October 2012 Almanac

In the Right

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How to Earn Great Referrals Understanding the ABN FORM

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O&P Almanac CONTENTS

OCTOBER 2012, VOLUME 61, No. 10

COLUMNS

Cover Story

14

Reimbursement Page When and how to fill out, deliver, and issue an ABN

36

Facility Spotlight Kentucky Prosthetics and Orthotics

22 In the Right Hands

By Deborah Conn Advances in upper-limb prosthetics have led to the development of a wide array of artificial hand options, including cuttingedge multi-articulating myoelectric devices. These newest prostheses offer proportional speed control and volitional grasp force, empowering patients to perform fine-motor tasks.

Photo: Touch Bionics

departments

4 AOPA Contact Page How to reach staff

6 At a Glance

Statistics and O&P data

08

In the News Research, updates, and company announcements

42 AOPA Headlines

Feature

30 Great Service, Great Referrals

By Adam Stone Earning referrals from both patients and physicians is a key component of running a successful O&P practice. Follow these tips to drive referrals, starting with doing good work and fostering personal connections with patients.

On the cover: A boy wearing a myoelectric hand prosthesis playing basketball

News about AOPA initiatives, meetings, and more

50 AOPA Membership 00 Applications 52 Marketplace 54 Jobs

Opportunities for O&P professionals

59 Calendar 63 Ad Index 64 AOPA Answers

Photo: Ottobock Healthcare

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 Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.

OCTOBER 2012 O&P Almanac

3

AOPA IN THE Contact NEWS INFORMATION

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org EXECUTIVE OFFICES

MEMBERSHIP and Meetings

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

Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org

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

Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org

O&p Almanac

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

Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com Stephen Custer, staff writer, 571/431-0876, scuster@AOPAnet.org Lia K. Dangelico, contributing writer, 703/914-9200 x24, ldangelico@strattonpublishing.com Christine Umbrell, editorial/production associate, 703/914-9200 x33, cumbrell@strattonpublishing.com

OP Almanac &

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

Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, landerson@AOPAnet.org

BOARD oF DIRECTORS

AOPA Bookstore: 571/431-0865

President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX

Communications Steffanie Housman, content strategist, 571/431-0835, shousman@AOPAnet.org Steven Rybicki, communications manager, 571/431-0835, srybicki@AOPAnet.org Government affairs Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com a

Officers

President-Elect Tom Kirk, PhD, Hanger Inc., Austin, TX Vice President Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

directors Kel M. Bergmann, CPO, SCOPe Orthotics and Prosthetics Inc., San Diego, CA Michael Hamontree, OrPro Inc, Irvine, CA Russell J. Hornfisher, MBA, MSOD, Becker Orthopedic Appliance Co., Troy, MI Alfred E. Kritter, Jr., CPO, FAAOP, Hanger Inc., Savannah, GA

MEMBER VALUE GUIDE www.AOPAnet.org

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

Member Benefits

Experience the Benefits of AOPA Membership

•

Challenging RAC and CERT audit policies implemented this past year by overly aggressive CMS contractors is AOPA’s number one priority.

All options are on the table to eliminate these burdensome and patient harming practices.

•

Your Voice in Washington. AOPA’s staff and the lobbying team of former CMS Administrator, Tom Scully of the Alston & Bird law firm and Nick Littlefield, former chief of staff for Sen. Ted Kennedy and now a partner in the Foley Hoag law firm 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.

•

Making Your Voice Stronger.

The O&P Political Action Committee supports candidates who understand the unique contribution the O&P community makes to restoring lives and hope.

MISSION

Experience the Benefits of AOPA Membership 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.

•

Making Your Voice Connect.

AOPA’s Annual Policy Forum brings O&P leaders to Washington to receive high level briefings and to deliver the O&P story personally to their members of Congress.

•

Expert Reimbursement and Coding Guidance. AOPA’s reimbursement specialists provide coding advice and keep you up-to-date on the latest Medicare quality standards, billing rules and regulations. Answer all of your questions related to O&P coding, reimbursement and compliance—via telephone or email.

Members have unlimited access to AOPA staff experts.

•

Cost Effectiveness Research.

The changing climate of health care is moving to a patient driven process and is demanding more and more evidence of cost effectiveness to measure outcomes. AOPA has funded the first in a series of research projects that will measure the cost effectiveness of timely O&P treatment of patients with the same diagnoses as patients who did not receive treatment. More cost effectiveness research projects will be necessary and are simply too expensive for individual O&P businesses to undertake. AOPA can aggregate the resources of the field to conduct this vital research.

Membership in AOPA is one of the best investments that you can make in the future of your company.

2013 AOPA Annual Membership enrollment is now open. Call 571/431-0876 to request an application form, or visit www.AOPAnet.org.

Join today!

4

O&P Almanac OCTOBER 2012

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

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AT IN THE A GLANCE NEWS

London 2012 Paralympics The London Games were called “the greatest Paralympic Games ever” by the organizers, with more athletes, spectators, and medals than ever before.

all change Top 5 Countries by Total Medal Count…

1

#

People’s Republic of China

2

Great Britain

3

Russian Federation

4

U.S.A

5

Australia

# # # #

U.S. Medals by Type…

231

31

GOLD

29

SILVER

38

BRONZE

120 102

98 85

Sept. 7-18,

2016

Dates for the next Summer Paralympic Games, to be held in Rio de Janeiro, Brazil.

Sources: www.london2012.com/paralympics.

4,280 Number of athletes who participated, from 165 countries.

227

Number of athletes on the U.S. Paralympic team.

1:05.63 Jessica Long’s 100-meter freestyle swim; Long won Gold in the event and a total of eight medals in London.

Sources: www.london2012.com/paralympics; The Independent newspaper.

6

O&P Almanac OCTOBER 2012

60.05 meters Distance thrown by U.S. athlete Jeremy Campbell, who won Gold in the men’s discus throw—F44.

46.68 seconds Time it took for Oscar Pistorius to run the 400-meter–T44 race, for which he won Gold.

2.7 million Number of tickets sold for 2012 Paralympic Games.

