March 2015 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

M AR C H 2015

Preventing Denials During Prepayment Reviews

O&P Almanac Leadership Series: Is Encroachment Inevitable? P.34

P.16

The Profession Calls: Participate in O&P Research P.20

News on the Medicare O&P Improvement Act of 2015 P.30

Bracing for

RESULTS WHY 19 PERCENT OF PATIENTS FITTED WITH OTS ORTHOSES SUBSEQUENTLY NEED CUSTOM DEVICES

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BUSINESS CE

CREDITS

WWW.AOPANET.ORG

P.18

YOUR CONNECTION TO

EVERYTHING O&P

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M U R O F Y C LI

MARCH 23-24, 2015 Special Extended Program March 24-25

Meet your Members of Congress in Washington, DC with AOPA!

The Policy Forum is your best opportunity to learn the latest legislative and regulatory details and how they will affect you, your business, and your patients. Once you are armed with the facts, we as a profession will educate our Members of Congress to offer common sense solutions and share how the O&P profession restores lives and puts people back to work. Your Congressional appointments will be organized by AOPA staff and lobbyists.

The 2015 AOPA Policy Forum will be held March 23-24, 2015 with post-conference events being held March 24-25 at the Renaissance Hotel in Washington, DC.

TENTATIVE SCHEDULE MONDAY March 23 12:45 – 4:40 PM •

Policy Forum General Session

Briefings and updates from Senators and Representatives, the AOPA lobbying team, and other experts on critical issues confronting the O&P community

4:45 – 5:45 PM

O&P PAC Fundraiser (optional event)

6:30 PM

Reception and Dinner (included)

TUESDAY March 24 7:30 AM

Breakfast and General Session

•

Review of Talking Points

•

Mock Congressional Visit

8:00 AM – 4:00 PM Congressional Visits Noon

Lunch

4:00 – 4:30 PM

Debriefing Session

OPTIONAL ADD-ON PROGRAM

Stay an extra day to participate in post-forum education modules and earn up to 10.5 CE Credits. These high-level executive meetings will provide the business information and Washington insider focus you need to continue to run your highly successful business. Location

TUESDAY March 24 5:00 – 8:00 PM

Extended Education (Module 1) with Dinner

A closer look at how Washington will impact your business. WEDNESDAY March 25 8:30 AM – 1:00 PM Extended Education (Module II) with Breakfast and Lunch

Special business and clinical education program— Coding, RAC, OTS Coding, Appealing to the ALJ and EDA Education Program Segments.

Registration Fees Policy Forum

$150

Module I

$200

Module II

$300

BIG VALUE EARN UP TO

10.5 CE

Make your plans now to attend the 2015 AOPA Policy Forum. American Orthotic & Prosthetic Association

www.AOPAnet.org

Discover our historic city and enjoy easy access to all the attractions of our nation’s capital from this ideal location. Walk to Congressional Office buildings, the Smithsonian and the National Mall, visit monuments and museums—all just minutes from this Capitol Hill hotel.

CREDITS!

Entire Program $575 (save $75!)

Support your profession!

Renaissance Hotel 999 Ninth St., NW Washington, DC

Registration is open.

Hotel Reservations The AOPA block of rooms at the Renaissance has sold out. Please call AOPA headquarters for assistance with reserving a room at 571/431-0876.

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MARCH 2015 | VOL. 64, NO. 3

FEATURES COVER STORY

DEPARTMENTS | COLUMNS President’s View....................................... 4

Insights from AOPA President Charles Dankmeyer, Jr., CPO

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 13

22 | Bracing for Results

Transitions in the profession

Why do 19 percent of Medicare beneficiaries who are fit with off-the-shelf orthoses subsequently require custom devices? Certified orthotists share their own experiences with such patients and explain how the health-care and reimbursement climates must change to prevent these occurrences going forward.

Are you guilty of any of the five most common denial reasons given during prepayment reviews?

By Christine Umbrell

20 | This Just In

Here’s Your Chance To Take Part in O&P Research AOPA has released several requests for proposals inviting O&P practitioners and those in related disciplines to submit proposals for grants of up to $60,000 to conduct research in select areas of clinical practice. Find out how to apply for funding before the April deadlines.

30 | Spreading the Word

Has poaching by noncertified O&P practitioners had an adverse effect on O&P businesses or patients in general? The O&P Almanac’s Leadership Series debuts this month, sharing insights and opinions from senior-level O&P business owners and managers on the topic of encroachment.

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

Amfit Sunshine Prosthetics & Orthotics

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

AOPA meetings, announcements, member benefits, and more

Welcome New Members .................. 47 Marketplace............................................. 48

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

By Adam Stone

Turf Wars

CE Opportunity to earn up to 2 CE credits by taking the online quiz.

CREDITS

P. 30

More than 100 O&P business owners, practitioners, and advocates are expected to arrive in Washington, D.C., this month to take part in AOPA’s 2015 Policy Forum. Participants will meet with legislators to lobby for provisions in the Medicare O&P Improvement Act of 2015 and explain their positions on competitive bidding, audit delays, and more.

34 | New: Leadership Series

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

Eradicating Error Rates

P. 34

Professional opportunities

Ad Index....................................................... 53

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

Upcoming meetings and events

Ask AOPA................................................... 56 Expert answers to your questions about acceptable signatures

O&P ALMANAC | MARCH 2015

PRESIDENT’S VIEW

When Competitors Become Collaborators

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

HEN YOU GET A lot of smart and talented people in a room, a lot of good things can happen. And that’s exactly what happened at the Futures Leadership Conference in Florida over the weekend of January 9-11. First, there was the happy problem: We had more than twice the anticipated attendance! The conference is one of only a few I have attended in recent years where we had open, collegial collaboration. It was as if the curtain of competition had been lifted and participants worked together to develop and explore how to function in the rapidly changing world of health care. Three very identifiable themes came from speaker after speaker and from the smaller discussion groups: data, data, data; value, value, value; and outcomes, outcomes, outcomes. We need data to prove our value, and identify our outcomes. You will recall the Dobson/Davanzo data mining of Medicare claims that identified, despite the initial cost of an ankle-foot orthosis (AFO), that treatment for those patients with the same diagnoses who were provided an AFO cost less overall than those who did not receive an AFO. Similarly, the data mining also demonstrated that 19 percent of those patients who received an off-the-shelf AFO, TLSO, or LSO also received a custom orthosis within a few months. This finding points to the potential conclusion that Medicare could have saved money for at least a portion of those 19 percent had those beneficiaries been provided a custom AFO to begin with. (For details on this topic, see this month’s cover story on page 22.) The AOPA Board of Directors met the week following the Futures Conference and voted to provide $280,000 to support new research to demonstrate the value of O&P services and to establish an O&P registry of patients. These are significantly important initiatives to secure O&P’s place in health care. One of the sessions at the Futures Conference covered the topic of “poaching,” a subject that also is featured in the new O&P Almanac Leadership Series article on page 34 of this issue. We all know the drill—the pharmacy gets all of the back supports, the therapeutic shoe fitters get all of the partial foot prostheses, the athletic trainers do all of the knee trauma bracing, and the physicians do all of the CAM walkers and have “closets” to dispense off-the-shelf and custom-fit orthoses. O&P professionals know that many of the devices dispensed through these outlets are marginally effective. A certified O&P professional should be making the decision on the appropriate device to meet the condition. Well, why is the O&P professional shut out? Were we too complacent? Were these nuisance devices we did not want to provide in the first place? Is it really poaching, or did we not see the changing delivery model? I’d like to hear your views on poaching, too. What do you think? Email info@AOPAnet.org. We’re working hard to introduce a new and revised version of the Medicare O&P Improvement Act in time for the March 23-24 AOPA Policy Forum (see the Policy Forum preview article on page 30). The legislation will include a fix for many of the issues you have dealt with these past four years, including distinguishing O&P from durable medical equipment; recognition of the orthotists’ and prosthetists’ notes; a voluntary settlement of delayed hearing claims for O&P as was done for the hospital industry; delaying recoupment until the appeals process is complete; and clarification of “minimal self-adjustment” by only the patient as defining OTS devices. This is important stuff. Only you can help bring it across the finish line. I hope to see you in Washington.

Charles H. Dankmeyer Jr., CPO AOPA President 4

MARCH 2015 | O&P ALMANAC

Board of Directors OFFICERS

President Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD President-Elect James Campbell, PhD, CO, FAAOP Becker Orthopedic Appliance Co., Troy, MI Vice President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Immediate Past President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis Inc., Rochester Hills, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Endolite, Miamisburg, OH Scott Schneider Ottobock, Austin, TX Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA

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AOPA CONTACTS

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

Publisher Thomas F. Fise, JD Editorial Management Content Communicators LLC

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

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide. These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org

MEMBERSHIP & MEETINGS Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0865

MARCH 2015 | O&P ALMANAC

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/662-5828, cumbrell@contentcommunicators.com

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email almanac@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2015 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise with Us! Reach out to AOPA’s membership and 15,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options!

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NUMBERS

Spinal Orthoses Shown To Save Money, Promote Independence Report finds that patients who received a spinal orthosis saved money for Medicare

STUDY PARAMETERS

Dobson-DaVanzo recently studied Medicare patients who received spinal orthoses over an 18-month period and found that those patients saved Medicare an average of $93 per patient compared to patients whose condition would have qualified them for a spinal orthosis, but who did not receive one. Findings were published in the report “Retrospective Cohort Study of the Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries,” available at www.MobilitySaves.com

MEDICAL COSTS

>50%

~75%

About three quarters of participants were Caucasian, with another 18 percent African-American.

More than half of all patients had an etiological diagnosis of spondylosis, invertebral disc disorders, or other back problems.

71 Years

Average patient age was 71 years old.

MORE INDEPENDENCE

$32,598 Patients who received spinal orthoses had higher utilization of physician and DME services.

$32,691

SPINAL ORTHOSES

Patients who would have qualified for a spinal orthosis but did not receive one cost Medicare $32,691 in episode payments for inpatient and outpatient therapy.

TOTAL SAVINGS

0.03%

Patients who received spinal orthoses saved Medicare 0.03 percent.

$93

Patients who received spinal orthoses saved Medicare $93. 8

MARCH 2015 | O&P ALMANAC

Patients who received spinal orthoses had lower utilization of skilled nursing and other inpatient facilities.

Cumulative Medicare Episode Payment by Cohort (18-Month Episodes From 2008-2010) $35,000

Average Cumulative Medicare Payments

Patients who received spinal orthoses cost Medicare $32,598 in episode payments for inpatient and outpatient therapy.

$30,000 $25,000 $20,000 $15,000 $10,000 $ 5,000 $

0 1

10 11 12 13 14 15 16 17 18

Months from Index Study Group

Comparison Group

Source: Dobson-DaVanzo analysis of custom cohort Standard Analytic Files (2007-2010) for Medicare beneficiaries who received O&P services from January 1, 2008 through June 30, 2009 (and matched comparisons), according to custom cohort database definition.

“...Patients who received spinal orthoses … used less facility-based care and appear more likely to have remained in the home and received home health care or outpatient visits than comparison group patients.” —“Retrospective Cohort Study of the Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries,” Dobson-DaVanzo

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INSURANCE INSIGHTS

More Americans Access Health Insurance The uninsured rate among adults in the United States for the fourth quarter of 2014 averaged 12.9 percent, which is a significant drop from the uninsured rate for the same period one year ago of 17.1 percent, according to Gallup. The increased number of insured adults is largely credited to the rise in Americans signing up for health insurance through federal and state exchanges. The uninsured rate has declined across all key demographic groups since the Affordable Care Act took effect, but it has decreased most significantly among blacks, Hispanics, and lower-income Americans. The largest majority of adults younger than 65 receive health insurance coverage through their employer. Sixteen percent of adults younger than 65 use Medicaid or Medicare for health insurance.

Type of Health Insurance Coverage in the U.S. Among 18- to 64-Year-Olds Employer

43.4%

Self-Paid Medicaid Medicare Military/Veterans Union Other Insurance

20.6% 8.6% 7.5% 4.7% 2.6% 4.1%

Source: Gallup-Healthways Well-Being Index

MARCH 2015 | O&P ALMANAC

Jurisdiction B DME MAC Reports Results of Prepayment Review of Spinal Orthoses National Government Services, who serves as the Jurisdiction B durable medical equipment Medicare Administrative Contractor (DME MAC), has reported the third quarter 2014 results of its ongoing widespread prepayment review of spinal orthoses described by codes L0450-L0640. Of the 553 claims reviewed, 532 were denied, resulting in an error rate of 96.2 percent. While the extremely high error rate is cause for concern, of even bigger concern is the report that many of the denials were due to the lack of a “detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary,” according to AOPA staff. This signals that the DME MACs are looking very closely at providers who are billing customfitted versions of orthoses that have a corresponding off-the-shelf (OTS) code available for use.

The report from Jurisdiction B follows a recent report from Jurisdiction D that reported error rates of 100 percent for knee orthoses described by L1832 and L1843 due, in part, to lack of documentation regarding “substantial modifications made for the custom fitted item being billed.” The DME MACs are now using the criteria outlined in policy necessary to justify claims for custom-fitted orthoses as grounds to deny claims, says AOPA staff. AOPA members are reminded that it is crucial to document the specific modifications that were made to an orthosis to achieve a custom fit and ask referral sources to document the medical need for a custom-fitted orthosis rather than an OTS orthosis. Questions regarding these recent audit results may be directed to Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.

IN THE KNOW

What’s Your Take? If you haven’t visited AOPA’s Take— AOPA’s new blog designed to deliver breaking news and commentary on issues that will impact your business—then you’re missing out on information of vital importance to the O&P community. AOPA’s Take is available at no charge, and subscribing is easy. Simply go to www.aopastake.org and click on the Subscribe button. Here’s a sample of recent postings: • DME MACs Clarify Proof of Delivery Requirements (February 12):

Did the DME MACs set up yet another hurdle to reimbursement for practitioners who are providing medically necessary O&P care to Medicare beneficiaries? • Super Bowl Inspiration (February 5): What was all the buzz about? Find out which two multibillion-dollar companies debuted commercials featuring prosthetic technologies during the Super Bowl. • And Much More: Visit www.aopastake.org.

HAPPENINGS

RESEARCH ROUNDUP

#ICYMI

Fewer PAD Patients Require Amputations Medicare patients with peripheral artery disease (PAD) experienced a 45 percent decrease in amputation rates over the 15-year period from 1996 to 2011, according to a study published in the January issue of JAMA Surgery. A research team from the vascular surgery section of Dartmouth-Hitchcock Medical Center analyzed Medicare claims to calculate lower-limb amputation rates. The team also reviewed data from Medicare surveys and the Behavioral Risk Factor Surveillance System to analyze smoking and diabetes trends. The researchers, led by Philip P. Goodney, MD, MS, determined that the lower-limb amputation rate fell by 45 percent, from 196 to 119 procedures per 100,000 patients. The researchers found that the decrease in amputations coincided

with increases in the rates of most peripheral vascular interventions, including angioplasty, stenting, atherectomy, and diagnostic lower-extremity angiographic procedures. While no evidence of cause was determined, “it is evident that the increasing use of vascular and preventive care, especially among patients with diabetes, has been temporally associated with lower rates of major amputation,” says Goodney.

CMS Announces Interest Rate Reduction CMS has announced that, effective Jan. 1, 2015, the Medicare interest rate for overpayments and underpayments has been updated to 10.5 percent. This represents a reduction of 0.25 percent since the last quarterly update in October of 2014.

