OP
The American Orthotic & Prosthetic Association
MAY 2014
&
WWW.AOPAnet.ORG
In J u s t s— s i h T Save
ilit y ey Mob Mon d n a Lives 20 Page
THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY
A Fresh Look at Diabetes Treatment
Extending patients’ options with unconventional care and awareness
E! QUIZ M
2
Earn
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Credits
Making Sense of Claim Modifiers
Page 19
$10 Million for O&P Outcomes Research: How to Get Involved
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O&P MAY 2014, VOLUME 63, No. 5
CONTENTS FeatureS
20 This Just In: Mobility Saves—Lives and Money
NEW!
By Adam Stone Backed by industry research, this new initiative seeks to help demonstrate the value of O&P care to payers and policymakers alike.
Cover Story
22 A Fresh Look at Diabetes Treatment
By Christine Umbrell While the number of U.S. adults with diabetes is rising, the rate of diabetes-related amputations is declining, indicating the effectiveness of pedorthic and orthotic interventions in diabetic foot care. Here, several diabetes specialists share success stories in treating patients in various stages of the disease.
28 Funding the Future
By Lia Dangelico The 2014 omnibus appropriations bill included language allocating $10 million for O&P outcomes research. Here’s what you need to know about how the funding will be dispersed and how to get involved.
COLUMNS
16
Departments
Reimbursement Page Submitting a clean claim, with appropriate modifiers, every time
4
President’s Corner Insights from AOPA President Anita LibermanLampear, MA
E! QUIZ M
6
AOPA Contact Page How to reach staff
8
At a Glance Statistics and O&P data
Earn
2
Business CE
Credits SEE PAGE 19
32
Member Spotlight Fillauer Companies Inc.
10 35
In the News Research, updates, and company announcements AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more
42 Marketplace
Products and services for O&P
44 Jobs
Opportunities for O&P professionals
46 Calendar
Upcoming meetings and events
47
Ad Index
48
AOPA Answers Expert answers to your FAQs
O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.
MAY 2014 O&P Almanac
3
President’s IN THE NEWS corner
O&P Making a Difference— Your Difference
T
he 2014 Policy Forum, held April 2-4, in Washington, D.C., was a classic opportunity for O&P to make its case, as more than 100 of our colleagues took time from their already busy schedules to invest first-hand in the future of their patients, their businesses, and their families. The AOPA staff and AOPA’s lobbying team orchestrated more than 350 appointments during the event, which provided the opportunity to bring the crippling effects of CMS’s audit overreach to the attention of lawmakers and their staff. In addition, participants had the privilege of meeting Rep. Kevin Brady (R-Texas) and Sen. Dick Durbin (D-Illinois) at two fundraisers hosted by the AOPA PAC. It was great to see the number of AOPA members who donated to these fundraisers and to be able to talk to legislators about the issues facing O&P today. During the event, AOPA members drove home the unfairness of being deprived of their last hope for “due process” with the recently announced suspension of hearing date assignments for the final step of appeals before the Administrative Law Judges (ALJs). Taking a claims denial to the ALJ could now take three or more years if providers have not already been assigned a hearing/date. The AOPA legislative agenda also got top billing, as AOPA members plugged the Medicare O&P Improvement Act (HR 3112), the Insurance Fairness for Amputees Act (HR 3020), and the Injured and Amputee Veterans Bill of Rights (HR 3408). AOPA members delivered their thanks and appreciation for Congress’s passage of the 2014 omnibus appropriations bill, which included $10 million in funding for O&P research in the Department of Defense budget (read more in “Funding the Future” on page 28) and the pending Veterans Appropriations bill, which includes another $10 million to expand or create masters-level O&P education opportunities. The thirst for knowledge—any knowledge—that could help O&P survive this potentially devastating turn of events was evident in the enthusiasm witnessed over the extended program, which was tacked on to the usual two-day Policy Forum schedule. The AOPA Board made the right call when it urged raising the value stakes for members coming to Washington by making sure that, in addition to the prime mission of educating legislators and their staff, members also received needed how-to information to help them navigate the rapidly changing health-care environment. One education module focused on gaining a better understanding of how the Congressional Budget Office and the scoring process really works, as well as understanding accountable care organizations and post acute-care bundling—all new developments that could potentially impact our future in service provision and reimbursement. Another module drilled down on avoiding audits, pursuing appeals, suing CMS, and the importance of knowing how the FDA is becoming a regulatory force in O&P and how to avoid compliance violations. I urge all AOPA members to continue to stay involved. Over the past year or two, AOPA has seen a significant rise in attendance at the Essential Coding and Billing Techniques seminars and audio conferences, as well as the much higher utilization of AOPA’s online education opportunities—many of which provide those much needed continuing education (CE) credits. Be sure to take advantage of the two CEs you can earn by reading the O&P Almanac’s monthly Reimbursement Page (page 16) and quarterly Compliance Corner columns and passing the online quizzes. One final note: Registration is now open for the 2014 AOPA National Assembly, Sept. 4-7, 2014, at the Mandalay Bay Resort and Casino in Las Vegas. For more information, or to register, go to www.aopanet.org/ education/2014-assembly/. Thank you for your continued support. It’s an honor to serve as your president. Sincerely,
Anita Liberman-Lampear, MA AOPA President 4
O&P Almanac MAY 2014
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AOPA IN THE Contact NEWS INFORMATION AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org EXECUTIVE OFFICES
MEMBERSHIP & Meetings
BOARD of DIRECTORS
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org
Officers
Directors
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org
Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA
Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org
President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI
O&p Almanac Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000 bob.rhmedia@comcast.net Lia K. Dangelico, managing editor and contributing writer, 703/914-9200 x24, ldangelico@strattonpublishing.com Stephen Custer, production manager, 571/431-0810, scuster@AOPAnet.org Christine Umbrell, editorial/production associate and contributing writer, 703/914-9200 x33, cumbrell@strattonpublishing.com
Stephen Custer, communications manager, 571/431-0810, scuster@AOPAnet.org Lauren Anderson, manager of membership services, 571/431-0843, landerson@AOPAnet.org Betty Leppin, project manager, 571/431-0876, bleppin@AOPAnet.org AOPA Bookstore: 571/431-0865 Government affairs Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org
President-Elect Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD Vice President James Campbell, PhD, CO Becker Orthopedic Appliance Co., Troy, MI Immediate Past President Tom Kirk, PhD Member of Hanger Inc. Board, Austin, TX Treasurer James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA
Devon Bernard, assistant director of coding reimbursement, programming and education, 571/431-0854, dbernard@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com
Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Alfred E. Kritter Jr., CPO FAAOP, Hanger, Inc., Savannah, GA Eileen Levis Orthologix LLC, Trevose, PA Ronald Manganiello New England Orthotics & Prosthetics Systems LLC, Branford, CT Dave McGill Ă–ssur Americas, Foothill Ranch, CA Michael Oros, CPO Scheck and Siress O&P Inc., Oakbrook Terrace, IL Scott Schneider Ottobock, Minneapolis, MN Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA
O&P Almanac Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company
Copyright 2014 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.
6
O&P Almanac MAY 2014
AT IN THE A GLANCE NEWS
A Closer Look at the ALJ Hearing Delay The Administrative Law Judge (ALJ) level in the Medicare claims appeal process allows a provider to present an appeal to a judge who independently reviews the materials and renders a new decision in accordance with the law, rather than one based on Medicare policy. In early 2014, the Office of Medicare Hearings and Appeals (OMHA) temporarily suspended the scheduling of any new ALJ hearings. AOPA believes this suspension, which is expected to last two years, is a clear violation of the rights of due process afforded by the Benefits Improvements and Protection Act (BIPA), and sent a letter to CMS expressing this opinion.
The weekly average of requests for appeals has risen dramatically in past two years:
15,000
YEAR
FY 2009 FY 2011
1,250
YEAR
The average processing time for an appeal decided by an ALJ also has risen dramatically:
January
December
2012
2013
94.9
days
121.3 days
220.6
FY 2013
days
FY 2014
335.5 days
Source: “Restore Due Process Rights & Proper Administrative Law Judge Timeframes,” published by AOPA, www.aopanet.org.
Up to
24
Length of time OMHA anticipates assignments of requests for ALJ hearings may be delayed.
Months
65
Current number of Administrative Law Judges.
351,000 Total requests for ALJ hearings in FY 2013, up from 36,000 in FY 2009.
NO MORE THAN
90 DAYS
56%
Timeframe defined within statutory requirement in BIPA within which ALJs are required to issue decisions.
Percentage of appeals in which ALJs reversed prior-level decisions and decided fully in favor of appellants in FY 2010.
184%
Increase in workload of ALJs since 2010.
Source: “Restore Due Process Rights & Proper Administrative Law Judge Timeframes,” published by AOPA, www.aopanet.org. 8
O&P Almanac MAY 2014
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IN THE NEWS
Probe Uncovers High Error Rate for Lower-Limb Prostheses Claims Jurisdiction D DME MAC has announced it will Noridian Healthcare Solutions, the initiate a widespread pre-payment review for claims Jurisdiction D Durable Medical Equipment involving L5987. Medicare Administrative Contractor (DME AOPA reminds members that the DME MAC), has released results of its prepayment MACs expect the medical need for any device or probe review involving claims for code L5987, component to be documented in the records of or lower-extremity prostheses. Of the 99 claims HIGH CLAIM ERROR RATE both the provider and the prescribing physician. In selected for the probe review, 81 were denied, addition, the DME MACs expect detailed inforfor an overall error rate of 79 percent. mation supporting the patient’s functional level to According to the DME MAC, major reasons be incorporated into the prescribing physician’s note. Failure for claim denials included a lack of documentation to to obtain this documentation often results in claim denials. support the patient’s functional level, a lack of documenQuestions regarding this issue may be directed to Joe tation of the need to replace components described by McTernan at jmcternan@aopanet.org or Devon Bernard at L5987, and failure to respond to the additional documendbernard@aopanet.org. tation request. As a result of the 79 percent error rate, the
CMS Issues Revised CMS-1500 Paper Claim Form Health-care professionals who submit paper claims using the CMS-1500 form must ensure they use the updated and revised form, Version 02/12. As a reminder, effective for claims received on or after April 1, 2014, Medicare will accept only the revised CMS-1500 claim form. To read about updates to the CMS-1500 form, visit the CMS website at www. cms.gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/ MM8509.pdf. Contact Devon Bernard at dbernard@AOPAnet.org or Joe McTernan at jmcternan@AOPAnet.org with questions.
10
O&P Almanac MAY 2014
CMS Expands Contractor Authority to Deny ‘Related‘ Claims Effective for claims with a date G EXISTIN NEW of service on or after March 6, 2014, ED I N E CMS has expanded the authority of D RELATED CLAIM its contractors to automatically deny CLAIM claims that are related to another denied claim. While the examples provided do not involve O&P claims, the CMS announcement indicated that claims NEW involving other Medicare services are RELATED subject to the same rules. CLAIM The example provided by Medicare discussed a situation where an inpatient (Part A) admission was denied as not medically necessary. Under the new authority, the Medicare Administrative Contractor that processes any Medicare Part B physician services provided during the noncovered admission may automatically deny those physician services claims solely on the denial of the related inpatient admission. AOPA will monitor this situation closely to gauge any potential impact on coverage of O&P services, and also is reviewing the CMS change request with respect to potential CMS circumvention of the proper notice and rulemaking process as required by the Administrative Procedures Act. The CMS change request, CR8425, may be viewed at www.cms.gov/Regulationsand-Guidance/Guidance/Transmittals/Downloads/R505PI.pdf. Questions may be directed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.
+
=
IED
DEN
IN THE NEWS
HHS Compliance Tool to Help Mitigate Security Risks The U.S. Department of Health and Human Services (HHS) has released a new security risk assessment tool to help health-care providers in small- to medium-sized offices conduct security risk assessments of their organizations. The Health Insurance Portability and Accountability Act (HIPAA) Security Rule requires organizations that handle protected health information to regularly review the administrative, physical, and technical safeguards they have in place to protect the security of the information. Conducting a security risk assessment is a key requirement of the HIPAA Security Rule and a core requirement for providers seeking payment through the Medicare and Medicaid Electronic Health Record Incentive Program. By conducting these risk assessments, health-care providers may uncover potential weaknesses in their security policies, processes, and systems. The risk assessments also may help providers address vulnerabilities, potentially preventing health data breaches or other adverse security events. The application, which is available for download at www.HealthIT. gov/security-risk-assessment, also produces a report that can be provided to auditors. The tool was developed by the HHS Office of the National Coordinator for Health Information Technology and the Office for Civil Rights.
