January 2012 Almanac

OP

The American Orthotic & Prosthetic Association

JANUARY 2012

&

WWW.AOPANET.ORG

THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY

DIABETES In AMerica As the number of patients skyrockets, early intervention, patient education remain vital for retaining and restoring mobility

NonComPete Contracts: Good, Bad, or Useless?

Complex Code Modifiers Explained

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O&P Almanac CONTENTS

JANUARY 2012, VOLUME 61, No. 1

departments

Cover Story

4 AOPA Contact Page How to reach staff

20 Diabetes in America

By Anya Martin By intervening early, assigning proper risk categories, and educating patients on caring for their feet or socket after amputation, O&P professionals can help ensure that more diabetics retain their limbs or get walking again with the help of a prosthesis.

6 At a Glance

08

Statistics and O&P data

In the News Research, updates, and company announcements

32 AOPA Headlines

News about AOPA initiatives, meetings, member benefits, and more

39 AOPA Membership Applications

Feature

28

40 Marketplace

Products and services for O&P

Breaking Up Is Hard To Do

By Deborah Conn In every state but one, employers have the right to require employees to sign noncompete agreements, but can these contracts be enforced, and do they send the wrong message to potential employees?

42 Jobs

Opportunities for O&P professionals 48 Calendar

Upcoming meetings and events

51 Ad Index 52 AOPA Answers

COLUMN

Expert answers to your FAQs

16 Reimbursement Page

Help for understanding complex code modifiers

Want a Taste of O&P History?

Get your fill at www.oandplibrary.org/op— a digital archive of issues ranging from 1975 to 1988 of O&P Journal, predecessor of the O&P Almanac.

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.

JANUARY 2012 O&P Almanac

3

AOPA CONTACT 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 and Meetings

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org O&p Almanac Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com

Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org Michael Chapman, coordinator, membership operations and meetings, 571/431-0843, mchapman@AOPAnet.org

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

Stephen Custer, coordinator, membership operations and meetings, 571/431-0876, scuster@AOPAnet.org

Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com

AOPA Bookstore: 571/431-0865

Steven Rybicki, production manager, 571/431-0835, srybicki@AOPAnet.org Stephen Custer, staff writer, 571/431-0876, scuster@AOPAnet.org Christine Umbrell, editorial/production assistant, 703/914-9200 x33, cumbrell@strattonpublishing.com

Government affairs Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com a

AOPA Member-Get-A-Member Campaign GROWING FOR

THE FUTURE CLUB

Take 10% or More OFF Your 2012 Dues

Every major membership organization in the world has found their current members to be their most successful growth partners.

And there has to be something in it for the current member!

You, as an AOPA member, are invited to join our Growing for the Future Club. For each new member company you sign up who designates you as its recruiting member, AOPA will discount your current 2012 renewal by 10%. Get 10 new members and enjoy your 2012 AOPA benefits for free. The 10% discount per new member applies to company members signed up who pay the full 2012 dues of $1,745. For affiliates signed up at $305 each, AOPA will provide a credit of $30 against 2012 dues. You may also use the earned discount as a credit when you purchase any AOPA product, service, or seminar.

Discover MORE HUGE BENEFITS—To enroll in the club and receive your Growing for the Future membership marketing kit, email scuster@AOPAnet.org and we’ll take it from there. You can help make it happen!

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O&P Almanac JANUARY 2012

OP Almanac &

Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales M.J. Mrvica Associates Inc. Design & Production Marinoff Design LLC Printing Dartmouth Printing Company

BOARD oF DIRECTORS Officers President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Orthopedic Group, Houston, TX President-Elect Tom Kirk, PhD, Hanger Orthopedic Group, Austin, TX Vice President Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer James Weber, MBA, Prosthetic & Orthotic Care, Inc., St. Louis, MO Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

directors Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA Michael Hamontree, OrPro Inc, Irvine, CA Russell J. Hornfisher, MBA, MSOD, Becker Orthopedic Appliance Co., Troy, MI Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Prosthetics & Orthotics Inc., Savannah, GA Eileen Levis, Orthologix LLC, Philadelphia, PA Ron Manganiello, New England Orthotic & Prosthetic Systems LLC, Branford, CT Mahesh Mansukhani, MBA Össur Americas, Aliso Viejo, CA Michael Oros, CPO, Scheck & Siress, Chicago, IL Frank Vero, CPO, Mid-Florida Prosthetics & Orthotics, Ocala, FL Copyright 2012 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

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At a Glance

U.S. Diabetes Fast Facts Oral medication most common treatment‌ Treatments among adults with diagnosed diabetes Insulin only Insulin and oral medication

Number of new cases diagnosed

Ages 20-44

12% 14%

Oral medication only 16%

Source: National Diabetes Fact Sheet 2011, National Center for Chronic Disease Prevention and Health Promotion

65,700 Number of nontraumatic lower-limb amputations performed in 2006 in people with diabetes.

$174

Billions of dollars spent on diabetes costs in the United States in 2007.

18.7%

Percentage of all non-Hispanic blacks ages 20 and older who had diagnosed or undiagnosed diabetes in the United States in 2010.

465,000

Ages 45-64 58%

Neither insulin nor oral medication

Middle-age adults most at risk‌

Ages 65 and Older

1,052,000

390,000

Source: National Diabetes Fact Sheet 2011, National Center for Chronic Disease Prevention and Health Promotion

60-70%

Percentage of people with diabetes who have mild to severe forms of nervous system damage.

8

The number of times more likely diabetics are to have a lower limb amputated than nondiabetics.

231,404 Number of U.S. death certificates that listed diabetes as either an underlying cause or contributing cause of death in 2007.

Sources: National Center for Chronic Disease Prevention and Health Promotion; National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases; American Diabetes Association; Diabetes Care Journal.

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O&P Almanac JANUARY 2012

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In the News

Katherine Bomkamp

Photo: Thinkstock.com

20-Year-Old Invents Pain-Free Socket for Phantom Limb Pain

Kabul, Afghanistan

Amputations Among Troops in Afghanistan On the Rise A U.S. Army report published in September 2011 confirmed more troops stationed in Afghanistan are suffering devastating wounds, including arm, leg, and multiple-limb amputations, because of bomb blasts. While the rate of service members killed in action in Afghanistan has decreased steadily since 2006, the severity of injuries has continued to rise.

The uptick in amputations is partly due to the increase in foot patrols—a counterinsurgency strategy that gets service members out among the Afghan people, according to an article in the Sept. 21, 2011, Stars and Stripes e-paper. The tactic leaves troops more vulnerable to roadside bombs, mines, and other buried explosives.

Between January and September 2011, 147 service members had an amputation. At that rate, the

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O&P Almanac JANUARY 2012

total number of amputations for 2011 was expected to exceed any year since the war in Afghanistan began. In 2009, 86 amputations were performed in Afghanistan; in 2010, 187 were performed.

During the January-September 2011 period studied, 77 cases of multiplelimb amputations were recorded, the most of any year so far.

In 2010, more than 90 percent of the amputations took place at combat hospitals or at Landstuhl Regional Medical Center in Germany, the hub for troops injured in theater. It’s a sign of just how devastating these injuries are, according to military surgeons who try to perform only crucial operations in theater, preferring to leave amputations until an injured service member has returned stateside and has had time to recuperate.

Katherine Bomkamp, a sophomore at West Virginia University (WVU), has invented a pain-free socket, a device designed to alleviate phantom pain among amputees. The device works by incorporating thermal biofeedback into prostheses. It forces the brain to focus on the heat produced through the thermal biofeedback rather than sending signals to the missing limb.

Bomkamp started working on the device four years ago during a high school science fair after visiting Walter Reed Army Medical Center with her father, a member of the U.S. Air Force. She talked to young amputees returning from Iraq and Afghanistan who complained of phantom pain.

After her initial research at the science fair, Bomkamp continued to work with a team from the University of Maryland to develop the pain-free socket. The invention won her several awards at local and national science fairs. Now a 20-year-old sophomore at WVU, Bomkamp is working to have her device commercialized. She has received one patent for the pain-free socket and hopes to have the device on the market within a couple of years.

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In the News

CSUDH Debuts Master of Science in Health Science, Orthotics, and Prosthetics The California State University (CSU) Chancellor’s Office has approved the master of science in health science, orthotics, and prosthetics option at California State University Dominguez Hills (CSUDH). Classes will begin in June.

This degree option is a 22-month program offering clinically focused instruction with extensive laboratory experience.

Students will be seated for courses during the fall and spring semesters. During summer semesters, students will gain clinical experience while attending distance-learning courses.

Students will complete 540 hours of supervised clinical work (clinical practicum) in preparation for their residency. The program culminates in a capstone project and practical clinical fittings of orthoses and prostheses.

For more information, visit www.csudh.edu/oandp.

transitions

People in the News

Orthocare Innovations has promoted two members of its management team to new leadership positions within the company.

David Adams has been named chief operating officer and Adam Arabian has been appointed director of product development.

Kwabena Boahen, PhD, associate professor of bioengineering at Stanford University School of Medicine, received a Transformative Research Project award from the National Institutes of Health.

Seventy-nine winners nationwide will receive a total of $143.8 million.

Jeff Cain, a member of the Amputee Coalition’s Board of Directors, has been chosen presidentelect of the American Academy of Family Physicians.

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O&P Almanac JANUARY 2012

O&P1, Waterloo, Iowa, has hired Sarah Clark as director of product development. Clark is the daughter of Dennis Clark, CPO, and granddaughter of Dale Clark, CP. Hanger Prosthetics & Orthotics, a division of Hanger Orthopedic Group, announced the following new practitioners: • Philip Brereton has joined the Reno/Carson City, Nevada, facility.

• David Egan has joined the South Sacramento, California, facility.

• Sarah Ewing has joined the Folson, California, facility.

• Brian Tolsma, CO, has joined the Hazel Crest, Illinois, facility.

• Other new hires include Richard Colvin, BOCP; Joyce Hess, C.Ped; and William Woslum, CO.

Kirk Simendinger, CP, has been hired by Bulow BioTech Prosthetics to lead its new clinic in San Antonio, Texas.

Terry Hall, CFo, CPOA, co-owner of Rehabilitation Technologies of Syracuse, New York, recently earned ABC-certification as a Certified Prosthetic-Orthotic Assistant.

The Orthotics and Prosthetics program at Eastern Michigan University announced its incoming class of 2013. Two second-year O&P students, Pamela DeKouchay and John Gross, received the Wyle G. Bonine Scholarship. Jeremy Murray, CO, a 2006 graduate of the program, was one of two recipients of the Distinguished Alumni Award for the School of Health Promotion and Human Performance.

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In the News

Study Finds Gamma Radiation Strengthens Prosthetic Joints Gamma radiation has the ability to strengthen prosthetic joints, giving them a longer lifetime and improving their mechanical properties, according to a study published in the International Journal of Biomedical Engineering and Technology. The research was conducted at the Changzhou Institute of Light Industry Technology in Changzhou, China, and was led by Maoquan Xue. The study tested the addition of ceramic particles and fibers to two experimental materials, ultra-highmolecular-weight polyethylene (UHMWPE) and polyether ether

transitions

The Department of Veterans Affairs dedicated a new Polytrauma Rehabilitation Center at the South Texas Veterans Health Care System in San Antonio. The $66 million inpatient/outpatient rehabilitation center will treat veterans and activeduty service members with multiple traumatic injuries.

O&P Almanac JANUARY 2012

point to the next, microscopic fractures had no way to spread throughout the material.