Decreases in Lower-Limb Amputations Among PAD Patients Above-Knee Amputations

Below-Knee Amputations

48%

39%

Total Lower-Limb Amputations

45%

Study Focuses on Role of Cerebellum for Brain-Controlled Interfaces Researchers at the University of Missouri have studied the brain and determined that the cerebellum, a region of the brain that has changed very little over time, may play a critical role in helping people use visual cues to control their hands to reach for and manipulate objects. Findings could lead to advancements in assistive technologies benefiting people with disabilities. Led by Scott Frey, professor of psychological sciences in the College of Arts and Sciences and director of the Brain Imaging Center, the researchers asked participants complete a series of ordinary reaching and grasping tasks involving colored Scott Frey wooden blocks. Regions of the brain were monitored by functional magnetic resonance imaging. In a subsequent training session, participants were introduced to a robotic arm that performed the same reaching and grasping

tasks when they pressed specific buttons. Participants were told that the next day’s tasks would involve their controlling the robot remotely by video feed from within an MRI scanner. “We found evidence that the brain is very flexible and can be rapidly conditioned to associate new consequences with a variety of movements,” says Frey. “Pressing a button is a very simple act that does not naturally result in grasping. Nevertheless, after subjects learned that pressing one button would result in grasping objects with a robotic arm, this same movement resulted in a dramatically different pattern of brain activity than pressing an identical button known by them to have no effect on the robot’s behavior. Localized activity within the cauliflower-shaped cerebellum, or ‘small brain’ sitting toward the back of the head, increased dramatically. These findings suggests that we might look to the cerebellum when seeking potential targets for brain-controlled interfaces.” The full research study was published in the Journal of Cognitive Neuroscience. O&P ALMANAC | MARCH 2015

HAPPENINGS

INTERNATIONAL OUTREACH

Children in Developing Countries To Receive 3D-Printed Sockets

Hanger Hosts 2015 Education Fair Opening Ceremony. Hundreds of O&P profesRanging in age from sionals descended on five to 11, the particiLas Vegas in February to take part in Hanger Inc.’s pants were recipients 2015 Annual Education of the Hanger Kids Fair and National Meeting. Scholarship to Camp Held February 2-6 at the No Limits, a nonprofit Rio Hotel, the confercamp for children with limb loss or limb ence offered continuing difference to receive education, exhibits, education, mentorawards, and networking opportunities to more ship, and support. In than 850 attendees. 2014, Hanger donated A highlight of the $100,000 to establish Vernita Jefferson, the first person in the world to receive the new event was the debut of the scholarship. Triton smart ankle, with Hanger the Triton smart ankle, Hanger also unveiled Clinic Vice President of Prosthetics a microprocessora change to its peer Kevin Carroll, MS, CP, FAAOP. controlled prosthetic support program, ankle-foot, which was commercially fit now called AMPOWER. The program on two Hanger Clinic patients for the is designed to empower and strengthen first time on February 3. Additionally, those affected by amputation or limb Hanger’s Accelerated Care Plus busidifferences through peer mentorship, ness unit demonstrated a new dysphagia education, and community. In addisolution, a technology with a virtual tion, the company held its second reality component designed to improve annual Women in Leadership course, swallowing for dysphagia patients. which included presentations from In addition to clinicians, several O&P senior leaders and speakers whose patients attended the Education Fair, goal was to help women leaders at including eight pediatric amputees who Hanger connect and engage with one helped kick off the conference at the another and the company as a whole.

Hanger Clinic patients at the 2015 Hanger Education Fair & National Meeting. 12

MARCH 2015 | O&P ALMANAC

PHOTOS:Hangar Clinic

The Christian Blind Mission (cbm) Canada organization is leading a project to aid child amputees in developing countries by scanning and printing prosthetic sockets. The organization recently won a $90,000 grant from the Canadian government to fund the project. The team plans to leverage 3D printing technology to produce prostheses in developing countries for approximately $250 per device. Project leaders will scan a patient’s residual limb using a handheld infrared laser scanner, then use a software program to produce a digital 3D image to design a matching prosthetic socket. The project leaders will send the digital model to a 3D printer to print a socket using cornstarch-based plastic. The socket will connect to a patient’s residual limb, then the patient will be fit with a standard artificial limb provided by aid agencies. The project is in early stages: The cbm Canada team is currently teaching staff from the Comprehensive Rehabilitation Services for Uganda Hospital to use the technology, and is creating and testing sockets for four patients. The team will conduct clinical trials at the Uganda hospital over the next sevUganda eral months. The materials will be tested for durability before being more widely used.

MEETING MASHUP

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Becker Orthopedic has announced the hiring of several employees: • Beatrice M. Janka, MPO, CO, has been hired as both a product development engineer and a clinician for Becker’s patient-care division. • Karen King has joined the staff as the company’s art director. • Jopi Siirtola, PT, has been hired as international regional sales manager for Europe and Asia Pacific. • Greg T. Wahl is a new sales analyst for the company. The Board of Certification/ Accreditation has announced the 2015 Executive Committee of its www.bocusa.org Board of Directors. The following Executive Committee members have been elected to another one-year term in their respective roles: • James L. Hewlett, BOCO, DMEPOS consultant for ConsultantsPRN, educator and author for OandPEdu.com, has been chosen as chair. • R. Jeffrey Hedges, CDME, president of R. J. Hedges and Associates, has been elected as vice chair. • James Newberry Jr., BOCPO, BOCPD, LPO, owner/practitioner at Mahnke’s OrthoticsProsthetics Inc., has been named treasurer. Achilleas Dorotheou has been named to Freedom Innovations’ board of directors. He is vice president and head of the human motion and control business unit with Parker Hannifin Corp. Paralympic athlete Keith Gabel won the gold medal in the Snowboard X Adaptive event at the ESPN Winter Games in Aspen, Colorado, on January 23. Gabel’s time was 0:57.168. During the 2014 Sochi Paralympics, Gabel took home bronze in the para-snowboarding event.

Christa Kreuzburg has been named to Freedom Innovations’ board of directors. She has more than 20 years’ experience in the health-care and chemicals sector. Wayne Lawall, CPO, president of Lawall Prosthetic & Orthotic Services, has been awarded New Jersey Family Magazine’s “Favorite Kids Doc Award.” Lawall, who has been practicing O&P for more than 30 years, has a passion for servicing the pediatric population Wayne Lawall, CPO and individuals needing advanced technology solutions for their orthotic and prosthetic needs. He sees patients out of several Lawall offices in Pennsylvania and New Jersey, and services various hospitals and rehab centers throughout Central and North New Jersey.

Rod McCrimmon

Cali Solorio

Rod McCrimmon has been hired as director of marketing for Ottobock North America. He is responsible for the product marketing team managing prosthetics, orthotics, bracing, and mobility. Before joining Ottobock, McCrimmon worked at St. Jude Medical as director for integrated lab marketing. Cali Solorio has been hired as a marketing manager for Ottobock. Solorio’s focus in her new position includes supporting new product introductions and the orthopedic rehab business, as well as adding expertise to product lifecycle management. Solorio most recently worked as a senior marketing manager for Inova Labs.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics Inc. (ABC) and the National Commission on Orthotics and Prosthetics Education (NCOPE) have once again been awarded Category I recognition from the International Society for Prosthetics and Orthotics. The Category I recognition validates the ABC/NCOPE pathway for those individuals interested in obtaining their CPO designation.

PHOTO:Edwin Stee

Becker Orthopedic is consolidating the operations of Becker Oregon, in Albany, Oregon, with Becker Orthopedic’s main central fabrication services located in its Troy, Michigan, headquarters. The consolidation is being done to increase efficiency, to expand capacity, and to provide improved customer and technical support from a single, centrally located facility. O&P ALMANAC | MARCH 2015

PEOPLE & PLACES BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

The Board of Certification/ Accreditation (BOC) recently earned reaccreditation from the www.bocusa.org National Commission for Certifying Agencies (NCCA) for its pedorthist certification program for another five-year period. Approximately 275 professionals are currently certified as BOC pedorthists (BOCPDs). BOC first received NCCA accreditation for the BOCPD certification program in 2008. The Canadian Association for Prosthetics and Orthotics and the Canadian Board for Certification of Prosthetists and Orthotists have combined to form Orthotics Prosthetics Canada (OPC), effective Jan. 1, 2015. The organization’s mission is to protect the public and advance the profession of prosthetics and orthotics through quality standards of practice, professional credentialing, education, and awareness. Other primary roles for OPC include the establishment of standards for the profession and ensuring ethical conduct by its professionals. OPC plans to establish itself as a hub for information, news, and education about prosthetics and orthotics. The Dralla Foundation is seeking to make a bigger impact. Since forming in 2011, the foundation has awarded more than $100,000 in grants to organizations across the United States, funding events and programs that help adults and children with physical challenges have fun. The Dralla board seeks to fund a meaningful percentage of events and programs that align with its mission. The organization is able to provide grants thanks to a generous donation from Allard USA. Andy Berke, mayor of Chattanooga, Tennessee, issued a proclamation declaring Jan. 12, 2015, Fillauer Companies Day. The proclamation was made in honor and recognition of Fillauer Companies Inc. celebrating 100 years in business. The company was founded in September 1914 by George W. Fillauer Sr. The company opened as Red Cross Pharmacy on Third Street across from Erlanger Hospital in Chattanooga. In the late 1920s, Fillauer renamed itself Fillauer Surgical and started its orthotic and prosthetic divisions. New England Orthotic and Prosthetic Systems (NEOPS) has launched a campaign to raise awareness of women during March, which is Women’s Awareness Month. Samantha Alder, the company’s director of marketing, 14

MARCH 2015 | O&P ALMANAC

is spearheading a social media campaign highlighting women’s history throughout the years, gender inequality, salary inequality, and other issues affecting women in O&P. Though women traditionally have comprised a smaller segment of the O&P profession than their male counterpoints, NEOPS has a high number of female employees. In addition, NEOPS will release a video made by Ottobock featuring Kristin, a NEOPS patient who is a lower-limb amputee and single mom. Visit NEOPS’s website or hashtags #NEOPS, #Equality, and #Women for more information. Össur and Myomo, a manufacturer of myoelectric orthoses, have signed an agreement to sell Myomo’s patented MyoPro orthosis technology in the United States. The MyoPro is a custom orthosis that is designed to help support and restore function for people who have a paralyzed arm. Ottobock has named Carlos Gonzalez of San Francisco as the $1,000 Grand Prize winner of the C-Leg Heroes 15-year Anniversary Photo Contest. Gonzalez’s winning photo submission shows him performing a martial arts move, a sport he took up following his amputation and one that has gone far in helping to rebuild his confidence and self-esteem. Gonzalez’s amputation was the result of a series of complications from a stray bullet gunshot wound, and he experienced a long healing process. “It wasn’t until I was fit with the new C-Leg in 2012 at the Orthotic and Prosthetic Center at UCSF Orthopaedic Institute that I finally felt I had what I needed to be able to really move forward in regaining my mobility and trying new activities. It’s been life-changing in so many ways,” said Gonzalez. The photo contest was implemented by Ottobock as part of the celebration taking place to mark the arrival of the C-Leg in the United States in 1999. The contest asked users of the C-Leg or another prosthetic product to submit photos or videos showing how it has changed their lives. Weekly winners received a C-Leg Heroes T-shirt, and the monthly overall prize winners were awarded an iPad or equivalent gift certificate.

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REIMBURSEMENT PAGE

By DEVON BERNARD

Eradicating Error Rates Follow five tips to prevent claim denials during prepayment reviews

Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

E! QU IZ M EARN

BUSINESS CE

CREDITS P.18

Y NOW EVERYONE IS aware of the

Medicare prepayment probe reviews and widespread prepayment reviews being conducted by the durable medical equipment Medicare Administrative Contractors (DME MACs). Currently the DME MACs are reporting high error/ claim denial rates, as high as 100 percent in some jurisdictions. With such high error rates, it may be easy to point the finger and assume all of the denials are the result of nontraditional O&P suppliers and providers, but we cannot make this blanket assumption for all cases—especially when there continue to be high error/denial rates, and the denial reasons are consistent. Some of the reasons for the error rates may be beyond your control, but there are some factors you can control—or, at least, influence. Below are five of the most common denial reasons as reported by the DME MACs with extremely high claim denial/error rate, along with suggestions for how you can control or influence them to lower the overall claim denial/error rates.

The physician’s records did not provide detailed documentation to support the medical necessity of a custom orthosis.

This type of physician documentation is not a new requirement. However, it is the hardest denial reason to address because what a physician puts in his or her records is out of your control. But it is not out of your influence. It is acceptable for you to work with and educate your referral sources about 16

MARCH 2015 | O&P ALMANAC

the type of information that must be in the patient’s record. This education can be carried out through direct interactions between you and the referral source, or you may provide them with copies of the policies and/or the Medicare physician documentation letters. You also may sit down with the physician in a documentation collaboration session and guide him or her, as long as the physician is writing or dictating his or her own notes. It also is acceptable for the physician to amend his or her notes as long as the physician is building upon information already present in the medical record and he or she is following the guidelines established in the Medicare Program Integrity Manual. You may want to enlist the help of other providers when it comes to determining and supporting the medical necessity of a custom orthosis because the policies and other Medicare documents clearly state: “It is expected that the beneficiary’s medical records will reflect the need for the care provided. The beneficiary’s medical records include the physician’s office records, hospital records, nursing home records, home health agency records, records from other healthcare professionals, and test reports.” For example, if the physician has made a vague statement about the need for a custom orthosis in the notes, and he or she signed a prescription for a custom orthosis, and you have detailed notes from a therapist or another physician specialist, then you could use those notes to augment or corroborate the physician’s existing notes to demonstrate the medical necessity.

REIMBURSEMENT PAGE

Documentation is insufficient to support that substantial modifications were made for the custom-fitted item billed.

Based on this denial reason it is clear that the DME MACs are now looking very closely at the billings of customfitted orthoses that have a corresponding off-the-shelf (OTS) version available, such as L1832 and L1833. According to policy, there is not a difference in the function or design of the OTS version and the custom-fit version of a particular orthosis; the difference in the item comes in the amount of modifications required to fit it to a particular patient. In other words, the difference is that a custom-fit item has been substantially trimmed, bent, molded, assembled, or otherwise modified by a person with expertise to fit one specific patient only.

Be sure you understand how the split codes work, and ensure there is detailed documentation that justifies the code you selected.

L1833

L1832

With these guidelines, as they are published in policy, documenting just the why (medical necessity) is no longer sufficient for these split codes; you also must document the what (modifications)—or, more importantly, the specific modifications that were made to an orthosis to achieve a custom fit. When documenting your modifications, it is important to demonstrate

that the modifications go beyond basic cutting and bending and that they were more substantial. Be sure to document exactly what was modified—for example, how much of the orthosis was trimmed or bent and where these modifications were made—and be sure to account for the time it took to achieve each modification and what tools were used for each modification. It also will be key to document any last-minute modifications that must be made at the time of the final fitting and delivery. Finally, be sure to document who exactly did all of the modifications. Until everyone is accustomed to the presence and proper use of these split codes, the documentation in your records that justifies the code selected will be a target for audits and reviews. Be sure you understand how the split codes work, and ensure there is detailed documentation that justifies the code you selected.

No documentation was received in response to an ADR.