TRANSITIONS
people in the news
Steve Cash, a threetime Paralympian and the goalie for the Gold-medal-winning U.S. sled hockey team, Steve Cash was the flag-bearer for the U.S. Paralympic team at the Closing Ceremonies of the 2014 Sochi Games. Tyler Dunham, CPO, of Ability Prosthetics & Orthotics’ Charlotte, North Carolina, patientcare center, participated in the 14th Annual Cycle Tyler Dunham, CPO to the Sea in April. The event was held by the Adaptive Sports and Adventure Fund and raised more than $50,000. Jack Richmond and David S. Sanders have been named to the board of directors of the Amputee Coalition, where they will serve three-year terms. Richmond is
director of sales for Fillauer Inc., and Sanders is a partner with Foley & Lardner LLP. The Amputee Coalition also has announced three new members on its Education and Conference Committee: Roberta Cone, PsyD; Tammie Higginbotham; and Sienna Newman, CPO. Dara Ross, CPO, has joined Ability Prosthetics & Orthotics, headquartered in Exton, Pennsylvania. Jamie Seabold has been hired to fill the new position of sales director at Scheck & Siress. John Spillar has been promoted to the position
Dara Ross, CPO
Jamie Seabold
John Spillar
of market manager for lower-extremity prosthetics at Ottobock. Previously, Spillar had been Ottobock’s technical orthopedics territory sales representative for South Texas. Paralympic athlete Evan Strong, who won a Gold medal in the snowboard cross event in Sochi, has become the first elite paraathlete to appear on the iconic Wheaties cereal box. Evan Strong Virginia Prosthetics & Orthotics, based in Roanoke, Virginia, has announced the addition of three practitioners: Bill Earles, CO; Indi Hewavita, CP; and Ben Sigmon, CO.
Bill Earles, CO
Indi Hewavita, CP Ben Sigmon, CO
MAY 2014 O&P Almanac
11
IN THE NEWS
Amy Purdy Captures Nation’s Attention on ‘Dancing with the Stars’ Amy Purdy, a bilateral amputee, has had success in acting, modeling, business pursuits, and the Sochi 2014 Paralympic Games, where she earned a Bronze medal in the inaugural snowboard cross event. Now she is adding the role of “professional dancer” to her résumé, with her participation in the 18th season of the television show “Dancing with the Stars,” which aired this spring. Purdy was originally paired with pro dancer Derek Hough on the show, and she quickly became a crowd favorite. For dancing, Purdy has worn special prostheses from Freedom Innovations, an Irvine, California-based company. The prostheses are technically designed for high-performance swimming and enable Purdy to perform on pointed toes. The company also designed the high-tech prostheses Purdy wore during the Paralympic Games. Purdy shared her thoughts on trying to win the competition with the Los Angeles Times in April: “Coming into the
competition I had very, very little time to prepare and was trying to do so while I was competing in the Paralympics in Russia, so to be honest coming in I was just trying to get through the first week and not be the first dancer sent home,” she said. “Now that I’ve been here a few weeks the fire is definitely burning to stay here as long as I can. I’m in it to win it!”
Prosthetic Implant Could Improve User Comfort, Reduce Infection Sixteen above-knee amputees at the Royal Orthopaedic Hosptial in Birmingham, England, have undergone operations to insert a metal socket into their bones so prosthetic legs can be clipped on. “The bone and skin grow onto the implant, which works like a tooth implant,” says Professor Robert Grimer, lead researcher. The goal is to reduce rubbing, soreness, and sweating that can sometimes make prostheses feel uncomfortable. The first few patients reportedly experienced significant problems with infection. The process has been adjusted to incorporate silver coating technology, and patients are being kept immobile 10 days after their operation, reducing the risk for infection. Michael Lloyd, one of the clinical trial patients, said the
12
O&P Almanac MAY 2014
new device has “revolutionized” his life. Lloyd, whose left leg was amputated 34 years ago after bone cancer, previously wore a prosthesis held in place with suction, which would become uncomfortable after exercising or walking long distances. “This is attached directly to the bone so it does away with all of that and it means I can walk for miles each day,” says Lloyd. He also said the implant has enabled him to drive vehicles with a manual gearbox because he can “feel the clutch bite.” Grimer said there is exciting potential in using this type of implant with the next generation of moving bionic artificial limbs. The implant could have applications for the prostheses of Paralympic athletes and wounded veterans.
IN THE NEWS
AOPA Celebrates Limb Loss Awareness Month AOPA leaders and staff showed their support of Limb Loss Awareness Month by hosting a lunchtime Charity Walk at its headquarters in Alexandria, Virginia, on April 21. AOPA was joined by staff members from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics and the National Commission on Orthotic and Prosthetic Education. The group walked in an effort to boost awareness of Limb Loss Awareness Month, and raised more than $2,335 to support the Amputee Coalition Youth Camp. Participants also enjoyed lunch, awards, and special recognition. Sponsors of the event included Marinoff Design, Freeman The following individuals were the top contributors to the event: Decorating, and Doyle Printing. Paolo Astorga Anita Liberman-Lampear
Top CONTRIBUTOR Samlane Ketevong, ABC Credentialing Programs Manager
TRANSITIONS
Debbie Ayres Roxanne Bobb-Semple Cathy Carter Don DeBolt Tom Fise Dan Jones Samlane Ketevong Jim Lawson Eileen Levis
Catherine Marinoff Megan Matijevich Joe McTernan Tina Moran Kelly O’Neill Abbey Potter Scott Schneider Robin Seabrook
BUSINESSES in the news
The American Board for Certification in Orthotics, Prosthetics, and Pedorthics is seeking nominees for its board of directors. The open positions are for director and public member director. Each position entails a four-year commitment beginning Dec. 1, 2014. The deadline for submission of nominations is June 1, 2014. For more information or to submit a nomination, contact Steve Fletcher, CPO, LPO, at sfletcher@abcop.org or 703/836-7114 x216. The Board of Certification/ Accreditation (BOC) www.bocusa.org has announced the unification of the organization’s certification and accreditation departments. Wendy Miller, BOC, CDME, has been promoted to chief credentialing officer and will lead the direction, Wendy Miller, strategy, policies, and BOC, CDME
day-to-day operations of BOC’s credentialing programs. Jeff Price, MCP, has been promoted to chief operating officer and will direct, maintain, Jeff Price, MCP and support BOC’s strategic and operational initiatives. FitBionic, a Boulder, Coloradobased manufacturer of bionic limbs and clinical-outcomes solutions, has been approved for a $250,000 matching grant by the State of Colorado’s Advanced Industries Accelerator Program. The grant was approved in support of development of the diabetes-appropriate FitBionic Foot 2.0 and FitDash, a patient outcomes reporting app. The Orthotic and Prosthetic Activities Foundation’s (OPAF’s) Dale Yasukawa Scholarship Fund is now accepting
applications from full-time master’s candidates enrolled in Northwestern University’s Prosthetic Orthotic Center (NUPOC). The $1,000 scholarship is intended to assist a NUPOC student in attending his or her local chapter or society meeting of the Academy. More information is located on the OPAF website at http://opafonline.org/programs/ scholarship. Contact the OPAF office at 980/819-9404 or robin@opafonline.org. Ottobock, the Americas corporate headquarters of Otto Bock HealthCare, GmbH, has announced it is relocating its North America logistics and distribution operations from Minneapolis and Toronto, Ontario, to Louisville, Kentucky. The move is part of an expanded investment by Ottobock in the United States and North America that includes the goal to triple its business, with Louisville serving as a strategic shipping hub.
MAY 2014 O&P Almanac
13
IN THE NEWS
2014 Policy Forum Draws Support for Key O&P Legislation
Policy Forum attendees visit with Rep. Dave Camp (R-Michigan). From left: Ted Trower; 2014 AOPA Vice President James Campbell; AOPA President Anita Liberman-Lampear, MA; Scott Dombroski; and Les VanKuren.
AOPA Board Director Eileen Levis and Steven Chu meet with Rep. Mike Fitzpatrick’s (R-Pennsylvania) assistant (middle).
Left to right: 2014 AOPA Past President Thomas Kirk, Sen. Dick Durbin (D-Illinois), and AOPA Executive Director Thomas Fise at the O&P PAC Fundraiser Breakfast.
14
O&P Almanac MAY 2014
AOPA President Anita LibermanLampear, MA, and 2014 AOPA President-Elect Charles Dankmeyer Jr. (right) meet with Rep. Kevin Brady (R-Texas) after Brady’s congressional perspective on “What is the Future of Health Going to Look Like, 2014-2016.”
Held April 2-4 in Washington, D.C., the 2014 AOPA Policy Forum brought together more than 100 AOPA members, industry leaders, and lobbyists to discuss the latest legislative and regulatory issues affecting the profession and to learn how to educate members of Congress to help support the O&P industry. Almost 400 congressional meetings were scheduled with legislators and their staffs, as O&P practitioners shared their biggest challenges and pushed key O&P legislation, including two bills that acquired new co-sponsors as a direct result of Policy Forum efforts. Recruited by attendees, Rep. Steve Israel (D-New York) and Rep. James McGovern (D-Massachusetts) joined as co-sponsors of The Medicare Orthotics and Prosthetics Improvement Act (HR 3112), which will help prevent fraud by requiring O&P professionals to be licensed or accredited, and tying payment eligibility to complexity of care delivered. Additionally, Rep. Michael Honda (D-California) and Rep. Nita Lowey (D-New York) joined more than 30 co-sponsors of The Injured and Amputee Veterans Bill of Rights (HR 3408), which would promote consistency of care for veterans by posting the Bill of Rights (that veterans are already entitled to but may not be aware of) at every VA O&P clinic and on the VA website. Stay tuned to the June issue of O&P Almanac for more in-depth highlights from the Policy Forum.
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Reimbursement Page By Devon Bernard, AOPA government affairs department
Making Sense GZ of Modifiers
Take control of the audit process by submitting a clean claim, every time
RB
RA Editor’s Note: Readers of Reimbursement Earn 2 Page are now eligible Business CE Credits to earn two CE credits. SEE PAGE 19 After reading this column, simply scan the QR code or use the link on page 19 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! QUIZ M
KX
Directional Modifiers
GA
16
O&P Almanac MAY 2014
W
ith the increase in prepayment audit activity and the numerous ways a claim can be denied or delayed, it is more important than ever to control the things that you can control. And one thing you can control is making sure you submit a clean claim with the appropriate modifiers, every time. Modifiers are essential, but are sometimes viewed as an afterthought and used incorrectly. This edition of the Reimbursement Page will examine some of the more common modifiers used by O&P providers, provide a review of when they must be included, when they should be included, and when they should not be included on your claim, and explain exactly what each modifier means.
Let’s begin with the simplest of the modifiers: the directional modifiers. The directional modifiers are used to inform the payer where on the patient’s body the device has been fit or where the service is being provided. There are only three directional modifiers used by O&P providers: LT, RT, and LTRT. Relatively self explanatory, LT is used to indicate that an item is being worn
on the patient’s left side; RT is used to indicate that an item is being worn on the patient’s right side; and LTRT is used to indicate that the patient is receiving identical items on both limbs. When you provide the same service bilaterally, you will indicate two units of service along with the LTRT modifier. These may seem simple but if you don’t use them, your claim could be denied or delayed, as indicated in the diabetic shoe policy: “Claims billed without modifiers RT and/or LT will be rejected as incorrect coding.”
Informational Modifiers Next we have the informational modifiers, which make up the largest category of Medicare modifiers and are used to convey information that is either required to pay the claim or provides the payer with valuable information needed to process the claim correctly. The big three of the informational modifiers are the KX, GA, and GZ. These may be some of the more important modifiers that you will use because a majority of the Medicare medical policies include a statement along the lines of, “claims billed with without a KX, GA, or GZ modifier will
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be rejected as missing information.” This means that a majority of your claims must include one of these three modifiers or the claim will not be processed.