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IN THE NEWS

Technology May Help Amputees Improve Mobility A researcher at the Colorado School of Mines in Golden is using the same technology used to reproduce realistic movements for animated films and the video-gaming industry to analyze gait, which may lead to a better understanding of mobility in people with lower-limb amputations.

Anne Silverman, PhD, assistant professor of mechanical engineering, led a study to investigate lower-limb mechanics in individuals with an amputation. The 24 subjects had small, reflective spheres attached to their feet, ankles, shins, knees, thighs, and hips. High-speed motion-capture cameras then tracked the movement of the spheres, which allowed Silverman to characterize human-body motion.

After combining data from motion-capture and ground-force

measurements, Silverman calculated the net power generated and absorbed at each joint, to better understand how individuals with an amputation compensate while walking in the absence of a biological ankle. Her findings show that, rather than using their intact legs to compensate, most subjects use hip muscles high in the amputated leg to do the heavy lifting, especially when walking at faster speeds.

By combining that electromyography data with other biomechanical measurements, Silverman generated three-dimensional walking simulations, which can be used to understand the roles of individual muscles and prosthetic devices in whole-body movements. Silverman hopes the findings will contribute to technologies that can be applied in a clinical setting, such as improving the long-term mobility of individuals with lowerlimb amputations.

Combat-Related Upper-Limb Revision Amputations Improve Outcomes According to a retrospective analysis published August 15 in The Journal of Bone and Joint Surgery, revision amputation to address surgical complications and persistently symptomatic residual limbs improves patients’ overall acceptance of prostheses and leads to outcomes equivalent to those following amputations that did not require revision.

A team of physicians from Orthopaedic Surgery Service, Walter Reed National Military Medical Center, in Bethesda, Maryland, performed a retrospective analysis of a consecutive series of 96 personnel who had sustained a total of 100 major combat-related upper-limb amputations

8

O&P Almanac OCTOBER 2012

in Operation Iraqi Freedom and Operation Enduring Freedom.

All amputations resulted from high-energy trauma, with 87 percent occurring secondary to a blast injury. Forty-two residual limbs underwent a total of 103 repeat surgical interventions. The physicians indicated that, when compared with patients with all other amputation levels, those with a transradial amputation were 4.7 times more likely to have phantom limb pain and 2.8 times more likely to require neuropathic pain medications. In the group of patients who underwent revision surgery, regular prosthesis use increased from 19 percent before the revision to 87 percent after the revision.

IN THE NEWS

FDA Rule Requires Registering Medical Devices On August 2, the U.S. Food and Drug Administration (FDA) published a final rule in the Federal Register requiring medical device end-product and contract manufacturers to register their products electronically on the FDA Unified Registration and Listing System (FURLS). Each medical device manufacturer, both foreign and domestic, must establish an account on the FURLS, which will be used to update information regarding its device establishment registration and device listing information.

The rule also eliminates an existing exemption for foreign companies, which stated that re-export devices from a foreign trade zone did not have

TRANSITIONS

people in the news

Richard W. Brown, CO, has joined the Ability Prosthetics & Orthotics patient-care facility in Hagerstown, Maryland, as a prosthetics resident.

Tyler Dunham, prosthetics resident and board-eligible orthotist, has joined Ability Prosthetics & Orthotics in York, Pennsylvania.

Patrick Logan, CPO, has been appointed vice president of operations and development for the Mary Free Bed Orthotics & Prosthetics program in Grand Rapids, Michigan.

Mike Martin, CP, has joined the staff of Round Rock Orthotics & Prosthetics Inc. in Round Rock and Austin, Texas.

10

O&P Almanac OCTOBER 2012

to comply with electronic registration requirements.

According to the FDA, under the new guidelines, the process of submitting registration and listing information for devices will be more efficient for the industry and will provide faster access to that information for both the FDA and industry.

In addition, the FURLS will allow FDA to gather information concerning marketed devices that might be needed to accomplish statutory and regulatory objectives.

Information submitted prior to Sept. 15, 2007, has been migrated to the FURLS database. The final rule goes into effect Oct. 1, 2012.

Hector Picard became the first double-arm amputee to complete the Ironman U.S. Championship.

Picard, who ran the race on behalf of the I Will Foundation, completed a 2.4-mile swim, 112-mile bike ride, and 26.2-mile run with a time of 16 hours and 42 minutes.

Mark Pitambersingh, CP, has joined Lawall Orthotic & Prosthetic Services, headquartered in Philadelphia.

Robert M. Sehnert has joined the board of directors of The Wounded EOD Warrior Foundation.

The Amputee Coalition has named three new members to its Scientific and Medical Advisory Committee (SciMAC): Troy Turner, David Dunville, and Stella Sieber.

ABC Debuts Central Fabrication Accreditation Program The American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc. (ABC) has developed the first comprehensive accreditation program exclusively for central fabrication facilities in the orthotic, prosthetic, and pedorthic profession.

ABC’s new program follows the mandate of its other accreditation programs: Quality of care for the customer is of paramount importance.

The goal of the new program is to ensure O&P business owners that those central fabrication facilities with which they partner are held to the same level of standards they have already met. In turn, consumers, referral sources, and third-party payers can be assured that a stringent set of quality standards have been met.

The new program will follow the same model as ABC’s current accreditation programs, with an onsite survey and reaccreditation every three years.

Central fabrication facilities will be measured against 60 standards that directly correlate to best business practices and process improvement.

The Central Fabrication Accreditation program will begin accepting applications Jan. 1, 2013. For more information, visit www.abcop.org.

IN THE NEWS

PECOS Offers a Digital Documentation Repository

Wheelchair Softball Field Named for Todd Anderson

The CMS has updated the Provider Enrollment, Chain, and Ownership System (PECOS) to allow providers and suppliers to submit electronic copies of all supporting documentation during the Medicare Enrollment application submission process to a digital documentation repository (DDR). Prior to that enhancement, providers and suppliers were required to mail copies of all supporting documentation to their Medicare Administrative Contractor (MAC).