The probe/widespread prepayment reviews require you to respond to an additional documentation request (ADR) within 45 days of the date listed on the ADR letter (not the date you receive the letter). Not responding to an ADR letter is an automatic denial and could lead to other problems; for example, the DME MAC could report you to the National Supplier Clearinghouse (NSC) for a violation of the Supplier Standards—Standard 28 in particular— which could lead to the deactivation of your Medicare supplier number. There are a few things you may do to ensure that you are receiving and responding to all ADR requests in the allotted amount of time. First, check your correspondence address, as listed on your Medicare application, and make sure it matches your existing location’s address. If the addresses don’t match, update the address with Medicare. Also, if you have multiple locations, including offices you may not use or visit on a routine basis, make sure those addresses are correct as well.

You also may consider changing the Medicare correspondence address, Section 4 of the 855-S form, for those offices to be the address of your main office so all Medicare letters go to one central location. Once all of the addresses have been updated and verified, put protocols in place defining who is responsible for opening, sorting, and delivering the mail. This person should be able to identify the ADR requests and should know who is in charge of handling the ADR requests. Also, make sure there is at least one person in charge of collecting the information requested by the ADR and responding to the ADR; this will eliminate any duplicate work and ensure that the ADR is not forgotten.

Proof of delivery is invalid or missing.

The proof of delivery (POD) is completely within your control. If you include the five key elements laid out by Medicare, there is no reason for you to fail a review based on an invalid POD. A valid POD must include the following: • Patient’s name • Delivery address • Description of the item(s) being delivered, including quantities • Date the item(s) were delivered • Patient’s signature and date signed Three elements tend to cause the most issues or confusion: delivery address, description of the items, and the patient’s signature/date. O&P ALMANAC | MARCH 2015

The delivery address listed on the POD must be the physical address of where the items/services were delivered. For example, if you deliver an item/service in your office, then you should use your office address as the delivery address. If, however, you deliver an item in a physician’s office, then you must list the physician’s office address as the delivery address. With the description of the items being provided, it is best to remember the audience for whom you are writing the delivery slip: the patient first and then an auditor second. Thus, the POD should be in simple, everyday language; the patient must be able to look at the delivery slip and the item/service he or she is receiving and say, “Yep. That is what I got.” The auditor should be able to look at the POD and the claim form and say, “Yep. That was what was billed.” With a prefabricated item, the best way to describe the item(s) being delivered is to simply include the manufacturer’s name, the brand name, and the serial/ model number. If the item is custom fabricated, you may include a narrative description, but do not simply list the L codes and their descriptors. Remember to use everyday layman’s terms. (On February 12, 2015, the DME MACs released a joint announcement that discussed the proper format for PODs. They stated that a list of HCPCS codes and their descriptors alone on the POD is not acceptable. The sudden shift in policy appears to be inconsistent with other CMS publications and guidelines. AOPA is currently communicating its concerns and seeking clarification regarding this policy change with the DME MACs and CMS.) Finally, consider the patient’s signature and the date he or she signed the 18

MARCH 2015 | O&P ALMANAC

POD—the delivery date. It is assumed that the patient must physically date the POD, but this is not the case. The date of delivery may be entered by the patient or his or her representative, or by you, the supplier. If you preprint your delivery slips and they include the date of delivery on them, this is acceptable. Just be sure that the date entered on your POD is the actual date of delivery or the date the patient receives the item/service. If your POD has a date entered by you and a date entered by the beneficiary, the beneficiary-entered date is considered to be the delivery date and thus the date of service.

Detailed written order/ prescription is invalid or missing.

“Someone other than the ordering physician may produce the detailed written order (DWO).” This simple statement form policy provides you with total control over the validity of a DWO. You may create the DWO and simply have the ordering provider (physician, nurse practitioner, physician assistant, etc.) sign it, and if you include the following five key elements of a DWO laid out by Medicare, there is no reason for a denial based on an invalid DWO: • Name of patient • Name of ordering physician/ provider • Date of the order; this may require you to include two separate dates (the date you were contacted by the ordering provider and the date you started treating the patient, if different) • Detailed description of the items/ services you are providing, including quantities provided and any

supplies that may be replaced on a regular basis (this description may be accomplished in one of three ways: by listing the name, manufacturer, and model number of the item(s) you are providing; by providing a narrative description of the item(s); or by listing all of the items’ Health Care Common Procedure Coding System codes and their descriptors) • Ordering provider’s signature and date (for information on Medicare signature requirements, see Ask AOPA on page 56) When looking at these common reasons for denials, you may be tempted to throw up your arms and ask, “Why bother?” But try not to get overwhelmed and discouraged. Remember that when the reviews for lower-limb prostheses started a few years ago, there was an error rate of nearly 100 percent, but those have dropped off; now they are as low as 34 percent. Members of the O&P profession are capable of learning from previous errors and adjusting to what is required. Focus on these common errors and adapt; hopefully, you will pass future prepayment reviews with ease. And remember to track and record the results of all of your DME MAC prepayment reviews; if you can show that your error rate is well below the average and you demonstrate consistent compliance with Medicare policy, then you may petition to be removed from the prepayment review lists. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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This Just In DEADLINES APRIL 1 and APRIL 30

Here’s Your Chance To Take Part in O&P Research AOPA releases RFPs for clinical research support in diverse areas of O&P study

N FEBRUARY, AOPA ANNOUNCED

requests for grant proposals in several potential areas of O&P research, including an open topic. For 2015-2016, the association is seeking proposals for one-time grants in amounts up to $60,000 each for one year. The leadership of AOPA, working in conjunction with the Center for Orthotic and Prosthetic Learning and Outcomes/EvidenceBased Practice (COPL) and its board of directors (comprised of representatives from eight leading O&P organizations), recognizes that there currently is a modest amount of original evidence-based or outcomes research in orthotics and prosthetics. Consequently, the AOPA Board of Directors voted at its January meeting to fund original pilot research that will lead to larger trials that may qualify for government or other research funding support.

Covering All of the Bases

AOPA has published several different requests for proposals, with grants ranging in size from up to $15,000 to up to $60,000, and possibly higher amounts. AOPA is seeking individuals or teams to submit proposals to research specific O&P-related subject areas, including the following: Comparative Effectiveness Studies (Jointly Funded—Dollar Amount Open): • Prosthetic Feet, Emphasis on Lower Function • Off-the-Shelf (OTS) Versus Custom-Fit and Custom-Made Ankle-Foot Orthoses • Systematic Reviews (Up to $60,000 Each) • Cost Efficacy for Transtibial Interventions • Adolescent Idiopathic Scoliosis • Alternate Assessment Tools or Category Systems—Candidacy for Prosthetic Technology • Partial Foot in the Diabetic Population: Is Transtibial Amputation a Better and More Viable Option? Small Pilot Grant Topics (Maximum of Four Can Be Funded, Up to $15,000 Each) • Microprocessor Knee—Stumble Recovery Benefit for Nonvariable

MARCH 2015 | O&P ALMANAC

• • • • •

•

Cadence Ambulators, and Does Restricted Access for K-1 and K-2 to Hydraulic Controls Adversely Impact Patient Safety? TLSO/LSO: Utilization and Comparative Effectiveness of TLSO/ LSO: Pre- and Postoperative Use; Efficacy of Custom Versus Off the Shelf Relating to Clinical Outcome, Analyses of Providers’ Credentials Socket Interface: Methods for Measuring Proper Socket Fit and Alignment Vacuum-Assisted Socket Suspension Systems AFO/KAFO: Utilization and Comparative Effectiveness of Custom Versus OTS AFOs and KAFOs; Investigation and Analyses of Patients Who Receive Custom Orthoses Subsequent to OTS AFO Fitting L0631 Bracing—Performance and Outcomes Data That Differentiate Patient Results From What Could Be Achieved With an OTS Orthosis That Is Provided Without Any Fitting, Trimming, or Clinical Care Quality of Life, Wellness, Patient Satisfaction, and/or Outcomes Studies of Patients Who Have Received O&P Care Versus Those Who Have Not Outcomes Measures, Evaluation, and Quality-of-Life Metrics

This Just In

Related to Orthotic Management (Submissions Should be Pathology and/or Condition Related, e.g., Stroke, Cerebral Palsy, Multiple Sclerosis, Polio, Osteoarthritis) â&#x20AC;˘ Open Topics: Beyond the Above Priorities, Top-Quality Clinical O&P Research Topics Considered Submission deadlines range from April 1, 2015 (larger grants), to April 30, 2015 (small pilot grants). AOPA and COPL will give preference to grants that address evidence-based clinical application in orthotics and prosthetics. Each study must be completed within one year of the date of the award. Potential applicants need to consult directly the specific research RFP for details on each study.

Study Parameters

O&P professionals are eligible to apply for the grants, as are physicians in training (interns, residents, and fellows) and those in related disciplines, provided that the work is conducted

RFP FAST FACTS For detailed RFPs and step-by-step instructions on submitting proposals, visit www.AOPAnet.org/resources/research. Deadlines: April 1 for larger grants and April 30 for smaller grants. Questions? Contact Yelena Mazur, ymazur@aopanet.org. under the preceptorship of a more senior or experienced investigator. Successful applicants must agree to acknowledge support from AOPA in any publications or presentations that result from the research, and to submit a final report within 12 months of the date of the award. COPL will advise AOPA as to the merits of submissions for funding. Their recommendations will be based on feasibility, scientific and clinical

significance, originality, and anticipated contribution of the research to clinical practice. Applications also will be evaluated on the availability of adequate resources, including personnel and facilities. AOPA will submit applications to the COPL Board of Directors, which will review the grant proposals and provide input and recommendations to the AOPA Board of Directors. The AOPA Board of Directors will have the final decision on whether any research can be funded and in what amount. For detailed instructions on how to submit a proposal, which must be completed in electronic PDF format, and for complete copies of each RFP, visit www.AOPAnet.org/resources/research. Contact Yelena Mazur, AOPAâ&#x20AC;&#x2122;s membership and meetings coordinator, with inquiries or to request applications, ymazur@aopanet.org or 571/431-0899. Successful applicants will be notified on or about June 15, 2015, with availability of this support to take place as shortly thereafter as feasible.

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COVER STORY

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The O&P community reacts to the Dobson-DaVanzo study, which found 19 percent of Medicare patients who receive OTS orthoses subsequently require custom devices By CHRISTINE UMBRELL

MARCH 2015 | O&P ALMANAC

COVER STORY

Need To Know: • Recent Dobson-DaVanzo/ AOPA research shows that 19 percent of Medicare patients who receive OTS orthoses subsequently receive either a customfitted or custom-fabricated orthotic device. More specifically, 20 percent of patients who initially received OTS AFOs, 17 percent of those who initially received OTS LSOs, and 11 percent of those who initially received OTS TLSOs subsequently received custom-fitted or -fabricated orthoses. • Practitioners have observed similar situations in their practices, adding that in several cases, patients were initially sent to noncertified O&P personnel who provided OTS devices.

account for a relatively • These data have prompted small portion of the 19 much speculation as to percent. But it also appears why roughly one in five likely that there is a very patients receiving OTS significant percentage of orthotics subsequently cases where OTS devices do receive a customized not fully or appropriately device. We don’t yet meet the patients’ needs. know the answer to that AOPA has recently question. Clearly, some released an RFP seeking modest portion of these new prospective clinical data reflects instances in research studies, as this which OTS devices are is probably the only truly fitted out of necessity in reliable way to explain the acute or emergent this unique datapoint from setting and occasionally Medicare payment data. with the knowledge that a custom-fitted or custom-fabricated orthotic • The increased amount device will be required of prescribing across further down the road. physician specialties has There also are instances led to a broader range with progressive disorders of physicians, including where an OTS device some with less direct may be sufficient for a and focused expertise, period of time before selecting orthoses for their condition warrants a patients. This may custom-fitted or customcontribute to some poorer fabricated orthotic device. outcomes and perhaps Clinical experience indicates the need for a second that such instances could customized device.

Distribution of OTS Patients Who Subsequently Received Custom-Fabricated or -Fitted Orthotics (2008)

Type

Total Patients

Received OTS as First Orthotic Device

Subsequently Received Custom-Fitted/ -Fabricated Device

Patients

% of OTS Patients

Patients

% of OTS Patients

TLSOs

20,408

1,519

7.4%

163

10.7%

LSOs

197,906

19,917

10.1%

3,372

16.9%

AFOs

268,232

56,959

21.2%

11,359

19.9%

Total

486,546

78,395

16.1%

14,894

19.0%

Source: Dobson-DaVanzo analysis of custom cohort Standard Analytic Files (2007-2010) for Medicare beneficiaries who received O&P services from January 1, 2008, through December 31, 2008.

• Practitioners also note that some of those individuals in the 19 percent are likely receiving OTS orthoses in an emergency, when treatment decisions may be made without fully considering the long-term implications. • Complying with guidelines from Medicare and insurance companies also can lead to overprescribing of OTS devices. • Practitioners say educating and collaborating with physicians, referral sources, and payors about the necessity of a quality orthotic assessment is critical to increasing the number of patients who are initially fit with the correct custom device.

MONG THE MORE VEXING

findings of the recent DobsonDaVanzo research commissioned by AOPA is the discovery that 19 percent of Medicare patients who receive offthe-shelf (OTS) orthoses subsequently require custom devices. More specifically, 20 percent of Medicare patients studied over an 18-month period who initially received OTS ankle-foot orthoses (AFOs), 17 percent of those who initially received OTS lumbosacral orthoses (LSOs), and 11 percent of those who initially received OTS thoracolumbosacral orthoses (TLSOs) subsequently received custom-fitted or -fabricated orthoses. O&P ALMANAC | MARCH 2015

COVER STORY

While some of the data reflect instances in which OTS devices were fitted out of necessity in the acute or emergent setting or on patients with progressive disorders, such occurrences likely account for a relatively small portion of the 19 percent. The final analysis by Dobson-DaVanzo researchers? “While the clinical implication of receiving both OTS and custom devices does not in itself demonstrate an adverse patient outcome, this finding likely indicates that a sizeable proportion of beneficiaries are not receiving the appropriate device initially.” Given these findings, O&P Almanac spoke with several seasoned orthotists to gain perspectives on possible factors why nearly one in five Medicare patients who are fit with OTS orthoses subsequently require custom devices, and how O&P professionals might be able to improve this statistic.

Seeing Is Believing

The findings come as no surprise to certified orthotists who treat Medicare patients every day. “I have seen numerous times where the patient has received an OTS device when a custom device was the most appropriate choice,” says Eric Ramcharran, CPO, LPO, area clinic manager for Hanger Clinic in Tallahassee, Florida. “In most cases, these OTS were provided by noncertified O&P personnel. When these patients are seen by certified O&P personnel, they are much more likely to receive the most appropriate

“There are nonaccredited providers delivering care outside their abilities.” This contributes to some poorer outcomes and perhaps the need for a second, customized device being provided. Nonqualified providers “simply aren’t aware of the biomechanics of the devices.” —Pam Filippis Lupo, CO/LO device at the beginning of treatment, thus providing more positive patient outcomes.” Ramcharran believes the percentage cited by Dobson-DaVanzo is not something the O&P profession should take lightly. “Nineteen percent is a very significant number,” he says. “This percentage reflects all outpatient charges for TLSOs, LSOs, and AFOs. In several cases, these patients were sent to noncertified O&P personnel who provided OTS devices. These individuals are not qualified to make the most appropriate device choice for these patients, and as a result may have provided unnecessary OTS devices.” Carey Glass, CPO, LPO, FAAOP, also says he is “not surprised by the findings,” and believes the research reflects what he sees on a daily basis in his role as director of clinical services at AlliedOP in Somerset, New Jersey. Glass is quick to say that OTS devices can do a decent job of rehabilitating patients in some instances, and that some patients will benefit greatly from

“Off-the-shelf devices are designed to fit ‘most people.’ The patients we’re dealing with in O&P are not ‘most people.’ They are not in the normal anatomical position to be best fit with an off-the-shelf device.” —Carey Glass, CPO, LPO, FAAOP

MARCH 2015 | O&P ALMANAC

OTS devices, particularly those that can be fit to the patient. “But OTS devices in general don’t do as good a job as custom devices.” OTS devices are generally made to be anatomically correct for the average healthy individual, says Glass. “But no individual is exactly the same. Off-theshelf devices are designed to fit ‘most people.’ The patients we’re dealing with in O&P are not ‘most people.’ They are not in the normal anatomical position to be best fit with an off-theshelf device.” Many of the OTS devices initially given to the Medicare beneficiaries cited in the study may well have been “fit improperly, perhaps due to lack of a thorough evaluation by a clinician or physician,” suggests Elizabeth Ginzel, CPO/LPO, head of operations, Baker O&P Texas in Fort Worth. Ginzel suggests that in the Dobson-DaVanzo cases, it is likely the OTS devices simply could not accommodate the anatomy or the functional requirements of the individuals.

