or via email to copchr@centeropcare.com.
FEBRUARY 2014 O&P Almanac
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aoPa’s
national
assembly ’14
The premier meeting for orthotic, prosthetic, and pedorthic professionals
Products. Services. Networking.
clinical | Business | Technology
educaTion
sept. 4–7, 2014 Mandalay Bay, las Vegas
For information about the show, scan the QR code with a code reader on your smartphone or visit www.AOPAnet.org.
CALENDAR 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
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 scuster@ 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. Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate $80 $140 jobs.AOPAnet.org!
aOPa marketing
Be served a bigger
Specials: 1/4 page, color 1/2 page, color
$482 $678 $634 $830
20 14
OPPOrtunities
media kit
slice of the pie!
dollar of of the 3.5 billion AOPA Find your slice begin with an O&P business— opportunity today! advertising
rates effective
American Orthotic
DISCOVER more AOPA advertising opportunities. Call Bob Heiman, Advertising Sales Representative, at 856/673-4000 or email bob.rhmedia@comcast.net
& Prosthetic
Association
Jan. 1, 2014
(AOPA) rg
Promoting O&P
Since 1917
www.AOPAnet.o
Anet.Org www.AOP
AOPA 2014
MediA Kit
1
FEBRUARY 2014 O&P Almanac
45
CALENDAR
■ YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiplechoice and clinical-simulation exams. Apply now at http://my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.
www.bocusa.org ■ OnLIne Training Cascade Dafo Inc. Cascade Dafo Institute. Now offering a series of six free ABC-approved online courses, designed for pediatric practitioners. Visit www.cascadedafo.com or call 800/848-7332.
■■
2014 ■ February 1 ABC: Practitioner Residency Completion Deadline for March 2014 Exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification. ■ FEBRUARY 10-11 AOPA: Essential Coding & Billing Seminar. Royal Sonesta. New Orleans. To register, contact Betty Leppin at 571/431-0876 or bleppin@ AOPAnet.org.
■ February 12 AOPAversity Audio Conference–Billing for Diabetic and Orthopedic Shoes, Mastectomy Services, and Surgical Dressings. Register online at http://bit. ly/aopa2014audio. For more
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................$5.00 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 scuster@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. 46
O&P Almanac FEBRUARY 2014
information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ February 17-21 Applied Technology Institute (ATi) Orthotic Fitter School. Hampton Inn, Montgomery, AL. Independent comprehensive course to prepare for certification exam. Approved entry-level school by NCOPE (ABC) and BOC; & for continuing education by BOC. Course descriptions and registration available on website: www.kasseledu.com. Contact Lois Meier at 888/ 265-6077 or email lois@ kasseledu.com.
■ 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. ■ March 1 ABC: Application Deadline for Certification Exams. Applications must be received by March 1, 2014, for individuals seeking to take the May 2014 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification. ■ March 8-9 ABC: Orthotic Clinical Patient Management (CPM) Exam. University of Texas Southwestern Medical Center, Dallas. Contact 703/836-7114, email certification@abcop. org, or visit www.abcop.org/ certification.
■ MARCH 12 AOPAversity Audio Conference–The ABCs of Audits: What to Expect and How to Respond. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ March 14-15 ABC: Prosthetic Clinical Patient Management (CPM) Exam. University of Texas Southwestern Medical Center, Dallas. Contact 703/836-7114, email certification@abcop. org, or visit www.abcop.org/ certification. ■ March 17-22 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians in 250 locations nationwide. Contact 703/8367114, email certification@abcop. org, or visit www.abcop.org/ certification. ■ March 24-28 Applied Technology Institute (ATi) Orthotic Fitter School. Holiday Inn, Novi, MI. Independent comprehensive course to prepare for certification exam. Approved entry-level school by NCOPE (ABC) and BOC; & for continuing education by BOC. Course descriptions and registration available on website: www.kasseledu.com. Contact Lois Meier at 888/
265-6077 or email lois@ kasseledu.com.
CALENDAR
■ April 3-4 Rehabilitation Institute of Chicago: Advanced Pediatric Gait Analysis. Chicago. Must have taken an Elaine Owen course as prereq. 15.00 ABC credits. Contact Melissa Kolski at 312/238-7731 or visit www.ric.org/education.