The DDR also will apply to any requests from the MACs for additional documentation that may be essential to completely process the enrollment applications, and it will be available for PECOS users to upload Changes of Information (COI) applications and revalidation applications. Uploaded documents must be in a PDF or TIFF file format, and be equal to or less than 10MB per file. Users will have the ability to: • classify documents that are uploaded based on the document type • upload more than one document of a particular type • add or delete previously submitted documents as part of a COI application submission • view and/or print any supporting documentation that was previously submitted and is currently associated with an enrollment record.

A “Digital Document Repository How To Guide” is available at the CMS website, www.cms.gov.

Minnesota’s first softball field for competitive wheelchair play—Todd Anderson Field, Brooklyn Park—was inaugurated August 9. The celebration included a ribbon-cutting ceremony, a home-run derby, and an inaugural softball game.

The field was named after Todd Anderson, CP, FAAOP, who passed away unexpectedly nearly two years ago at the age of 50. It was funded in part by a $200,000 grant through the Major League Baseball/Pepsi Refresh Project.

Anderson, a transtibial amputee, was a long-time employee at Ottobock US HealthCare, in Minneapolis, who established himself as a leader in the O&P community by publishing clinical papers and giving presentations at numerous national and international meetings, and serving as Treasurer of the American Board for Certification in Orthotics, Prosthetics & Pedorthics. He was an eight-time National Wheelchair Softball Association (NWSA) National Tournament most valuable player and hall of fame inductee. a

TRANSITIONS

BUSINESSES in the news

The Amputee Coalition has opened a new headquarters in Manassas, Virginia, part of the Greater Washington, DC, area. The new location will allow the organization closer proximity to legislators as well as to such industry partners as the Veterans Affairs. The Knoxville, Tennessee, branch office will be retained, with the National Limb Loss Resource Center and other critical services housed there.

Boston Brace, headquartered in Avon, Massachusetts, celebrates its 40th anniversary in the O&P industry this year.

The nonprofit Dralla Foundation, established in 2011 by Allard in Rockaway, New Jersey, has announced the winners of the grants it awards to U.S. nonprofit organizations that best align with Dralla’s mission to “provide

12

O&P Almanac OCTOBER 2012

support for a better life” to enrich the lives of individuals with disabilities.

Visit www.dralla.org for a full list of winners.

Ergoresearch, located in Laval, Quebec, Canada, has signed a distribution agreement with Proteor, in St. Apollinaire, France, for the purchase and distribution of orthopedic components patented worldwide.

Honda Motor Company, headquartered in Tokyo, Japan, announced that its Stride Management Assist device will be featured in a program to assess independence solutions for elderly individuals. The study will be conducted by Japan’s National Center for Geriatrics and Gerontology (NCGG), in Obu, Aichi Prefecture, to research the applicability of the devices to be used as a mobility solution for elderly individuals.

New England Orthotic and Prosthetic Systems, headquartered in Branford, Connecticut, has donated knee braces and similar orthotic devices to U.S. Special Forces troops on patrol in Afghanistan.

The Gold Coast campus of Southern Cross University in Bilinga, Australia, will offer a bachelor of clinical science degree in pedorthics beginning in 2013.

Michigan State Sen. Judy Emmons (R-33rd) toured the recently renovated University of Michigan Orthotics and Prosthetics Center in August.

Emmons visited the workshop where the center’s O&P devices are made and talked with staff about the success stories and challenges related to meeting O&P needs across the state.

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2012-07-02 09:22:36

n

Reimbursement Page

By Devon Bernard, AOPA government affairs department

The ABN Form: It’s not as simple as ABC Tips for properly filling out, delivering, and issuing this important document

T

he Social Security Act contains a provision, the Limitation on Liability, which establishes when beneficiaries cannot be held financially liable for items or services they receive. Traditionally, a Medicare beneficiary can’t be held financially liable for denials, unless those denials are for services not covered as part of a defined Medicare benefit or service statutorily noncovered by Medicare, such as all elastic braces. However, when an item or service is a Medicare benefit (i.e., an item Medicare pays for or covers as a benefit), and is denied because it is not medically reasonable or necessary, the patient’s liability for payment may be limited.

The Limitation on Liability protects Medicare beneficiaries from having to pay for a service when they did not know and could not reasonably be expected to have known that a service would be denied as not medically necessary. In other words, as a Medicare Fee-for-Service provider you are expected to know all rules, policies, and guidelines governing Medicare coverage and payment. Your patients

14

O&P Almanac OCTOBER 2012

are not expected to know those rules and regulations; therefore, they cannot be held financial responsible if a claim is denied because Medicare policy criteria or guidelines were not met.

You may find yourself in a conundrum because you have to know all the rules (even if those rules routinely change), and you can’t bill the patient for a claim denied for medical necessity. That problem can be solved, however, with the Advance Beneficiary Notice of Noncoverage (ABN). If a beneficiary is notified in advance that the service he or she is scheduled to receive could be deemed not medically necessary and denied, then that beneficiary is no longer protected by the Limitation on Liability provision and can be held financially liable for the denial. The ABN form was created to provide advanced written notification, ensuring Medicare beneficiaries are properly made aware of their potential responsibility.

However, just because you have informed the patient that an item may be denied as not medically necessary

and provided him or her with an ABN, the financial liability has not necessarily shifted from you to the beneficiary. The ABN must be valid in the eyes of Medicare.

To ensure you are familiar with the ABN form, let’s review the sample form (found on page 17). Following are some tips to help ensure you properly fill out, deliver, and issue the ABN, so Medicare will consider it a valid ABN.

Issuing the ABN Deciding when you should provide a patient with an ABN is the first step in ensuring the ABN is valid.

If you hand out an ABN to every single patient for every single item or service you provide, please note that Medicare considers such blanket usage to invalidate the ABN. For an ABN to be considered valid, you must only issue it when you believe the item/ service you are providing is normally covered under an established Medicare benefit, but you have an established and documented reason to believe that Medicare may deny the service as not medically reasonable or necessary.