KX Modifier: The most commonly used of the big three is the KX. Since it is one of the most commonly used it also is one of the most overused and misunderstood modifiers. In a nut shell, the KX means that the service/item that is being provided is medically necessary and that documentation is available to support the medical necessity. This would indicate that any time you are providing an item/ service that is medically necessary and you have the proper documentation and you add the KX modifier, the claim gets paid. This is only partially true. You should have all documentation on file to support the level of services you are providing, but the KX is not required for all claims. However, the full Medicare definition of the KX modifier is that the requirements specified in the medical policy have been met. This means that if a medical policy has set forth special documentation criteria for billing, you must meet all the criteria in order to bill, and that is when you use the KX. There are currently only a few O&P medical policies that require the use of a KX modifier: ankle-foot orthosis (AFO), knee-ankle-foot orthosis (KAFO), knee orthosis (KO), orthopedic shoes, and therapeutic shoes for persons with diabetes. It also is important to note that the KX will mean different things in regards to the retention of the documentation in each of the four policies. Under the “Documentation Requirements” heading of the Local Coverage Determination portion of the policy, there will typically be a phrase that informs you when and how the KX modifier must be used. For example, in the KO policy under “Documentation Requirements,” it says, “Suppliers must add a KX modifier… If
Reimbursement Page
GA Modifier: The next of the big three informational modifiers is the GA modifier, which is only used in very specific instances. The GA modifier should only be used when you are providing items that you believe will be denied as not medically necessary. In other words, you are providing a service that is a covered benefit and is typically paid but, in this particular case, you believe the claim for those services will be denied. The purpose of including a GA modifier is to inform the payer that you expect the code or codes in question to be denied and to be denied as not medically necessary and that you have discussed the situation with the patient and the patient has signed an Advanced Beneficiary Notice (ABN). The ABN is used to notify the patient prior to provision of the service that Medicare will most likely deny the claim as not all of the coverage criteria… have been medically necessary. By signing the met and evidence of such is retained ABN, the patient agrees to assume in the supplier’s files.” This indicates financial liability for the codes in that you must physically have the question should Medicare deny documentation supporting the use the claim. of the KX modifier in your files, and if you don’t have this documentation you may not attach the KX modifier. However, if you review the same section of Therapeutic Shoes for Persons with Diabetes policy, you will not see such a statement. Instead, you will see the following statement, “Suppliers must add a KX modifier… only if criteria in the Non-Medical Necessity Coverage and Payment Rules section of the related Policy Article have been met. This documentation must be available upon request.” This indicates that you don’t have to have all the supporting documentation in your files but, rather, you must be able to provide it if the documentation is requested.
There are currently only a few O&P medical policies that require the use of a KX modifier: ankle-foot orthosis, knee-ankle-foot orthosis, knee orthosis, orthopedic shoes, and therapeutic shoes for persons with diabetes.
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Reimbursement Page
Without a GA modifier, Medicare assumes that financial liability remains with the provider. Claims without a GA modifier that are denied for medical necessity will result in no patient responsibility. So the GA can and should only be used when you have a properly issued and signed ABN on file.
All codes that describe prosthetic knees, ankles, and feet must contain a functional level modifier that consists of the letter K followed by the patient’s assigned functional level—for example, K0, K1, K2, etc.
GZ Modifier: The last of the big three informational modifiers is the GZ modifier, which should be used if you believe an item or claim will be denied as not medically necessary and you didn’t have the patient sign an ABN. The use of the GZ modifier will not shift financial liability to the patient, like the GA modifier, but it informs the payer that you know the items may not meet all the requirements of being medically necessary. If you use the GZ modifier, be aware that your claims will automatically be denied as not medically necessary; however, you may appeal the denial. The use of the GZ modifier helps you avoid any appearances of fraud.
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RA and RB ModifierS: The last example of informational modifiers is the replacement/repair modifiers: the RA and the RB. The RA modifier is defined as, “replacement of a [Durable Medical Equipment Prosthetics, Orthotics, and Supplies] DMEPOS item,” while the RB modifier is defined as “replacement of part of a DMEPOS item furnished as part of a repair.” If you are replacing an entire item (AFO, KAFO, KO, etc.) and providing the patient with an exact copy of the original item, then any base and/ or addition codes that were used to describe the original device should be submitted with the RA modifier. For example, if you are replacing a custom AFO with dorsiflexion assist joints on the patient’s left leg and the replacement is still medically necessary and all coverage criteria have been met, the proper way to code the replacement would be as follows: 1 x L1970 KXRALT 2 x L2210 KXRALT In this scenario, the KX modifier is added to indicate that the replacement of the AFO is necessary and that you have all the required documentation on file to support the claim. The RA modifier is used to indicate that the entire device is being replaced, providing the patient with an exact copy of the original. Now let’s assume that the entire AFO does not need to be replaced but the joints have snapped and need to be replaced. The proper way to code the replacement of the joints is as follows:
you are replacing liners for prostheses to indicate that the patient still only has two liners at any given time and is not in conflict with the lower-limb policy.
Functional Level Modifiers Now let’s cover the functional level modifiers that are used exclusively with claims for lower-limb prostheses. These modifiers are unique because they are used to describe the patient, not the item or service you are providing. Patients are assigned a functional level based on their expected ability to ambulate. The levels range from Level 0 to Level 4 and are defined as follows: • Level 0: Does not have the ability or potential to ambulate or transfer safely with or without assistance, and a prosthesis does not enhance quality of life or mobility. • Level 1: Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator. • Level 2: Has the ability or potential for ambulation with the ability to traverse low-level environmental barriers, such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulator.
2 x L2210 KXRBLT
• Level 3: Has the ability or potential for ambulation with variable cadence. Typical of the community ambulator, who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.
In the scenario above, the joints are being replaced as part of a repair to the AFO that will return it to a functional state. Because you are not replacing the entire AFO, the RB modifier should be attached instead of the RA modifier. The RB modifier also can be used when
• Level 4: Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.
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All codes that describe prosthetic knees, ankles, and feet must contain a functional level modifier that consists of the letter K followed by the patient’s assigned functional level—for example, K0, K1, K2, etc. No other line items on a lower-limb prosthesis claim require the K-Level/functional level modifiers, with the exception of the high-activity knee frame and the hip joint code L5961. These modifiers are used to verify that the components that are being billed are covered for the specific patient they are being provided to. Without a functional level modifier, the claim will automatically be denied as not medically necessary. The biggest mistake revolving around the use of K-Level modifiers is when the patient is a bilateral amputee. The belief is that bilateral amputees are not subject to prosthetic functional level restrictions and, therefore, don’t need to be assigned a functional level. There is a statement in the lower-limb policy that reads, “It is recognized,
within the functional classification hierarchy, that bilateral amputees often cannot be strictly bound by functional level classifications.” This allows for some wiggle room for consideration of coverage for components that are outside of a bilateral amputee’s normal and assigned functional level classification, but it doesn’t eliminate the need to assign a functional level to the patient. Modifiers are an essential part of the overall clean claims process. While they may not seem as important as other things, they provide valuable information and they are an element you can control. So use them correctly and wisely—and don’t provide Medicare with an easy way to deny or delay your claim payments. a Devon Bernard is assistant director of coding reimbursement, programming, and education for AOPA. Reach him at dbernard@aopanet.org.
Reimbursement Page
Take advantage of the opportunity to earn two CE credits today! Read and learn from O&P Almanac’s monthly reimbursement column and quarterly compliance corner—you will now not only gain knowledge, but also can earn CE credits by taking a short quiz and receiving a passing grade of 80 percent or higher. AOPA will automatically transmit the information to the certifying boards on a quarterly basis. Scan the QR code or visit the link below to take the quiz: https://aopa.wufoo.com/forms/ op-almanac-may-2014-reimbursementpage/ Earn CE credits accepted by certifying boards:
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By Adam Stone
Photos: AOPA
This Just In
Mobility Saves— Lives and Money Recent data can help the industry prove the true value of O&P care to payers, policymakers
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hen it comes to demonstrating the value of O&P, it’s one thing to say it. Proving it, however, is altogether different. For many years that proof has been lacking. O&P has had no solid metrics to demonstrate its clinical value, much less its economic advantages. Now that is changing. Thanks to research funded by AOPA and the Amputee Coalition, the profession now can stand before payers and policymakers with hard data. The research was conducted by Dobson DaVanzo & Associates, a health economics and policy consulting firm based in the Washington, D.C. area, whose lead partner is the former director of research for the Medicare program. Drawing from the vast Medicare database, researchers were able to put together a comprehensive picture of the impact of O&P over time. “Dobson DaVanzo’s work has provided the proof for the anecdotal story we have been saying for years: An O&P intervention is right for our patients and our payers,” says Tom Kirk, AOPA’s immediate past president
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and the chair of the Mobility Saves Task Force. “We had two PR events: one for press and one for legislators/ policymakers last August when the report was first completed. Sometimes for the payers, this message—investing now to do the right thing in order to save more money in the near future—is a bit counter-intuitive. Saying it just once isn’t enough to create an understanding. So AOPA created Mobility Saves—the full title is Mobility Saves Lives and Money—to keep the message alive. We want it to be on everyone’s radar screen every day of the year until it is universally recognized—a maxim of good health care, as it were.” Mobility Saves is the newly launched campaign by AOPA designed to bring this new data to the attention of key players across the healthcare spectrum. “In describing what [we in O&P] do, there has always been this intuitive reasoning. We know why we are O&P professionals. We know why we got into this field,” says Ashlie White, director of government affairs
for the North Carolina Orthotic and Prosthetic Trade Association. “But then we have to fight the insurance company, which means trying to prove that what we do is needed.”
Showing ROI The study results show the cost of co-morbidity treatment among those not receiving O&P care exceeds what the cost of care was for comparable patients who received such care. Researchers found that payers can realize a return on investment on O&P treatment within just 12 to 18 months, an indication that such treatments are highly cost effective. The cumulative cost of health care for those who received O&P care was lower than it was for those who did not, ranging up to 10 percent for some conditions during the 12- and 18-month windows of time that services were tracked. These figures prove something the industry has continually struggled to prove. “This is the first time we have actually been able to bring data to the proposition that patients who receive orthotic and prosthetic care actually
Making the Case For better or worse, financial arguments hold sway in today’s healthcare landscape. Practitioners who can make a sound financial argument have the best chance of meeting a positive response when discussing reimbursement and related issues. “People either see insurance payers as a glass half full or a glass half empty,” says Fise. “If the glass is half empty you may perceive that payers are very skeptical, or that they even take joy in denying claims, saying that treatments are experimental, that you don’t have the data to show this new technology is any better than the old technology.” Even if the glass is half full—payers want to do right while still balancing the books—the net result is the same. Money matters. “In the area of cost justification for payers, maybe if they can understand
that it is to their economic advantage to avoid the costs of obesity and depression and peripheral vascular disease and other co-morbid conditions that go along with a lack of mobility, then they can look at the numbers and see a story in which they spend less money,” says Fise. When it comes to numbers, timing can sometimes be a major consideration. Again, the Dobson DaVanzo data makes a vital new case in favor of O&P. The average subscriber in an insurance plan stays with a payer for just about two years. By fiscal logic, a payer might conclude that there is no point in paying for an expensive course of treatment the benefits of which might not be seen for many years. But the study shows O&P generates a positive fiscal outcome in less than two years. “Now as the payer you might want to begin to think differently about what kind of care you want to support for your subscribers even in the short-term,” says Fise. “It’s a gamechanging proposition.”
Reaching Out Through Mobility Saves, AOPA aims to address five key audiences: clinicians, referral sources, payers, regulators, and policymakers. AOPA’s Mobility Saves website will be a prime source of information. Driven by a search promotion advertising component, the Dobson DaVanzo data will be among the first matches to turn up for searches on amputees, health insurance for amputees, costs of O&P care, and similar topics. The campaign’s online component will extend out beyond the web page to encompass a range of online outreach efforts, likely including a daily/weekly core of strategic Facebook postings, Tweets, and other social media entries. Mobility Saves will keep O&P clinicians up to date, with timely updates
as well as a PowerPoint available for member viewing and downloading— resources to keep them informed while also giving them talking points as they share the message of Mobility Saves. A professionally produced video will generate “good news” stories for news outlets—the kind of information that practitioners will want to share with their constituents. Referral sources will have access to a PowerPoint presentation explaining Mobility Saves, as well as advertising and public service announcements. It is AOPA’s hope that payers will hear the message through video, news releases, possible presentations at their meetings, and in peer-reviewed publications and good news stories about cost effectiveness and patient empowerment. Mobility Saves will approach regulators with messages intended to help shape policy decisions over the long term. Through hard data, the industry will make the case that effective regulations and credentialing are vital to ensuring the efficacy and cost effectiveness of O&P. Finally, qualified providers will be prepped to meet with policymakers at the state and national levels to help make the case for O&P, armed for the first time with data showing the financial and clinical benefits of such care. Perhaps the most significant benefit of this new research is the way that it can help O&P advocates to cut through the clutter. In a health-care landscape awash in noise, with competing interests all vying to see their niches’ needs met, this hard data will help O&P to bring home its message in the simplest terms. “The core of this research is that Mobility Saves—both lives and money,” says Fise. a Photo: AOPA
cost less money than patients who could have received such care and did not,” says AOPA Executive Director Tom Fise. Accordingly, the numbers help to back up arguments about the intrinsic value of O&P care. “Mobility is really the heart of what the O&P profession is all about—optimizing a person’s mobility, and restoring his or her function. It is more than saving a limb, it is saving what the limb does, and in turn, ultimately impacting life expectancy and quality of life,” says Anthony Potter, product marketing director at Hanger Clinic. Such claims have helped to generate sympathy for the needs of O&P, but that has not always translated into dollars and cents. The new data bridges that gap, demonstrating that such quality-of-life concerns are in line with payers’ and policymakers’ broader financial best interests as well. “While prosthetic and orthotic interventions may seem like an additional cost, the net effect of the intervention is really to reduce the total cost,” says Potter.