Whole-joint replacements are traditionally made of stainless steel, titanium alloys, or ceramics and coated with nonstick polymer or nylon to replace the damaged or diseased bone of the joint. However, these materials may produce debris as the body uses the joint, resulting in pain and inflammation. Xue’s research found that the treated UHMWPE and PEEK materials were stronger than polymer alone and would not produce problematic debris. a

BUSINESSES in the News

College Park’s iPecs (Intelligent Prosthetic Endo-Skeletal Component System) device has been named winner of the Electronics Category in NASA’s 2011 Create the Future Design Contest.

The iPecs is a medical research device that provides researchers with a tool to accurately measure human locomotion or gait parameters on users of lowerlimb prostheses.

12

ketone (PEEK), for coating prosthetic joints. Although both materials would crack and fracture when used as prosthetic cartilage materials on their own, Xue and his team demonstrated that adding ceramic particles and a blast of gamma radiation modified the structure of UHMWPE and PEEK and improved their mechanical properties.

According to the study, it is possible to break the main polymer chains without interfering with the overall structure of the artificial cartilage.

Because there were no longer stretches of polymer to carry force from one

Disabled Sports USA (DSUSA) hosted the 24th annual Hartford Ski Spectacular Dec. 4-11, 2011, at Beaver Run Resort and Breckenridge Ski Resort, Breckenridge, Colorado. The eight-day event, sponsored by The Hartford Financial Services Group Inc., founding partner of U.S. Paralympics, is the nation’s largest winter sports festival for individuals with physical disabilities.

Kootenai Prosthetics & Orthotics of Couer d’Alene, Idaho, purchased Valley Orthopedic and opened a new office in Spokane Valley, Washington.

Three practitioners were hired for the facility: Sunye Tafoya, LCO; Alexandra Gates, COLP; and Patrick Sullivan, C.Ped.

Össur Americas, Foothill Ranch, California; the Amputee Coalition; and Johns Hopkins University, Baltimore, Maryland, are collaborating to create a new, nationwide program to help prosthetists address the emotional needs of people with limb loss. Tools and training material will be trailed in 2012.

For the second year in a row WillowWood was recognized by Columbus Business First newspaper as one of the top 50 places to work in central Ohio. A team of WillowWood employees attended the November 9 luncheon and accepted the award on behalf of the company.

O&P Assistants

BE RECOGNIZED FOR YOUR TRAINING AND EXPERIENCE –

Become an ABC Certified Assistant!

If you are currently working as an orthotic or prosthetic assistant, now’s the time to gain recognition for your training and experience.

The future of the profession depends on your skills. Many O&P practices are looking for ways to deliver services more cost efficiently, ways that allows them to meet the challenges of today’s health care regulations while effectively meeting the needs of an increasing patient population. Your unique position may be the answer for many practices as they look to the future.

ABC’s Certified Assistant credential will be phasing in over the next two years — for 2012, the eligibility requirement is your experience in the profession. Take advantage of this window to become certified as an orthotic or prosthetic professional.

The American Board for Certification in Orthotics, Prosthetics & Pedorthics, Inc. 330 John Carlyle St., Suite 210 Alexandria, VA 22314 703-836-7114 :: 703-836-0838 (fax)

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Reimbursement Page

By Devon Bernard, AOPA government affairs department

Modifiers and Meanings Help for using those complex code modifiers when you’re filing Medicare claims

A

s if choosing the correct codes wasn’t confusing enough, you also have to choose the correct modifiers, which are a vital part of any claim. Modifiers provide valuable information to Medicare to assist in the proper processing and paying of your claims. But modifiers also can be the most confusing part of the claims process, and as a result, they often are overused or used improperly.

This month’s Reimbursement Page explains some of the more confusing modifiers.

Policy Criteria Modifiers The KX and CG modifiers indicate that you have met all policy requirements related to your claim and that any required documentation is on file in your records or available upon request.

The KX modifier must be added to all KO, AFO, and KAFO base and addition codes, plus diabetic shoes and inserts and orthopedic shoes attached to a brace. Specific use of

16

O&P Almanac JANUARY 2012

the KX modifier depends on the policy itself, as each policy may have different requirements for the use of the KX modifier.

For example, the KO policy states that if you use the KX modifier, all supporting documentation must be in your files. But in the Therapeutic Shoe policy, adding the KX modifier means that supporting documentation is available upon request. (In other words, it could be in your files or in the files of other health-care providers.)

The CG modifier is primarily used with LSO/TLSO codes, specifically codes L0450, L0454, L0625, and L0628.

Because these codes can describe items that are both flexible and elastic in nature. One that is flexible but not made of elastic materials needs the CG modifier to identify that the spinal orthosis meets the definition of a brace and is eligible for coverage. So, if a spinal orthosis described by codes L0450, L0454, L0625, or L0628 contains a rigid posterior panel, is primarily made of nonflexible materials such as

canvas or nylon, and is rigid or semirigid in construction (and therefore meets the definition of a brace), then the CG modifier must be added for your claim to be processed. But if the brace is flexible and elastic in nature (and not eligible for the CG modifier), you must code the item as an A4466.

Be sure to also use the CG modifier when providing a hand-finger orthosis described by code L3923. In the case of the L3923, the device must contain a rigid plastic or metal component if the CG is to be used.

A word of caution: You shouldn’t add the KX or CG modifier simply because you know it has to be on the claim for it to be paid. When you include these modifiers, you are attesting that everything required by policy is in place. If you do not have all required documentation in your files or have access to the information, or if all policy requirements have not been met, these modifiers should not be added, and you should expect the claim to be denied as not medically necessary.

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Reimbursement Page

Replacement Modifiers The modifiers RA and RB are used to indicate that an item or device is a replacement for one previously delivered. The RA modifier is defined as “replacement of a DMEPOS item” before the end of its useful lifetime; the RB modifier is defined as “replacement of part of a DMEPOS item furnished as part of a repair.”

If you are replacing an entire device, the base code and any additional codes that were used to describe the original device, the claim should be submitted with the RA modifier. For example, when replacing an AFO with limitedmotion joints, and the original is less than 5 years old, your claim lines might look like this: 1x L1970 KXRALT and 2x L2200 KXRALT. The KX modifier is added to indicate the replacement of the AFO is not due to wear and tear within the five-year useful lifetime, the item still meets the coverage criteria, and that you have all the required documentation on file to support the claim.

What if you have to replace just the joints on that AFO? Your claim might look like this: 2x L2200 KXRBLT. In this case, the joints are being replaced as part of an overall repair to the device. Because you are not replacing the entire AFO, you should use the RB modifier instead of the RA.

Functional-Level Modifiers Functional-level, or K-level, modifiers are used to provide information about patients and their potential ability to ambulate using a prosthesis. Patients are assigned a function level, from K0 to K4. K0 indicates that the patient does not have the potential to use a prosthesis; K4 indicates that the patient has the highest potential to use a prosthesis because of an extremely active lifestyle.

K-level modifiers are not required to be added to every line of a prosthetic claim; they are only required to be added to codes that describe prosthetic knees, ankles, and feet. The Lower Limb Prostheses Policy clearly outlines which components require K-level

18

O&P Almanac JANUARY 2012

modifiers and which level is assigned to each code.

Two additional codes also require a K-level modifier even though they do not describe prosthetic knees, ankles, or feet. These are the high-activity knee frame (L5930), which requires a K4 modifier, and the prosthetic hip code (L5961), which requires a K3 modifier.

Because the policy clearly states which codes require K-level modifiers and the K-level modifier associated with each code, where do confusion and misuse come into play? The answer is K-levels and bilateral amputees.

It’s in your best interest to be knowledgeable on all of these modifiers to ensure that your Medicare claims will be processed properly.

The policy states that “bilateral amputees often cannot be strictly bound by functional level classifications.” This doesn’t mean that K-level modifiers don’t apply to bilateral amputees and that bilateral amputees don’t have to be assigned a K-level.

It also doesn’t mean that bilateral amputees have no limits on the type of prosthesis they may receive.

Rather, the statement recognizes occasions when bilateral amputees need componentry that exceeds their assigned functional level. Bilateral amputees still must be assigned a functional level and given the appropriate componentry; however, if there is a well-documented clinical need for components that exceed a bilateral amputee’s functional level classification, the patient may receive components beyond his or her functional level.

ABN Modifiers The ABN is a specific form used as an advance notice to the patient before you provide a device or service that Medicare may deny the claim or part of the claim as not medically necessary. By signing the ABN, the patient agrees to assume financial liability for the code or codes in question if Medicare denies the claim.

The modifiers associated with the ABN include the GA, GZ, GY, and GK. Here are brief explanations of each: • GA modifier. This modifier informs Medicare that you expect the code(s) in question to be denied as not medically necessary, that you have informed the patient of this possibility, that the patient is willing to accept financial liability, and that you have a properly issued and signed copy of the ABN on file.

Use the ABN and the GA modifier only when you believe Medicare will deny the claim as not medically necessary and you have a properly issued ABN on file. Don’t have every single patient sign an ABN, and don’t submit every claim with the GA modifier.

• GZ modifier. What if you believe an item will be denied as not medically necessary and you didn’t have the patient sign an ABN, or the patient refused to sign it?

You can submit your claim with the GZ modifier, which indicates that you are aware that the item/ service you are providing may be denied as not medically necessary but don’t have a signed ABN on file. A claim submitted with the GZ will automatically be denied as not medically necessary; you may still appeal the denial, but the patient is not financially liable if the appeal is unsuccessful.

The ABN form may also be used to inform a patient that an item or service is not a covered benefit under Medicare. Keep in mind that while it is a good idea to use the ABN to notify a patient in writing that an item is not covered, it is not mandatory to do so.

• GY modifier. If you use the ABN to notify the patient that the item or service is not covered and the patient signs it, you shouldn’t submit the claim with the GA modifier. Instead, use the GY modifier to indicate that the code(s) you are submitting are statutorily excluded from Medicare coverage. (In other words, there is no Medicare benefit for the service. An example might be an elastic spinal brace.)

It is not mandatory to submit a claim to Medicare for a statutorily noncovered service unless the patient requests that you do so. Patients commonly ask you to submit such claims because they have secondary insurance that requires a Medicare denial before considering a claim. In this scenario, the claim should be submitted with a GY modifier, Medicare denies the claim as noncovered, and the subsequent EOB can then be forwarded to the secondary insurance for possible payment.

• GK modifier. The ABN also may be used to bill for an upgraded item or a deluxe feature, and pass the additional cost to the patient, and allow you to receive a partial payment from Medicare.

An upgraded item is one that goes beyond the scope of what is considered to be medically necessary for the patient; a deluxe feature is something that goes beyond the official descriptor of a code and doesn’t serve any medical benefit.

A combination of the GA or GZ and the GK modifiers are used to isolate the additional cost of the upgrade or deluxe feature, which may become the responsibility of the patient. The GK modifier means an item is reasonable and/or medically necessary and is only to be used in conjunction with the GA or GZ modifiers.

Here’s an example of billing for an upgrade: You believe the patient will benefit from a K3 foot, perhaps because of his or her body weight, but he or she is classified

as a functional level 2. In this case, the patient can choose to accept the upgrade to a K3 foot and pay the difference by signing the ABN. Both codes will be listed on the claim form, but the modifiers will tell Medicare that only one foot was provided and which foot should be paid for. As a result, the two claim lines would look something like this: 1x L5976 GAK3RT and 1x L5972 GKK2RT. Or let’s say the patient wants a knee brace but wants it to be a certain color. The two claim lines would look something like this: 1x L1845 GART and 1x L1845 GKKXRT. The first line is the code for the upgraded item or the item with the deluxe feature, with a GA modifier (if the ABN is signed) or a GZ modifier (if no ABN is signed). Line two is the code for the reasonable and necessary item or the item that meets coverage criteria, with the GK modifier.