Who’s Writing and Filling the Prescription?

The increased amount of prescriptions from physician specialties has led to a broader range of physicians, including some with less direct, focused expertise, selecting orthoses for patients. “We have physicians, physician assistants, and others with much less knowledge of orthotic devices actually prescribing them,” says Pam Filippis Lupo, CO/LO, director of orthotics and director of orthotic residency at Wright & Filippis, in Rochester Hills, Michigan.

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COVER STORY

“There are nonaccredited providers delivering care outside their abilities. These individuals lack the education to do an assessment and formulate a treatment plan due to a lack of knowledge on the range of devices available,” says Lupo. This contributes to some poorer outcomes and perhaps the need for a second, customized device being provided. Nonqualified providers “simply aren’t aware of the biomechanics of the devices,” Lupo says. Some physicians are filling prescriptions with in-stock devices instead of referring patients to orthotists. The rise in physicians who provide devices from within their own facilities “has decreased the quality orthotic assessment that a patient needs, and a certified orthotist provides,” Lupo says. In some cases, it “limits patient access to quality care.” AFOs seem to be the devices most commonly prescribed to patients who subsequently require custom devices, according to Dobson-DaVanzo. And these are devices that noncertified orthotists commonly deliver. “Take, for instance, the OTS AFO that a patient received from a noncertified O&P provider,” says Ramcharran. “A large number of these patients will need a custom AFO for foot drop long-term, so that OTS AFO may not be the most appropriate device for the patient. When an OTS AFO is provided first, but the custom AFO is more appropriate, this adds to the cost of treatment to the patients and to the payers.” Among those physicians who do refer patients to certified orthotists, some are sending prescriptions for OTS devices when a custom device would better serve the needs of the patient. “When a doctor sends me a patient, he’s usually sending him to me because he couldn’t fix the problem with an OTS device, and the pharmacy couldn’t fix the problem with an OTS,” says Glass. So chances are, that patient will need a custom device—and the prescription should reflect that. When Glass works with patients who have been referred by a physician who prescribes an OTS device, he does his homework before following 26

MARCH 2015 | O&P ALMANAC

“We must document, validate, and prove what we do. Health care in its current state is going to continue to change. We, as a field and an industry, must change if we’re going to survive. We must transform the mindset to fee-for-value versus fee-for-service.” —Elizabeth Ginzel, CPO/LPO through with the requested orthosis. “If I know I will have to go to a custom-fit or a custom-made item to fully rehabilitate the patient, I will ask the doctor for a reassessment,” he says. For example, a doctor may request an OTS for a patient who has neuropathy. “But if I am sure drop foot is developing, I will call the doctor and ask for him to re-evaluate the patient. I will spend the time to get the doctor to put the re-evaluation in his notes, and get the letter of medical necessity for a custom device, so that my patient gets what he needs,” says Glass. Ginzel says a significant number of patients have been referred to her clinic by physicians “who request their patients be fit with very general OTS orthoses that are only indicated when treating a weakness or deformity in one plane.” But in most cases, those patients exhibit issues in multiple planes that can be addressed only through the use of an appropriately fitting custom orthosis. “As a field, we must ensure that we do not practice as prescription-fillers. The role of the practitioner is to play a key part in the patient’s care, which includes evaluating and recommending the appropriate device and educating the physician if we are to be considered the expert in orthotic rehabilitation,” says Ginzel. “When a prescription for an OTS device is provided, and after a thorough evaluation a custom device is indicated, we must confer with the physician and see if he or she is in agreement when provided the appropriate rationale and justification.”

Haste Makes Waste

O&P practitioners also note that some of those individuals in the DobsonDaVanzo 19 percent are likely receiving orthoses in an emergency, when treatment decisions may be made without thinking through the long-term implications. “Sometimes orthotists are being asked to do things too quickly,” says Glass. He cites the example of a patient who has a stroke on a Monday and is given an OTS AFO on Tuesday. “But by Friday, his drop foot could be gone—or it could be much worse, and he could actually require a custom item providing more stability,” says Glass. “Simple and quick is not always the best way to handle patients.”

Playing By the Payors’ Rules

Complying with guidelines from Medicare and insurance companies also can lead to over-prescribing of OTS devices. The guidelines are designed to encourage use of the less expensive options. The Medicare Local Coverage Determinations (LCDs) are written so that patients usually are fit with OTS first—because OTS devices are less expensive than custom devices, says Glass. “Medicare’s rules were written with good intentions, but Medicare deems too many things ‘not medically necessary,’” he says. In many instances, when Medicare dictates that patients—who are likely part of the senior population— be initially fit with an OTS device, “the problem is, these patients have multiple problems and are going to get worse,” says Glass.

COVER STORY

Glass cites the example of an 80-year-old patient with spinal stenosis who also has kyphosis. While Medicare guidelines would cover an OTS device, a practitioner would have to “do all kinds of things to try to make the OTS fit”—whereas a custom device would be much better, and easier for the patient, Glass says. “There are times an off-the-shelf or custom-fit device is provided initially, then the patient’s medical necessity may change, requiring a custom-made device,” Lupo adds. “This results in a ‘Same/Similar Rejection’ for the custom device, and we have to jump through hoops to get paid. After costly additional documentation and resubmissions, we may end up with no payment in addition to the cost of employee labor.” And it’s not just Medicare that has guidelines encouraging OTS orthoses. “To assume that Medicare is the only area where this is a problem would be inappropriate,” says Lupo. Coverage for custom devices

is becoming an increasing problem among payors, she says. Custom devices usually require preauthorization from private insurers, which makes it a more daunting task for the facility that may incur the cost. “Frequently, facilities won’t provide custom devices such as knee orthoses because payment is difficult to obtain from the payor,” says Ginzel. “I don’t believe it has anything to do with what insurance the patient has,” adds Ramcharran. “In my opinion, it is an ongoing trend that we are seeing in all payors. The problem is that most payors do not have the criteria that prevent patients from being dispensed orthotic devices from unqualified suppliers.”

Education and Collaboration

The only way the profession will see an increase in the number of patients who are initially fit with the correct custom device is through educating physicians, referral sources, and payors about the necessity of a quality orthotic

assessment. “When we see a patient who comes in with an OTS device who does need a custom device, that’s a great opportunity to contact the physician,” says Lupo. “We can explain that we need a new prescription, but we also can educate the physician about the opportunity missed. The goal is providing the best possible orthosis to meet that patient’s needs with the least inconvenience to the patient.” Delays in rehabilitating patients also cause a delay in quality outcomes.

O&P ALMANAC | MARCH 2015

COVER STORY

Findings on Custom-Fit Versus Custom-Fabricated Orthoses Whether patients who were initially fit with off-the-shelf devices were subsequently given custom-fit devices versus custom-fabricated devices varied significantly based on type or orthosis, according to the Dobson-DaVanzo report: Received Custom-Fitted

Received Custom-Fabricated

Type

Subsequently Received Custom-Fitted/ -Fabricated Device

Patients

% of OTS Patients

Patients

% of OTS Patients

TLSOs

163

147

90.2%

9.8%

LSOs

3,372

3,306

98.0%

2.0%

AFOs

11,359

3,454

30.4%

7,905

69.6%

Total

14,894

6,907

46.4%

7,987

53.6%

Source: Dobson-DaVanzo analysis of custom cohort Standard Analytic Files (2007-2010) for Medicare beneficiaries who received O&P services from January 1, 2008, through December 31, 2008.

“It takes a collaborative effort to achieve the best outcome for the patient,” Lupo says. “We need to foster relationships so we can be a resource and help educate physicians about the vast opportunities in design, materials, and function available today.” She also suggests working directly with physicians to educate them on supporting medical necessity documentation and specific prescriptions, for the best outcome. “We must continue to educate Medicare, other payors, and our referral sources,” agrees Ramcharran. “Ultimately, it should be the certified O&P clinicians who are the best resource to make the decisions as to what device is most appropriate for the patients. We are all seeking the best outcomes for the patients and we, as a field, must continue to be the most qualified experts to choose the best

device for each individual patient’s needs and diagnosis.” Communicating to payors the benefits of treating the patient correctly at the outset—even if that means a more expensive orthosis—will be key to remediating the trend identified in the Dobson-DaVanzo findings. “From a dollar standpoint, if a person is initially fit with an OTS device, there is an increased cost if the individual must return to his or her physician to obtain a prescription for the appropriately fabricated custom orthosis,” says Ginzel. The benefits for the patients also should be shared with payors: Patients who are not getting optimal outcomes are at greater risks for falls, readmissions, or other adverse health outcomes. “We must document, validate, and prove what we do,” says Ginzel. “Health care in its current state is

“We must continue to educate Medicare, other payors, and our referral sources. Ultimately, it should be the certified O&P clinicians who are the best resource to make the decisions as to what device is most appropriate for the patients.” —Eric Ramcharran, CPO, LPO

MARCH 2015 | O&P ALMANAC

going to continue to change. We, as a field and an industry, must change if we’re going to survive. We must transform the mindset to fee-for-value versus fee-for-service.” Ultimately, the O&P community must demonstrate that when certified orthotists treat patients with custom devices when warranted, the patients will have better outcomes and costs will be reduced. “We’re looking at people who are debilitated, and we want to get them rehabilitated,” says Glass. “We’ve proven that custom-fit results are better.” These data have prompted much speculation as to why roughly one in five patients receiving OTS orthotics subsequently receive a customized device. Again, we do not yet know the answer to that question. Even as we speculate about potential explanations for the 19 percent of patients who receive both an OTS and either a custom-fitted or customfabricated orthotic device, we must recognize that the Dobson-DaVanzo data is based on claims from 20072010, which was before CMS expanded substantially the list of items they deem to be OTS orthotics. Some would expect that once we see comparable data for 2014 with this bigger “cache” of orthotic devices Medicare deems OTS, the percentage of Medicare patients who receive both an OTS and either a custom-fitted or custom-fabricated orthotic device might balloon well above 19 percent, perhaps even up to 25 to 30 percent. But this is more speculation—what we need is more data and reliable clinical answers. That said, we look forward to the pending prospective clinical study AOPA is trying to foster to help give the profession more reliable answers, but with at least some preliminary signs that shipping the majority of patients a purely OTS orthotic device actually may neither be saving payors’ money, nor delivering patients the quality of care they deserve. Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com.

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Word Word Spreading the Word

make u can

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More than 100 representatives of the O&P profession are expected to take part in AOPA’s Policy Forum in Washington, D.C., March 23-25

Need To Know: • This year’s AOPA Policy Forum is expected to draw attendees from all corners of the country to discuss strategy and issues of interest to O&P business owners, practitioners, and advocates. • Participants will engage in one-on-one meetings with members of Congress from their home towns, making the most impact by discussing O&P interests with a wide range of legislators and their aides. • Several high-profile guests agreed to speak to Policy Forum participants, including Rep. Brett Guthrie (R-Kentucky), Rep. Mark Meadows (R-North Carolina), and Sen. Chuck Grassley (R-Iowa). • “Hot topics” up for discussion during congressional visits include provisions in the Medicare O&P Improvement Act of 2015, competitive bidding, market-based pricing, acute care bundling, Recovery Audit Contractors, OTS, and ALJ program delays, among others.

MARCH 2015 | O&P ALMANAC

ITH THE BRUTAL WINTER dumping

snow and ice in many areas of the country, it might be hard to believe spring is right around the corner. But warmer weather is almost here, bringing with it the capstone of the O&P advocacy season: the 2015 AOPA Policy Forum, March 23–25. Each year more than 100 O&P delegates from throughout the country converge on the nation’s capital to compare notes, brief one another on the latest regulatory evolutions, and, most importantly, meet directly with members of Congress and their aides to advocate on behalf of the profession. “This is best opportunity we have to tell our members of Congress precisely what policy changes we need, in order for us to be able to provide appropriate care for our patients,” says AOPA President Charles H. Dankmeyer Jr., CPO. It also provides the opportunity to showcase the 2015 version of the Medicare O&P Improvement Act of 2015, which is expected to be introduced in Congress just prior to the Policy Forum, according to Dankmeyer. This legislation has been led by AOPA in the past several sessions of Congress and has earned the endorsement of the Orthotic & Prosthetic Alliance (O&P Alliance), a coalition of the leading national O&P organizations that has joined AOPA in lobbying Congress and CMS and taken other steps to further the interests of O&P. (See sidebar on page 32.)

care of O&P patients. In lean fiscal times, with Medicare always seeking new ways to contain expenses, it’s more important than ever for the O&P community to make its case, to ensure that the needs of O&P patients and practitioners are clearly understood. With that in mind, here’s a preview of what the Policy Forum will tackle.