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Reimbursement Page

Because the onus is on you to determine whether an item is not medically necessary and to inform the patient, it is wise to review the Medicare medical policies. When reviewing those policies, look for this key phrase: “not reasonable and necessary.” If you see that phrase, it should trigger thoughts of an ABN. Besides searching for trigger terms in policy documents, noticing inadequate or missing physician and/ or other supporting documentation should alert you to the necessity of an ABN. The reason an ABN can be issued and considered valid in that scenario is because if there is not sufficient documentation to support the item/service being provided, then most likely policy criteria has not been met or medical necessity has not been established. If medical necessity has not been established, Medicare could deny the item as not medically necessary or reasonable.

Filling Out/Completing the ABN Here are some helpful suggestions to keep in mind when filling out the ABN.

When reviewing those policies, look for this key phrase: “not reasonable and necessary.” If you see that phrase, it should trigger thoughts of an ABN.

Section A: Notifier. This section indicates who is providing the ABN to the patient. To be considered valid, this section must include your company’s name, address, and telephone number.

Customization of the ABN to include your logo or multiple facility locations is acceptable as long as it contains the required information. If you included multiple facility locations in the Notifier section, be sure the facility where the services are being provided is clearly marked, so the patient can contact the correct location if he or she has any issues or questions.

It is important to note you cannot automatically have a patient sign an ABN for missing or inadequate documentation, or because you think the referring physician didn’t document or hasn’t provided you with documentation in the past. You must first make a good faith effort to obtain and review the available documentation and have a genuine belief that the documentation is inadequate or doesn’t exist.

Section D: Title Unfiled. In this section, list the items/services you believe will be denied. Using language the patient can easily understand is important, so avoid just listing the Healthcare Common Procedure Coding System (HCPCS) code.

Customization of the ABN to have this section prefilled out to include the items you provide on a regular basis is acceptable. It is also okay to use check boxes in this section as long as the item you are providing is clearly identified.

16

O&P Almanac OCTOBER 2012

Section E: Reason Why Medicare Will Not Pay. Explain here why you believe the items/services you are providing may be denied as not medically necessary. The key to this section is to provide a detailed explanation. For an ABN to be valid, it must clearly identify the particular item or service being provided as well as the specific reason or the genuine doubt why you believe Medicare will deny the item/service as not medically necessary. Simply stating that a denial is possible or that the service is not medically necessary is not sufficient.

Those types of statements are viewed as routine/generic usage and can invalidate the ABN. In this section, it’s important to avoid using technical or Medicare jargon. You want to provide a reason that the patient can easily understand.

If you want to provide technical reasons or Medicare jargon (such as excerpts from policy), you can provide that information in Section H of the ABN. Customization of the ABN to have Section E prefilled out to include some of the more common reasons you issue an ABN (e.g., possible same/similar denials) is acceptable. Using check boxes in this section is also okay as long as the reason for possible denial is clearly identified.

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Reimbursement Page

ABN SamplE A. Notifier: B. Patient Name:

C. Identification Number:

Advance Beneficiary Notice of Noncoverage (ABN) NOTE: If Medicare doesn’t pay for D. below, you may have to pay.

Medicare does not pay for everything, even some care that you or your health care provider have good reason to think you need. We expect Medicare may not pay for the D. below.

D. E. Reason Medicare May Not Pay: F. Estimated Cost

WHAT YOU NEED TO DO NOW: • Read this notice, so you can make an informed decision about your care.

• Ask us any questions that you may have after you finish reading.

• Choose an option below about whether to receive the D. listed above.

Note: If you choose Option 1 or 2, we may help you to use any other insurance that you might have, but Medicare cannot require us to do this.

G. OPTIONS:

Check only one box. We cannot choose a box for you.

☐ OPTION 1. I want the D. listed above. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN. If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles. ☐ OPTION 2. I want the D. listed above, but do not bill Medicare. You may ask to be paid now as I am responsible for payment. I cannot appeal if Medicare is not billed. listed above. I understand with this choice I am ☐ OPTION 3. I don’t want the D. not responsible for payment, and I cannot appeal to see if Medicare would pay.

H. Additional Information: This notice gives our opinion, not an official Medicare decision. If you have other questions on this notice or Medicare billing, call 1-800-MEDICARE (1-800-633-4227/TTY: 1-877-4862048). Signing below means that you have received and understand this notice. You also receive a copy.

I. Signature: J. Date: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0566. The time required to complete this information collection is estimated to average 7 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850.

Form CMS-R-131 (03/11)

Form Approved OMB No. 0938-0566

OCTOBER 2012 O&P Almanac

17

n

Reimbursement Page

Miscellaneous Tips

Here’s another reason you want to be as specific as possible: If Medicare denies the item for a different reason than what is stated on the ABN, then the ABN is not valid.

Section G: Options. This section provides the patient with three options from which to choose. For the ABN to be valid, the patient must choose one of the three options listed, and you can’t make the choice for them.

Section J and I: Signature and Date.

The patient must sign and date the form. If the patient can’t sign, however, you may have a representative (someone with power of attorney, a spouse, an adult child, etc.) sign for him or her. That representative must have the best interest of the patient in mind and cannot have a financial interest in the claim. If someone besides the patient signs the ABN, you will want to document who signed, describe why the patient couldn’t sign, and indicate on the form that the signature is that of a representative.

Delivering the ABN For an ABN to be considered valid, you must present it to the beneficiary far enough in advance of the service to provide the beneficiary a sufficient amount of time to make an informed and rational decision on whether to receive the service. You can choose from three acceptable methods of delivering the ABN. 18

O&P Almanac OCTOBER 2012

Deliver the ABN in person. This option allows you to discuss any concerns or questions the patient may have. If you are delivering the ABN in person, make sure you provide it as early as possible to ensure the patient has time review the form and make an informed decision. If at all possible, the ABN should not be provided at the time you deliver the service.

2. Deliver the ABN via mail or email. If you mail the ABN to the patient, you may want to include a self-addressed stamped envelope, so he or she can easily mail you the signed ABN—or you could have the patient bring the ABN to his or her next appointment.