When Medicare processes a claim submitted with this two-line billing method, you will be reimbursed on the item submitted on line two, and the item on line one will be denied. In essence, you will receive a partial payment. You may appeal the denial and attempt to collect the full amount from Medicare by showing the medical necessity of the item on line one, but if you are unsuccessful, you may collect the difference from the patient, if the patient signed an ABN. Confusing? Yes. Complicated? Yes. But it’s in your best interest to be knowledgeable on all of these modifiers to ensure that your Medicare claims will be processed properly. a

Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.

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JANUARY 2012 O&P Almanac

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Diabetes

H

in America H

What you need to know about the pandemic, patient education, amputation prevention, and the road to improved mobility

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O&P Almanac JANUARY 2012

COVER STORY

By ANYA MARTIN

H

H D

iabetes has skyrocketed in the past few decades to pandemic proportions. About 25.8 million Americans have diabetes, according to the Centers for Disease Control and Prevention (CDC), and an estimated 79 million Americans age 20 or older have prediabetes, a condition in which blood-glucose, or A1c, levels are higher than normal but not high enough to be classified as diabetes. Even more troubling, most of these prediabetics aren’t aware of their condition.

Diabetics inevitably develop foot problems due to neuropathy, poor circulation, and peripheral artery disease, making diabetes the nation’s leading cause (60 percent) of nontraumatic lower-limb amputations. The majority of diabetes-related hospital admissions—between 30 and 40 percent—are to have a foot removed.

Do the math, and O&P practitioners are increasingly finding themselves at the eye of a hurricane, working to help all those patients retain their mobility and quality of life—or even just survive. The five-year mortality rate for diabetics after a limb amputation is 68 percent, according to a 2011 study by German researchers. But by intervening early, assigning proper risk categories, and educating patients on caring for their feet or socket after amputation, O&P professionals can help ensure that more diabetics retain their limbs or get walking again with the help of a prosthesis.

Ballooning Epidemic It’s no secret why diabetes is on such a steep rise. Americans are living longer, but also have become heavier and less active than they were 20 years ago. More than 60 percent of obese Americans can expect to develop diabetes sometime during their lives, and obese 18-year-old men and women can expect to live 5.6 and 2.5 fewer years, respectively, before developing the disease.

With obesity rates up dramatically, more Americans also are developing diabetes at younger ages and are spending more years with the disease, according to an Emory University/ CDC/University of Colorado study published in the October 2011 issue of Diabetes Care. Type 2 diabetes accounts for 90 to 95 percent of all diabetes diagnosed in the United States, according to the CDC. Although type 2 was once known as adult-onset diabetes, a rise in obesity among children has meant even some highschool students now suffer from the disease.

JANUARY 2012 O&P Almanac

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“[These results] seem to suggest a different type of support that needs to be offered patients,” says lead researcher Solveig Cunningham, PhD, assistant professor at Emory’s Rollins School of Public Health. “This is a population that has other morbidities and other issues, such as mobility.”

Obese patients may require additional resources and prosthetics that can support a heavier body, she points out. A younger obese population with diabetes also means patients who are going to need treatment for a longer period of time.

Type 1 diabetes, which is caused by an immune system deficiency, generally starts in childhood and accounts for only about 5 percent of all U.S. diagnosed cases. What’s less reported, however, is that type 1 also is rising at the same speed over the same period of time as type 2, says Dan Hurley, author of Diabetes Rising: How a Rare Disease Became a Modern Pandemic and What to Do About It. The reasons for the rise in type 1 diabetes are unclear, though researchers have suggested possible contributing causes, including cow’s milk in baby formulas, lack of vitamin D, and environmental factors. But these children grow up and develop complications such as neuropathy, poor circulation, and infection or ulceration that can lead to amputation, making them another population future practitioners may see more of—and for longer periods of time.

Improving Outcomes Diabetes is not just an American problem but a global one, extending into nations suffering from serious malnutrition and starvation issues. The most conservative figures estimate 60

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O&P Almanac JANUARY 2012

Diabetes in America by the Numbers

Americans

Americans affected by diabetes

diagnosed

25.8 million (8.3%)

with diabetes

18.8 million Seniors (age 65+) with diabetes

Americans with

10.9 million (26.9%)

undiagnosed diabetes

7 million Estimated Americans (age 20+) with prediabetes

Americans (age 20+) diagnosed with diabetes in 2010

79 million (35%)

1.9 million

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Source: National Diabetes Fact Sheet 2011, CDC. million diabetics live in India, and 105 million live in the People’s Republic of China, says David G. Armstrong, DPM, MD, PhD, professor of surgery, and director of the Southern Arizona Limb Salvage Alliance (SALSA) at

the University of Arizona College of Medicine. In other words, practitioners who perform pro bono work abroad also will be encountering record numbers of patients with diabetesrelated problems.

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AFOs for the Diabetic Patient Because patients who have had diabetes for a long time also often have foot and ankle deformities, they can greatly benefit from an ankle-foot orthosis (AFO) specifically designed for the diabetic patient, says Jonathon Moore, DPM, MS, a managing partner at Cumberland Foot & Ankle Centers of Kentucky who collaborated with Arizona AFO Inc. to develop the Moore Balance Brace. When determining the style and design of an AFO for a diabetic patient, practitioners also should consider fall risk, which can be significantly higher than for Moore Balance Brace nondiabetic patients, says Moore.

He recommends the following tips for designing an effective AFO for a diabetic patient: Photo: www.moorebalancebrace.com

“Once infected, about 20 to 30 percent are going to have some level of amputation,” says Armstrong, who is also a spokesman for the American Diabetes Association (ADA). “Around the world, there’s an amputation every 20 seconds due to diabetes.”

At the main SALSA unit in Tucson, where Armstrong practices alongside a team that includes prosthetists, orthotists, and pedorthists, most of the 13,000 diabetic patients in the past year presented with a limbthreatening wound. Many of these patients controlled their blood-glucose levels, blood pressure, or lipids well.

But because they lost feeling in their extremities, they didn’t recognize ulceration or infection in a wound until it became severe, Armstrong says.

The SALSA team always tries to treat the wound without amputation.

But if amputation is necessary, the situation for the diabetic patient— especially elderly patients—becomes even more critical. “You hope that if you get people out of bed and into a good quality prosthetic, you can get them walking,” says Armstrong.

“The problem is that many people don’t have the strength—the upperbody functional reserve—to put the prosthetic on. Only 40 percent of diabetics are able to regularly wear a below-knee prosthetic. It’s even worse for an above-knee prosthetic. Only 10-15 percent of above-knee amputees walk out of bed.”

• Consider a full-length orthosis that accommodates plantar foot deformity.

• Be sure the orthosis can fit easily into a diabetic or depth shoe.

• Design the orthosis to reduce or preferably eliminate any areas that can cause rubbing, blistering, or irritation to the skin. (For example, line it with Plastazote foam or other cushioning materials.)

• Make the AFO easy to put on with Velcro, instead of laces, to accommodate obese and elderly patients.

• Design a brace that is lightweight and customized to the body habitus of the patient. In other words, for a 300-pound patient, materials need to be able to support someone that size as opposed to a 90-pound fragile senior.

• Keep in mind that when you restrict anklejoint range of motion too much with an AFO, you might decrease the patient’s balance and postural control. In some cases, the AFO needs to have a trim line that can accommodate normal sagittal plane motion.

How do you improve outcomes for diabetics with prostheses? One way is to educate the patient in self-inspection to identify and report subtle volume changes, so the prosthetist can adjust the fit of the prosthesis to accommodate those changes, suggests John Angelico, CP, FAAOP, and chairman of Chicago-based Scheck & Siress. The only proven way to control volume with a prosthetic device is to use a vacuum system, he adds.

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O&P Almanac JANUARY 2012

“We try to fit [diabetics] pretty much the same as any population of patients, depending on their activities,” says Angelico. “We don’t fit them more or less with more high-tech components. The biggest thing is education. The patient needs a little more time to understand how the prosthesis fits and what they need to look for to prevent breakdown.”

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Shifting to Prevention

At Scheck & Siress, more time can be spent on education because assistants are trained to deliver essential information. Both verbal and written instructions are given, and the educational process is customized according to the patient’s most effective learning method, whether by watching, hearing, or touching. Frequent follow-up and return visits also are crucial to ensure that patients understand important concepts, he adds.

“The vacuum socket is a nice design in that it’s been proven to reduce the amount of volume change throughout the day, but it’s a high maintenance system,” Angelico explains. “You have to have a patient who recognizes when subtle things go wrong and understands how to adjust the fit properly.

If not managed properly in a vacuum system, things can go very wrong.”

Angelico recently saw an abstract on a new socket design that accommodates volume changes, but he anticipates that such technology is still years away from market availability.

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O&P Almanac JANUARY 2012

Of course, the best way to prevent amputation is to prevent diabetes altogether. Numerous studies have shown that if someone with prediabetes loses weight and increases physical activity even by moderate levels, the onset of type 2 diabetes can be delayed or even turned back, with blood-glucose levels returning to normal. Previously, intervention programs to trigger that type of lifestyle change were thought to be very expensive, but a 2005 pilot study at an Indianapolis YMCA proved different. The program is being rolled out to YMCAs across the nation, as well as other stakeholders, under the supervision of the CDC’s National Diabetes Prevention Program (DPP).

O&P professionals can do their part by recommending these prevention programs to their patients with prediabetes and to family members of diabetics, who have been shown to have a higher risk of developing the disease, says Ann Albright, PhD, RD, and director of the CDC’s Division of Diabetes Translation, which oversees the National DPP. Some financial aid may be available for program participants who need it, she says. In addition, UnitedHealthcare has agreed to partner and cover the program, and, by the end of the year, two to three more insurers are likely to be on board.

“This is not just another weightloss program,” Albright says. “The difference is that it has one of the strongest bodies of long-term evidence backing it up. It’s directed at people who are at high risk for diabetes, which allows it be to be cost-effective and scalable.” (To find out if a YMCA DPP is available in your area, visit www. ymca.net/diabetes-prevention, or for general information on all programs, visit www.cdc.gov/diabetes/prevention.)

At the Somerset, Kentucky, office of Cumberland Foot & Ankle

Centers of Kentucky, Managing Partner Jonathan Moore, DPM, MS, is seeing some prediabetics who are already experiencing early signs of neuropathy.

The number of diabetics among the company’s patient population has risen sharply over the past two years— enough that the 11-office practice now markets and advertises itself as a “diabetic center of excellence” because of the technology, services, educational tools, and ancillary programs it offers, says Moore.

Studies have shown that comprehensive foot-care programs—which include risk assessment, foot-care education, preventive therapy, treatment of foot problems, and referral to specialists—can reduce amputation rates by 45 to 85 percent, according to the CDC. At Cumberland, practitioners take the critical extra step of performing a comprehensive diabetic foot examination on each new diabetic patient to determine risk for ulceration and amputation. Patients are then assigned a foot-risk classification based on such markers as presence or absence of peripheral artery disease (PAD), deformity, neuropathy, and history of pathology.

“Many times when an O&P professional gets a diabetic patient referral, they may not possess the right tools to assign that patient a risk category,” says Moore. “It is critical that providers be able to accurately assess risk in order to educate the patient and to apply the best product for that patient based upon their risk level.