Rep. Brett Guthrie (R-Kentucky)

Intersecting Issues

The 2015 version cuts a wide swath in addressing major problems and challenges confronting O&P and includes provisions focusing on many of the pressing problems O&P has faced these past four years. Prior versions of the legislation primarily addressed fraud and abuse issues in an effort to save Medicare $250 million in O&P reimbursements every year. O&P still needs strong legislation curbing fraud. But the 2015 bill additionally addresses Recovery Audit Contractor (RAC) audits and administrative law judge (ALJ) delays, recognizes the notes of the prosthetist and orthotist in the medical record, separates durable medical equipment (DME) from O&P in tracking disposition of appeals, delays recoupment until after the ALJ phase has been completed, and includes a voluntary settlement option on denied claims similar to what CMS offered hospitals (68 percent for hospitals, but advocates hope that data may support an 85 percent option for O&P). “I’ve said this before and will say it again, ‘If you don’t ask, you don’t get.’” Dankmeyer says. “And now we have one bill that makes it an easy, less confusing ask.” AOPA Policy Forum attendees will bring to their representatives a host of issues related to the appropriate

To understand the issues on the table at this year’s Policy Forum, it’s important to grasp Sen. Chuck Grassley the big picture—one that is increasingly complex. It used (R-Iowa) to be enough to talk about RAC audits, off-the-shelf (OTS) Rep. Mark Meadows purchasing, postacute care (R-North Carolina) bundling, and other key issues as being separate phenomena. That’s no longer the case. A scenario, however, the move toward fistful of political, economic, and regucompetitive bidding will drive down reimbursement levels all around and latory strands today weave these key topics together, forming a web of issues potentially harm patients that really need custom-fit or custom-fabricated that must be seen in its entirety. devices addressing their specific, A number of high-profile guests unique conditions. All signs point to will help to describe that picture at reimbursements being lower, although the Policy Forum. Invitees include how much lower remains unclear. Rep. Brett Guthrie (R-Kentucky), vice Still, the potential fallout could be chair of the Energy and Commerce significant. If the compensation for Committee; Rep. Mark Meadows certain items drops low enough, some (R-North Carolina), an active O&P practitioners may have no choice but supporter; and Sen. Chuck Grassley to cease providing these forms of care. (R-Iowa), a long-time Finance The worst of these possibilities Committee member. may never come to pass, or perhaps One of the most pressing issues at the fallout will be even worse than this year’s forum will be the matter expected. What is clear is that the of competitive bidding—the dictum situation is ever evolving, and O&P to bid out OTS, or commodity, items. needs to find its way. “We are at a O&P has been lobbying for some time crossroads,” says Joe McTernan, to help CMS understand that many, if AOPA’s director of coding and reimnot most, of the devices CMS deems OTS should not be classified as OTS bursement, programming and educaand cannot be rightly classed as comtion. “We are moving away from a quantity-based health-care system and modities. Congress established the more toward a value-based system. criteria for what constitutes an OTS Payors are starting to look not at the device (and therefore is eligible for quantity of service but rather at value competitive bidding) as an orthotic and outcomes and data. We have to device that can be used by the patient adjust to that. The challenge is going “with minimal self-adjustment.” The effort now is to ensure CMS adheres to to be in finding our place in this new these definitions. Even in the best-case world order.” O&P ALMANAC | MARCH 2015

O&P Alliance: A Critical Conduit As the 2015 Policy Forum draws near, AOPA has been working in close cooperation with its allies at the Orthotic & Prosthetic Alliance, a coalition of leading national organizations chartered to advance the O&P agenda in regulation and legislation. Together, the O&P Alliance represents the scientific, research, professional, business, and quality improvement aspects of the O&P field. The O&P Alliance advocates for state and federal policies that improve the practice of O&P and the quality of services provided to patients. In addition to AOPA, members include: • American Academy of Orthotists and Prosthetists • American Board for Certification in Orthotics, Prosthetics, and Pedorthics • Board for Certification/Accreditation • National Association for the Advancement of Orthotics and Prosthetics

www.bocusa.org

The Alliance and its members work toward a broad set of goals, defined in detail on the organization’s website, http://oandpalliance.org. Many of these goals will be addressed during the 2015 AOPA Policy Forum. One of the group’s objectives is to have Medicare adopt appropriate quality standards for the provision of professional O&P care, with payments going only to providers who meet those standards. The Alliance also presses to ensure that Medicare reimburses O&P services and devices at reasonable levels, including reimbursements for medically necessary technologies. In addition, the O&P Alliance advocates for policies aimed at enhancing O&P education opportunities and promoting a broad range of research, including research that demonstrates the efficacy and cost effectiveness of O&P services. All of these issues are of critical importance to the O&P community. Attendees at the AOPA Policy Forum will hear national experts address these topics, and will have a chance to communicate these urgent messages to members of Congress. The O&P Alliance provides an important conduit to help keep all these issues at the forefront all year long.

MARCH 2015 | O&P ALMANAC

Another Thread

Competitive bidding and market-based value pricing are putting financial pressure on O&P, but they are not the only locus of stress. Another chief point of concern is acute-care bundling, an effort to check the rampant rise in health-care costs by Medicare bundling and paying a fixed price for all services a patient needs for 60-90 days after a surgery or major hospitalization. The payment, likely received by a hospital or rehab facility, would be parceled out likely in a lower-bidder basis to providers or specific services like O&P. This would generate big savings to Medicare, so much so that it has been suggested as a way to pay for implementing a permanent “doc fix,” a way to eliminate the sustainable growth rate (SGR) formula. Notably, Congress will need to pass at least a temporary fix to the SGR within one week after the AOPA Policy Forum or Medicare physician fees will drop by about 30 percent. It’s easy to see why O&P advocates will want to address this issue when they meet with legislators. Postacute O&P care does not last for 90 days. It goes on for months or years—or even a lifetime. So there is an inherent divergence between the bundling vision and the practice of O&P. AOPA believes bundling would inherently interfere not just with the fabrication of devices, but with the fundamental relationship between patient and provider. Medicare beneficiaries would find themselves limited in their choices as they seek out a healthcare provider who will be engaged in what usually is a lifelong relationship. For these reasons, AOPA has argued for exemption of O&P from postacute care bundling legislation. It hasn’t happened yet: Legislation is being crafted that could exempt O&P from this approach. That makes this year’s advocacy effort especially important, says AOPA Executive Director Thomas F. Fise, JD.

Delays and More Delays

Weave another thread into the web, this one an impediment to quality care related to the RAC program: judicial delay. Law stipulates that the findings of a RAC audit can be challenged in the court of the ALJ. Historically, O&P providers have a strong record of getting RAC findings overturned by the ALJ. More often than not, practitioners are reimbursed the funds collected by auditors (who get paid a percentage of what they collect). The issue on the table has to do with the almost inconceivable delays in the present system, delays that last not months, but years. It is a situation that is literally driving practitioners out of business. Moreover, it breaks the law: These delays are a clear violation of the due process afforded to suppliers and providers by the Benefits Improvements and Protection Act of 2000, which promises an ALJ decision within 90 days of filing. “If you are a small business and you have to pay now and wait four years for your day in court, you may go out of business even if in the end you win,” Fise says. When providers do collect after a win in court, this costs the government money, since funds taken in error must be returned with interest, typically paid at 10 to 13 percent. As a result of delays, the government comes out significantly behind. “It’s actually costing the federal government money to collect from you up front,” Fise says. In the face of persistent delays, AOPA and its allies have proposed a straightforward fix: Funds identified as due by the RAC auditors should be collected only after ALJ appeals have been exhausted. This would achieve two important ends. First, it would allow practitioners to keep their funds in circulation in support of their practices and their patients. At the same time, this approach would save the government significant expenses if and when RAC findings are overturned, which often is the case in O&P. These provisions are included in the Medicare O&P Improvement Act of 2015.

Keeping Records

Another discussion-worthy element to the RAC audit fix is a proposal in the Medicare O&P Improvement Act of 2015 to include documentation from certified orthotists and prosthetists in medical records. “We are working to get recognition of orthotists and prosthetists as the trained medical professionals they are,” McTernan says. “They are not simply handing a device over the counter. There is a clinical aspect to the care our members give, and we are pushing to have that professional role recognized.”

“

We are working to get recognition of orthotists and prosthetists as the trained medical professionals they are.

”

AOPA has argued that the notes of O&P practitioners should be included in the official medical record. The weight of that clinical documentation should be given the same consideration as any other part of the medical record. This issue provides a telling example of the way in which O&P issues dovetail these days. Suppose there is competitive bidding for OTS devices: This would give auditors free rein to make determinations as to whether the customization of any given device was really medically necessary. It opens a door to the broader question of medical necessity, which loops back to the question of medical records.

If an O&P provider’s determinations are recognized as an official component of the medical record, it gives those providers a more solid footing in the face of auditor examination. Physicians generally have neither the time nor the inclination to spell out the specifics or the medical necessity of O&P care. This task is up to our practitioners, and to fulfill that function, O&P needs the recognition that would come with having its official appropriate place in the medical record restored to Medicare recognition. AOPA has lobbied vigorously on the matter of inclusion, and that recognition presently is part of this year’s Medicare O&P Improvement Act. Advocacy at the Policy Forum could help to move the needle on this pressing issue.

Telling the Story

With so many elements coming together, it can become difficult to tell the O&P story—to separate out the main issues to help legislators and regulators see clearly the ways in which their actions can impact patient care. That’s why events such as the Policy Forum are so crucial. The 2015 forum will bring together concerned parties from across the spectrum: practitioners, patients, advocates, and affiliated groups, all converging to clarify the issues and press home the most significant topics. At the center of all discussions will be the importance of quality patient care. All of O&P’s priorities ultimately come down to the matter of delivering best-quality end results for orthotic and prosthetic patients. “The forum gives us the opportunity to go to Capitol Hill and to show members of Congress how we are actually saving the Medicare system money over time,” McTernan says. “We have reliable data showing that people who get treated with O&P devices have reduced health-care expenditures over time, and that is a very valuable message.” Adam Stone is a contributing writer to O&P Almanac. Reach him at adam. stone@newsroom42.com. O&P ALMANAC | MARCH 2015

LEADERSHIP SERIES

Turf Wars Is poaching a real problem or the inevitable effect of commoditization?

The O&P Almanac’s Leadership Series is a new feature revealing insights and opinions from seniorlevel O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the subject of encroachment.

VER THE PAST 20 YEARS, O&P business owners and practitio-

ners have noticed a sharp increase in the number of noncertified personnel dispensing supports and braces, infringing on territory that traditionally belonged to orthotists and prosthetists. Noncustom devices are currently being distributed by individuals outside the O&P profession with a wide range of job skills—from physicians and physical therapists to manufacturers’ representatives and durable medical equipment (DME) providers, among others. O&P practitioners have differing views on the effect of encroachment on the profession and patients, and what can be done to ensure O&P facilities remain viable. Dozens of senior-level O&P business owners and practitioners convened a session on “Poaching By Other Providers,” facilitated by Rick Riley, chief executive officer of Townsend Design, during AOPA’s Futures Leadership Conference in January, and shared their views on how competition is affecting their businesses. Recently, the O&P Almanac caught up with Riley and three other senior-level O&P professionals to discuss how competition has changed O&P business practices and strategies to ensure profitable facilities in the new competitive environment.

Meet Our Contributors

Rick Riley is chief executive officer of Townsend Design in Bakersfield, California.

MARCH 2015 | O&P ALMANAC

Cindy Henderson, BOCO, is director of clinical education at Breg Inc. in Oklahoma City, Oklahoma.

Charles Kuffel, MSM, CPO, FAAOP, is president and clinical director for Arise Orthotics & Prosthetics Inc. in Blaine, Minnesota.

Tom Padilla, CPO, is owner of Brownfield’s Prosthetics & Orthotics in Meridian, Idaho.

O&P ALMANAC: Over the past two decades, there has been some encroachment by other providers who deliver some of the products that may have previously been the turf of certified orthotists and prosthetists. Do you believe this is “poaching”? Why or why not? RICK RILEY: Yes, there has been

encroachment by physicians, therapists, DME distributors, and manufacturer reps who routinely dispense some of the products that may have previously been the turf of O&P practitioners. But I wouldn’t globally refer to this as “poaching.” Among those who have diverted patients and the associated revenues for their care, there may be two classifications: qualified providers and less qualified providers. Physicians and physical therapists are examples of qualified providers with a lot of clinical education, but not necessarily the same level of training in terms of assessing and fitting patients with various types of braces and supports. Manufacturer reps and DME are among the providers who have less clinical education and training than certified orthotists.

Research Shows 36 Percent of O&P Services Are Provided By Noncertified Staff Recent research undertaken by Dobson-DaVanzo sought to determine the extent to which Medicare is reimbursing noncertified personnel in select states with a licensure statute (Florida, Illinois, and Texas). “There’s a whole lot of folks out there that are providing services that aren’t licensed or certified,” said Al Dobson during a presentation at AOPA’s Futures Leadership Conference in January. The research found the following results for the time period between 2007 and 2011:

32%

36% 64%

32 percent of Medicare-allowed services for O&P base codes were billed by certified O&P personnel.

64 percent of O&P services were provided by either certified O&P personnel or physicians.

36 percent of O&P services were provided by other noncertified personnel.

TOM PADILLA, CPO: Our profes-

sion has evolved from blacksmiths to health-care professionals. In this evolution, we have become more skilled in providing orthopedic appliances, but other health-care professionals have also evolved their skill set either by necessity—nobody in the local area has the expertise—or for profit. The term “poaching” conjures ideas of something illegal. I would say that the marketplace is competitive, and if you don’t do a great job, someone else will. Certified orthotists/prosthetists need to focus on what they do really well. Appliances that anybody can fit with little or no training become commodity items and therefore will become “poached.” CHARLES KUFFEL, MSM, CPO, FAAOP: I believe poaching can be

viewed in a number of ways. If an ABC/BOC certified and/or licensed

clinician is not providing the care requested by a referring provider, the non orthotic and prosthetic entity providing the device is filling a need. I do not view this as poaching. Many O&P companies have limited their offerings to focus solely on custom management. This then leaves those non orthotic and prosthetic providers to fulfill the off-the-shelf or semi-custom needs. Although many of the off-the-shelf or semi-custom orthotic items require little specialized training to fit, I see them acting as a gateway to custom orthotics. A large number of manufacturers and central fabrication facilities will sell their services to anybody in the medical or DME profession. If

providers outside of the orthotics and prosthetics specialty can cast, purchase, and fit custom devices and receive the corresponding reimbursement, it creates a nice addition to their reimbursement. What these outside providers oftentimes fail to realize is management of these patients goes beyond merely fitting the orthosis or prosthesis. The “poachers” are those who fit orthotics and prosthetics for reimbursement’s sake with little regard for how well the item fits or how well it functions. Orthotic and prosthetic providers often set themselves apart because they view the totality of the person’s needs and provide items that enhance their patients’ outcomes. O&P ALMANAC | MARCH 2015

O&P ALMANAC: What specific aspects of O&P have been most affected by this encroachment? PADILLA: The most commonly affected areas are off-the-shelf items that require little or no training. RILEY: In terms of dispensing and bill-

ing of braces and supports, orthopedic manufacturers and their independent reps were among the first to change the landscape. Initially, it was through stock-and-bill closets and/or offers to physicians to fit patients in their homes or in the orthopedic physician’s office for the convenience of the patient. In more recent years, it is suppliers and billing companies that are assisting physician clinics with revenue diversification strategies. There are software tools and systems that help the clinics efficiently purchase, inventory, dispense, and bill DME.

Physician clinics in many markets are now routinely dispensing more braces and supports than O&P providers. Chiropractors, podiatrists, therapists, home health, DME, and pharmacies are among the other specialties and business venues where patients can seek services that were traditionally the domain of O&P. CINDY HENDERSON, BOCO:

Encroachment is a much bigger problem for orthotists. Some of this is a regional problem. Some areas of the country have fewer certified practitioners available to treat the O&P patient population, so other providers fill the 36

MARCH 2015 | O&P ALMANAC

void. For example, I don’t think there are enough certified orthotists to provide all of the products, especially in Texas. KUFFEL: Encroachment into orthot-

ics and prosthetics has mainly been focused on the orthotics side of the profession. The companies manufacturing durable medical equipment— specifically spinal, knee, and foot orthoses—are providing better options that are easier to use while providing increased stability. These advancements in the ease of use and the effectiveness of the products have allowed other professions to purchase, fit, and bill these products. As the “new era” of health care has restricted reimbursements and limited the time available with patients, products that are effective and easy to use are a prime target for those able to bill for these services. I believe we will continue to see providers outside of O&P providing orthotic services. If the manufacturers continue to sell their O&P products to non O&P providers, the business will continue to be stripped away from O&P. Orthotic and prosthetic facilities must use this new era of health care to educate insurance payors and referral sources on the importance of the care and expertise provided by orthotists and prosthetists. O&P ALMANAC: Does this

encroachment mean that patients have more choice and greater access to a wider range of products—or more limited choices? Why? PADILLA: I believe it means that they get items that are limited. It depends on what inventory or skill set the person has. KUFFEL: In regard to choice, I believe patients have additional choices to receive care. The problems that I am hearing, and experiencing in my own

practice, are the surge of patients being fit inappropriately by providers outside of the profession coming to the office to be “fixed.” We, as providers, walk a narrow line with our referral sources. These sources fit off-the-shelf orthoses to increase billables within their own offices, and when the extrinsic treatment fails to provide the intended outcome, the referral source sends the patient to the orthotist or prosthetist. We, as providers, are often unable to fix the problem and bill through insurance due to “Same or Similar” clauses or frequency red flags. This results in the patient either paying out of pocket for appropriate care or the orthotist/ prosthetist turning the patient away with possible referral repercussions. O&P ALMANAC: Have patients

been harmed or compromised by this encroachment in any way? RILEY: For some complex patients who require more complicated technology, the quality of care may not be as good—with more risk to the patient or at least a higher potential for a less optimum outcome than when the care is provided by a certified O&P professional. But there is no data to specifically show the quality of care is better if an orthotist fits a brace than a nurse, therapist, or rep. Payors don’t seem to care unless patients complain. PADILLA: I’m not sure. In our region, we do see poorly fitted devices that have to be replaced either because the device did not meet the needs of the patient or there was not ample instruction on how to best utilize the device. HENDERSON: I don’t feel patients have

been compromised in regard to what some consider OTS custom-fit orthopedictype devices when the products are provided by other skilled professionals. KUFFEL: It is difficult to tell if patients

have been harmed or not. The situation that I see most is that the patient may be harmed in the pocketbook.