Adam Stone is a contributing writer to O&P Almanac. Reach him at adam. stone@newsroom42.com.
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A Fresh Look
Key Notes:
at Diabetes Treatment
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The number of adults reporting diabetes more than tripled in the past 20 years, according to the CDC. But better management of the disease and its complications are helping stem the tide of complications.
O&P Almanac MAY 2014
Practitioners should help patients understand that proper pedorthic and orthotic management can lead to relatively healthy feet, even after ulcers and toe amputations.
Many new patients presenting with diabetes require detailed explanations of protocols and the “why� behind their treatment.
COVER STORY By CHRISTINE UMBRELL
Bucking conventional wisdom, practitioners share how they successfully prevent and treat diabetic amputations, complications
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supervision by O&P practitioners and oday’s pedorthists, orthoother clinicians, many are succeeding in tists, and prosthetists see slowing the disease’s progression. the full spectrum of diabetic “The people who are actively trying patients—from prediabetics without symptoms, to diabetics with foot ulcers, to manage diabetes today are doing a much better job of it,” Janisse says. to patients with neuropathic fractures, He cites the value of simple intervento those requiring amputations. Practitioners can offer patients a variety tions, such as therapeutic shoes, inserts, and custom orthoses, which help of solutions to ensure longer periods avoid foot ulcerations and assist in of foot health, and to assist patients in patient mobility. regaining mobility for those who do In fact, a new study require amputations. by the CDC shows a “Diabetes is the leading 51 percent decline in cause of nontraumatic diabetes-related amputalower-extremity amputations between 1990 and tions, and the majority 2010. The study was of those amputations are published in the April preceded by diabetic or 17 issue of New England foot ulceration,” says Journal of Medicine. “These Dennis Janisse, C.Ped, findings show that we president and CEO of Dennis Janisse, C.Ped have come a long way National Pedorthic in preventing complicaServices Inc. and a clinical tions and improving quality of life for assistant professor in the department of physical medicine and rehabilitation people with diabetes,” says Edward Gregg, PhD, a senior epidemiologist in at the Medical College of Wisconsin. the CDC’s division of diabetes transThe number of adults reporting lation and lead author of the study. diabetes more than tripled in the past To ensure diabetic patients continue 20 years, according to the U.S. Centers to live longer and healthier lives, for Disease Control and Prevention the work of pedorthists and O&P (CDC). But the ray of hope in the practitioners will be critical. Here, diabetes epidemic comes from better experienced practitioners offer tips management of the disease and its for treating diabetes patients in O&P complications. As some patients facilities—from early interventions to become more educated and commit to postamputation advice. focusing on their health, with closer
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A FRESH LOOK AT DIABETES TREATMENT
U.S. Diabetes Facts Diabetes affects nearly 26 million people, 8.3 percent of the U.S. population. 79 million people are considered to have prediabetes. Diabetes is responsible for more than 60 percent of lower-limb amputations from non-trauma cases. The rate of lower-limb amputation in diabetes patients declined by 51.4 percent between 1990 and 2010. Diabetes and its complications account for $176 billion in total medical costs each year. States with the highest prevalence of diagnosed diabetes include Mississippi, Alabama, Tennesse, West Virginia, Texas, and Puerto Rico. Sources: American Association of Diabetes Educators; Centers for Disease Control and Prevention.
2.
Keep Toe Amputations in Perspective
Practitioners should help patients understand that proper pedorthic and orthotic management can lead to relatively healthy feet, even after ulcers and toe amputations. “A lot of patients, and even doctors, don’t understand that pedorthic management can be effective in preventing future problems” once initial foot ulcers are discovered, says Janisse. He cites an example of a Type 1 diabetes patient who has been a patient for the past 25 years. The patient, a mailman in his late 30s, originally came to Janisse’s facility with an ulcer on his foot near his great toe. He had already had two
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1.
has benefitted from the joint-treatment approach: The patient, a bartender in his 30s with a family, has Type 1 Orthotists and prosthediabetes. Working on his feet all day, tists who work with other he was experiencing massive deteriohealth-care professionals in a team ration of his foot and ankle. Haun approach benefit from exposure to fitted him with a CROW boot, which the latest treatment regimens. Dennis offers benefits when joint stability Haun, CPO, clinical director of Metro and alignment must be maintained. Prosthetics’ Baltimore location, says Unfortunately, the patient continued that between 80 and 85 percent of to experience skin complications his facility’s patient base is diabetesand breakdown of the foot—to the related. Metro Prosthetics treats point where the patient requested patients in all stages of diabetes, fitting amputation. patients with off-the-shelf and custom Instead, Haun sent the patient to orthoses, Charcot Restraint Orthotic the Rubin Institute, where he was Walkers (CROW boots), and prosthetic deemed to be an ideal candidate for care, depending of the patient. Charcot reconstruction “Amputation prevention surgery. His foot and ankle is our number one priority,” were surgically rebuilt; says Haun. To that end, he is recovering well, and his facility works closely amputation has been with physicians and staff prevented indefinitely. at the Rubin Institute for Haun continues to treat the Advanced Orthopedics patient, as he still requires in Baltimore, which also custom footwear with a serves as a limb salvage site. rocker bottom and a lift as Haun offers one Dennis Haun, CPO well as orthotic care. example of a patient who
Stay Current
smaller toes amputated—one on each foot—and his physician had been unable to get the new ulcer closed. It turned out the doctor had not been seeing the patient frequently enough to properly debride the ulcer, so calluses built up, leading to
infection. The patient ended up losing his great toe—but Janisse worked closely with the patient to prevent further infected ulcers. “We got him into steel-toed extradepth high-top boots, with a custom orthotic toe-filler,” explains Janisse. The toe-filler, combined with modified rocker soles, helped compensate for the loss of the great toe and led to improved gait. With proper footwear and orthotic intervention, the mailman “has never had another amputation”—despite the fact that he worked on his feet all day, with totally insensate feet. “A lot of people think that once they start having complications, that’s ‘the end’—but that’s not true,” says Janisse.
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A FRESH LOOK AT DIABETES TREATMENT
3.
Try Different Approaches
Resisting “they way we’ve always done it” can be a critical component of advancing care for diabetes patients. Art Shea, CPO, who runs the Worcester, Massachusetts, branch of New England Orthotic and Prosthetic Systems (NEOPS), recently discovered that trying a different technique for treating diabetic patients immediately after transtibial amputation surgery offers multiple benefits.
Art Shea, CPO
Shea has begun working with vascular surgeons at University of Massachusetts Medical Hospital and St. Vincent’s Hospital in using the Immediate Post-Operative Prosthesis (IPOP) method of casting immediately following surgery. For each application, Shea is in the operating room during amputation surgery and applies a plaster cast up to a patient’s mid-thigh, instead of the traditional soft dressing. Sufficient global padding is applied inside the cast to prevent skin damage from the rigid cast. The day after amputation, Shea fits a removable prosthetic device onto the cast and secures it with a taut belt. He works closely with the physical
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therapist to stand the patient up and adjust the new prosthesis. First popularized in 1968 by Ernest M. Burgess, MD, for trauma patients during the Vietnam War, the IPOP method typically has been considered a “West Coast” protocol—with applications for patients without previous vascular complications (nondiabetes patients). Today, the majority of diabetes-related transtibial amputations involve soft compressive dressings, or rigid removable dressings, to allow for complete stump healing before initial prosthesis fitting. When Shea was first approached about trying the IPOP process in the New England area for diabetes patients, he consulted Burgess’ original research—and he made sure the patients were good candidates: not overly obese or noncompliant. After finding success with several patients using the IPOP approach, Shea became part of a research team that published the positive outcomes encountered by IPOP patients in a paper presented at the 40th Annual Symposium of the Society for Clinical Vascular Surgery. Diabetic patients who underwent IPOP placement postamputation were found to have similar perioperative systemic and wound complication rates as those undergoing conventional amputations. However, IPOP patients were less likely to require surgical revision of the stump. What’s more, researchers found the IPOP to be of physiological and psychological benefit because it allows for earlier ambulation and a shorter rehabilitation period, and minimizes the duration of postoperative immobility. Shea says that in contrast to the six-week waiting period to remove stitches or staples in conventional soft dressing procedures, IPOP patients wait only three weeks. The IPOP cast keeps the swelling down and speeds healing time. Because IPOP was “new” to medical professionals in the New England area, Shea has helped train therapists on the new protocol. He
notes that it’s imperative to remove the IPOP cast approximately once every week until it is no longer needed and to allow a wound care specialist to look at the wound, and then replace it with a new cast if appropriate. Shea says that IPOP casting is not appropriate for all diabetes patients because compliance is key to the protocol’s success. But for those patients who are willing to follow through with daily therapy and return for weekly cast checks, the benefits can be immense. “I anticipate this will become more widespread” because it promotes early return to ambulation and cuts down on costly therapy time, says Shea. It will save money and improve quality of life for patients.
4.
Educate, Lead by Example
Increasingly, new patients who present with diabetes belong to the baby boomer generation—and this population requires explanations of treatment protocols, says Janisse. Older generations were more apt to take a practitioner’s word at face value, but boomers are inclined to question practitioner mandates. “Education is part of the practitioner’s responsibility,” says Janisse. “You can’t just say, ‘You have to wear this shoe or your foot will be cut off,’” he says. “You have to explain how to wear it and why they should wear it—how the shoe will positively affect foot health. And then let them make up their own mind.” Populating your facility with positive role models can help encourage patient compliance, according to diabetes experts. At the Hartford orthotics division of NEOPS, Manager/Partner Marcia Rackliffe, C.Ped, is diabetic herself, so her words resonate strongly with her patients. “Ninety-five percent of people do not wear appropriately sized shoes,” says Rackliffe, noting that can lead to calluses, wounds, and ulcers from excessive
A FRESH LOOK AT DIABETES TREATMENT
shearing. “A lot of people with diabetes also have neuropathy, and they tend to wear shoes that are too small and too tight. Wearing appropriately sized, well-fitting footwear with inserts, and being seen on a regular Marcia Rackliffe, C.Ped basis and educated about how to care for their feet, can prevent amputations down the line,” says Rackliffe. Haun notes that he at one time employed a practitioner assistant who was a Type 1 diabetes patient. He was in perfect shape— “the ultimate role model,” according to Haun, since he demonstrated to patients that you could have diabetes and manage it well through diet and exercise. “He had something in common with the patients and served as an inspiration that he had had diabetes his whole life but could be healthy.” Janisse makes it a point to model healthy activity habits to his patients: He wears a pedometer every day and offers them for sale to his patients. “So many of our patients need to be exercising. Sometimes people have no idea how sedentary they are,” he says.
Podiatrists, Pedorthists, and Orthotists Help Prevent Diabetes Complications In addition to the recent New England Journal of Medicine article reporting a decline in diabetes-related complications, several recent studies have indicated that early footcare interventions do indeed lead to fewer complications, such as ulcers and even amputations: •
In a study published in the July 2013 issue of Foot & Ankle International, researchers looked at data from 2000 to 2010 Medicare claims of toe, feet, and leg amputations. The rate of upper and lower leg amputations declined by 29 percent. During the same time period, orthopedic treatments for foot and ankle increased by as much as 143 percent. Researchers concluded that increased attention to preventive footcare and early intervention with foot wounds and ulcers lead to fewer amputations.
•
Researchers at the Sahlgrenska Academy, University of Gothenburg, Sweden, concluded that use of shoe inserts for diabetic patients can significantly reduce diabetes-related amputations. In the Swedish study, the use of shoe inserts, podiatry, education, and regular checkups were shown to help patients avoid foot ulcers, reducing diabetes-related amputations by 50 percent compared with going barefoot. The research was presented by Ulla Hellstrand Tang, CPO, in February 2013 at the International Society for Prosthetics and Orthotics World Congress in Hyderabad, India. “By effectively distributing pressure under the sole, the inserts minimize the risk of ulcers and ultimately work to prevent amputations.”