This is where O&P professionals can really shine.”

Once Cumberland practitioners have assigned a risk level, they use a sophisticated and well-organized system to educate patients on how to care for their feet based on that assessment. All new diabetes patients receive a welcome packet that includes instructions on proper foot hygiene, exercise recommendations, advice on maintaining safe blood-sugar levels, and information on available diabetic footwear. If a patient presents with any vascular symptoms (such as pain,

cramping, or sores and ulcers that don’t heal), he or she is immediately referred for testing for PAD. “Patients with diabetes often have little to no feeling in their feet, and therefore they ignore serious problems and don’t seek help,” Moore says. “You need to tell patients that they have to use their eyes, not what they feel, as their guide.”

In the long run, the most powerful way to prevent ulcers and amputations is for practitioners who treat the diabetic foot to unite and collectively measure and compare the efficacy of orthotics, prosthetics, and other best practices.

Unfortunately, dynamic pressuremeasurement systems, an effective technology that can assess how well orthoses offload pressures for ulcer prevention, are prohibitively expensive for most O&P practices. Some insurers

don’t cover custom insoles at all, and Medicare reimbursement rates are only about $82 per pair, with an annual limit of three and one pair of depth-inlay or customized shows—insufficient to cover the cost of the expensive testing equipment.

SALSA researchers have just completed a major comparative effectiveness study on wound-healing treatments. Armstrong hopes that in the future, the high cost of diabetes— $174 billion total with $116 billion in direct medical costs in the United

States in 2007—will drive change.

He hopes the CMS, other federal funding agencies, and grant makers will support significant research that leads to mandated payment for dynamic pressure measurement, better wound treatment, and other strategies to help diabetics save limbs.

“Lower-extremity complications of diabetes encompass anywhere from 22 to 27 percent of the total direct costs of diabetes, so even a small amount of money funding this work can pay a major-league dividend in cost-savings,” Armstrong says. Of course, he adds, those dollar amounts translate most importantly to saved lives and higher quality of life for people with diabetes. a Anya Martin is a contributing writer to O&P Almanac. Reach her at anya99@ mindspring.com.

Breaking Up Is Hard To Do

Professional protection or unfair limitation?

Noncompete agreements are a sensitive SUBJECT

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O&P Almanac JANUARY 2012

By Deborah Conn

I

t’s like signing a prenup—just when you’re entering into what everyone hopes will be a rewarding and long-term relationship, fears of a breakup rear their ugly heads.

That’s how some O&P facility owners view the noncompetition agreement, or noncompete, a promise by employees not to engage in competitive activities within a specified area and time period should they leave the business. In every state but one, employers have the right to require employees to sign noncompete agreements, and the regulations vary by state, making it difficult to describe a standard.

(California bars the agreements except in very limited situations, such as partnerships or when someone is selling ownership interest in a company.)

As common as this practice is, it is a sensitive topic, and it’s not easy to find O&P facility owners willing to talk about it on the record. The real key to noncompetes is whether they can be enforced, and that question often cannot be answered without an expensive and time-consuming trip to court.

Some Strings Attached For employers, the best way to ensure that a noncompete is enforceable is to structure it as narrowly as possible, says Molly Malone Rezac, an attorney with Jones Vargas in Reno, Nevada.

Specify the least-restrictive constraints that will protect you, including the geographical area, time frame, and prohibited business activities.

“What type of competition would truly harm you?” she asks. “You need to determine the minimum restrictions that will protect your interests.

Also, target appropriate employees for noncompetes, people who have the knowledge or access that would require protection. A noncompete targeted to an employee is more likely to be

enforced than a noncompete given to every employee in the company.”

Some sort of consideration, or payment, for signing a noncompete can help enforceability as well. Although a job offer can serve as consideration, additional money or a promotion, particularly for existing employees, can strengthen a noncompete.

Nevertheless, there is no guarantee that a noncompete agreement will hold up in court, especially in today’s economic climate, notes Rezac. Would a court really want to tell people who are employed that they have to quit their jobs if they don’t really have to?

If an employee leaves the company and violates the terms of the noncompete, the owner must decide whether to pursue the matter in court.

If so, the court may issue a temporary restraining order against the employee and make a determination within 10 days or two weeks.

“It’s a time-intensive process,” says Rezac, “and as a result is very expensive.”

Parting Ways An O&P company’s position on noncompetes can relate to its size and structure, according to Ron Manganiello, CEO of New England Orthotic & Prosthetic Systems LLC. His business has 26 locations in Connecticut, Massachusetts, New York, and Rhode Island, and is the largest independent O&P patient-care provider in the country.

Nevertheless, Manganiello differentiates between New England O&P and a much larger company such as Hanger, for which he served as chairman and CEO from 1986 to 1996.

“For a very large company,” he says, “the philosophy is that it might spend a lot of money and time training people, giving them access to technology and proprietary information, and if they left, they might take it with them and give it for free to a competitor.”

Manganiello doesn’t disagree with this rationale, but says it can set the wrong tone for a smaller company.

“Smaller companies like ours are more

JANUARY 2012 O&P Almanac

29

nimble and can react to people leaving more quickly than a huge organization that has to have policies and procedures set in stone,” he says.

New England O&P Systems has a slightly unusual business model in which branch managers become partners, typically owning 20 percent of the branch.

“With those people, we do have a limited noncompete clause,” says Manganiello. “But only in the sense that if they want to get bought out after they’ve been vested, they have to agree not to compete.”

Other than for partners, though, Manganiello says he doesn’t believe in noncompetes. “I believe the days of

O&P Residents and Noncompetes Noncompetition agreements can be especially problematic for O&P residents, whose employment is a continuation of their education. They have no expectation that their jobs will continue beyond the one-year term of their residency.

The National Commission on Orthotic and Prosthetic Education (NCOPE) is philosophically opposed to noncompete agreements at any time during a residency, but the organization has no legal authority to prohibit them.

As noted in its published position statement, “There is no universal public policy reason against such an agreement. Residents are employees of, and receive salary and benefits from, their residency program. As employees, in most states they can be asked to sign valid noncompete agreements.”

“We try to educate residents before they accept a residency,” says Robin Seabrook, executive director of NCOPE. “And we try to have facilities tell residents in advance if they require a noncompete.

“I am aware of a situation where a resident signed the noncompete clause, completed the residency, and the facility did pursue it legally when the person tried to work for another company in the same area. In some states, a noncompete has more power than in others.”

Seabrook encourages residents to have a lawyer review any noncompetition clauses they are asked to sign. In addition, NCOPE is adding a question about the existence of such agreements on its facility residency application so that all parties understand any restrictions up front.

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O&P Almanac JANUARY 2012

indentured servitude are over. Frankly, we have hired several people over the years who have had noncompetes with other companies. Our experience has been that noncompetes don’t really hold up in most circumstances, at least in our states.

“If someone is unhappy working for us and they want to leave, they should leave,” he says. “People should work for a company that pays them well, treats them with respect and dignity, and provides opportunity for growth.

They shouldn’t stay because they are afraid of being sued over a noncompete.

“We haven’t had much turnover, so it hasn’t really been an issue. Maybe part of the reason is that we don’t insist on noncompetes.”

Lessons From the Exes A company with a similar business model is Scheck & Siress, based in Chicago. The company has 11 shareholders, all of whom are signed to noncompete agreements that prohibit them from soliciting former patients or referral sources and/or owning an O&P business within 18 miles of any Scheck & Siress office for a period of five years after leaving the firm.

“The idea is that these partners have full access to everything in the business,” explains Scheck & Siress President Michael Oros, CPO. “Because they’ve been integral to the development of our business, they know where our revenue comes from, our referral sources, things I don’t believe any one person should pick up and take elsewhere without consideration.”

Even so, when one shareholder left the company a few years ago and went to work for another facility less than 18 miles away, Scheck & Siress decided not to challenge the move.

“In this particular instance, it was a mutually beneficial decision for him to leave us,” says Oros. “He ended up working in an institutional environment and was not directly competing with us in most of our locations. Other than that, none of our shareholders has left with the intention of continuing to practice.”

The issue of noncompetes took a slightly different turn at Prosthetic and Orthotic Care Inc., based in St. Louis, Missouri. Co-owned by CEO Jim Weber and Clinical Director Jon Wilson, CPO, LPO, the company has two locations in Missouri and one in Fairview Heights, Illinois.

“When we started this business 10 years ago, we didn’t have noncompetes,” says Weber. “And then we had two of our practitioners incorporate their own O&P company six months before they even resigned from P&O Care. They located their facility six miles from our office. From a legal standpoint, there was not a lot we could do.”

That experience had an effect not only on Weber, but on everyone else in the company as well. “Our employees came to me and my partner and said they wanted noncompetes. They realized that these two practitioners were threatening everyone’s livelihood, not just ours. They said, ‘We need noncompetes to protect our interests as employees.’ Everyone in the company signed one.”

P&O Care’s noncompete agreement prohibits employees who leave from having ownership in any other O&P company while working for P&O Care and for one year after leaving the company. In addition, employees sign a nonsolicitation agreement that bars them from pursuing any referral sources or patients they treated within their last two years at the company. The agreement covers a 100-mile radius of P&O Care offices over a period of two years.

For Weber, the issue of noncompetes can be seen from two very different viewpoints. “It can carry a negative tone as soon as you say it,” he explains. “Mistrust is the first thing that comes to mind, and employees may think you’re limiting their freedom.

“But the truth is that noncompetes protect the assets of the company that provide a living for the employees as well as the owners,” Weber says. “We had to have a very negative experience to change the perspective of everyone in our company. These covenants in the agreements are commonly called ‘Restrictive Covenants.’

They should be called ‘Protective Covenants.’” a Deborah Conn is a contributing writer to O&P Almanac. Reach her at debconn@cox.net.

JANUARY 2012 O&P Almanac

31

n

AOPA Headlines AOPA WORKING FOR YOu

Let the Voyage Begin AOPA’s BOAT tool helps you navigate even the choppiest business waters

F

our years ago, AOPA launched the Business Optimization Analysis Tool—fondly known as the BOAT. The biggest users of this absolutely free AOPA member management tool are the more than 100 companies that regularly participate in the annual Operating Performance Survey and the biennial Compensation Survey and get their results through the BOAT website.

Now, something new has been added that turbo charges the BOAT, making it a must for every AOPA member. Having a Patient Satisfaction Survey (PSS) is now required for O&P facility accreditation. Having it done for you is a benefit from AOPA. To find out more about the survey,

32

O&P Almanac JANUARY 2012

go to www.AOPA-BOAT.com and select the patient survey button.

Create your own account; customize the survey template with special graphics and your logo; add or change questions; and you’re ready to go. Some general questions are set and cannot be changed or deleted without a special request because they facilitate “all industry” data comparisons.

The best thing about the new survey tool is that all you have to do is give your patients the link to the online survey. They complete and submit the survey, and the results are automatically tabulated for your company or location. The responses are also added to the all-industry

response database, so you can see how your patients are rating you compared with how all patients rate all O&P providers. If you choose an optional setting, the PSS will alert you to any neutral or negative survey responses. If patients provide contact information, which is optional, you can respond quickly to resolve their issues and create true patient satisfaction.

Patients without computer access can be given hard-copy surveys, too.

Their responses can be entered into the company’s BOAT patient-survey site by one of your staff members or, for a modest fee, by AOPA’s consultant, Industry Insights. All data collection is HIPPA compliant.