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When the patient is fit by a nonqualified provider, regardless of whether insurance claims the provider is qualified, the patient may have a limited ability to right the wrong. Many of the “poaching” providers merely open the package, fit the patient, and send them on their way. Modifications to improve the fit or function of the item are often nonexistent by many of these providers. O&P providers have the equipment to modify off-the-shelf items, whether that means sewing, heating, trimming, or flaring. Patients who see a certified and/or licensed O&P provider have recourse through the accrediting body if facility resolution is not possible. O&P ALMANAC: What, if any-

thing, can O&P providers do to move forward in relation to this encroachment? PADILLA: We should focus on custom items that require a greater skill set. HENDERSON: I am focusing my skills

on patients with more technical needs— such as scoliosis bracing or more complicated AFOs—instead of simpler ACL braces that are easier to fit. Too much focus on encroachment can distract O&P professionals from the bigger picture. We’ve been worrying about little things instead of bigger issues, such as competitive bidding, and OTS devices sold at pharmacies that are not being worn correctly. KUFFEL: The new era of health care is upon us, whether we agree with it or not. Medicare and third-party payors have failed to recognize, or limited their recognition of, the orthotist/ prosthetist in the health-care arena. We know that our health-care notes and current way of documentation are viewed poorly by CMS and other pay sources. I believe that we, as providers, must continue to use whatever venues we can to educate payors and those in health care on the importance of using and paying only those individuals specially trained in the field of orthotics and prosthetics. 38

MARCH 2015 | O&P ALMANAC

RILEY: During the poaching session at the AOPA Futures Leadership Conference, several participants felt it was useless to look in the rearview mirror and point a finger at other medical providers. While it was acknowledged that manufacturers and their reps are often both suppliers and competitors to the O&P industry, the discussion focused on what O&P providers need to do moving forward. These other providers are not likely to stop what they are doing unless new legislation or other factors like audits cause them to rethink revenueproducing strategies that include dispensing braces and supports. Orthopedic clinics have a growing reliance on DME revenues, as do some other physician specialties like pain management clinics that now routinely dispense spinal braces and OA knee braces. Manufacturers, manufacturer reps, and DME distributors are also not going away as a big part of their income comes from insurance billings. So O&P providers will continue to face competition in terms of who treats the patient. There were numerous comments about the need for O&P providers to focus on core competences, high-level technology, and services that are less likely to be replicated by other providers. Some feel it is not worth continuing the fight over who is qualified to dispense low-end OTS products. For example, it was suggested that certified practitioners would be better off focusing on high-end technology that requires a greater level of education than fitting a wrist, ankle, or knee

brace. Yet many O&P providers still rely on soft goods and lower-tech products for supplemental revenues to help cover general operating costs. Concern was raised about the lack of a level playing field, and that Medicare and private payors don’t adequately differentiate between providers. Payors don’t seem to care that they pay the same amount of reimbursement regardless of the training of the provider, and in some cases they are paying for services that are not being rendered. O&P providers don’t have any entitlement, and they are not specifically recognized by payors or physicians as offering a higher level of care than other providers. There needs to be more focus on differentiation via education and the promotion of high tech services. There probably needs to be acceptance that the dispensing of lower-tech DME by less qualified providers is not causing substantial harm to patients or costing payors more, so it will likely continue and really can’t be defined as poaching. If O&P providers want to be successful, they need to build the business platform for efficiently delivering patient-centered care, fight for a level playing field, and do a better job of making physicians and payors aware of their specialized training and core competences. O&P providers also need to be willing to reinvent their business model and be open to collaborating with other providers like therapists, podiatrists, DME providers, etc., as market consolidation and integration will continue and likely accelerate.

MEMBER SPOTLIGHT

Amfit

By DEBORAH CONN

Orthotic Enabler Company offers equipment for in-house orthosis fabrication as well as central fab options

MFIT, BASED IN Vancouver,

Washington, was founded in 1977 with the goal of providing customized footwear to the retail market. In the 1980s the company sought to broaden its offerings and, with input from medical professionals, computerized its mechanical measuring system, using an array of sensor pins to capture the shape of the bottom of the foot. Arjen Sundman, president of Amfit since 1999, joined the firm in 1987 as one of three engineers tasked with redesigning the earlier retail system. “With digital information, we could add inversion, eversion ramps, heel lifts, and later metatarsal pads and excavations,” says Sundman. Amfit introduced its digital system at the AOPA annual meeting in 1989. Today, Amfit has expanded to four core product lines. It offers tools and equipment to enable practitioners to fabricate foot orthoses in house, including a milling machine that can be paired with a contact Pins raised and foot raised off the digitizer

MARCH 2015 | O&P ALMANAC

FACILITY: Amfit OWNERS: Privately held LOCATION: Vancouver, Washington; wholly owned subsidiary in Australia HISTORY: 38 years

digitizer (the Contact Pro) or a foam impression scanner (the Impress) that eliminates the need to create a plaster positive of the impression. The company also provides central fabrication services for facilities that prefer to outsource orthotic inserts. “Many O&P providers prefer to focus their time and skills elsewhere,” says Sundman. “They can capture and edit the foot scan and post it to the Amfit Cloud, so that we can usually turn it around in 24 hours. Practitioners receive the orthosis in fabrication time plus shipping.” Amfit’s central fab products include orthotic inserts made of ethylene-vinyl acetate, polypropylene, or carbon fiber, as well as diabetic inserts. In addition, Amfit will produce custom orthotic inserts for customers who use foam impression boxes to capture the foot shape. Customers may use an Amfit mill on site or send orders to another Amfit mill operator. Insole blanks are offered through the company’s third division, with an array of sizes, densities, and modalities of the molded components, such as varying density

in different parts of the foot. In addition, the company offers off-the-shelf insoles with a wide range of sizes, arch heights, and heel widths for men and women. Part of Amfit’s marketing approach is to highlight practitioners who apply the technology within various professional specialties. The website offers case studies and testimonials by certified pedorthists, a certified orthortist/pedorthist, a podiatrist, and others. Looking ahead, Sundman is anticipating the release of a milling machine capable of higher levels of productivity. “Our current machine can produce four pairs of orthotic inserts per hour,” he says. “A regional lab needing to produce more will often use several machines. The design in development will be able to create 10 pairs an hour, so it can service some of these larger sites.” The company also is coming out with the Amfit Precise, the “broadest line of preforms in the industry,” says Sundman. With 24 sizes and shapes to choose from, practitioners can fit patients immediately with a near customfit device. Often, this will serve as a place holder while their custom device is being manufactured. With so many offerings and plans to introduce greatercapacity machines, Amfit is well-positioned for growth in the industry for years to come. Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Amfit

Digitizer scanner with Flash Scan operation

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MEMBER SPOTLIGHT

Sunshine Prosthetics & Orthotics

By DEBORAH CONN

Balancing Act New Jersey practitioner strives for work/life balance while running her own facility

ROOKE ARTESI, CPO, LPO,

MARCH 2015 | O&P ALMANAC

FACILITY: Sunshine Prosthetics & Orthotics OWNER: Brooke Artesi, CPO, LPO LOCATION: Wayne, New Jersey HISTORY: 2 years

Brooke Artesi, CPO, LPO, hiking with her son

Brooke Artesi, CPO, LPO, with a prosthetic patient

The practice sees children, adults, and seniors and provides orthotic and prosthetic services to nearly every type of patient, from those who need wound care and offloading of diabetic feet to a patient who was fitted with a prosthesis for a hemipelvectomy. Artesi fits many technologically advanced products, such as the Touch Bionics iLimb and functional electric stimulation devices for patients with movement disorders. “We also do Bioness rehabilitation devices and Walkaide for foot drop,” she notes. Sunshine offers designer fairings, or prosthetic covers, from

the Alleles Design Studio and UNYQ for lower-limb amputees. Patients can choose from ready-to-wear versions or create their own patterns and designs. “Fairings are walking art,” says Artesi. “They allow patients to express themselves and have a final say in the finished product.” Artesi is herself an amputee, having lost her leg below the knee in a traumatic accident 20 years ago. She is an active athlete and leverages the attention she receives when competing in races to market her practice. She is a great believer in networking and used word of mouth almost exclusively to launch her practice.

PHOTOS: Sunshine Prosthetics & Orthotics

describes the launch of her facility, Sunshine Prosthetics & Orthotics, as “a love story.” After graduating with a bachelor’s degree in biology and obtaining her postgraduate credentials through the Newington Certificate Program in O&P, Artesi worked as a technician and then a practitioner for other facilities. Now, she says, owning her own practice is a dream come true. Artesi had definite ideas about the feelings she wanted her facility to elicit. Starting with the name and echoing through the design of the physical space, she wanted a cheery, inspirational atmosphere. The office includes a waiting room, two patient rooms, a fabrication room, conference room, and Artesi’s office. Artesi is the sole clinician, with support from two administrative employees, a technician, an intern in the process of applying to O&P schools, and a marketing/social media expert. While Sunshine P&O has recently expanded its fabrication facilities, “my business model is that I don’t get paid to be in the back room,” she says. “We have scanners and digital equipment and send almost everything to central fabrication.”

MEMBER SPOTLIGHT

PHOTOS: Sunshine Prosthetics & Orthotics

Although Sunshine P&O faces little competition in the immediate northern New Jersey area, the facility uses its website and social media to attract and educate patients. The website features testimonials; FAQs about prosthetics, orthotics, and diabetic care; and an “Inspirations Blog,” with monthly messages from Artesi on such recent topics as the Athletes With Disabilities Network, the story of an elite amputee athlete, and information about participating in an area hiking event. A Facebook page includes daily posts on topics ranging from recent news stories about O&P advances to the facility’s products and services. “I get great hits from Facebook,” says Artesi. “It’s been an effective marketing tool.” For Artesi, the most challenging aspects of being a small business owner are both personal and professional. She has a two-year-old son and tries to balance being a mother—and an avid hiker and runner—with managing her own company. From a business standpoint, navigating insurance contracts has been the most difficult test. She credits yoga with helping her find balance, in both senses of the word. Looking ahead, Artesi is open to the idea of hiring another clinician. “Most of our business is orthotics, so even adding a part-time orthotist would be a big help,” she says. At some point, she might consider expanding with another facility, but, she says, “I don’t want to get too big.” For now, Artesi is perfectly happy with her cheerful office, interesting mix of patients, and the opportunity to do what she loves best. Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

Brooke Artesi, CPO, LPO, works with a patient on the parallel bars

O&P ALMANAC | MARCH 2015

AOPA NEWS

AOPA Submits Comments on CMS’s Proposed Rule Regarding Essential Health Benefits AOPA recently submitted extensive comments in response to a proposed rule issued by CMS entitled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2016.” This sweeping regulation proposed several updates to the Affordable Care Act (ACA) that will go into effect in 2016, including a proposed definition of the term “habilitative services” as it relates to provision of essential health benefits under the requirements of the ACA. AOPA’s comments urged CMS to include prosthetics and orthotics in any standard definition of habilitative services and also encouraged CMS to establish a standard definition for the term rehabilitative services that specifically includes orthotics and prosthetics. The comments also reiterated AOPA’s concern regarding the decision to allow individual states to define essential health benefits through the use of benchmark plans. AOPA pointed out several inconsistencies within coverage parameters that already have occurred through delegation of authority to the states regarding essential health benefits. The Office of Personnel Management released an almost identical proposed rule around the same time as the CMS proposed rule. AOPA submitted essentially identical comments on this proposed rule as the comments that were submitted to CMS. AOPA’s full comments may be viewed at bit.ly/aopaEBH.

MARCH 2015 | O&P ALMANAC

$60,000

$40,000

$80,000

$5,000 $1,500

AOPA Urges Journalists to Fact-Check Stories Featuring Pricing of Prostheses AOPA in February issued official comments on recent articles that have included incorrect estimates of customfabricated prosthetic devices in discussions of 3D-printed devices. AOPA issued the following statement: “America’s prosthetic and orthotic health professionals deliver patient-centered care each day to persons of all ages whose mobility has been compromised by limb loss and chronic limb impairment. This includes the commitment for trained, licensed, and accredited health professionals delivering cost-efficient care that also meets all patient protections established via federal and state statutes and rules, utilizing devices that satisfy all Food and Drug Administration (FDA) requirements. We are intrigued by the emerging 3D technologies outlined in several recent TV, print, and web-based media reports, while noting that in many cases the care featured involves instances that do not fully comply with FDA rules and/or federal or state licensure and accreditation requirements. We also must underscore that these reports frequently include serious inaccuracies in characterizing current costs of federally compliant advanced upper-extremity prosthetics as between $40,000 and $80,000, when actual costs often are only about one-twentieth of those amounts ($1,500 to $5,000). All who share a true commitment to quality care would strongly encourage media involved in preparing and fact-checking such reports to be cognizant of these rampant inaccuracies, even as we all watch with great interest how new and promising patient treatment options may be evolving.”

AOPA NEWS

Mastering Medicare Webinar:

Who Gets the Bill? A Complete Look at Medicare Inpatient Billing March 11

Stay in the Know— Subscribe to AOPA’s Take!

AOPA has designed AOPA’s Take, a new blog to keep you informed with important issues and real-time news that arise within the O&P world. This is a more immediate avenue to find the latest updates. AOPA’s Take is available at no charge to all members of the O&P community, and subscribing is simple. Go to www.aopastake.org and click on the subscribe button. Fill out a few fields, and you’re in! Welcome to AOPA’s Take…..Where you go when you need to know!

Are you talking to the correct representatives from the inpatient facility? Join AOPA for an AOPAversity Mastering Medicare Webinar that will focus on Medicare inpatient billing for your O&P practice. Gain a competitive edge by learning useful strategies to determine who is responsible for your bills. The webinar will address the following issues: • Proper use of the “Two-Day Rule” • Skilled nursing facility prosthetic exemptions • Part A rules and hospice • Statutorily noncovered services • Billing responsibility AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register online at bit.ly/aopawebinars. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Contact Betty Leppin at bleppin@ AOPAnet.org or 571/431-0876 with registration questions.

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

O&P ALMANAC | MARCH 2015

AOPA NEWS

Mastering Medicare Essential Coding & Billing Techniques Seminar

AOPA Coding Experts Come to Seattle in April

Coding Questions Answered 24/7 AOPA members can take advantage of a “click-ofthe-mouse” solution available at LCodeSearch.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways—by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.