3. Call the patient and inform him or her that you believe the item/ service you are providing may be denied and explain why.

This should be your last resort.

Inform your patient about the three options in Section G of the ABN form, and ask how he or she would like to proceed. When using this option, make sure to document all aspects of the call (note who you spoke with, the date and time of the call, a description of the conversation, etc.). You will then want to have the patient sign the ABN form when he or she comes into the office or follow up by mailing a copy of the ABN for him or her to sign.

1.

To ensure you provide a valid ABN in the eyes of Medicare, be sure you are using the required form.

The current official ABN, Center for Medicare and Medicaid Services form CMS-R-131, was introduced in March 2008; use of that version became mandatory in March 2009. In March 2011, the ABN form was modified slightly, and the new version is CMS-R-131 (03/11); that version became mandatory as of Jan. 1, 2012.

This form number can be found on the lower-left corner of the form.

If your ABN doesn’t contain that document number, Medicare may deem the ABN invalid.

To be considered valid, the length of the ABN cannot exceed one page.

You may use attachments, but you have to make sure that Sections A, D, E, F, G, I, and J are on one page.

(In other words, you are not splitting the form into more than one page.)

If you need to use attachments, include the phrase “see attached” in Section D. Each attachment must include the following information: patient’s name; date the ABN was provided; the information found in Sections D, E, and F; and a space where the patient can indicate he or she received the attachments (patient initials are sufficient).

Finally, because you are not required to submit a copy of the ABN, how does Medicare know you have issued a valid ABN? Simple: the GA modifier. The GA modifier will inform Medicare that you have a properly issued and signed ABN on file, and it is available for review.

To learn more about the proper use of an ABN, review Chapters 20 and 30 of the Medicare Claims Processing Manual located on the CMS website: www.cms.hhs.gov/manuals/IOM. a Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.

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Beginning January 2013 all Written and Written Simulation exams will be given every other month, and the Clinical Patient Management exams will be given three times a year. In addition, candidates for the Practitioner Certification exams will have 30 days after the application deadline to complete their residency requirements.

For more information on exam dates and application deadlines go to abcop.org.

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In the Right

Hands

Photo: Ottobock Healthcare

New technologies offer patients more options to suit their individual needs

22

O&P Almanac OCTOBER 2012

COVER STORY

The Touch Bionic i-digits hand

U

ntil recently, upper-limb amputees have had far more limited options than those seeking lower-limb prostheses. Because upper-extremity amputees represent only about 10 to 15 percent of the total amputee population, the pace of research and development has lagged behind that for prosthetic legs, feet, and ankles.

Finding a prosthetist with upperlimb expertise can be difficult as well because practitioners so rarely treat patients with upper-limb loss or deficiency.

Photo: Liberating Technologies Inc.

By Deborah Conn

The RSLSteeper Select Myo Electric Hand

As most upper-limb amputees tend to be younger and more active, they are well suited for more sophisticated, highly functional devices. That’s because upper-limb deficiencies or amputations are usually congenital or the result of trauma, rather than conditions such as diabetes or cancer, which typically affect older individuals.

“They want to achieve more, to get back to work and their hobbies and activities,” says Lynsay Whelan, OTR/L, clinical practice consultant at Touch Bionics.

Within the past decade, however, manufacturers have come out with striking developments in upper-limb prosthetics—and that progress is perhaps most dramatic in artificial hands. Where amputees previously made do with body-powered hooks or single-grasp terminal devices, they can now choose among electrically and myoelectrically powered devices that offer a wide range of grips and features.

What Is Available Determining the best hand prosthesis can be a complicated decision, and it all rests on the needs and capabilities of the user. Many amputees have more than one artificial hand, as it is difficult to find a single device that will meet all of a user’s demands.

At the low end of the technological spectrum is the passive hand, designed for people who are primarily concerned with the natural appearance of their prosthesis. High-definition restoration gloves can mimic details so effectively that it can be hard to distinguish the artificial from the real.

But cosmesis and functionality are not usually compatible, says William Hanson, president of Massachusettsbased Liberating Technologies. “One has to be a priority,” he says. “You seldom get both.” While the passive hand can assist in pushing, pulling, and stability-type tasks (such as pushing a shopping cart), they lack prehension.

OCTOBER 2012 O&P Almanac

23

Photo: Liberating Technologies Inc.

Photo: Liberating Technologies Inc.

Touch Bionic’s i-limb ultra hand

A more functional prosthesis is the mechanical hand, a split-hook or other terminal device operated by a cable and triggered by movement in another part of the body, such as the shoulder or elbow. “These have been around since before World War II,” says Hanson. “They are popular and functional, but not cosmetic.” One advantage of a mechanical prosthesis is that it can be customized to perform highly specific tasks, making it useful for work or sports activities.

Another option would be an electrically or myoelectrically powered hand, such as the traditional single-motor, single-grasp hand, where the thumb opposes two fingers to create what is called the tripod pinch grasp. This device can be powered by a cable that converts a body movement into an electrical signal or by myoelectric signals from sensors placed on the skin.

The most advanced prosthetic hands are multi-articulating, myoelectric devices that provide a wide range of grasp patterns and functional features—as well as a natural appearance.

Two such devices, developed by British firms, are currently on the market: the i-limb ultra from Touch Bionics and the bebionic, manufactured

by RLSteeper. Ottobock is releasing the third, the Michelangelo hand.

All three offer proportional speed control, which is useful for performing

24

O&P Almanac OCTOBER 2012

fine-motor tasks, says Hanson. Another valuable feature is volitional grasp force. “This is important when you want to grasp something less firmly, like an egg or a child’s hand,” he says.

Here’s a closer look at each: Touch Bionic’s i-limb ultra has individually powered fingers, each with its own motor. The amputee can manually rotate the thumb and use combinations of myoelectric signals to activate different grip patterns. The i-limb offers 14 grip patterns, including index pointing, power grips, tripod grasping, and precision pinches. Users can choose up to four at a time to be programmed into the device, which can also be changed on an iPod Touch. The hand automatically moves to a natural position after a period of inactivity.