Take the Helm Not familiar with the BOAT? Go to AOPA’s home page, www.AOPAnet. org, and click on the BOAT icon. Enter the user name “testaopa” and the password “BOAT”. On the right side of the screen you’ll see the BOAT tutorial, a five-minute tour of all the management tools that will help you operate more efficiently and profitably.

Remember, all data shared on the BOAT are confidential and seen by no one except our consultants at Industry Insights, the firm that built and maintains the BOAT website for AOPA. The site provides four management tools, each of which has a special role to play in your decisionmaking process: 1. Financial management. AOPA members can measure their financial health using the Financial Management tool. Members who participate in the annual Operating Performance Survey year after year create their own historical data, which are measured against data from other members participating in the survey. This tool also can be used to create annual and monthly budgets, entering actual data as available to measure performance against budget targets.

Some members turn this task over to their accountants, who find it invaluable.

2. Compensation results. For those participating in the biennial Compensation Survey, this tool works in much the same way as the financial management tool. If you are not a survey participant, you can still activate the tool to find out how you measure up with your peer group on compensation and benefits.

3. Market and competitive analysis. Next go to this tool,

which is an ongoing record of how your local market is changing.

Because you can accumulate history up to five years, you can observe your current year and forecast five years out. You’ll be asked specific questions, the answers to which are generally available with a click of a mouse or using data you already have at your fingertips. This is a wonderful tool for helping you focus on your market’s potential and how you can best harness it.

4. Practice management. The final tool lets you conduct ongoing selfevaluations of your performance in five areas critical to the success of your business: billing and accounting, patient care, human resources, practice advancement, and marketing. You’ll be asked to rank your performance on a scale of 1 to 5, with 5 being best, on a number of elements related to each major performance area. A description of each element gives you guidance on what’s good and what’s bad performance.

Set Your Course Some O&P teaching institutions have used the BOAT in their classroom instruction, and some have made curriculum adjustments to include the five sections of the practice management tool. AOPA has made the BOAT available to students in each of these institutions to further their education about all aspects of facility management.

The PSS service alone can provide a big payoff for your AOPA membership investment. Having a simple-to-use, free, comparative measurement tool available 24/7 to help gauge your patient satisfaction is the best business-building tool you could possibly imagine.

So set your course, take your first voyage on the BOAT, and enjoy all the benefits. And remember, the Patient Satisfaction Survey is a free member benefit for AOPA members through the 2012 membership year. a Visit www.AOPA-BOAT.com for more information.

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AOPA Headlines

AOPA Announces 2012 FDA Compliance Workshop Join AOPA on February 24 at the Sheraton Inner Harbor in Baltimore for an exclusive one-day seminar examining the compliance policies required of the O&P industry by the U.S. Food and Drug Administration (FDA).

Regulatory compliance awareness is important because regulatory agencies are legally entitled to conduct unannounced inspections if they believe there are suitable grounds for doing so. Regulatory compliance training is needed, so your organization can comply with FDA regulations that apply to manufacturing and distributing practices; medical devices and device classification; and forms, fees, and contacts. Penalties—ranging from fines to product recall—are severe if your company is in noncompliance.

AOPA is offering this compliance training in the wake of reports from members of increased FDA security. A major interest is whether FDA good manufacturing practices

applies to O&P patient-care facilities, especially those with central fabrication companies.

Register online at https://aopa.wufoo.com/forms/2012-fdacompliance-workshop-baltimore/ or contact Steve Custer at scuster@AOPAnet.org with questions.

2012 National Assembly Call for Papers and Poster Presentations

AOPA Mastering Medicare: Essential Coding & Billing Techniques

AOPA has issued a call for papers and poster presentations for the 95th annual AOPA National Assembly, September 6-9 in Boston.

Practitioners interested in presenting should submit an abstract of their proposed clinical or business paper.

Poster presentations should be graphical displays of research findings or a case study in a poster format using photographs, diagrams, flowcharts, graphs, and any sample educational materials.

Presentations will be selected by the AOPA Assembly Program Committee, and selected presenters will receive a complimentary full-conference registration for the 2012 AOPA National Assembly.

Applications will be accepted until July 1. For more information, contact Tina Moran at tmoran@AOPAnet. org or 571/431-0808.

Join AOPA on February 5-7 at the Hyatt Regency Tampa in Tampa, Florida, for the first Billing and Coding Seminar of 2012. At this seminar, AOPA experts will provide the most 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 with AOPA experts and your colleagues and much more. Meant for both practitioners and office staff, this advanced, two-day event will feature break-out sessions for these two groups to ensure concentration on material appropriate to each group.

Basic material that was contained in our previous Coding and Billing Seminar programs have been converted into nine one-hour Web casts. Register for the Web casts on AOPA’s homepage, www.AOPAnet.org.

For more information, contact Devon Bernard at dbernard@aopanet.org or 571/431-0854.

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O&P Almanac JANUARY 2012

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AOPA Headlines

AOPA Accepting Membership Sales Proposals AOPA is proud to announce a Request for Proposals for collaboration in expanding the membership and sale of AOPA products, including publications and seminars.

Every organization should continually search for ways to develop and expand its membership base. AOPA’s current membership is approximately 900 companies and suppliers that operate 2,037 affiliated locations. Of those members, 750 are patient-care companies, and AOPA seeks to expand its patient-care membership to a minimum of 1,500 companies operating 3,000 affiliated locations.

Proposals should include the following: • specific products or services the submitter would market (Products and Services Catalogue available upon request) in addition to AOPA membership • proposed method(s) of marketing AOPA membership and products • expected commitment of submitter’s resources • expected commission rate on membership, products, and seminar sales • estimated time frame for activity, including sales goals for memberships, products, or seminars • expected support needed from AOPA, such as any AOPA staff responsibilities.

Submissions must comply with the following ground rules: • AOPA’s Board of Directors will consider proposals submitted at its regular meetings beginning in January 2012.

• Timing of submission is at the discretion of the submitter.

• Such arrangements will not be exclusive to any single party.

• AOPA’s Board will act on each proposal as soon as possible after submission.

• Action on any proposal will not preclude consideration of concurrent or subsequent proposals submitted.

• Action on any proposal is at the sole discretion of AOPA and not subject to external review. AOPA reserves the right to decline to accept any and all proposals or accept more than one proposal.

Submissions should be emailed to info@AOPAnet.org with a subject line “Growth Proposal.”

FEATURED NEW AOPA CAMPAIGN

AOPA Member-Get-A-Member Campaign TAKE 10% or MORE OFF Your 2012 Dues Every major membership organization in the world has found their current members to be their most successful growth partners.

And there has to be something in it for the current member!

GROWING FOR

THE FUTURE CLUB

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O&P Almanac JANUARY 2012

You, as an AOPA member, are invited to join our Growing for the Future Club. For each new member company you sign up who designates you as its recruiting member, AOPA will discount your current 2012 renewal by 10%. Get 10 new members and enjoy your 2012 AOPA benefits for free. The 10% discount per new member applies to company members signed up who pay the full 2012 dues of $1,745. For affiliates signed up at $305 each, AOPA will provide a credit of $30 against 2012 dues.

You may also use the earned discount as a credit when you purchase any AOPA product, service, or seminar.

Discover MORE HUGE BENEFITS—To enroll in the club and receive your Growing for the Future membership marketing kit, email scuster@AOPAnet.org and we’ll take it from there. You can help make it happen!

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Medial view of the knee in flexion demonstrates the greater elasticity of the anterior fabric to extend over the front of the knee. Paring it with the limited vertical stretch posterior fabric reduces the overall effort expended by the amputee to bend the knee and increases comfort.

Alps New Extreme Cushion Liner has limited vertical stretch to reduce movement of redundant tissue. Use appropriate for TT or TF Alps New EZ Flex Liner applications. (anterior view shown above) is available in 3mm or 6mm Uniform thicknesses. Eight sizes fit circumferences of 16 cm to 44 cm.

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AOPA Headlines

First of 2012 AOPA Audio Conferences Announced AOPA has confirmed the dates and topics for its 2012 audio conferences. These one-hour sessions come to you in the comfort of your office on the second Wednesday of each month at 1 pm ET. This series provides an outstanding opportunity for you and your staff to stay abreast of the latest topics in O&P, as well as gain clarification and ask questions on topics that you may not understand as fully as you would like.

Here is more information on upcoming conferences (a full list is available online at www.AOPAnet.org):

January 11: RAC Audits—What Are They and How to Prepare?

February 8: Resources for O&P Patient Care Facilities

March 14: AFO/KAFO Policy—What You Need To Know

Recovery Audit Contractor (RAC) audits have arrived and they are here to stay. The RACs 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, join AOPA on January 11 for expert advice about the RAC program, including how to prepare for a audit, attend the audio conference.

Have you ever wondered what resources are available to you when the AOPA offices are closed? Do you have trouble navigating the CMS website?

If you have ever faced these challenges, join AOPA on the February 8. This conference will provide you with the tools to help answer most of your O&P coding and billing questions, including how to quickly find information on the CMS website, how to use your DME MAC websites as a resource, and the type of information can be found on the PDAC website.

Obtaining Medicare reimbursement for AFOs and KAFOs can sometimes be a challenging and often frustrating experience. Join AOPA on March 14 for a Mastering Medicare Audio Conference that will focus on the nuances of AFO/KAFO LCD and Policy Articles to help you better understand the rules. Learn what documentation must exist in order to use the KX modifier on your claim, the coverage rules for AFOs with ambulatory and nonambulatory patients, and how to bill for repairs.

The cost to participate in any audio conference is always just $99 per line 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 an 80 percent.

Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.

Register online at https://aopa.wufoo.com/ forms/2011-telephone-audio-conferences/. Contact Steve Custer at scuster@AOPAnet.org or 571/431-0876 with registration questions.

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AOPA Applications

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

Active Mobility Upstate LLC 138 Crockett Street Spartanburg, SC 29303 864/541-0028 Fax: 864/541-0027 Category: Affiliate Parent Company: Carolina Orthotics & Prosthetics Inc., North Charleston, SC

Advanced Prosthetics Center 5955 S. Highway 16 Rapid City, SD 57701 605/721-0100 Category: Affiliate Parent Company: Advanced Prosthetics Center, Omaha, NE

Amputee Prosthetic Clinic

Sandberg Foot Health Center PC

1915 Palmyra Road Albany, GA 31701 229/436-0117 Fax: 229/436-0117 Category: Affiliate Parent Company: Amputee Prosthetic Clinic, Macon, GA

939 Emerald Avenue, Ste. 706 Knoxville, TN 37917 865/523-5655 Category: Patient Care Facility Mark D. Kirshner, CO, C.Ped

Beacon Prosthetics & Orthotics

15900 Preston Road Dallas, TX 75248 214/382-9720 Fax: 214/382-9721 Category: Affiliate Parent Company: Scott Sabolich Prosthetics & Research, Oklahoma City, OK

2704 Wooten Boulevard SW Wilson, NC 27893 252/291-5858 Fax: 252/291-5542 Category: Affiliate Parent Company: Beacon Prosthetics & Orthotics, Raleigh, NC

Beacon Prosthetics & Orthotics

Scott Sabolich Prosthetics & Research

South Georgia Orthopedic Resources

241 Freedom Way, Ste. 2 Jacksonville, NC 28544 910/219-1455 Fax: 910/219-1456 Category: Affiliate Parent Company: Beacon Prosthetics & Orthotics, Raleigh, NC

127 Enterprise Path, Ste. 403 Hiram, GA 30141 678/384-1921 Category: Affiliate Parent Company: South Georgia Orthopedic Resources, Tifton, GA

Beacon Prosthetics & Orthotics

Suncoast Brace & Limb Inc.