UPS Savings Program The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The Coding & Billing Seminar will teach you the most up-to-date information to advance your O&P practitioners’ and billing staff’s coding knowledge. The seminar includes hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments. Breakouts are tailored specifically for practitioners and billing staff. Start the year off right for your business, staff, and patients! Join your colleagues in the Emerald City April 13-14. Top 10 Reasons To Attend: 1. Get your claims paid. 2. Increase your company’s bottom line. 3. Stay up-to-date on billing Medicare. 4. Code complex devices. 5. Earn 14 CE credits. 6. Learn about audit updates. 7. Overturn denials. 8. Submit your specific questions ahead of time. 9. Advance your career. 10. Learn from AOPA coding and billing experts who have more than 70 years of combined experience. In this audit-heavy climate, can you afford not to attend? Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more, register, or see the rest of the year’s schedule at bit.ly/2015billing.

MARCH 2015 | O&P ALMANAC

AOPA Members now save up to 30% on UPS Next Day Air® & International shipping! Sign up today at www.savewithups.com/aopa! Take advantage of special savings on UPS shipping offered to you as an AOPA Member. Through our extensive network, UPS offers you access to solutions that help you meet the special shipping and handling needs, putting your products to market faster. AOPA members enjoy discounts for all shipping needs and a host of shipping technologies. Members save: • Up to 30% off UPS Next Day Air® • Up to 30% off International Export/Import • Up to 23% off UPS 2nd Day Air® All this with the peace of mind that comes from using the carrier that delivers outstanding reliability, greater speed, more service, and innovative technology. UPS guarantees delivery of more packages around the world than anyone, and delivers more packages overnight on time in the US than any other carrier. Simple shipping! Special savings! It’s that easy! www.savewithups.com/aopa

AOPA NEWS

Earn CE Credits by Reading the O&P Almanac!

WELCOME NEW MEMBERS

E! QU IZ M EARN

BUSINESS CE

CREDITS P. 17

BECAUSE OF THE HIGHLY EDUCATIONAL content of the O&P Almanac’s Reimbursement Page and Compliance Corner columns, O&P Almanac readers can now earn two business continuing education (CE) credits each time you read the content and pass the accompanying quizzes. It’s easy, and it’s free. Simply read the Reimbursement Page column (appearing in each issue) and Compliance Corner column (appearing quarterly), take the quizzes, and score a grade of at least 80 percent. AOPA will automatically transmit the information to the certifying boards on a quarterly basis. Find the digital edition of O&P Almanac at: • www.AOPAnet.org/publications/digital-edition/ Be sure to read the Reimbursement Page article in this issue and take the March 2015 quiz. Access March’s quiz and previous monthly quizzes at: • bit.ly/OPalmanacQuiz

Take advantage of the opportunity to earn up to four CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz.

www.bocusa.org

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become www.AOPAnet.org 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.

Orthocare Solutions Inc. 6101 Executive Blvd., Ste. 330 Rockville, MD 20852 301/940-1640 Category: Patient-Care Facility Asanki Abeyratne Spectrum Prosthetics & Orthotics LLC 2510 NW Edenbower, Ste. 148B Roseburg, OR 97470 541/673-1275 Category: Affiliate Parent Company: Spectrum Prosthetics & Orthotics, Grants Pass, OR

Spectrum Prosthetics & Orthotics LLC 2231 N. Eldorado Klamman Falls, OR 97601 541/884-5348 Category: Affiliate Parent Company: Spectrum Prosthetics & Orthotics, Grants Pass, OR

Is Your Facility Celebrating a Special Milestone in 2015? O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email cumbrell@contentcommunicators.com.

O&P ALMANAC | MARCH 2015

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.

Allard USA KiddieGAIT/KiddieROCKER KiddieGAIT and KiddieROCKER are dynamic response floor-reaction carbon composite AFOs developed for the pediatric population. KiddieGAIT and KiddieROCKER will encourage functional heel-to-toe gait while offering lower-leg anterior support and stability with the opportunity for management of the knee extension/flexion moment. For more information, contact Allard USA at 888/678-6548 or visit www.allardusa.com.

Aqualeg With New Soft Shell Technology The Aqualeg soft shell cover has an exact fit and is self-supporting without the need for foam underneath. This allows the cover to be used in and around water. It has flexibility modeled after real limbs and is available in a precise 3D custom fabrication. Every cover is produced to fit perfectly on the socket. The covers are intended to be used everyday and provide a solution for active people who have lifestyles that include getting into water or harsh environments. They offer the perfect solution for prosthetic devices that are traditionally difficult to cover, including those with electronic components or vacuum assistance. For more information, contact Aqualeg Inc. at 855/955AQUA (855/955-2782) or visit www.aqualeg.com.

Aspen Medical Products: Introducing the New Peak Scoliosis Bracing System The revolutionary Peak Scoliosis Bracing System is an unloader brace designed to relieve pain and enhance the quality of life for adult scoliosis patients. This patented, highly adjustable brace from Aspen has been shown to improve posture, enhance mobility, increase vital capacity, and ultimately increase a patient’s ability to perform activities of daily living. For more information, contact Aspen Medical Products at 800/295-2776 or visit www.aspenmp.com.

MARCH 2015 | O&P ALMANAC

Genesee Metro Liner From College Park The College Park Genesee liner provides the ideal benefits required of a gel liner in an affordable package. Shaped for fit and flexibility with cushioning comfort and excellent limb conforming properties, this durable liner accommodates a wide range of users. The unique fabric provides a superior fiber to gel bond, reduces pistoning, and eases donning. Shear forces are absorbed to prevent skin friction as the mineral oil provides continuous moisture over the entire lifespan of the liner. Features include: • Mineral oil infused for continuous skin hydration • Retrofits with industry standard liners of like thickness & profile • Longer length for the perfect fit • Suitable for K1-K3 levels For more information, call 800/728-7950 or visit www.college-park.com/liners.

Coyote Composite Coyote Composite is made from the melting of basalt (volcanic rock), which is then extruded into a filament that is braided to our proprietary specifications for use in prosthetics and orthotics. Basalt has many applications in fields that demand extremely tough, lightweight material that retains flexibility, including the aerospace and hockey equipment industries. Features include: • Noncarcinogenic and Nontoxic: Because of the inert nature of basalt (the primary ingredient in Coyote Composite), it is not a carcinogen. Additionally, basalt fibers are too large to be inhaled. • Less itch than carbon • Tough and durable: Basalt is extremely tough, more so than fiberglass, while still offering the lightweight strength and rigidity needed for prosthetics and orthotics. • Lightweight • High saturation • Cost-effective • Easy to use for rigid or flexible lay ups • All prosthetic resins are fully compatible with basalt • Because of its superior saturation, Coyote Composite finishes as good or better than carbon laminations For more information, contact Coyote Design at 800/819-5980 or visit coyotedesign.com.

MARKETPLACE Coyote Design’s New Solid Brass Pins Coyote Design has introduced two new heavy-duty solid brass pin options for its Air-Lock and Easy Off Lock lines. After a year of product and patient testing, Coyote found the new brass pin has much greater durability, zero deflection, and exceptional wear characteristics. Like most Coyote products, it is noncorrosive and water resistant, making it great for active people and heavier weight patients. Combined with new teeth geometry and the low friction of brass, the new pin will give many customers another great option to try. For more information, contact Coyote Design at 800/819-5980 or visit coyotedesign.com.

ePAD: The Electronic Precision Alignment Device The ePAD shows precisely where the point of origin of the ground reaction force (GRF) vector is located in sagittal and coronal planes. The vertical line produced by the selfleveling laser provides a usable representation of the direction of the GRF vector, leading to valuable weight positioning and posturing information. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

New Sure Stance Knee by DAW This ultralight, true-variable cadence, multiaxis knee is the world’s first 4-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion. The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K-3 patients. For more information, contact DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

Freedom Foot Products Just Got Better

Now, with the broadest range of sandal-toe options available anywhere, you can focus first on performance and rest assured that your patient’s desire to wear sandals can be easily satisfied. Achieve improved clinical outcomes by delivering a product designed to meet your functional objectives. Whether it’s shock absorption, hydraulic ankle motion, heel height adjustability, or multiaxial ground compliance, the new sandal-toe product line delivers form and function—unrestricted. Choose from 13 high-performance designs: • Highlander® • Kinterra® • Pacifica® & Pacifica® LP • Renegade® & • Runway® & Runway® HX Renegade® LP • Thrive® • Agilix™ • WalkTek® • DynAdapt™ • Sandal-Toe Foot Shell • Sierra® Our second-generation Sandal-Toe Foot Shell is available in sizes 22-28 cm and in three different skin tones (light, medium, and dark). For additional information, contact customer service at 888/818-6777 or email us at info@freedom-innovations.com.

Silicone, Urethane, and Copolymer Liners

The Skeo family of silicone liners includes an internal matrix to reduce pistoning plus a slick outer surface to aid in donning and doffing. Choose from a variety of options that include preflexed for enhanced fit, and SkinGuard protection to reduce odor. Our copolymer liners are ideal for lower activity patients, and our Anatomic 3D Urethane liner is preferred for Harmony vacuum or valve systems. Whether your patients need a silicone, urethane, or copolymer solution, Ottobock can help you find the right fit. Call your local sales rep to find out more.

The S comb with ortho Str K

K Th that o main

Ottobock • 800.328.4058 www.professionals.ottobockus.com

O&P ALMANAC | MARCH 2015 medi USA Introduces the 4Seal TFS Liner

The new medi 4Seal TFS Liner combines a

MARKETPLACE

Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.

Introducing the Stronger, Smarter, Submersible Plié® 3 MPC Knee

Stronger construction makes the new Plié 3 Microprocessor Controlled (MPC) Knee both submersible and more rugged than ever. Yet it’s still the fastest MPC knee, responding 10 to 20 times more rapidly than other MPC knees. With the most responsive stumble and fall protection, users can instinctively move at their own pace in any direction...even if it’s taking small short steps or pivoting in confined spaces. And with a more streamlined, intuitive set-up, the Plié 3 MPC knee makes it even easier for prosthetists to help patients expand their freedom. To learn more about the Plié 3 MPC knee, contact Freedom Innovations at 888/818-6777 or visit www.freedom-innovations.com.

Dynamic Chopart Gait Stabilizer This unique AFO has been designed for Chopart amputees that wish to remain active. Often a traditional full-length AFO for this patient will be stiff, feeling unnatural. Using a hinged ankle and flexible foot plate with a segmented dynamic filler allows flexion before providing a “stop” that protects the residuum and prevents shoe vamp collapse. The PTB design and the anterior shell redistribute ground reaction forces up the lower extremity. For more information, contact at 800/301-8275 or visit www.hersco.com.

LEAP Balance Brace Hersco’s Lower Extremity Ankle Protection (LEAP) Brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semi-rigid AFO that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, contact at 800/301-8275 or visit www.hersco.com.

Ottobock ProCarve ProCarve provides you targeted support to take on the challenge of snow skiing, waterskiing, and snowboarding. It also meets the highest demands of performance you require on the slopes. It has been specially designed for skiing and snowboarding with extreme carving. Integrated,Products high-performance dampers & Services For Orthotic, Prosthetic & Pedorthic Professionals control the flexion and extension movements for users with a transtibial or transfemoral amputation. 2014 OPERATING To learn more, log onto professionals.ottobockus.com PERFORMANCE REPORT or call your local sales representative at 800/328-4058.

AOPA Helps Run

Your Business 2014 OPERATING PERFORMANCE REPORT

AOPA Operating Performance Report

2014

(Reporting on 2013 Results)

Are you curious about how your business compares to others? This updated survey will help you see the big picture. The Operating Performance Report provides a comprehensive financial profile of the O&P industry including balance sheet, income statement and payer information organized by total revenue size, community size and profitability. The data was submitted by more than 98 patient care companies representing 1,011 full time facilities and 62 part-time facilities. The report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2012 operations. Electronic Version AOPA Member: $85.00 Non-Members: $185.00

HOW TO ORDER BY FAX: 571/431-0899

PUBLICATIONS. EDUCATION. SERVICES. Everything you need to manage a successful patient care facility.

MARCH 2015 | O&P ALMANAC

ONLINE: www.AOPAnet.org BY MAIL: AOPA Bookstore, 330 John Carlyle Street, Suite 200, Alexandria, VA 22314 MORE INFORMATION: For AOPA products and educational opportunities, contact 571/431-0876 or e-mail info@AOPAnet.org.

MARKETPLACE NEW! Orthomerica® Wound & Limb Salvage (OWLS) Program Orthomerica Introduces the Wise Choice for Diabetic Wound Care. Orthomerica Wound Limb & Salvage (OWLS) Program is a culmination of 10-plus years of clinical orthotic development—treating diabetic ulcers classified Wagner 1-4 with custom orthoses to better enhance diabetic wound unloading and mobility and promote healing. These orthoses will complement the ongoing wound therapies and postoperative care being offered at Wound Centers worldwide. OWL products include: • Wound Healing Orthosis: Heel Relief • Wound Healing Orthosis: Forefoot Relief • Wound Healing Orthosis: Midfoot/Walking AFO • Advanced Diabetic Orthosis For more information, contact Orthomerica at 877/737-8444 or visit www.orthomerica.com.

Spinal Technology Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lower-limb orthotics, and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses. For information, contact 800/253-7868, fax 888/775-0588, email info@spinaltech.com, or visit www.spinaltech.com.

The Source for Orthotic & Prosthetic Coding

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

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

Log on to LCodeSearch.com and start today. Need to renew your membership? Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

NEW

Manufacturers: for 2015! AOPA is now offering Enhanced Listings on LCodeSearch.com. Don’t miss out on this great opportunity for buyers to see your product information! Contact Betty Leppin for more information at 571/431-0876.

www.AOPAnet.org

O&P ALMANAC | MARCH 2015

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Southeast

Job location key:

CPO or CO

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

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

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

Member Nonmember $80 $140

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

Discover new ways to connect with O&P professionals. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamedia for advertising options.

Chattanooga, Tennessee Fillauer Companies Inc. is seeking a CPO or CO to join its team as the director of orthotics at its headquarters in Chattanooga, Tennessee. The qualified candidate will manage the product development and clinical education for Fillauer’s orthotic product lines. Requirements: • The minimum education is a bachelor’s degree in O&P and/or master’s degree in O&P is a plus. • ABC certification is preferred. • A minimum of five years of recent patient-care experience with emphasis on orthotics. • Licensed or ability to be licensed in Tennessee. • If not currently living in Chattanooga or the surrounding area, the candidate must be willing to relocate. • Must work well in a team environment. • Excellent communications skills, including oral and written, are necessary. • Must have the ability to travel up to 30 percent of the time, or as needed. Fillauer Companies Inc. offers a competitive benefits package, including 401K and medical, dental, and vision insurance. Please apply at:

Website: Fillauer.com/careers

Southeast Certified Prosthetist-Orthotist

Johnson City, Tennessee Well-established multioffice ABC-certified O&P company is looking for certified individual with excellent orthotic and prosthetic skills to provide comprehensive treatment of patients. Excel offers competitive salary and bonus opportunity with full benefits package. Salary to be determined on experience. Send resume to:

Email: sethwalters@excel-prosthetics.com

MARCH 2015 | O&P ALMANAC

MEMBER VALUE GUIDE www.AOPAnet.org/join

CAREERS AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

Member Beneﬁts Pacific Here We Grow Again… Openings: CPO, CP, and CO

•

Challenging RAC and CERT audit policies implemented by overly aggressive CMS contractors is AOPA’s number one priority. We have ﬁled litigation against CMS seeking relief from the unfair and unauthorized actions of CMS, its RAC auditors, and DME MACs relating to physician documentation requirements, and the change in policy resulting from the “Dear Physician” letter.