“The i-limb is designed to be compliant. If the hand starts to come into contact with an object, the fingers can wrap around to the closed position,” explains Robert Lipschutz, CP, at the Rehabilitation Institute of Chicago (RIC). Another feature is the ability to gradually increase the strength of its grip on an object, which is useful when tying shoelaces tightly or strengthening one’s hold on a heavy object. It also offers an optional wrist flexion unit.

One advantage of the i-limb is that it is available in a size and aesthetic look appropriate for women, says

The bebionic3 hand, developed

by RSLSteeper

Andrea Giovanni Cutti, PhD, of the Centro Protesi INAIL, a specialized division of the Italian Workers’ Compensation Authority.

Like all electrically powered prosthetic hands, the i-limb requires a covering to protect it from moisture and dust. In addition to its inventory of realistic-looking gloves in a variety of skin colors, Touch Bionics offers a semitransparent or black glove that reveals the robotic appearance of the hand.

The bebionic3 hand, developed by RSLSteeper, based in Leeds, England, also has individually powered digits.

Users have access to eight different grip patterns at a time, plus open palm and finger abduction, says Cutti. Uniquely, the device includes microprocessors that continually monitor finger positions.

“One finger knows where the other is,” explains Cutti. “The gripping is always consistent. No finger can be left behind. Another unique feature is that the bebionic thumb can be adjusted to two different postures to create opposition and lateral positions.

It is simple to switch between them, without the thumb becoming trapped in the middle position. It gives the patient confidence that the thumb and hand will behave in a certain way.”

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Photos: Liberating Technologies Inc.

RSLSleeper’s high-definition fingers

The bebionic3 also has a button on the dorsal side that offers additional gripping possibilities. “One very nice option is a double click, like with a computer mouse, especially for bilateral patients,” says Cutti. “Another is the column grip, which is good for pushing buttons and operating levers, and it is useful for getting dressed and helps the hand slide more easily through sleeves.”

The hand includes auto grip, which senses when an object slips and automatically adds power to maintain a secure hold, such as holding an empty glass that is being filled with water.

Ottobock’s AxonBus prosthetic system with the new Michelangelo hand is the only myoelectric hand to have an electronically positionable thumb. “With a passive thumb, the user has to reach over with the sound hand or push against some external object to move it into position,” says Bambi Lombardi, OT, an upper-limb marketing specialist at Ottobock. “That can be a problem if you’re holding something in your other hand.”

The Michelangelo hand uses two motors: one for the thumb and one for the remaining fingers (which are not individually powered). It offers seven gripping movements, including a neutral, physiologically natural position. An integrated wrist with a

26

O&P Almanac OCTOBER 2012

flattened, oval shape can be flexible or locked into one of eight different positions. “Combining options with the thumb, wrist, and hand, you end up with multiple positions and grips to accomplish activities of daily living,” says Lombardi.

The Michelangelo hand has a wrist that can be flexed or extended. “This is useful, for instance, for driving,” says Cutti. “When you drive a car, it can be tricky to turn the steering wheel with a fixed wrist. If you can flex your wrist, you can push your hand toward the wheel and grip in firmly. And if you have to grab an object on the floor, you can push your hand down, flex the wrist, and grasp the object.”

Lombardi emphasizes that the Michelangelo hand is fast and adds a remarkable amount of freedom of movement to everyday life situations.

Partial Prostheses Many amputees don’t require a full prosthetic hand; in fact, Hanson estimates that partial hands represent fully half of the upper-limb population.

Yet, he says, prosthetists usually underestimate the market.

There’s a lot of variation in partial hands, and not that many prosthetic components available. “You have to be very creative for partial-hand fabrication. I think clinicians tend to stay away from partial-hand prostheses because of the limited component

Photo: Ottobock Healthcare

Partial Hand Solutions’ M fingers

The Ottobock Michelangelo hand

selection and unique fabrication requirements,” Hanson says.

Prosthetists can choose from three basic approaches to partial-hand devices. The first is aesthetic, the restoration of finger length by using suction suspension to tightly attach a partial silicone digit. While the main benefit is a more natural look, the prosthesis can make it easier for the user to perform some tasks, such as picking up items or typing.

Multi-articulating mechanical fingers, such as M fingers, from Partial Hand Solutions, in Holliston, Massachusetts, and X fingers, developed by Naples, Florida-based Didrick Medical, use the wearer’s wrist or hand movements to activate. M fingers operate from wrist flexion; X fingers by movement in the residual finger.

Electric fingers are a more recent development, says Hanson. Touch Bionics offers i-limb digits, and the German-based Medical Technic Group has developed the Vincent System of electric fingers.

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Photos: Liberating Technologies Inc.

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Choosing the Appropriate Device

The Touch Bionic i-digits hand

The biggest challenge with an electrical solution to longer-level amputations is finding space to place a battery, according to RIC’s Lipschutz.

Placing surface electrodes also can be tricky because each amputation presents different available muscles.

“It’s most practical to use signals from the muscle below the thumb or pinkie, as long as the thumb or pinkie is not there,” he says. “But if those digits are intact, moving those muscles will trigger movement in other parts of the hand that you don’t want to move.”

Another issue is timing.

“Partial-hand amputees are often seen first by occupational therapists who give them a low-temperature plastic type of device to achieve an oppositional grip,” he says. “When they do see a prosthetist, it can be hard to transition to a more sophisticated device.”

Centro Protesi INAIL also uses a partial-hand solution that incorporates osseointegration. “This is used for the thumb especially, when the residual finger is too short for a suction solution,” Cutti says.

28

O&P Almanac OCTOBER 2012

Advanced prosthetic hands offer a staggering array of features, so matching those capabilities to the needs of specific patients is not an easy task. Not only must the prosthetist identify what tasks the patient wants to be able to do, but also he or she must determine whether the patient has the capacity and motivation to master a complex prosthesis. For some amputees, a simpler hand with more limited choices may be the best option.

Moving between grip patterns may be confusing to some patients; others may not be determined enough to undergo the lengthy training required to operate complicated devices.