2800 Aston Drive Wilmington, NC 28412 910/399-4524 Fax: 910/399-4532 Category: Affiliate Parent Company: Beacon Prosthetics & Orthotics, Raleigh, NC

4020 State Road 674, Ste. 17 Sun City Center, FL 33573 813/633-7232 Fax: 941/798-3626 Category: Affiliate Parent Company: Suncoast Brace & Limb Inc., Bradenton, FL

Methodist Rehab Orthotics & Prosthetics

Suncoast Brace & Limb Inc.

804 1st Street Cleveland, MS 38732 601/936-8899 Category: Affiliate Parent Company: Methodist Rehab Orthotics & Prosthetics, Jackson, MS

Orthotic & Prosthetic Centers of St. Petersburg Inc. 3611 5th Avenue N. St. Petersburg, FL 33713 727/327-3332 Fax: 727/327-7304 Category: Patient Care Facility Paul Weott, CPO, LPO

301 S. Citrus Avenue Inverness, FL 33452 352/726-0111 Fax: 352/726-5153 Category: Affiliate Parent Company: Suncoast Brace & Limb Inc., Bradenton, FL

Wolfchase Limb & Brace LLC 367 Van Drive, Ste. B Jackson, TN 38305 731/660-5900 Fax: 731/660-5050 Category: Affiliate Parent Company: Wolfchase Limb & Brace LLC, Memphis, TN a JANUARY 2012 O&P Almanac

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Marketplace

Introducing KISS Replacement Kits. Available in beige or black These kits are designed to replace key components, without the need to purchase a distal base.

CMP32/A: Includes a Velcro-sewn placard, proximal nut and screw, proximal strap, and distal strap.

CMP31/A: Includes an adhesive-ready placard, proximal nut and screw, proximal strap, and distal strap.

For more information, contact KISS Technologies LLC at 410/663-KISS or visit www.kiss-suspension.com.

Friddle’s Hot Mill Gloves Friddle’s Hot Mill Gloves are rated for up to 450°F and come in various lengths and sizes.

These gloves make a great addition to any c-fab. Contact Friddle’s to order your pair today!

• Rated to 450°F • Standard and X-Long lengths • Men’s and women’s sizes.

For more information call 800/3692328, fax 800/369-1149, or visit www. friddles.com.

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O&P Almanac JANUARY 2012

New from Motion Control MC Wrist Rotator

• New MC Wrist Rotator (p/n 3010748) • Two new versions – both mount in forearm • Standard: use with ProControl2, U3, Utah Hybrid • ProWrist: use with microprocessorcontrolled TDs • 2x speed and torque of previous versions • New lamination collar—available in three sizes • In-hand version also available— built into MC Hand or ETD. For more information call 888/6962767, email info@UtahArm.com, or visit www.UtahArm.com.

WALK Knee with Sfx from PEL Supply Available from PEL Supply, the Hosmer Weight Activated Locking Knee (WALK) is a compact, durable option for patients requiring an extra degree of stability and performance. Independent friction and mechanical stance control adjustments make it easy to fine-tune this new knee to each patient’s individual needs.

Adding the Sfx provides adjustable

stance flexion and greater stability at heel strike. It increases balance during initial weight loading and adds a moderate amount of shock absorption for a smoother gait. Weighing just 241 g with a small build height of 3.34 in, the Sfx comes in three adjustable load levels for optimized function.

For more information on these and other innovative products from the Fillauer Companies, call 800/321-1264, fax 800/222-6176, or email customerservice@pelsupply.com.

The NEW Balance Knee by Össur: The Perfect Balance of Safety and Stability for K2 Patients Balance Knee offers less active users a balance of stability and security, providing superior adjustability and durability accommodating all single-speed ambulators. The four-bar geometric design is easily adjusted, optimizing the required balance between stability and walking dynamics. Key features include: • Mid-swing shortening increases toe clearance, preventing hip hiking while reducing chances of tripping • Adjustments are quickly completed without taking off the distal tube • Adjustable extension assist ensures full knee extension (externally accessible) • Self-adjusting friction maintains constant friction, preventing terminal impact from building over time • Adjustable stance control balances. stability and swing initiation.

For more information, please call 800/233-6263 or visit www.ossur.com.

WillowWood Adapter Provides Adjustability Designed to provide clinicians versatility when creating a prosthesis, WillowWood’s Rotating Slide Adapter provides the adjustability to slide a foot either medial/lateral or anterior/posterior.

The rotating slide adapter provides up to a .5 in of slide capability and 360° rotation. The aluminum adapter has a stainless steel pyramid and a maximum weight limit of 250 lbs.

For heavy-duty applications, the Magnum Rotating Slide Adapter is available. This titanium adapter has the same features as the aluminum but carries a maximum weight limit of 350 lbs. The adapters have a one-year warranty.

For information, please call 800/8484930 or visit willowwoodco.com.

New Waterproof Prostheses from Otto Bock—Dive in.

Ottobock now offers a line of waterproof components! Designed specifically for use in the water, the Aqualine® waterproof prostheses provide waterproof protection for either below-knee or above-knee users.

The Aqualine components are perfect for use as a shower leg or for other water activities. The Aqualine accommodates users who weigh up to 330 lbs and includes specially modified adapters, pylons, and a tube clamp along with the waterproof knee and foot. Call your local sales representative to learn more at 800/328-4058.

WalkOn Fit Kits from Ottobock–Assess Your WalkOn Patient Anywhere.

At hospital, clinic, home or office—evaluate your drop-foot patients on the spot for a WalkOn AFO with either the 28T1N WalkOn Fit Kit or the 28T2 WalkOn Flex Fit Kit. Each kit comes in a handy carrying bag and contains four WalkOns (two small, L&R; two medium, L&R; plus four calf pads).

With the smaller footplates, there’s no need for grinding to get them into the shoe. Get an instant check of the WalkOn function—and then take the order for a fit.

Contact your local sales representative at 800/328-4058 to order your Fit Kits today. a

Expert Coding Advice 24/7

24/7

at www.LCodeSearch.com •

•

•

The O&P coding expertise you’ve come to rely on is now available whenver you need it.

Log on to LCodeSearch.com and get started today.

Match products to L codes and manufacturers—anywhere you connect to the Internet.

Contact Michael Chapman at 571/431-0843 or mchapman@AOPAnet.org.

This exclusive service is available only for AOPA members.

Not an AOPA member? GET CONNECTED

Manufacturers: Get your products in front of AOPA members!

Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811.

Visit AOPA at www.AOPAnet.org

JANUARY 2012 O&P Almanac

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Jobs

Increase exposure and save!

Place your classified ad in the O&P Almanac and online on the O&P Job Board at jobs.AOPAnet.org and save 5 percent on your order. BONUS! Online listings highlighted in yellow in the O&P Almanac.

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific Use our map to find which region you fit into!

Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate.

Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color

1/2 page, color

$482 $678 $634 $830

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org.

No orders or cancellations are taken by phone.

Ads may be faxed to 571/431-0899 or emailed to srybicki@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711.

Note: AOPA reserves the right to edit Job listings for space and style considerations.

Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge.

Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140 Save 5 percent on O&P Almanac classified rates by placing your ad in both the O&P Almanac and on the O&P Job Board, online at jobs.AOPAnet.org.

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O&P Almanac JANUARY 2012

Northeast Certified Orthotist/Certified Fitter Long Island/New York City We are a well-established practice offering an excellent opportunity for a driven person with a positive attitude. We offer benefits including 401(k), health, and profit sharing.

Send resume to:

O&P Ad 0611 C/O: The O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-8099

Certified Prosthetist/Orthotist, Certified Prosthetist, Board-Eligible/Certified Orthotist Southern Maine Do you want to be more than a number? We are a terrific, patient-oriented company looking for some awesome practitioners. Is this you? Our well-established, O&P facility is seeking self-motivated, energetic practitioners. Our Southern Maine locations are in close proximity to the coast and mountain region. Our comprehensive compensation package includes bonuses commensurate with productivity.

Learn more about joining our team of dedicated specialists by contacting:

O&P Ad 1111 C/O: The O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

Certified Prosthetist/Orthotist Nashua, New Hampshire We are expanding our business into the New Hampshire area and are looking for a dynamic individual with excellent communication and patient care skills who can provide competent, comprehensive care to our patients.

We can offer a very competitive salary/benefit package along with relocation assistance and signing bonus potential. Management skills would be a plus! Send resume to:

O&P Ad 1011 C/O: The O&P Almanac 330 John Carlyle St., Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

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Get Involved in Cutting Edge O&P Research

Researchers at the University of Washington are developing the Prosthetic Limb Users Survey (PLUS), a free tool to help clinicians and researchers measure prosthetic mobility.

We need clinical partners to help us recruit lower limb prosthetic users. We can provide free posters and take-home flyers for your clinic.

Help us to develop measurement tools to facilitate evidence-based care in O&P

Jobs

Northeast Certified Prosthetist Vermont Yankee Medical, providing orthotic and prosthetic services for more than 64 years, is looking for a certified prosthetist ready to relocate to Vermont.

With five locations in some of the most scenic areas of the country, Yankee Medical offers a lifestyle that attracts professionals. Send resume to:

Attn: President, Yankee Medical 276 North Avenue, Burlington, VT 05401 Email: jnf@yankeemedical.com

Patients who take our online survey will receive $25.

Contact info@mobilitysurvey.org

or call 1-800-504-0564 for more information.

AVAILABLE POSITIONS Orthotist Springdale, AR Tucson, AZ Frisco, CO Roswell, GA Indianpolis, IN Belleville, IL Quincy, IL Urbana, IL

Syracuse, NY Tahlequah, OK Hermitage, PA Philadelphia, PA Spartanburg / Union, SC Houston, TX Milwaukee, WI Parkersburg, WV

Prosthetist American Canyon / Fairfield, CA Jackson, MS

Oneonta, NY Waukesha, WI Bridgeport, WV

Prosthetist / Orthotist Denver, CO Hollywood, FL Naples, FL Tamarac, FL West Palm Beach, FL Griffin, GA Macon / Warner Robins, GA Baltimore, MD Brooklyn, NY

Long Island, NY Mayfield Heights, OH Tallmadge, OH Bend, OR Portland, OR Salem, OR Lancaster, PA Austin, TX San Antonio, TX

Certified Pedorthist Bangor, ME Portland, OR Roseburg, OR Pittsburgh, PA

Nashville, TN Tacoma / Renton, WA Huntington, WV

JANUARY 2012 O&P Almanac

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Jobs Inter-Mountain

Certified Orthotist or Certified Prosthetist (licensed or eligible) San Antonio, Texas Seventh-largest city in the U.S. and second-largest in Texas. San Antonio is home to five Fortune 500 companies; regional headquarters to other large companies such as Kohl’s, Nationwide Mutual Insurance, Chase Bank, Toyota, AT&T, QVC, and Lockheed Martin; Brook Army Medical Center; the Center for the Intrepid; the South Texas Medical Center; home to one of the largest military concentrations in the U.S. employing more than 89,000; San Antonio Spurs!