•
In early 2014, researchers at Leicester University in the United Kingdom presented findings on a study on risk for amputation compared to length of delay in seeking medical attention. The researchers studied past cases of foot problems in which care had been delayed an average of 18 weeks. In 30 percent of the cases in which care was delayed, amputation was required to prevent more serious complications. The researchers concluded that diabetic patients with symptoms such as in-grown toenails, bunions, dry skin, grazes, burns, and wounds should seek medical attention as early as possible.
Hope for the Future Overall, O&P practitioners see a brighter future for today’s diabetes patients. In addition to health and wellness initiatives, Haun cites advances in orthotic materials as well as the development of prosthetic suspension for disvascular limb loss as extremely beneficial to patients. “Elevated vacuum systems have promoted the health of residuals limb volume, for both aboveand below-knee amputees,” he says. As practitioners work closely with other health-care professionals and stay current with diabetes research, O&P patients who have diabetes will remain healthy for longer periods of time. Ultimately, “it all goes back to education,” says Janisse. a Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@strattonpublishing.com.
The 2014 AOPA National Assembly will feature a four-day education track for pedorthists and orthotists on treating the diabetic foot. Join us September 4-7 in Las Vegas for top education programming from our multi-disciplinary team of MDs, wound-care specialists, PTs, CTOs, and C.Peds.
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By Lia Dangelico
Funding the
Future
What $10 million in outcomes research funding can bring to O&P and how to get involved
Key Notes:
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Early this year, the 2014 omnibus appropriations bill was signed into law and included language that allocates $10 million in grant funding for O&P outcomes research through the Department of Defense.
Everyone in O&P must act now to help educate Congress, their staffs, and the general public with good information on the industry’s biggest challenges and needs for the future.
The official Program Announcement for the grants, which will explain specific award types, eligibilities, and other key details, is expected to be released from the USAMRMC within the next 90 days.
O&P Almanac MAY 2014
M
any in O&P agree that the industry is years behind the level of clinical outcomes research it needs to support evidence-based practice and satisfy the requirements of Medicare and third-party payers. With that in mind, in 2010, AOPA formed an alliance with the National Commission on Orthotic and Prosthetic Education (NCOPE) to garner support for O&P outcomes research and expansion of higher-level education opportunities for O&P students and professionals.
Sen. Dick Durbin (D-Illinois)
AOPA’s first step was to retain Linchpin Strategies and its president, Catriona Macdonald, who is a legislative consultant on securing appropriated funding, to help navigate the choppy appropriations process. Her efforts convinced Sen. Dick Durbin (D-Illinois) to introduce S 521, the Wounded Warrior Research Enhancement. She also emphasized the need for AOPA members to write letters and visit with members of Congress to share the biggest challenges facing O&P.
On Jan. 17, 2014, President Obama signed into law an omnibus appropriations bill that included language pulled from S 521, which would have provided $30 million in funding to support three areas in O&P: outcomes research, materials research, and technology and devices. But it’s important to note that only part of it was picked up and included in the appropriations bill—language allocating $10 million in grant funding through the Department of Defense (DOD) for O&P outcomes research.
The actual language that went into the appropriations bill was very limited. The bill reads, “Outcomes research in orthotics and prosthetics: $10 million.” No other explanatory language is included.
5 Key Elements of the Proposal Process The $10 million in grants for O&P outcomes research will be dispersed by the U.S. Army Medical Research and Materiel Command (USAMRMC), located in Fort Detrich, Maryland. Troy A. Turner, MBA, scientific domain manager for rehabilitation and human performance, Telemedicine and Advanced Technology Research Center, at USAMRMC, shares five elements of the process every applicant should know: •
Program Announcement: The process begins with the release of a Program Announcement, which is created by USAMRMC and then pushed out to the public, says Turner. The Program Announcement explains specific award types, eligibilities, and other key details.
•
General Application Instructions: General Application Instructions, or GAIs, are released with each Program Announcement and contain more helpful information for those trying to get involved, says Turner. Because GAIs for this funding have not been released yet, Turner suggests interested parties review previous announcements, which are available in the Program Announcement Archives under the Funding Opportunities tab at cdmrp.army.mil.
Getting the Facts Many in O&P have been closely tracking S 521, says Macdonald, but that bill is broader and more expansive than the mere piece of it that went into the appropriations bill. “There has been a little bit of confusion on whether or not the $10 million that went into the appropriations bills will go toward those three areas or just for outcomes,” she says. “So it’s been important to help those in the O&P industry understand that the piece of the Durbin legislation that was picked up and funded was only the outcomes research.” The actual language that went into the appropriations bill was very limited. The bill reads, “Outcomes research in orthotics and prosthetics: $10 million.” No other explanatory
•
Pre-application: “Submitters will send in a pre-application, which is reviewed by a peer-review panel of scientific experts, and a determination will be made whether or not to invite the submission of a full proposal,” says Turner.
•
Full Proposals: Applicants who are invited to submit a full proposal will go through a second round of reviews, according to Turner. “Those applications meeting scientific and programmatic fit are ranked and funded to the extent that funding is available,” he says.
•
Timeline: According to Turner, USAMRMC anticipates the Program Announcement (and accompanying GAIs) will be released within the next 90 days. “The review process and timeline will be published as part of that announcement,” says Turner, “but examples of prior timelines can be seen in the Announcement Archives available on the CDMRP website.”
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language is included. But here’s what we do know: $10 million in new funding will be dispersed via grants to conduct O&P outcomes research. The U.S. Army’s Medical Research and Materiel Command (USAMRMC) agency will handle reviewing submitted research proposals and distributing the grants. With input from the O&P industry, the DOD will determine research priorities and establish the number and size of grants that will be issued. Although the funding is being funneled through the DOD, study participants will not be limited to service members, and areas of study will be open beyond those faced by the military population. “The DOD… recognizes that the research should have broad reach and applicability to Veterans and civilians as well,” according to a statement from AOPA released in early February. Durbin addressed the outcomes research funding during his remarks at the 2014 AOPA Policy Forum in Washington D.C. “This is money well spent. This is money well invested,” he said. “We want to come out with the best devices and the best practices… [the grant process] is a competition that I think many great companies will be glad to compete in, because not only [is it] dollars for research but it’s recognition that you have something to offer as a company.” “While the funding for the outcomes program is naturally of economic importance to the O&P community, the direction of the program must also serve to emphasize the importance of patient functional and quality of life improvement as the primary justification behind every provider device prescription and manufacturer product development and innovation,” says Troy A. Turner, MBA, scientific domain manager for rehabilitation and human performance, Telemedicine and Advanced Technology Research Center, at USAMRMC. “The comprehensive objective of the program is still being discussed, but among other things, this
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O&P Almanac MAY 2014
program will strive to validate and/ or improve upon current standards of care in the arena of prosthetic and orthotic care for our military amputees and those with functional impairment.” It will take approximately four to six months (from January 2014) for the funds to make their way to the USAMRMC, and a call for proposals will be issued within six months—so those looking to get involved should expect the call to go out in early to mid-summer. Once proposals have been submitted, they will be peerreviewed and awards will be made 60 to 90 days later. According to Macdonald, Durbin has made it clear he will be monitoring the process to ensure timely awarding of funds.
“This is money well spent. This is money well invested. We want to come out with the best devices and the best practices…” —Sen. Dick Durbin (D-Illinois)
Spreading the Word To achieve this victory, AOPA and NCOPE established a committee tasked with identifying major challenges in the O&P field that could benefit from evidence-based research, and called on Macdonald to help communicate the industry’s challenges to Congress and drum up support for these critical initiatives. As Macdonald worked to educate legislators, she quickly learned there were several misconceptions on Capitol Hill—for example, none of the
congressional committees knew which federal agency was responsible for O&P outcomes research or whether or not any research was actually being conducted. (It wasn’t.) “Outcomes research has moved forward in a really substantial way in so many other aspects of health care,” she says, “and the idea that there has been virtually none in O&P was really astonishing [to members of Congress.]” As a small field, O&P struggles to come up with the manpower to represent its interests and educate legislators on the Hill, adds Macdonald. But, despite that, O&P must take advantage of its time in the spotlight before it’s too late. She points to another misconception about O&P care and technology, this one within the public eye: “I think the coverage of the wars in Iraq and Afghanistan has both created opportunities and challenges for O&P,” she says. “The public, congressional staff, and members of Congress have seen all of this press coverage of amputees coming back from the wars, and soldiers with amputations and traumatic brain injuries that result in mobility issues… it creates a perception that those needs are being taken care of.” For example, when former President George W. Bush went jogging with two amputee service members, it was “a wonderful way to help direct the attention to the needs and challenges in O&P. But if that press attention and visibility is not accompanied by good information, everybody assumes it’s getting lots of attention and being addressed.” And, she says, as service members return home and media attention shifts from the front page, it will be an increasing challenge to get the attention and opportunities to educate members of Congress and their staffs. “I think we need to take advantage of this opening and really do everything we can now so that when we’re no longer on the front page we’ve got a really solid base of support and knowledge in Congress to build on,” she says.
How to Get Involved Of course, getting involved is easier said than done, and Macdonald acknowledges that O&P practitioners are busy caring for their patients and working hard just to keep the lights on. But there is a window of opportunity that has opened and the industry must rise to the challenge and seize the moment before that window closes again. Unfortunately, it is still unknown what areas of study will be given highest priority but the industry will get a better idea of that once the official Program Announcement is released from USAMRMC. “There will be a general focus on outcomes based research as guided by congressional language, although the specific language of the announcement is still being developed,” says Turner, who expects the announcement to be released in the next 90 days. Beyond the research itself, there are plenty of other ways to get involved. According to Macdonald, a great way for practitioners and facility owners
“It’s a great time to be developing relationships with members of Congress and helping them understand the big picture of O&P and what O&P does.” — Catriona Macdonald
to promote good information about O&P is to invite members of Congress to visit their O&P facility to see and understand what they do, or to come to the university research lab and see how O&P research is conducted and how it benefits the industry. “Nothing educates a member of Congress like seeing it for themselves,” she says, noting that 2014 is election year. Congress is in session and voting very few days this year—just more than 100 days—which means the rest of the time will be devoted to meeting with constituents in their districts. “It’s a great time to be developing
relationships with members of Congress and helping them understand the big picture of O&P and what O&P does,” she says. “That way, when we need to ask for a vote on research, when we need to ask for a vote on advanced education, or when we need to ask for a vote on audit policies or other Medicare policies, that base of a relationship and some understanding of our field makes all of those asks much, much easier.” a Lia Dangelico is a contributing writer to O&P Almanac. Reach her at ldangelico@strattonpublishing.com. www.AOPAnet.org
AOPA’s
national
Sept. 4–7, 2014
assembly ’14
Mandalay Bay Resort and Casino
The premier meeting for orthotic, prosthetic, and pedorthic professionals
Las Vegas, Nevada
Experience the energy—attend the country’s oldest and largest meeting for the orthotics, prosthetics, and pedorthic profession.
Energize your staff—ask about group discounts and space for your company to hold their own corporate meeting in conjunction with the Assembly.
The 2014 National Assembly education program will feature a learning program tailored specifically to meet your needs with programs to teach you the latest technology, best business practices, premier patient care through case studies, symposia, manufacturers workshops, panel discussions, live demonstrations, and fun networking events.
There is a reason why more O&P professionals attend the National Assembly than any other national meeting.
Visit www.AOPAnet.org for information and updates.
CLINICAL | BUSINESS | TECHNOLOGY
EDUCATION
Exhibits. Services. Networking.
Earn Choice CE Credits!
REGISTRATION IS
NOW OPEN
MAY 2014 O&P Almanac
31
n
Member Spotlight By Deborah Conn
The storefront window of Fillauer Surgical Supplies, circa 1940.
A Family Approach to Business Taking a look back at the evolution and history of a 100-year-old O&P company Carlton Fillauer (front) and Karl Fillauer (back) with Karl’s sons Michael and David.