Cost and insurance coverage always are issues, and finding a prosthetist with up-to-date expertise in upperlimb systems can be problematic. “The fact is that other than upper-extremity specialists, many prosthetists don’t do many upper-limb systems,” says Hanson. “Therefore, as technology advances, it is difficult for them to keep current with what’s available.”

What Constitutes Success?

One of the most important elements of a prosthetic fitting is determining its success. Yet objective measures for hand devices are hard to find.

Most clinicians rely on patient feedback. “For me, success means their ability to get back to all the activities they identify as priorities,” says Whelan.

Quantitative assessments are more elusive, although some include the Southampton Hand Assessment

Procedure (SHAP), Box and Blocks, Disability of the Arm Shoulder and Hand (DASH), and the Trinity Amputation and Prosthetic Experience Scale (TAPES). “We have very few acknowledged measures of success,” says Hanson. “Most are subjective.”

The patient’s ability to perform the basic activities of daily living is one measure of success; a high priority for worker’s compensation and the military is the ability to return to work.

“A variety of measures have been proposed, but none have gained any traction,” says Hanson. “And yet the insurance industry is asking for evidence-based medicine.”

Some manufacturers are beginning to integrate quantitative data tools into the devices. Those allow clinicians to collect basic usage data: How often are they being used? How fast do they work? “That kind of information is especially important with children, who are not always good at reliable reporting,” Hanson notes. “But the question is: What do we do with this information? We need to learn how to analyze and interpret it in a way that third-party payers will consider valid.”

“The greatest thing a patient can tell you is that a new hand is opening up doors in his mind that were closed, that he had the chance to start thinking again about possibilities and doing new things,” says Cutti. “When a patient starts calling you and saying, ‘I did this for the first time in 15 years,’ that’s a successful feature.” a Deborah Conn is a contributing writer to O&P Almanac. Reach her at debconn@ cox.net.

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Great Service,

Great Referrals How building on your relationships helps to create a thriving practice

W

ould a patient refer you to a friend? Would a referring physician send a client your way? Every practitioner would like to answer with an unequivocal “yes,” but not everyone can. Patient satisfaction is no small matter, and it’s not easily achieved.

The problem, in part, comes from the intangibles.

Satisfaction is the result of goodwill, confidence, and trust: All factors easier to recite than to define. And the potential negative factors—poor staff attitude, lukewarm administration—can be difficult to redress.

But don’t be discouraged; most O&P practitioners report positive relationships with their patients. The significant question, most often, is this: How to build on that base to develop a booming practice?

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O&P Almanac OCTOBER 2012

Go

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By Adam Stone

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OCTOBER 2012 O&P Almanac

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Forming some type of personal bond with patients earns providers high marks and goes hand in hand with quality of care.

Be Your Best The most direct strategy for generating customer satisfaction is simply to do good work.

“People worry about their marketing campaigns; they worry about things that are not in front of them. But you can make the best impact just by doing a great job for the person who is right in front of you,” says Jeff Wensman, clinical technical director at the University of Michigan Orthotics and Prosthetics Center. “What people can judge is what they know, and what they know is how they were treated.”

Forming some type of personal bond with patients earns providers high marks and goes hand in hand with quality of care. For Kevin Matthews, whose San Antonio-based Advanced Orthopedic Design sees about 20 patients a day, that bond begins with open communication.

By sharing information freely, Matthews is able to build the bonds of trust.

“I explain their situation. I explain my approach to solving this problem. I want them to buy into the care. I want them to understand what we are doing and how it is going to impact their lives,” he explains.

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O&P Almanac OCTOBER 2012

That is just the kind of personal connection consumers of health care say they are looking for from their providers.

In a recent survey of 6,000 consumers, PwC Health Research Institute found that 42 percent said personal experience, rather than price, was their most important consideration when choosing a health-care provider. That statistic means personal experience is 2.6 times more important to consumers for health care than for other industries such as banking and airlines. (Respondents also singled out peer recommendations as being twice as important.)

Personal contact may be a priority, but most doctors aren’t meeting that bar. Among the 409 patients polled by consumer research firm MarkeTrak, only 54 percent thought their doctor would know their name if they ran into each other on the street.

Human interactions between caregiver and patient need to extend throughout the medical office if you want to perpetually drive referrals— and they ought to be documented.

To be most effective, the style and

substance of a personal connection ought to be put down in writing, says Wendy Miller, director of facility accreditation for the Board of Certification/Accreditation (BOC).

Miller advocates identifying a series of employee values—such as responsibility, initiative, integrity, and teamwork—and making them part of the annual review. Thus, the practitioner sets the expectations, and employees know what they need to do to generate the relationships that stem from good customer service.

Establishing expectations can be a valuable exercise. In the PwC study, six out of 10 said their health-care experiences were defined by the attitude of the staff, making this twice as important in health care than in any other industry.

Take the Pulse It’s a basic rule of business that you cannot manage what you cannot count.

The BOC requires ongoing customer satisfaction surveys, but that is hardly the only reason to query patients periodically. A customer survey can deliver valuable feedback on your office operations and can even be a tool to generate referrals.

Wensman surveys every patient who gets a device, and that survey covers every experience of the service: How long were you on hold?

Could you find a parking spot?

Did the office run on time? Was the provider respectful?

The survey is extensive, yet people seem willing to take the time to fill it out. In a recent span of just a couple of days, the office took in 238 completed surveys. Most rank the practice in the 90th percentile, and, when the practice falls short, Wensman tries to find out why. He knows if he can dig a little deeper, he may turn up information that could help improve the practice.

The best survey questions are openended: How close was this to your ideal visit? If not, why not? The idea is to get beyond the simple response, to develop more substantive feedback. The O&P community is getting better at this.

“When they first started doing customer satisfaction surveys, we asked simple yes or no questions.”

Miller notes. “We’ve improved them over the years to include open-ended questions that yield better, more actionoriented results.”