San Antonio is blessed with museums, Six Flags, Sea World, and Splashtown San Antonio. And we must mention the Tex-Mex cuisine at many fine restaurants. If you want more than a job and are ready to make a move, we would love to discuss your goals. We offer a very competitive salary and benefit package accompanied by relocation assistance and sign-on bonus potential…plus much more! We also have positions available in Houston and Austin! To apply for this position, please contact, in confidence:

Sharon King Hanger Prosthetics & Orthotics Inc. Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

Prosthetic/Orthotic Technician Arizona Established, independently owned company located in Central Arizona is looking to hire an experienced prosthetic/ orthotic technician. Applicant will be confident in skills and able to adjust techniques to client specifications. Growth and bonus opportunities are available. Please send resume with salary requirements to:

Northern Arizona Prosthetics Fax: 928/583-0505 Email: nap@nazprosthetics.com www.nazprosthetics.com

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O&P Almanac JANUARY 2012

Certified Orthotist, Certified Prosthetist/ Orthotist Tucson, Arizona Are you excited about coming to work every day? Excited about the improvements you can make in others’ lives? Want to be a part of a team that values education and professional advancement? Want to be part of a group that will change the field of orthotics and prosthetics? Do you want to be at a place where business is never usual? We are looking for energetic practitioners who possess great communication, organization, and patient-care skills in the following positions: CO or CPO. We offer a very competitive benefit and salary package, along with relocation assistance and the opportunity to work for a company that can provide security from being the oldest O&P patient care company in the world. If you have been looking for the good life and a great company to work for, visit www.hanger.com/careers.

Contact, in confidence:

Sharon King Hanger Prosthetics & Orthotics Inc. Phone: 512/777-3814 Fax: 512/777-3772 Email: Sking@hanger.com www.hanger.com/careers

North Central ABC-Certified Prosthetist/Orthotist St. Louis Area Privately owned, rapidly growing practice located in St. Louis, Missouri, has an opening for certified prosthetist/ orthotist. This is a great opportunity for someone looking to become part of a motivated successful team. We offer a competitive compensation package including health care, 401(k), and profit sharing.

Send resume to:

Premier Prosthetics and Orthotics Richard Doerr 633 Emerson Road St. Louis, MO 63141 Fax 314/743-3575 Email: Richard.Doerr@premierpando.com

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION

Business OpTimizATiOn AnAlysis TOOl (BOAT) AOPA’s largest and most successful members use the BOAT and you should also.

The BOAT will help you:

This AmAzing Profit Booster is FREE for AoPA MeMbers.

You will have access to your own secure and confidential account on the BOAT which will contain your company’s reported data and is specifically tailored to help O&P business owners manage their business for

•

Create budgets

•

Track your finances

•

Participate in the annual Operating Performance and Compensation survey (OPC)—which provides you with a personal benchmark comparison study

•

OPC data you submit will automatically populate your BOAT site providing valuable historical information

•

Provide access to the new AOPA Patient Satisfaction Survey (required by certifying bodies)

•

Examine the financial fitness of your business

•

Help you identify and understand your competition, market conditions and referral sources

•

Much more!

3

Enroll Today!

greATer prOfiT And quAliTy pATienT cAre.

If you do not already have a BOAT account, contact AOPA’s BOAT partner, Michael Becher, Industry Insights, (614)389-2100 x 114 or mbecher@industryinsights.com, to enroll today.

n

Jobs

London, England Senior Orthotist and Senior Prosthetist Queen Mary’s Hospital, Roehampton Opcare is looking to recruit an experienced Senior Orthotist and a Senior Prosthetist to join the world-class prosthetic and orthotic team at Queen Mary’s Hospital, Roehampton. Queen Mary’s Hospital is part of St. George’s Healthcare NHS Trust, which is one of the UK’s largest health-care organizations with an established national and international reputation for specialist care.

The successful applicants will join an established team of five orthotists and eight prosthetists providing in and outpatient services to a range of patients, some of whom have complex needs. The service covers paediatric, trauma and orthopaedic, complex neuromuscular, and diabetic clinics.

Both services are based in the Douglas Bader Rehabilitation Centre within a consultant-led multidisciplinary team including Prosthetics/Orthotics, Gait Laboratory, Podiatry, and Amputee Therapy services. The Centre also includes inpatient amputee services providing multidisciplinary rehabilitation to patients often with multiple amputations, as well as access to other clinical and diagnostic services to enhance patient care. The onsite workshop provides all manufacturing for orthotics, prosthetics, and special seating.

The service at Queen Mary’s is proactive in embracing new technologies, while also maintaining skills in traditional manufacturing techniques. The Centre also covers in- and outpatient clinics at St. Georges Hospital, Tooting.

This provides an ideal setting for enthusiastic clinicians with a vision to develop their career, clinical expertise, and interests in teaching and research.

Senior Orthotist This position ideally requires the successful applicant to have been practicing in a senior capacity for at least three to five years, treating patients with a variety of challenging needs within a busy clinic. This position will require autonomous working and contribution to service development, provision of professional input on orthosis design and use, and to take an active role in the day-to-day clinical activities including research projects and CPD.

Senior Prosthetist This position ideally requires the successful applicant to have been practicing in a senior capacity for at least five years, treating patients with a variety of challenging needs within a busy clinic. This position will also require the mentoring and development of graduate and junior prosthetists, provide professional input on prosthetic product usage, and to take an active role in the

46

O&P Almanac JANUARY 2012

day-to-day clinical activities including special projects and CPD. The successful applicant for each of the positions will need to have obtained a BS in prosthetics and orthotics or other suitable and appropriate qualifications, be registered with HPC, and ideally be a member of BAPO and or ISPO. The position is subject to enhanced CRB clearance and satisfactory references.

Opcare, part of the international health-care company Ability Technology Group, is the largest supplier of prosthetic services to the NHS in England. We aim to deliver a first-class service for users while applying the most advanced and exciting clinical and technical solutions available to patients. Through our investment in technology, we have developed cutting-edge facilities using the most advanced systems in the world for meeting patients’ needs, such as CADCAM, advanced biomechanical assessment, and gait analysis laboratories.

We offer a competitive salary together with inner London weighting allowance.

This position offers the right candidate a satisfying and challenging role. If you are interested in being considered, please see details below:

To apply, please email your CV with a cover letter to recruitment@abilitytechnologygroup.com.

For more details and additional vacancies, please see our website www.abilitytechnologygroup.com.

Mid-Atlantic Director, Clinical Services Rockville, Maryland The director clinical services is a certified clinician (CO, CP, or CPO) responsible for clinical and quality management programs including: Professional Review of Orthotic & Prosthetic Services (PROPS), Utilization Review Accreditation Commission (URAC) accreditation, quality management committees, and credentialing.

Directly reporting to the director, clinical services are PROPS program director, senior manager credentialing, and URAC coordinator. This individual is directly responsible for coordinating quality management program and meeting URAC accreditation requirements. Performs all duties of the chief case reviewer for PROPS. Works with direct reports to create and implement work flows to meet efficiency requirements, write standard operating procedures for all functions of responsibility, and support organizational goals.

Essential Functions: • Ensures policies, practices, and procedures comply with administrative, legal, and regulatory requirements • Participates in developing and implementing Linkia’s strategic direction for clinical operations and programs • Performs all duties of chief case reviewer—PROPS program clinical lead • Consults with all constituents (internal and external) as clinical expert • Oversees credentialing and compliance functions • Coordinates quality management program and documents—QI/UM/Credentialing Plan, QI, Indicators, QI Committees • Writes SOPs for all areas of responsibility as appropriate • Performs other duties as assigned.

Required Skills and Abilities: • Demonstrated ability to lead and manage through influence and change • Strong interpersonal skills emphasizing flexibility and diplomacy • Exceptional presentation and public speaking skills • Strong analytical and creative problem solving skills • Ability to prioritize and manage multi-task functions • Knowledge of Microsoft Office Suite • Demonstrate excellent time management, organization, prioritization, research, analytical, negotiation, communication (verbal and written), and interpersonal skills.

Required Credentials: • Five to ten years’ clinical experience as certified orthotist and/or prosthetist clinician (CO, CP, or CPO) • Education: BA/BS • Three to five years’ supervisory/management experience preferred.

If interested, please contact in confidence:

Jim Gillette Hanger Orthopedic Group Email: JGillette@hanger.com www.hanger.com/careers

CO or CPO Marshfield Clinic is one of the largest patient care, research and educational systems in the United States. The Marshfield Clinic’s Orthotic and Prosthetic department is dedicated to helping patients regain their active lifestyles and live life without limitations.

Our department offers the newest advancements in orthotic, prosthetic and pedorthic technology combined with friendly, highly skilled and experienced staff that is committed to the highest quality patient care.

Discover Marshfield, Wisconsin & enjoy:

• Low cost of living • Clean, safe environment • Short commutes with low traffic volume • Excellent educational opportunities for both you and your family • Recreational & cultural activities during all four seasons • Easy access to urban centers at Chicago, Madison, Milwaukee or Minneapolis/St. Paul • Competitive total compensation package

ABC Certified in Orthotics & Prosthetics and 3 years of experience required.

Experience in Pediatrics would be helpful.

Join us and see how your career can shine.

To apply, please visit:

www.marshfieldclinic.jobs Reference Job Number MC090202 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

JANUARY 2012 O&P Almanac

47

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■■

Calendar

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.

Member Nonmember Words Rate Rate 25 or less $40 $50 26-50 $50 $60 51+ $2.25 $3.00

per word per word Color Ad Special: 1/4 page Ad $482 1/2 page Ad $634

$678 $830

BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org.

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

For information on continuing education credits, contact the sponsor.

Questions?

Email srybicki@AOPAnet.org.

48

O&P Almanac JANUARY 2012

■■ YEAR-ROUND TESTING Multiple Choice Examinations.

BOC has year-round testing for Multiple Choice Examinations; candidates can apply and test when ready. Orthotist and prosthetist candidates can take the Clinical Simulation Examination in February, May, August, and November.

Applications are accepted any time, although seating is limited. For more information, visit www.bocusa.org or email cert@bocusa.org.

On-site Training Motion Control, Inc. On-site Training Course is focused on the expedited fitting of your first patient. Course Length: 3 days, CEUs: 19.5 hours (estimated). Recommended for: Prosthetists with a patient ready to be fit immediately.

For more information call 888/696-2767 or visit www.

UtahArm.com.

■■

2012 ■■ January 11 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 5–6 pm ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology. Presenter: Keith Smith, CO, LO, FAAOP. Call 800/220-6670 or register at www.ultraflexsystems.com.

■■ January 14 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 9–10 am ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length.

Presenter: Keith Smith, CO, LO, FAAOP. Call 800/2206670 or register at www. ultraflexsystems.com.

■■ January 26 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon–1 pm ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function. Presenter: Jim Rogers, CPO, FAAOP. Call 800/220-6670 or register at www.ultraflexsystems.com.

■■ january 17 WillowWood: Discover LimbLogic® VS via WebEx, 1:30 pm ET. Critical components and operation discussed. Covers interpreting feedback from fob and basic fabrication processes for system. Credits: 2.5 ABC/2.5 BOC. To register online, visit www.willowwoodco.com.

■■ JanuARy 31 Ultraflex: Adult UltraSafeStep® Continuing Education Course, via WebEx, Noon–1 pm ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology.

Presenter: Mark DeHarde.

Call 800/220-6670 or register at www.ultraflexsystems.com.

■■ january 18 WillowWood: LimbLogic® VS for Technicians via WebEx, 1:30 pm ET. Learn essentials of elevated vacuum socket fabrication using available socket adaptors with LimbLogic VS. Learn how to deal with airtight issues, unit operation, and diagnostics that will keep the system optimal for patient use.