COMPANY: Fillauer Companies Inc. Location: Headquartered in Chattanooga, Tennessee, with divisions in California, Utah, North Carolina, and Sweden Owner: Karl Fillauer, CPO, FAAOP History: 100 years in business
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O&P Almanac MAY 2014
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his year, Chattanooga-based Fillauer Companies celebrates its centennial anniversary, a distinction achieved by very few in the O&P industry. The history of this family-owned business is marked by growth, loss, a hostile takeover, reacquisition, and growth once again. German immigrant George W. Fillauer arrived in Tennessee more than 100 years ago, after a complicated journey that included George W. Fillauer Sr. an initial arrival in New York City, forced labor aboard a ship, and a brief sojourn in Buenos Aires, Argentina. After working with family in East Tennessee for a time, Fillauer obtained his pharmacy degree and eventually opened his own store, White Cross Pharmacy, in 1914. A short
time later, he brought over a German orthotist to help sell soft goods and orthotic devices, and the ultimate direction of the company—now called Fillauer—was set. George’s two children, George, Jr., and Carlton, went into the family business: George, Jr., as a pharmacist and Carlton as an orthotist-prosthetist. During World War II, Carlton served in an Army hospital, where he honed his O&P skills. After the war, he became the first staff prosthetist named to the National Research Committee on Prosthetic Devices, and then returned to Chattanooga, married, and became involved in both patient care and product development at his father’s company. The next era for Fillauer began in the early 1970s, when George, Sr., retired, and the company merged with
Photos: Fillauer Companies Inc.
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Alabama-based Durr Medical. Known as Durr-Fillauer from 1972 to 1993, the publicly held firm provided pharmaceutical and surgical supplies as well as O&P supplies and clinical services. Carlton oversaw the O&P side of the enterprise, and his brother, George, Jr., led the pharmaceutical business. Carlton’s son Karl also worked there, but left the company in 1977 and started his own patient-care operation, Fillauer O&P, in Knoxville. In 1993, Durr-Fillauer was taken over by California-based Bergan Brunswig Corp., which was interested in the company’s pharmaceutical and surgical supply divisions. Karl Fillauer, who had sold off his own O&P clinics by then, purchased the orthotic and prosthetic division.
Back in the Family Once back in the family’s hands, Fillauer began a steady expansion, acquiring Michael Fillauer, such companies as CPO Hosmer, in 1996, and Motion Control, in 1997, which brought in a strong upper-extremity product line, both body-powered and myoelectric. In 2008, the company started Emotis, which uses advanced composite materials to produce such devices as the Element prosthetic foot; and purchased OTS (2009), a high-end provider of orthotic componentry, including the StepLock knee joint, and ovens for O&P fabrication. The Center for Orthotic Design, acquired in 1999, developed a new version of the reciprocating gait orthosis; and Swedish-based Centri AB, acquired in 2002, produced gloves, liners, and protective leg coverings, in addition to other orthotic and prosthetic components.
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O&P Almanac MAY 2014
Photos: Fillauer Companies Inc.
Photos taken throughout Fillauer’s 100-year history.
“The point of all the acquisitions was always to complete our product line, to grow our O&P footprint. All the companies work together and complement one another,” says Michael Fillauer, CPO, George W. Fillauer, Sr.’s great grandson. Today, he is president of Fillauer LLC, perhaps best known for its prosthetic suspension lock systems, first developed by Michael’s grandfather, Carlton. In addition to its development and manufacturing companies, Fillauer has a patient-care facility located on site at Fillauer LLC in Chattanooga, where Karl’s son and Michael’s brother David Fillauer, CPO, is the president. That proximity between designers and end users is a valuable one, creating practical interactions and leading to innovative orthotic and prosthetic solutions. Fillauer continues to look at new technology and new materials. “We have developed one of the top-selling microprocessor feet, the Raize foot. We
are also working with thermoformable carbon, and used it to design the Dynamic Walk orthosis,” says Michael. “Newly designed apps and features for our myoelectric devices are popular with a lot of higher-activity, upperextremity amputees. Many of our high-performing devices are used with the military.” Fillauer intends to celebrate its centenary several times this year. After hosting festivities at the Leipzig, Germany, meeting of OT World in May, plans include a big party in September at the AOPA National Assembly in Las Vegas, followed by a larger event in Chattanooga. And it might not be too soon to give a thought to Fillauer’s bicentennial. After all, Karl Fillauer has six grandchildren, and several have already started expressing interest in the family business. a Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.
AOPA WORKING FOR YOU
AOPA HEADLINES
Closing the Gap on O&P Research Funding
W
ith one successful AOPAbacked O&P research appropriation signed into law by President Obama, and education funding pending in the VA appropriations bill, HR 1982 Section 322, it may be time to take stock of what AOPA’s role has been in this funding effort over the past five years. It should help the industry to look ahead and see the many new opportunities that could come from the $10 million in O&P research funding in the Department of Defense (DOD) budget for 2014 and another $10 million pending to advance masters-level education. In early 2009, AOPA invited seven other O&P-related organizations to join together in creating the Center for O&P Learning and Outcomes/ Evidence-Based Practice (COPL), including the American Board for Certification in Orthotics, Prosthetics & Pedorthics; the American Academy of Orthotists & Prosthetists; the Amputee Coalition; the Board Of Certification/ Accreditation; the National Association for the Advancement of Orthotics and Prosthetics; the National Commission on Orthotic and Prosthetic Education; and the Orthotic & Prosthetic Activities Foundation. Each organization appointed one of its own to serve on the COPL Board of Directors. The first RFP issued by COPL invited proposals in four subject areas: vacuum-assisted suspension systems, prosthetic ankle mechanisms, transfemoral prosthesis versus no prosthesis for a K-2 patient, and custom orthoses. Preference was given to projects that address evidencebased clinical applications in O&P, and grant awards were $7,500 each.
These pilot studies were intended to create a platform for more extensive research in subject areas that are attracting substantially more funding from private foundations, government agencies, or other interested parties. The grants were increased to $15,000 in 2012 and, to date, awards have been made to 14 principal investigators, with results showcased at AOPA’s annual meetings. Building on these modest efforts, AOPA continued to pursue more advanced research projects under the direction of then President-Elect, Anita Liberman-Lampear, MA, which led to the collaboration with the Amputee Coalition and AOPA’s funding of groundbreaking cost-effectiveness research. The Amputee Coalition commissioned Dobson DaVanzo, the noted health-care research and consulting firm headed by Allen Dobson, PhD, who served as director in the office of research at CMS (then known as the Health Care Financing Administration), to conduct the study. As suspected, this study confirmed that timely O&P intervention pays off in the long run, compared to Medicare costs for beneficiaries who did not receive O&P treatment. The CMS database used in this study also has been the resource for a subsequent project, which examines Medicare payment data to take a closer look at CMS’s ongoing practice of paying unlicensed providers in licensure states at about the same rate as they did in 2009, despite its statements to the contrary, that no unlicensed provider payments were currently being made. This research buttresses AOPA’s
case for passing the O&P Medicare Improvement Act, or HR 3112, which, among other fraud-fighting provisions, would specifically order CMS to stop paying unlicensed providers, saving taxpayers more than $250 million over the next five years. Two more very important research efforts undertaken by the Six Survival Imperatives project addressed systematic reviews of the existing literature on the poststroke management of transtibial amputees and orthotic management of stroke patients. This work, under the direction of AOPA Vice President, Jim Campbell, PhD, CO, and AOPA Past-President Tom DiBello, CO, FAAOP, will lead to clinical practice statements and treatment pathways that will help form practice guidelines to support the clinical decisionmaking process and provide a scientific evidence base for O&P care. The information from these research projects will be extremely valuable in assessing what priorities should be identified in consulting with the agency chosen to administer the DOD O&P research funds. AOPA and other stakeholders expect to have a role in advising where the funds can be best applied for the broadest possible benefit to amputee and limb-impaired veterans and others needing O&P care. There’s a long research road ahead for the O&P community, but the good news is that we got out of the parking lot and are now on the road to generating more measurable cost effectiveness through outcomes and evidence-based practice research efforts. a
MAY 2014 O&P Almanac
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AOPA HEADLINES
AOPA 2014 National Assembly Registration Is Now Open Register today for the AOPA 2014 National Assembly, September 4-7 in Las Vegas, Nevada! Experience the country’s largest, oldest, and most essential meeting for orthotic, prosthetic, and pedorthic professionals. Registration is now open at www.AOPAnet.org. Why You Should Attend: • Earn more than 32 CE credits • Learn in any of the five dedicated education tracks— providing you with the most relevant education for orthotists, prosthetists, technicians, pedorthists, and business managers • Unprecedented business education featuring experts in O&P business management, documentation, heath-care reform, and marketing • Innovative four-day Pedorthic Education Program focusing on diabetic treatment and wound care from a multidisciplinary faculty of physicians, wound care experts, and diabetes educators • Four days of technical education • New and improved Thranhardt Golf Classic scheduled the day before workshops
• Revised Exhibit Hall schedule provides more time in the exhibit hall without sacrificing CE credits • More receptions and networking events • Scientific programs featuring extensive symposia on relative topics such as scoliosis, orthotic pediatric management, MPK, modern technologies, clinical use of direct measurement, evaluating evidence, managing the diabetic foot, and more. • Networking and career advancement for practitioners and suppliers at all levels of experience—opportunities abound, from receptions to golf to a happy hour reception to the wine auction and tasting. • Fabulous shopping, entertainment, championship golf, and unparalleled people watching—all of this on the Las Vegas Strip! Don’t miss out on your opportunity to attend the 2014 AOPA National Assembly—the place to be! Get program updates and registration information at www.AOPAnet.org. Questions? Please call AOPA Headquarters at 571/431-0876.
Calling O&P Students and Residents:
Gain National Recognition and Advance Your Career Enter to win one of two prestigious awards: The StudentResident Poster Awards honor two meritorious scientific papers submitted for presentation as a poster at the AOPA National Assembly. The Otto and Lucille Becker Award will be presented for the best orthotic abstract submitted by a qualifying student or resident. The Edwin and Kathryn Arbogast Award will be presented for the best prosthetic abstract submitted by a qualifying student or resident. •
•
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The poster must be exhibited and presented at the AOPA National Assembly for the award recipient to receive the prize. The winners of the two scientific poster awards will be published in a future issue of the O&P Almanac. The winners will receive a $500 cash award, registration to AOPA’s National Assembly, coach-class airfare to the meeting, and three nights’ hotel stay. To qualify to present a poster in this category and be eligible for consideration for this award, the main author must be a student (baccalaureate or master level) or a resident at a qualified patient-care facility.
O&P Almanac MAY 2014
• Abstracts will not be considered for either award if they have been previously presented or published, or are currently submitted with pending decision on acceptance elsewhere. • These awards have been made possible by a special endowment by Becker Orthopedic and WillowWood. Submit your abstract at https://aopa.wufoo.com/ forms/2014-aopa-studentresident-poster-submissions/. From left, Edwin and Kathryn Arbogast 2013 Award Winner Darren Bolger, AOPA Immediate Past President Tom Kirk, and Otto and Lucille Becker 2013 Award Winner Kier Book.
AOPA HEADLINES
en · er · gy 3rd
ANNUAL
Compete in the Third Annual Technical Fabrication Contest
en · er · gy noun, plural en·er·gies. The capacity for vigorous activity; available power; an adequate or abundant amount of such power; often, energies. A feeling of tension caused or seeming to be caused by an excess of such power; an exertion of such power; the habit of vigorous activity; vigor as a characteristic.
Take part in AOPA’s Third Annual Technical Fabrication Contest, which has a theme of “Energy.” Fabricate a lowerextremity orthosis or prosthesis that best reflects your interpretation of “energy” as it applies to prosthetics and orthotics. Your project will be judged on ingenuity, design, finish, and function. One winner and one runner-up will be selected in each of the three categories: practitioner, technician, and student. All three categories will also be entered into the People’s Choice
Award—where AOPA National Assembly attendees will vote and select their favorite device. First-place winners receive a $500 cash prize. Runners-up receive a $200 cash prize. The People’s Choice Award recipient will receive $300, special recognition in the form of a trophy, and a press release. All entries require a statement that provides the contestant’s insights as to why they fabricated the specific design submitted. Enter the contest at https://aopa.wufoo.com/ forms/2014-aopa-opta-technical-fabrication-contest/.
en · er · gy
Join the May and June Audio Conferences May 14: Modifiers: How and When to Use Them Learn how the modifiers affect your claims, and learn use them properly to avoid potential claim denials. Join AOPA May 14 for an AOPAversity Mastering Medicare Audio Conference that will focus on how to use modifiers. • What is the difference between the RA & RB modifiers? • Which modifier allows you to provide services to a patient under hospice care? • What is the true meaning of the KX modifier? Answers to these questions and many others will be discussed during the call!
AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring
June 11: Self-Audit: A Useful Tool Why perform a self-audit? Government agencies are scrutinizing vast numbers of claims to reduce overpayments for health-care services. To ensure your documentation can withstand the scrutiny of these audits, perform a self-audit and find out what the auditors are looking for. Join AOPA June 11 for an AOPAversity Mastering Medicare Audio Conference that will focus on catching mistakes before they become problems. • • • •
How do you create an in-house or self-audit? Where do you start? How often you should perform self-audits? What type of audits audit works best?
at least 80 percent. Contact Devon Bernard at dbernard@ AOPAnet.org or 571/431-0854 with content questions. Register online at http://bit.ly/aopa2014audio. Contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876 with registration questions.
MAY 2014 O&P Almanac
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AOPA HEADLINES
Mastering Medicare: AOPA’s Advanced Coding & Billing Techniques June 12-13: Sheraton Boston Hotel
Join your colleagues June 12-13 at the Sheraton Boston Hotel for AOPA’s Mastering Medicare: Advanced Coding & Billing Techniques seminar. AOPA experts will provide up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Meant for both practitioners and office staff, this advanced
two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage. AOPA has reserved a block of hotel rooms at the Sheraton Boston Hotel at the rate of $199 per night for reservations made before May 21, based on availability. Hotel reservations can be made by calling 617/236-2000. Register online for the Boston seminar at http://bit.ly/ aopa2014boston. Questions? Contact Devon Bernard at dbernard@aopanet. org or 571/431-0854.
New Business Education Programs for 21st Century Entrepreneurs:
BUY 3
GET 1
FREE Survive and Thrive— Bottom-Line, Profit-Oriented Business Programs for O&P If you missed the 2013 O&P World Congress, don’t let this opportunity to participate in these important programs pass you by: • Everything You Need to Know to Survive RAC and Prepayment Audits in a Desperate Environment • Competitive Bidding: Devastation to Orthotic Patient Care, Or Just a Passing Storm? • Food and Drug Administration Compliance for Patient-Care Facilities, Manufacturers, and Distributors • Your Mock Audit: Are You Ready for the Auditor to Examine Your Claims Record?
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O&P Almanac MAY 2014
You and your staff can now have a private viewing of business saving strategies and earn continuing education credits at the same time. Learn more about each session by visiting http://bit. ly/CreditCEpromo. AOPA members just $59 per session ($99 per session for nonmembers), and the price covers your entire staff. Take advantage of a special offer to buy three, get one free. Review the videos as many times as you like. Register at http://bit.ly/aopabusiness. Contact Betty Leppin at bleppin@ AOPAnet.org or 571/431-0876 with any questions.
AOPA HEADLINES
EW N
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Read the O&P Almanac and Earn CE Credits!
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Business CE
Credits Easy & free!
Find the digital edition of O&P Almanac at: Because of the highly www.aopanet.org/publications/digital-edition/. educational content Find the archive at http://issuu.com/americanoandp. of the O&P Almanac’s Access the January, February, and March 2014 Reimbursement Page and quizzes at: Compliance Corner columns, O&P Almanac readers can now • http://www.aopanet.org/publications/op-almanac-magazine/ quiz-archive/ earn two business continuing The April 2014 quizzes are located at: education (CE) credits each • https://aopa.wufoo.com/forms/ time you read the content and pass the accompanying op-almanac-april-2014-reimbursement-page/ quizzes. It’s easy, and it’s free. • https://aopa.wufoo.com/forms/ Simply read the Reimbursement Page column op-almanac-april-2014-compliance-corner/ (appearing in each issue) and Compliance Corner column (appearing quarterly), take the quizzes, and score a And be sure to read the Reimbursement grade of at least 80 percent. AOPA will automatically Page article in this issue and take the transmit the information to the certifying boards on a May 2014 quiz, available soon. quarterly basis.
AOPA’s 2014 Coding Products are Available in the Bookstore 2014 Illustrated Guide This easy-to-use reference manual provides an illustrated guide to the coding system in use for orthotics, prosthetics, and shoes, including HCPCS codes, official Medicare descriptors, and illustrations.
2014 Coding Pro The Coding Pro is O&P’s comprehensive guide to Medicare codes, reimbursement, and medical policies. This is the singlesource reference for all of your coding needs! The Coding Pro CD-ROM provides updated Medicare fee schedules for all 50 states and allows you to customize and import other fee schedules used by your office. Illustrations of the codes allow you to quickly sort codes. And writing prescriptions just got easier with the prescription writing tool. Network Version for use on multiple office terminals.
2014 Quick Coder Stop searching through numerous pages to find a code! AOPA’s redesigned Quick Coder provides a speedy reference to the HCPCS orthotic, shoe, and prosthetic codes and modifiers. These laminated cards are durable, longlasting, and convenient to store.
2014 Coding Suite Save $50 when you purchase the newly updated Coding Suite, which includes all of the coding products discussed above: 2014 Illustrated Guide, 2014 Coding Pro (Single-User CD Software), and the 2014 Quick Coder.
Go to the AOPA Bookstore and order your Coding Products today; visit http://bit.ly/BookStoreAOPA.
MAY 2014 O&P Almanac
39
AOPA HEADLINES
Log On to AOPAversity Online Meeting Place for Free Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you. For a limited time, AOPA members can learn and earn for FREE at the new AOPAversity Online Meeting Place: www.AOPAnetonline.org/education. Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn continuing education credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis.
Coding Questions Answered 24/7 AOPA members can take advantage of a “click-of-the-mouse” solution available at LCodeSearch.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways––by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/4310854 with content questions.
24/7 40
O&P Almanac MAY 2014
AOPA also offers two sets of webcasts: Mastering Medicare and Practice Management. • Mastering Medicare: Coding & Billing Basics: These courses are designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare. • Practice Management: Getting Started Series: These courses are designed for those establishing a new O&P practice. Register online by visiting http://bit.ly/WebcastsAOPA.
Welcome to AOPA Jobs AOPA’s Online Career Center gives you access to a very specialized niche. The Online Career Center is an easyto-use, targeted resource that connects O&P companies and industry affiliates with highly qualified professionals. The online job board is designed to help connect our members with new employment opportunities. Job Seekers: Post your resume online today, or access the newest jobs available to professionals seeking employment. Whether you’re actively or passively seeking work, your online resume is your ticket to great job offers. Employers: Reach the most qualified candidates by posting your job opening on our Online Career Center. Check out our resumes and only pay for the ones that interest you. Recruiters: Create and manage your online recruiting account. Post jobs to our site and browse candidates
interested in your positions. The AOPA Online Career Center is your one-stop resource for career information. Create an account and learn about opportunities as a job seeker, an employer, or a recruiter. Get started at http://jobs.aopanet.org. In addition, take advantage of O&P Almanac’s Jobs section to post or browse an employment opportunity, and advertise to AOPA’s 2,000+ member organizations! Regardless of your staffing needs or budget, we have an option that is right for you. For advertising, call Bob Heiman, Advertising Sales Representative at 856/673-4000 or email bob.rhmedia@comcast.net.
AOPA HEADLINES
O&P PAC Update The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*: • • •
George Breece Maynard Carkhuff Claudia Zacharias
The O&P PAC advocates for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@ AOPAnet.org. *Due to publishing deadlines this list was created on April 1, 2014, and includes only donations received between Jan. 1, 2014, and April 1, 2013. Any donations received on or made after April 1, 2014, will be published in the next issue of the O&P Almanac.
Follow AOPA on Facebook and Twitter Follow AOPA on Facebook and Twitter to keep on top of latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities. Like us on Facebook at: www.facebook. com/AmericanOandP with your personal account and your organization’s account! Follow us on twitter: @americanoandp, and we’ll follow you, too! Contact Steve Custer at scuster@AOPAnet.org or 571/4310835 with social media and content questions.
Top 5 Reasons To Follow AOPA: Be the first to find out about training opportunities, jobs, and news from the field. Build relationships with others working in the O&P field. Stay in touch with the latest research, legislative issues, guides, blogs, and articles—all of the hot topics in the community. Hear from thought leaders and experts. Take advantage of special social media follower discounts, perks, and giveaways. a
MAY 2014 O&P Almanac
41
Marketplace
PEL Offers the K2 FOOT from Fillauer
New WillowWood Alpha® Classic Liners
Engineered from the ground up for the functional level 2 patient. Other K2 designs are typically stiffer SACH feet or softer K3 designs. The Fillauer K2 Foot is a new design specifically for the functional level 2 patient.
WillowWood is pleased to offer its Alpha Classic Liners for transtibial, transfemoral, upperextremity, pediatric, and custom applications. The new Alpha Classic Liners are “gel” liners and are offered with the following specifications: • Original, Spirit, and MAX Fabrics • Uniform, Tapered, Contoured, or AK profiles • 3-mm, 6-mm, and 9-mm gel thicknesses • A full range of sizes • Custom Alpha DESIGN® Liners for transtibial and transfemoral applications.
For more information, contact PEL at 800/321-1264 or customerservice@pelsupply.com. Customers can order online at www.pelsuppy.com.
Results of mechanical, biocompatibility, and clinical testing show the new gel delivers the performance and comfort that customers expect from Alpha Liners. For information, contact WillowWood at 800/848-4930 or visit willowwoodco.com. a
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• Unique, flexible keel/multi-axis design • Flexible, impact-reducing design • Roll-Over Shape (ROS) designed for a natural gait • Compliant dynamics for comfort and stability • Positive lock foot shell interface for stability • Simple, maintenance-free design • Foot comes assembled in foot shell for an easy “out-of-the-box” fit.
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O&P Almanac MAY 2014
UPS Savings Program AOPA Members now save up to 30% on UPS Next Day Air® & International shipping! Sign up today at www.savewithups.com/aopa! Take advantage of special savings on UPS shipping offered to you as an AOPA Member. Through our extensive network, UPS offers you access to solutions that help you meet the special shipping and handling needs, putting your products to market faster. AOPA members enjoy discounts for all shipping needs and a host of shipping technologies. Members save: • Up to 30% off UPS Next Day Air® • Up to 30% off International Export/Import • Up to 23% off UPS 2nd Day Air®
al i c e Sp s! ng savi
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!
Get the AOPAversity Advantage!
Distance Learning Opportunities Through AOPA
New!
O&P ALMANAC Because of the highly PER MODULE educational content of the O&P Almanac’s Reimbursement Page and Compliance Corner, O&P Almanac readers can now earn two business continuing education (CE) credits each time they read these articles and pass the accompanying quiz. EARN CREDITS
2.0 CE
IT’S EASY AND IT’S FREE!
Read and learn from O&P Almanac’s monthly reimbursement column and quarterly compliance corner—you will now not only gain knowledge, but also can earn CE credits by taking a short quiz and receiving a passing grade of 80 percent or higher. AOPA will automatically transmit the information to the certifying boards on a quarterly basis. The print version of the O&P Almanac is delivered to all AOPA members, ABC certified practitioners, BOC certified practitioners as well as subscribers. Additionally the electronic version of O&P Almanac is available online at www.aopanet.org/publications/digital-edition/. Learn more at: www.aopanet.org/publications/op-almanac-magazine/
AOPAVERSITY WEBCASTS
VIDEO LEARNING LIBRARY EARN UP TO
Series 2> Practice Management: O&P Administration Services contains five modules, including topics such as Establishing an O&P Practice, Acquiring an existing O&P Practice, and Enrolling in Medicare and Medicaid.
During these one-hour PER CONFERENCE sessions, AOPA experts provide the most up-todate information on a specific topic. Perfect for the entire staff—one fee per conference, for all staff at your company location ($99 Member/$199 Non-Member). A great teambuilding, money-saving, educational experience! Sign up for the entire series and get two conferences FREE. Entire Series ($990 Members/$1,990 Non-Members). The fee is per location and there is no limit on the number of staff you can assemble in one location.
AOPA’s video learning library PER VIDEO offers many different types of high-level education—clinical, business, motivational, and more. Many of the videos have been approved for CE credits. After viewing the educational video in its entirety, complete and submit the quiz continuing education (CE) credits. AOPA will automatically transmit the information to the certifying boards on a quarterly basis for those with passing grades of 80 percent or higher. Those not passing the quiz will be notified.
Learn more at: www.aopanet.org/education/ webcasts/
Learn more at: www.aopanet.org/education/ audio-conferences/
Peruse the complete library at: www.aopanetonline.org/education
EARN CREDITS
1.5 CE PER MODULE
AOPA offers two webcast series:
AUDIO CONFERENCES
Series 1> Mastering Medicare: Coding & Billing Basics and Principles contains nine modules is a recommended prerequisite to the Advanced Coding & Billing Techniques Seminar.