MISSION

•

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

Expert Reimbursement and

•

Cost-Effectiveness Research. The

changing of health is Coding Guidance. AOPA’s Membership inreim-AOPA is climate one ofcarethe moving to a patient driven process bursement specialists provide

Your Survival Advocacy in Washington. AOPA’s staff and the lobbying team bring years of healthcare knowledge and experience to the issues of O&P. AOPA’s efforts help assure equitable reimbursement policies in these uncertain ﬁnancial times to ensure quality patient care.

and is demanding more and more

coding advice and keep you up-to-date on the latest Medicare quality standards, RAC and other audits, billing rules and regulations. Answers to all of your questions related to O&P coding, reimbursement and compliance—via telephone or email. Members have unlimited access to AOPA staff experts.

of cost-effectiveness to best investments that evidence yououtcomes. canAOPAmake measure has

Making Your Voice Connect. AOPA’s Annual Policy Forum brings O&P leaders to Washington to receive high level brieﬁngs and to E E GUIDdeliver the O&P story personally to VALU BER MEM rg/join their members of Congress. www.AOPAnet.o

& PROST HETIC

ASSO CIATIO

•

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•

the Beneﬁts

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mbership

of AOPA Me

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and Prosthet

diagnoses as patients who did not receive treatment. AOPA can aggregate the resources of the ﬁeld to conduct this vital research that individual ﬁrms cannot conduct.

LCodeSearch.com, AOPA’s online coding resource, provides members with a one-stop, up-to-the minute coding reference available 24/7, from anywhere you connect to the Internet.

eﬁts Member Ben AMER ICAN

funded a major study by health care ﬁrm Dobson-DaVanzo proving

cost-effectiveness of timely O&P in the future of your company. treatment of patients with the same

•

Experience

Attention: Human Resources Inland Artificial Limb & Brace, Inc. Fax: 951/734-1538

Experience the Benefits of AOPA Membership

Experience the Beneﬁts of AOPA Membership

is to work

n Orthotic services; audit of the America regulation and RAC and CERT The mission Challenging business in laws, ented by overly of the O&P to e treatment policies implem contractors is g skills; and for favorabl and marketin CMS aggressive management one priority. ion. s improve their the associat AOPA’s number to help member industry and litigation against unfair nding of the We have filed relief from the CMS, ss and understa of CMS seeking raise awarene rized actions MACs and unautho The , and DME ss Research. is ectivene its RAC auditors n documenta• Cost-Eff of health care t and relating to physiciaand the change changing climate driven process ents, Reimbursemen reimto a patient tion requirem • Expert the “Dear more AOPA’s moving e. and from ing more Coding Guidanc ts provide in policy resulting s to and is demand cost-effectivenes bursement specialis Physician” letter. evidence of and keep you s. AOPA has coding advice the latest Medicare measure outcome Advocacy in study by health up-to-date on s, RAC and other • Your Survival funded a major -DaVanzo proving standard ons. team Dobson Washington. quality regulati rm fi lobbying and O&P care rules and the s of timely AOPA’s staff healthcare knowlaudits, billing of your questions the same cost-effectivenes of all sepatients with bring years Answers to ce to the issues did treatment of coding, reimbur patients who can assure edge and experien related to O&P nce—via telephone diagnoses as efforts help t. AOPA of O&P. AOPA’s sement policies ment and complia s have unlimited not receive treatmen s of the field to resource equitable reimbur or email. Member aggregate the vital research that n financial times staff experts. in these uncertai access to AOPA to conduct this cannot conduct. patient care. rms ensure quality AOPA’s online s individual fi earch.com, • LCodeS Connect. , provides member Your Voice coding resource, up-to-the minute • Making Policy Forum ton Annual one-stop a AOPA’s with e available 24/7, leaders to Washing (Continued) and to brings O&P coding referenc you connect to the level briefings re to receive high story personally to from anywhe deliver the O&Pof Congress. Internet. s their member

MIS SIO N

Orange County, Riverside County, San Bernardino County, California A reputable, well-established, multioffice, Southern California O&P company is looking for energetic and motivated individuals who possess strong clinical skills and experience to provide comprehensive patient assessments to determine patient needs, formulate and provide treatments, perform necessary protocols to ultimately deliver the best orthotic/prosthetic services, and provide follow-up patient care. Candidates must have excellent communication, patient-care, and interpersonal interaction skills, and always abide by the Canons of Ethical Conduct instilled by ABC. We offer competitive salaries and benefits. Salary is commensurate with experience. Local candidate preferred. Send resumé to:

2015 AOPA Annual Membership enrollment(Continued) is now open. Call 571/431-0876 to request an application form, or visit www.AOPAnet.org.

Join today!

ADVERTISERS INDEX

Company

Page Phone

Website

4tellSoftware Inc.

888/261-7113

www.4tellsoftware.com

ABCOP - American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc.

703/836-7114

www.abcop.org

Aqualeg Inc.

855/955-2785

www.aqualeg.com

Allard USA

888/678-6548

www.allardusa.com

Aspen Medical Products

800/295-2776

www.aspenmp.com

Cailor Fleming Insurance

800/796-8495

www.cailorfleming.com

Cascade Dafo

800/848-7332

www.cascadedafo.com

College Park Industries

800/728-7950

www.college-park.com

Coyote Design

800/819-5980

www.coyotedesign.com

800/252-2828

www.daw-usa.com

Delcam Healthcare Solutions

877/335-2261

www.orthotics-cadcam.com

Freedom Innovations

888/818-6777

www.freedom-innovations.com

Hersco

800/301-8275 www.hersco.com

Orthomerica

800/446-6770

Ottobock

C4 800/328-4058 www.professionals.ottobockus.com

DAW Industries

Spinal Technology Inc. WillowWood

www.orthomerica.com

800/253-7868

www.spinaltech.com

Between 16/17, 37

800/848-4930

www.willowwoodco.com

O&P ALMANAC | MARCH 2015

CALENDAR

2015

March 20-21

March 11

Who Gets the Bill: A Complete Look at Medicare Inpatient Billing. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

PrimeFare West Regional Scientific Symposium 2015. Marriott City Center, Denver. Sponsored by ReliaCare Alliance IPA. For more information, visit www.primecareop.com or contact Jane Edwards at 888/388-5243 or jedwards@reliacare.com.

Webinar Conference

March 14-15

ABC: Orthotic Clinical Patient Management (CPM) Exam. University of Texas Southwestern Medical Center, Dallas. Contact 703/836-7114, certification@abcop.org, or visit www.abcop.org/certification.

March 16-21

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 250 locations nationwide. Contact 703/8367114, certification@abcop.org, or visit www.abcop.org/certification.

March 23-25

AOPA Policy Forum. Renaissance Hotel, Washington, DC. Come make a difference! Educate Congress on issues affecting your business. For more information, contact Devon Bernard at dbernard@AOPAnet.org or call 571/431-0876.

April 1

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

April 8

Lower-Limb Prostheses Policy: Learn the Policy Inside and Out. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

March 20-21

ABC: Prosthetic Clinical Patient Management (CPM) Exam. University of Texas Southwestern Medical Center, Dallas. Contact 703/836-7114, certification@abcop.org, or visit www.abcop.org/certification.

April 9-10

Orthomerica Wound & Limb Salvage Accredited Seminar. Orlando, FL. Registration online at https:// orthomerica.formstack.com/forms/owls or for more information, email marketing@orthomerica.com.

Year-Round Testing

Online Training

BOC Examinations. BOC has year-round testing for all of its exams and no application deadlines. Candidates can apply and test when ready and receive their results instantly for the multiple-choice and clinical-simulation exams. Apply now at my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.

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

www.bocusa.org

Calendar Rates Let us share your upcoming event! Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www. AOPAnet.org for content deadlines.

MARCH 2015 | O&P ALMANAC

CE For information on continuing education credits, contact the sponsor. Questions? Email landerson@AOPAnet.org.

CREDITS

BONUS! Listings will be placed free of charge on the â&#x20AC;&#x153;Attend O&P Eventsâ&#x20AC;? section of www.AOPAnet.org.

Words/Rate: Member Nonmember Color Ad Special: Member Nonmember 25 or less

$40

$50

1/4 page Ad

$482

$678

26-50

$50

$60

1/2 page Ad

$634

$830

51+

$2.25/word $5.00/word

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

CALENDAR

Motion Control

April 9-11

Texas Association of O&P Annual Meeting. San Antonio, TX. Registration is online at www.taop.org. Contact us at taopstaff@gmail.com or call 210/591-8267.

SUPERCOURSE SPRING 2015 APRIL 8-11, 2015

Motion Control Headquarters, Salt Lake City, UT

April 13-14

AOPA: Mastering Medicare Essential Coding & Billing Techniques Seminar. Grand Hyatt Seattle. Register online at bit.ly/2015billing. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

April 24-25

• In-depth training of Utah Arm 3+ / Hybrid Arm / ProPlus TDs and Wrist

• Latest MC components, integrating with i-limb, bebionic, and others

• Hands-on training with UI software - bring your Windows laptop

• Convenient Wednesday Saturday schedule Plus training in the NEW

• Casting/fitting/socket design F.L.A.G. (Force Limiting Auto for SD/FQ, T-H, T-R levels; Grasp) feature for ETD & Hand patient subjects provided

PrimeFare Central Regional Scientific Symposium 2015. Tower Hotel, Oklahoma City. Sponsored by ReliaCare Alliance IPA. For more information, visit www.primecareop.com or contact Jane Edwards at 888/388-5243 or jedwards@reliacare.com.

The 4-day SuperCourse fee is $1,350.00 CEUs: 28 (estimated) ABC/BOC

April 30-May 2

2015 International African-American Prosthetic Orthotic Coalition Annual Meeting. Ocean Front Studio Suites, Virginia Beach, VA. Contact Michael Smith at 757/548-5656, email aopcnow@gmail.com, or visit www.iaaopc.org.

For more information or to register for the SuperCourse, email: info@UtahArm.com

May 13

The New Player in Town: Understand How the RAC Contract Works. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

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

May 14-16

PA Chapter of AAOP Annual Spring Conference. DoubleTree by Hilton Hotel Pittsburgh-Meadow Lands, Pittsburgh, PA. For more information, call Beth or Joe at 814/455-5383.

June 10

O&P Almanac Calendar Ad SuperCourse Spring 2015.indd 1

Stay Out of Trouble: Building a Medicare-Approved Compliance Plan. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

July 13-14

AOPA: Mastering Medicare Essential Coding & Billing Techniques Seminar. Philadelphia. Register online at bit.ly/2015billing. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Webinar Conference

June 11-12

MOPA: Michigan Continuing Education Meeting. DoubleTree by Hilton Bay City-Riverfront. Now offering pedorthic continuing education credits. Contact 517/784-1142 or visit www.mopa.info.

August 12

Off-the-Shelf vs. Custom Fit: The True Story. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

September 9

Prior Authorization, How Does It Work? Register online at bit. ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

June 19-20

PrimeFare East Regional Scientific Symposium 2015. National Convention Center, Nashville, TN. Sponsored by ReliaCare Alliance IPA. For more information, visit www.primecareop.com or contact Jane Edwards at 888/388-5243 or jedwards@reliacare.com.

July 8

Who’s on First? Medicare as a Secondary Payer. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

12/30/14 10:21 AM

October 7-10

98th AOPA National Assembly. The Henry B. Gonzalez Convention Center, San Antonio, TX. More information at bit.ly/2015assembly. For exhibitors and sponsorship opportunities, contact Kelly O’Neill, 571/4310852, or koneill@AOPAnet.org. General inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

O&P ALMANAC | MARCH 2015

ASK AOPA

What’s in a Name? Learn the guidelines of acceptable use for handwritten and electronic signatures

EDICARE’S SIGNATURE REQUIREMENTS AND guidelines

are such that any record used in the processing of a claim must include a signature. Since chart notes are part of a patient’s medical record and can be used to support the medical necessity of items, they would require an acceptable signature; the signature must be from the individual who entered the material into the record.

What is considered an acceptable signature?

Medicare will accept handwritten signatures as long as they are legible. Electronic signatures also are acceptable as long as they can be tied to an individual and cannot be altered. This is usually accomplished with a password and PIN-code system. It is not a requirement, but some of the Medicare contractors—including the durable medical equipment Medicare Administrative Contractors (DME MAC)—have suggested that each electronic signature should include a statement indicating that the documents or entries have been electronically signed. Some examples, provided by the DME MACs, for acceptable statements are the following: • Electronically signed by • Authenticated by • Approved by • Completed by • Finalized by • Signed by • Validated by

Faxed copies of a signature are acceptable as well. When using faxed signatures, keep in mind that Medicare can request a copy of the original signature. Under most circumstances, the only type of signature that is not acceptable to Medicare is a stamped signature. 56

MARCH 2015 | O&P ALMANAC

What if the signature is not legible?

There are some precautions you may take to ensure that a signature will be acceptable even if it is deemed not legible. For example, you may include a line or space below the signature where the person signing also may print or type his or her name. Another option is to create a signature log for your office. The signature log should include the person’s typed name, his or her signature, and his or her initials. The signature log will allow the Medicare contractors to cross-reference and tie the illegible signature to an individual, and verify that a specific individual was the one who made an entry into the medical record.

statement that says, “The information in the medical record was entered by me and is accurate and true.” When using an attestation statement, the statement must clearly identify the patient to whom the statement refers, and the statement must be signed and dated by the individual who made the entry into the medical record. The attestation statement may be used only to verify the identity of the individual who entered specific information into the medical record, and it may not be used to add new or additional information to the medical record. Do these same guidelines apply to medical records I request and receive from a physician?

Yes. If you are submitting physician records to help adjudicate your claim, the physicians’ records must be signed, and the same signature requirements would apply.

May initials be substituted for a full signature?

Yes, initials may be used as a substitute for a full signature, as long as a few criteria are met. The initials must be above a typed or printed full name, and they must be legible. If the initials are not above a printed or typed name, you must submit a signature log or an attestation statement.

What if there is no signature present in the medical record?

If you forgot to sign the medical record, you may submit an attestation statement to collaborate the entry. In other words, you may send a

Editor’s Note: If you have additional questions about Medicare guidelines regarding signatures, please contact AOPA. You also may review the guidelines as they are written in the Medicare Program Integrity Manual, www.cms.gov/Manuals/IOM/ list.asp, in Chapter 3, Section 3.3.2.4.

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@contentcommunicators.com.

ABC Assistants Helping the O&P Team

Succeed

American Board for Certification in Orthotics, Prosthetics & Pedorthics, Inc.

If you’re currently working as an orthotic or prosthetic assistant, become certified with ABC and gain the recognition you deserve for your knowledge, training & experience.

abcop.org • certification@abcop.org • 703.836.7114

Mobility + Stability = 3R62 New K2 Knee

The 3R62 Pheon packs a lot into a small package for your K2 patients. The stability of a polycentric design with added safety features like an optional manual lock and extension assist means it gives your patients the security they need. As patients progress, they’ll appreciate the smooth extension stop and up to 10⁰ of stance flexion the knee provides. You’ll appreciate that this little knee packs so much function into such a small package. To find out more, ask your sales representative or call us at 800 328 4058.