Credits: 2.5 ABC/2.5 BOC. Visit www.willowwoodco.com.

January 24–26 WillowWood: OMEGA® Tracer® Training. Mt. Sterling, OH. This hands-on class covers both orthotic and prosthetic software tools, scanner applications and tasks, “by measurement” shape creation, advanced tool usage, and creating custom liners. Attendees work with patient models. Must be current OMEGA Tracer facility to attend. Credits: TBD. Visit www.willowwoodco.com.

■■ February 1 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 8–9 am ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology. Presenter: Keith Smith, CO, LO, FAAOP. Call 800/220-6670 or register at www.ultraflexsystems.com.

■■

■■ February 13–18 ABC: Certification Exams.

ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. The application deadline for these exams was December 1, 2011. Contact 703/836-7114, info@abcop.org, or www.abcop.org/certification.

HYNES CO NVENTI O N CENT ER , B O S T O N

Mark your calendar to attend the country’s largest, oldest, and essential meeting for orthotic, prosthetic, and pedorthic professionals.

S AV E T H E D AT E For information about the show, scan the QR code above with a code reader on your smartphone or simply visit www.AOPAnet.org.

The

e c a l P e!

To B

S P E A K E R S • E D U C AT I O N • E X H I B I T S • S P O N S O R S • N E T W O R K I N G

ate ★

e the D ★ Sav

*

SEPTEMBER

6-9, 2012

Join us at the AOPA 2012 National Assembly and NE Chapter combined meeting at the Hynes Convention Center in Boston. The Place to Be for learning, networking, and exhibits.

• • • • • •

Superior Clinical Education featuring the best speakers from around the world

• • •

Largest Display of O&P exhibits in the United States

Advanced Business Programs to ensure your success during uncertain economic times Practical Learning and live demonstrations Networking with an elite and influential group of O&P professionals Preparation for the massive changes that health care reform is sure to bring Learn the latest rules, regulations, and Medicare billing changes needed to serve your patients Earn more than 34 CE Credits Ideal Location in the heart of one of America’s most historic cities.

Four miles from Logan Airport and blocks from the financial district, Charles River, trendy Newbury Street, and Fenway Park.

Earn more than 34 CE credits!

Visit www.AOPAnet.org for updates on events and education.

JANUARY 2012 O&P Almanac

49

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Calendar Motion Control

SuperCourse SPRING 2012 February 22 – March 2, 2012

at Motion Control Headquarters, Salt Lake City, Utah • In-depth training of Utah Arm / U3+ / Hybrid / ProControl2.

• Hands-on experience with UI-software—bring your laptop.

• CEUs: 34 (estimated) awarded by ABC.

Overview of: NEW LI-Ion Battery for Utah Arm / U3+ / Hybrid NEW Electric Wrist Rotator NEW TRIAD Preamps Plus an overview of the NEW & EXCITING Motion Foot from Motion Control

The Spring 2012 SuperCourse is a 5-Day Course = $1,350.00 For more information or to register for the SuperCourse email: info@UtahArm.com

Motion Control, Inc. 115 N. Wright Brothers Dr. • Salt Lake City UT 84116 Phone: 801/326-3434 • FAX: 801/978-0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com

■■ February 16 WillowWood: LimbLogic® VS Applications Practitioners Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.25 ABC/7.75 BOC. Registration deadline is Jan. 26. Contact: 877/665-5443. Visit www. willowwoodco.com.

■■ february 16–18 PrimeFare West Regional Scientific Symposium 2012.

Salt Palace Convention Center, Salt Lake City. For more information, contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

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O&P Almanac JANUARY 2012

■■ February 17 WillowWood: LimbLogic® VS Applications Technicians Course. Mt. Sterling, OH. Learn all aspects of fabricating LimbLogic VS for various applications: socket materials, controller configurations and care, fob operation, troubleshooting.

Fabricate sockets following recommended techniques for airtight socket designs.

Credits: 9.75 ABC/9.75 BOC. Registration deadline is Jan. 26. Contact: 877/665-5443.

Visit www.willowwoodco.com.

■■ FEBRUARY 24 AOPA: FDA Compliance Workshop”. Sheraton Inner Harbor, Baltimore. For more information, see page 34.

■■ March 1 ABC: Application Deadline for Certification and Clinical Patient Management (CPM) Exams. Applications must be postmarked by March 1, 2012, for individuals seeking to take the May 2012 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians or summer CPM ABC exams for orthotists and prosthetists.

■■ March 9–10 Oklahoma Association for O&P Annual Meeting.

Best Western Saddleback Inn and Conference Center, Oklahoma City, OK. For more information, contact Jane Edwards at 888/388-5243 or jledwards88@att.net or visit www.okaop.org.

■■ march 21–24 38th Academy Annual Meeting & Scientific Symposium. Atlanta. Hilton Atlanta. Contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

April 17–18 AOPA Policy Forum.

Washington, DC. L’Enfant Plaza Hotel. To register, contact Stephen Custer at 571/432-0876 or scuster@ aopanet.org.

■■

■■ April 26–28 International AfricanAmerican Prosthetic Orthotic Coalition Annual Meeting.

Hyatt Regency Jacksonville Riverfront. Jacksonville, FL. For more information, contact Reginald Mays at jax@ unitedpando.com, call 904/4443970, or visit www.iaapoc.org.

■■ May 14–19 ABC: Certification Exams.

ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. The application deadline for these exams is March 1, 2012. Contact 703/836-7114, info@abcop.org, or www.abcop.org/certification.

■■ May 17–19 WAMOPA: Western and Midwestern Orthotic and Prosthetic Association.

Annual Meeting at Peppermill Hotel Reno, NV. Best CEU credit value available! Contact Steve Colwell 206/440-1811 or Sharon Gomez 530/521-4541 or visit www.wamopa.com.

■■ June 1 ABC: Certification Exam Application Deadline.

Applications must be postmarked by June 1, 2012, for individuals seeking to take the summer 2012 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters and orthotic and prosthetic technicians. Contact 703/8367114, info@abcop.org, or www.abcop.org/certification.

■■ June 1–2 ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg, FL. The application deadline for this exam is March 1, 2012. Contact 703/836-7114, info@abcop.org, or www.abcop.org/certification.

■■ June 4–6 LAOP: Annual Educational Conference. Hilton Riverside, New Orleans. Earn up to 13 credits in O, P, and Administrative tracts. Come enjoy summer family fun, unique city culture, cuisine and all that jazz. Contact Sharon at 504/464-5577,

laymansh@yahoo.com, or visit www.laop.org.

■■ June 8–9 ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg, FL. The application deadline for this exam is March 1, 2012. Contact 703/836-7114, info@abcop.org, or www.abcop.org/certification.

■■ june 15–16 PrimeFare East Regional Scientific Symposium 2012.

Nashville Convention Center, Nashville, TN. For more information, contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

n

■■ AUGUST (Date Pending) Mastering Medicare: Advanced Coding and Billing Techniques. Seattle.

To register, contact Steve Custer at 571/431-0876 or scuster@AOPAnet.org.

■■ September 6–9 AOPA National Assembly & NE Chapter Combined Meeting. Boston. Hynes Convention Center. The 2012 AOPA National Assembly will be held jointly with the NE Chapter Meeting.

Please plan to join us for this significant event.

Exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or

koneill@AOPAnet.org. To

register, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

2013 ■■ February 20–23 39th Academy Annual Meeting & Scientific Symposium. Orlando.

Caribe Royale Orlando.

Contact Diane Ragusa at 202/380-3663, x208 or dragusa@oandp.org.

■■ September 18–21 O&P World Congress.

Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/431-0876 or scuster@ aopanet.org. a

Ad Index

Company

Page

Phone

Website

ALPS

37

800/574-5426

www.easyliner.com

American Board for Certification in Orthotics, Prosthetics & Pedorthics

13

703/836-7114

www.abcop.org

Arizona AFO

7

877/780-8382

www.arizonaafo.com

Aspen Medical Products

23

800/295-2776

www.aspenmp.com

BOC International

25

877/776-2200

www.bocinternational.org

DAW Industries

1

800/252-2828

www.daw-usa.com

Dr. Comfort

5, C3

800/556-5572

www.drcomfortdpm.com

Ferrier Coupler Inc.

27

800/437-8597

www.ferrier.coupler.com

Fillauer Companies Inc.

11

800/251-6398

www.fillauercompanies.com

Friddle’s Orthopedic Appliances

17

800/369-2328

www.friddles.com

KISS Technologies LLC

35

410/663-5477

www.kiss-suspension.com

KNIT-RITE

2

800/821-3094

www.knitrite.com

Orthotic and Prosthetic Study and Review Guide

19

www.oandpstudyguide.com

OPTEC

14, 15

888/982-8181

www.optecusa.com

Ossur Americas Inc.

C4

800/233-6263

www.ossur.com

Otto Bock HealthCare

C2

800/328-4058

www.ottobockus.com

PEL Supply Company

9

800/321-1264

www.pelsupply.com

®

JANUARY 2012 O&P Almanac

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AOPA Answers

Special Circumstances Answers to your questions regarding out-of-the-ordinary products and services 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. A.

Are compression garments a covered Medicare benefit?

To answer this question, you have to look in an obscure place—the Medicare Surgical Dressing Policy. Typically, most compression garments are considered noncovered by Medicare, but there are a few compression garments that may be covered under certain circumstances. The Surgical Dressing Policy states that the following codes are eligible for coverage: • A6531—Gradient compression stocking, below knee, 30-40 mmhg each • A6532—Gradient compression stocking, below knee, 40-50 mmhg each • A6545—Gradient compression wrap, non-elastic, below knee, 30-50 mmhg each.

In order for these codes to be considered for coverage, they must be used for the treatment of an open venous stasis ulcer. The garments are not covered when they are used to treat lymphedema or used to prevent the occurrence of ulcers. If these codes are being used to treat an open venous stasis ulcer, you must attach the AW modifier to your claim. The AW modifier indicates that the compression garment is being used to treat an open venous stasis ulcer and is being used in conjunction with a surgical dressing.

Q. A. 52

O&P Almanac JANUARY 2012

Are helmets a covered benefit under Medicare?

No. Helmets are a statutorily noncovered service under the Medicare program.

Q.

Can the codes used to describe concentric adjustable torsion style mechanisms (L2861 and L3891) be used when billing Medicare?

A.

No. These codes have been deemed invalid for claims submitted to Medicare.

In addition, you cannot use L2999 or L3999 (not otherwise specified codes) to describe these joints, even if patients are provided with an orthosis.

The AFO/KAFO policy and the KO policy are very clear on the use of these codes. These policies state that if a device contains a concentric adjustable torsion style mechanism, the device may no longer be coded using an L code. The device must be coded using the DME codes E1810 (if the mechanism is used in the knee joint) or E1815 (if the mechanism is used in the ankle joint).The policy also states that any lines on a claim using an L code to describe these type of mechanisms, including a not otherwise specified code, will be rejected as incorrect coding.

Q. A.

Can an AFO be used solely to treat ulcers and be covered as a Medicare benefit?

Unfortunately, an AFO is not covered when it is solely being used to treat ulcers or offload the foot. For an AFO to be covered by Medicare, it must be used to treat an underlying orthopedic condition, or meet the definition of a brace (an item used to treat a weakened or deformed body member). If an AFO is solely being used to treat an ulcer, then it is no longer considered to be a brace; is no longer a covered benefit under Medicare; and must be coded as A9283 (foot pressure offloading/ supportive device, any type, each). a

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