EARN CREDITS
1.5 CE
1.5 CE
AOPAversity is your one-stop resource for quality O&P education, developed explicitly for orthotic, prosthetic and pedorthic professionals. Most education has been approved for continuing education (CE) Credits. Learn on your terms with one of our opportunities listed above! Earn CE credits accepted by certifying boards:
Visit www.AOPAnetonline.org/education today!
JOBS CALENDAR
Find your region on the map to locate jobs in your area.
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color
$482 $678 $634 $830
Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to scuster@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140
aOPa marketing
Be served a bigger
media kit
slice of the pie!
dollar of of the 3.5 billion AOPA Find your slice begin with an O&P business— opportunity today! advertising
rates effective
American Orthotic Promoting O&P
& Prosthetic
Since 1917
Association
Jan. 1, 2014
(AOPA)
Anet.org www.AOP
net.Org
www.AOPA
44
DISCOVER more AOPA advertising opportunities. Call Bob Heiman, Advertising Sales Representative, at 856/673-4000 or email bob.rhmedia@comcast.net
20 14
OPPOrtunities
AOPA 2014
MediA Kit
1
O&P Almanac MAY 2014
Inter-Mountain CPO/C.Ped Bosie, Idaho Outdoor Enthusiast Wanted. Do you enjoy outdoor activities? Idaho offers many opportunities to explore the great outdoors—hunting, fishing, skiing, and biking, just to name a few. Brownfield’s Prosthetics & Orthotics is looking for a CPO and a C.Ped who wants to improve their standard of living, Boise is consistently ranked by The Wall Street Journal, Kiplinger’s, Forbes and others as one of the top 10 locations for business and family in the U.S. On top of our comprehensive benefit package, we can offer you job stability. Brownfield’s P & O has three full-service locations in the Boise area. Please send resume to:
Email: jgillespie@brownfieldstech.com
Job Opportunity CPO/BOCPO At Center for Orthotic & Prosthetic Care (COPC) our staff of orthotic and prosthetic professionals is committed to our mission of providing the highest level of patient care possible. COPC is a private partnership that enjoys the privilege and challenge of serving in leading and renowned medical centers in Kentucky, Indiana, North Carolina, and New York. Due to an opening at a new patient-care facility in Paducah, Kentucky, we are seeking a CPO, or Kentuckylicensed BOCPO, with a minimum of five years’ clinical experience. Because we have experienced rapid growth at our patient-care facilities in the Binghamton, New York, area, we are seeking a CPO/BOCPO with a minimum of two years’ experience. Candidates must possess excellent communication, organizational, and interpersonal skills, and the demonstrated ability to provide the highest quality patient care. These positions offer a competitive salary, relocation assistance, and excellent benefits including medical, dental, disability, 401K, certification and licensure fees, and continuing education expenses. If you meet these requirements and have an interest, please submit your resume, in confidence, to:
For the Paducah, Kentucky, position, via fax at 502/451-5354 or via email to copchr@centeropcare.com. For the Binghamton, New York, position, via email to dsickles@centeropcare.com.
CALENDAR JOBS
O&P Board Study Resources We can help you PASS your BOARDS All products updated to 2013 test standards.
Discover a place where ideas, collaboration, and experience combine to innovate healthcare.
Think excellence.
Think UNM Hospitals. Orthotist (Req# 12371454)
Requires 3 years of related experience and certification as an Orthotist from the American Board for Certification in Orthotics and Prosthetics. As the region’s only Academic Medical Center, UNM Hospitals continues to be a leader in medical and academic excellence. It’s a level of distinction made possible by the ability of our diverse and richly experienced organization to collaboratively solve challenges and innovate healthcare solutions. It’s what makes us uniquely positioned to continuously raise the level of care we offer, and why we’ve been recognized by Diversity Inc. as a Top 10 Hospital System for 2013. So join us and add your unique perspectives and ideas to our distinction. For more information about UNM Hospitals and our benefits, visit http://hospitals.unm.edu/jobs Text UNMH to 313131 to join our Talent Community!
Introducing our NEWEST Study Guide in PEDORTHICS
The ONLY Comprehensive Study Guides Specifically for Orthotics and Prosthetics
Now Offering Customizable Orthotic and Prosthetic Patient Device Instruction Sheets in English AND Spanish
Our Products NOW available for IMMEDIATE DOWNLOAD! No need to wait, BEGIN your STUDIES NOW!
Visit facebook.com/ UNMHospitals
www.oandpstudyguide.com
“The most gratifying piece of what I do O & P ALMANAC MAGAZINE 05/01/2014 every day is to get up early in the 1277210-PAPC64459 morning, get to the office and know that UNMHOS we are going to make a difference.” 3.5” x 4.5” - Kevin Carroll, MS, CP, FAAOP Madelene Kane v.1 Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all available through a career at Hanger Clinic. Join Hanger Clinic and make a difference today. To view available positions and apply online visit: www.hanger.com/careers or scan the QR code. Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state or local law. Residency Program Info, contact: Robert S Lin, MEd, CPO, FAAOP Director of Residency Training and Academic Programs, Hanger Clinic, Ph. 860.667.5304; Fax 860.666.5386.
AVAILABLE POSITIONS CLINIC MANAGER
Jackson, MI Ardmore, OK Bartlesville, OK
Charleston, WV Lynchburg, VA Philadelphia, PA
Albuquerque, NM Burr Ridge, IL Columbus, OH Dayton, OH Denver, CO Englewood, CO Enid, OK Gurnee, IL Henderson, NV Kissimmee, FL Macon, EOE GA
San Antonio, TX San Francisco, CA Santa Rosa, CA St. Louis, MO Stratford, CT Thomasville, GA Tulsa, OK Worcester, MA Springfield, IL Columbia, MO
Bronx, NY Evansville, IN Johnston, IA Kansas City, KS La Mesa, CA Modesto, CA Salisbury, MD
Valdosta, GA Wethersfield, CT Cincinnati, OH Sheridan, WY Bullhead City, AZ Wichita, KS Hammond, IN
Overland Park, KS Riverside, CA
St.Louis, MO Pittsburgh, PA
PROSTHETIST/ORTHOTIST
ORTHOTIST
PROSTHETIST
MAY 2014 O&P Almanac
45
CALENDAR
■ YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiplechoice and clinical-simulation exams. Apply now at http://my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.
www.bocusa.org
OnLIne Training Cascade Dafo Inc. Cascade Dafo Institute. Now offering a series of six free ABC-approved online courses, designed for pediatric practitioners. Visit www.cascadedafo.com or call 800/848-7332. ■
■■
2014 ■ May 12-17 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians in 250 locations nationwide. Contact 703/8367114, email certification@abcop. org, or visit www.abcop.org/ certification. ■ May 14 AOPAversity Audio Conference–Modifiers: How and When To Use Them. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ June 1 ABC: Practitioner Residency Completion Deadline for July and August 2014 Exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification. ■ June 11 AOPAversity Audio Conference–The Self-Audit: A Useful Tool. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. ■ June 20 Summer 2014: Learning and Leisure—“Dynamic Response Orthotic System” Certification Course. Join us at Harrah’s Hotel in New Orleans. Workshop fulfills requirement for Phase I toward certification as a “Dynamic Response Systems Specialist.” 7.75 CEUs. For registration information, visit www. phatbraces.com. For more information, call 515/554-6132.
PROMOTE Events in the O&P Almanac
CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Words
Member Rate
Nonmember Rate
25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$5.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email scuster@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations. For information on continuing education credits, contact the sponsor.
■ SEPTEMBER 4-7 97th AOPA National Assembly. Las Vegas. Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org.
■ September 10 AOPAversity Audio Conference–Urban Legends in O&P: What To Believe. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ October 8 AOPAversity Audio Conference–Medicare Enrollment, Revalidation, and Participation. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
BIO-MECHANICAL COMPOSITES, INC. ■ July 9 AOPAversity Audio Conference–The OIG: Who Are They and Why Are They Important? Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ August 13 AOPAversity Audio Conference–AFO/KAFO Policy: Understanding the Rules. Register online at http:// bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ October 10 Fall 2014: Learning and Leisure—“Dynamic Response Orthotic System” Certification Course. Join us at the LaGuardia Airport Marriott in NY the day prior to the POMAC meeting. Workshop fulfills requirement for Phase I toward Certification as a “Dynamic Response Systems Specialist.” 7.75 CEUs. For registration information, visit www.phatbraces.com. For more information, call 515/554-6132.
Questions? Email scuster@AOPAnet.org. BIO-MECHANICAL COMPOSITES, INC.
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O&P Almanac MAY 2014
www.AOPAnet.org/join
CALENDAR AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)
•
■
■ November 15 Midwest Chapter AAOP— One-Day Fall Symposium. Hickory Hills, IL. For more information, visitwww. mwcaaop.org/meetings-events. html or email mwcaaop@gmail. com.
Experience the Benefits of AOPA Membership
Experience the Benefits of AOPA Membership
•
2015
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
November 12 AOPAversity Audio Conference–Gifts: Showing Appreciation Without Violating the Law. Register online at http://bit.ly/ aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
Member Benefits
December 10 AOPAversity Audio Conference–New Codes and Changes for 2015. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. ■
•
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
■ OCTOBER 7-10 98th AOPA National Assembly. San Antonio. Henry B. Gonzales Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org. a
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
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•
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Experience •
the Benefits
N (AOPA )
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of AOPA Me
ic Association
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
•
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 ons. team Dobson Washington. quality standard regulati rm fi lobbying and O&P the care rules and 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 24/7, AOPA’s with e available 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
October 16-18 Virginia Orthotic & Prosthetic Association. Glen Allen, VA. Wyndham Virginia Crossings Resort & Conference Center. For more information, visit www.vopaweb.com or email vopainfo@gmail.com. ■
2014 AOPA Annual Membership enrollment(Continued) is now open. Call 571/431-0876 to request an application form, or visit www.AOPAnet.org.
Join today!
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ALPS South LLC
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800/574-5426
www.easyliner.com
Board of Certification/Accreditation
33
877/776-2200
www.bocusa.org
Cailor Fleming Insurance
5
800/796-8495
www.cailorfleming.com
DAW Industries
1
800/252-2828
www.daw-usa.com
Delcam Healthcare Solutions
19
877/335-2261
www.delcam-na.com
Dr. Comfort
7
877/713-5175
www.drcomfort.com
Fillauer LLC
15
800/251-6398
www.fillauer.com
Hersco Ortho Labs
2
800/301-8275
www.hersco.com
O&P Study Review Guide
45
410/266-1671
www.oandpstudyguide.com
Ottobock
C4
800/328-4058
www.professionals.ottobockus.com
PEL
C2
800/321-1264
www.pelsupply.com
Spinal Technology
9
800/253-7868
www.spinaltech.com
WillowWood
25
800/848-4930
www.willowwoodco.com
MAY 2014 O&P Almanac
47
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Reimbursement Page AOPA Answers
Pushing the Pause Button Answers to your questions regarding the suspension of RAC audits, and more
AOPA
receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.
Q.
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City A R tiv
pa
ac
48
O&P Almanac MAY 2014
I just received a prepayment audit from my Durable Medical Equipment Medicare Administrative Contractor (DME MAC). I thought all audit activity has been suspended. Why have I received this audit?
A.
Not all audit activity has been suspended; only the Recovery Audit Contractor (RAC) audits have been temporarily suspended. You may still receive postpayment and prepayment reviews from your local DME MAC, and you may still receive Comprehensive Error Rate Testing audit requests as well.
Q.
Why did the RACs temporarily suspend their audit activities?
A.
The initial RAC contracts are reaching the end of their term, and CMS is in the process of reviewing requests for proposals, which will ultimately result in the award of new RAC contracts. CMS announced that due to the transition of contractors, providers may see a pause in RAC activities. This pause is only temporary and has the following provisions: The last day a RAC contractor could send an additional documentation request to a provider was Feb. 21, 2014; and the last day a RAC may send an overpayment notice for purposes of collection is June 1, 2014.
Q.
If we are nonparticipating providers with Medicare and we are not accepting assignment on a claim, are we still required to obtain all of the required documentation before we can submit a claim for payment?
A.
Yes, you are required to adhere to all Medicare policies and procedures, and this includes ensuring you have the proper documentation to support medical necessity. The choice of being a participating or nonparticipating provider and accepting or not accepting assignment only relates to how you bill the patient and how much you may collect from the patient. a
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