APRIL 7-8 AOPA: Essential Coding & Billing Seminar. Bally’s Hotel & Casino. Las Vegas. To register, contact Betty Leppin at 571/431-0876 or bleppin@ AOPAnet.org. ■
April 9 AOPAversity Audio Conference–How To Use Advanced Beneficiary Notices (ABNs) Effectively. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. ■
■ May 5-9 Applied Technology Institute (ATi) Orthotic Fitter School. Courtyard Gwinnett Mall, Atlanta. Independent comprehensive course to prepare for certification exam. Approved entry-level school by NCOPE (ABC) and BOC; & for continuing education by BOC. Course descriptions and registration available on website: www.kasseledu. com Contact Lois Meier at 888/265-6077 or email lois@ kasseledu.com.
■ May 14 AOPAversity Audio Conference–Modifiers: How and When to Use Them. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
June 11 AOPAversity Audio Conference–The Self-Audit: A Useful Tool. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. ■
■ July 9 AOPAversity Audio Conference–The OIG: Who Are They and Why Are They Important? Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ September 10 AOPAversity Audio Conference–Urban Legends in O&P: What To Believe. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ August 13 AOPAversity Audio Conference–AFO/KAFO Policy: Understanding the Rules. Register online at http:// bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ October 8 AOPAversity Audio Conference–Medicare Enrollment, Revalidation, and Participation. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ SEPTEMBER 4-7 97th AOPA National Assembly. Las Vegas. Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org.
■ November 12 AOPAversity Audio Conference–Gifts: Showing Appreciation Without Violating the Law. Register online at http://bit.ly/ aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. a
AD INDEX Company Page Phone Website ALPS South LLC 7, C3 800/574-5426 www.easyliner.com American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc. 11 703/836-7114 www.abcop.org Cailor Fleming Insurance 2 800/796-8495 www.cailorfleming.com College Park Industries C2 800/728-7950 www.college-park.com DAW Industries 1 800/252-2828 www.daw-usa.com Dr. Comfort 5 877/713-5175 www.drcomfort.com Dycor Manufacturing Inc. 42 800/794-6099 www.dycormfginc.com Ferrier Coupler Inc. 29 810/688-4292 www.ferrier.coupler.com Flo-Tech O&P Systems Inc. 35 800/356-8324 www.1800flo-tech.com Hersco Ortho Labs 25 800/301-8275 www.hersco.com JMS Plastics 17 800/342-2602 www.jmsplastics.com O&P Study Review Guide 33 410/266-1671 www.oandpstudyguide.com Ottobock C4 800/328-4058 www.professionals.ottobockus.com PEL 15 800/321-1264 www.pelsupply.com WillowWood Insert 800/848-4930 www.willowwoodco.com FEBRUARY 2014 O&P Almanac
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AOPA Answers
PDAC Particulars Answers to your questions regarding PDAC verification for orthoses
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.
Are there any other devices that require PDAC verification in order to be billed to Medicare?
A.
• • •
Q.
Which spinal orthosis codes require a Pricing, Data Analysis and Coding (PDAC) verification in order to be billed to Medicare?
A.
Any prefabricated spinal orthoses described by codes L0450, L0454L0472, L0488-L0492, L0625-L0628, L0630, L0631, L0633, L0635, L0637, and L0639 require PDAC verification. Any custom-fabricated spinal orthoses fabricated by a central fabrication facility or manufacturer described by codes L0452, L0480L0486, L0629, L0632, L0634, L0636, L0638, and L0640 also require PDAC verification. If you fabricate a custom lumbar sacral orthosis or thoracic lumbar sacral orthosis in-house and provide it directly to the patient, the product does not need to be verified by the PDAC. However, you must be able to provide a list of materials used and a description of your fabrication process if requested.
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O&P Almanac FEBRUARY 2014
•
The following devices require PDAC verification: a double upright knee orthosis described by code L1845 a pneumatic knee splint described by code L4380 a functional electric stimulator described by code E0770 a multiligamentous support described by code L1906.
Q.
If an item requires PDAC verification and the product I wish to provide is not listed on the PDAC website, www.dmepdac. com, how do I bill Medicare for the item?
A.
The answer depends on the specific Medicare medical policy or PDAC coding guidelines announcement that required the item to be verified and listed on the PDAC website. Typically, you would use the code A9270 (noncovered item or service). a
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R
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