The outcomes of those surveys can be valuable, but they also should be taken with a grain of salt. It’s easy to become complacent when patient feedback rates a practice solidly in the 90th percentile. But what does that A+ really mean? Maybe it signifies that only those who really love your practice are taking the time to fill in the blanks.

Patients who are satisfied may be more willing to take the time to complete a survey; those who are disgruntled may be less likely to share their feedback. Unless a practitioner is ready to follow up, figures that seem too good to be true ought to be treated with skepticism.

Suppose, though, that a practice has drawn great feedback and is confident the numbers reflect its performance.

Now comes the payoff.

Build the Business Giving great service, gathering feedback, evaluating responses, building a reputation. If done correctly,

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O&P Almanac OCTOBER 2012

When a patient returns to his or her primary-care doctor for a follow-up, that is the Holy Grail for practitioners like Matthews. these practices can provide the one thing every business needs—referrals.

When a patient returns to his or her primary-care doctor for a follow-up, that is the Holy Grail for practitioners like Matthews. “Those appointments are our bread and butter. The doctor gets feedback from the patient; the patient tells the doctor that they felt well cared for, they liked the people that they met, they are doing ok,” Matthews says.

Verbal feedback is, from an economic standpoint, a must for Matthews. “We compete with marketers who take these doctors hunting, who take them fishing,” he says. “I don’t have that kind of marketing acumen. I don’t want to make small talk. I want my work to be the reason they send people to me, and that’s how it has been since I started.”

It’s possible to go a step further without a marketing degree, suggests the BOC’s Miller. Put customer testimonials on your website. Write up your survey data, and send it around to physicians.

And if you want a referral, ask for one. If a patient seems happy, grateful, pleased—then ask: Will you tell your friends about me? Would you mind telling your physician about your experience? There’s nothing wrong with asking because your patient may not understand the importance of referrals.

This whole process starts with good communication, helping the patient understand what is happening, what it means, what the options are. Communication is the core of a successful practice, and it’s the core of a successful referral program.

Keep Your Eye on the Ball As a practitioner, you can do a lot of things right: caring, communicating, providing outstanding service.

But there also is a lot you can do wrong. It doesn’t take much to leave a patient with a bad taste in his or her mouth, and that bad taste can sour an entire relationship.

Nobody likes to wait, and your patients won’t thank you if you keep them sitting around for too long reading last month’s Fly Fishing Digest.

Although everyone’s schedule has a little flexibility—and patients will cut a busy practitioner some slack—a long wait is a sure way to lose the goodwill of your patients.

How long do you keep your patients waiting? Interestingly, it may depend on your geography, according to Vitals, a website that helps patients find and connect with doctors. Patients in Wisconsin and New Hampshire typically wait about 15.5 minutes to see a doctor, while Mississippi and Alabama residents wait around 25 minutes.

Long wait times could have an effect on your bottom line. When MedPageToday.com asked 3,200 readers if they thought patients who were kept waiting should get a discount on their bills, half said yes.

The same can be said of telephone hold times. Various statistics show the majority of callers hang up after just a couple of minutes in the silent zone.

Those calls may well represent lost business opportunities.

Fortunately, those pitfalls can be avoided. Even with his relatively small offices, Advanced Orthopedic Design’s Matthews has put in place a range of systems to keep traffic flowing smoothly.

His method for booking appointments efficiently is effective, if hardly sophisticated. “We juggle,” he explains.

He’s only partly joking. Matthews wants patients to be able to get in within a day or two of calling, so he has trained his people to be flexible. If the receptionist offers an appointment for next week, and the patient accepts, that keeps short-term openings available.

Ultimately, customer service begins not in a daily planner or a satisfaction survey but rather in the heart of the practitioner.

But Matthews is also willing to get squeezed: “If they block me out an hour for a 15-minute fitting, that’s a place to squeeze somebody in. Or I can work through lunch if I need to. There’s always someplace to fit someone in.”

“I do get behind, but it is still never more than a 30-minute wait for a patient. It’s only a problem when we get a lot of walk-ins or when people don’t keep their appointed times. If one is late and the next two are early, that’s bad,” he says.

When the system hits a snag, he tries to address the shortfall as straightforwardly as possible. “We apologize,” he says. “[Patients] have to understand that they are the most important person in the room. They need to know that we understand that their time is just as important as ours. If you inconvenience a person, there has to be an apology that comes with it. If you are honest, people will understand it.”

When it comes to the dreaded phone hold times, Matthews has a system for that too: “If it rings once, the receptionist picks up. If it rings twice, the receptionist or the claims person picks up. If it rings three times, the office manager picks up, and it should never ring more than three times.”

Of course, it’s also possible that procedural issues are moving along just fine, and still the customers are not

satisfied because of clinical issues.

“Maybe there are problems with the device that was fitted to them.

Maybe they are not getting it to fit right, it hurts them, or the patient’s expectations were higher than what was realistic,” Miller explains. Some problems can be corrected mechanically, while others can be dealt with through communications, either after or before a device is fitted. “The practitioner needs to be really up front with that patient. They need to be sure they really understand what a patient’s expectations are.”

But satisfaction is a two-way street.

While practitioners must do their due diligence, they also need to impress upon the patient his or her responsibilities. “You can tell a patient they need to come back and have their brace checked in two weeks and then they don’t come back,” Miller says. “So you need to have that commitment from the patient as well.”

There are other steps a practitioner can take to drive referrals: Attend customer service workshops, talk it up at staff meetings. Ultimately, customer service begins not in a daily planner or a satisfaction survey but rather in the heart of the practitioner.

“You’ve got to have kindness at all levels,” Miller concludes. a Adam Stone is a contributing writer to O&P Almanac. Reach him at adam. stone@newsroom4.com.

OCTOBER 2012 O&P Almanac

35

n

Facility Spotlight

By Deborah Conn

Never

Say ”No” With a friendly, small-town-like appeal, a Louisville O&P facility helps patients achieve their goals

F Sienna Newman, LPO, CPO, and Owner Matthew Hayden, CP, LP

Facility:

Kentucky Prosthetics and Orthotics

Location: Louisville, Kentucky

Owner:

Matthew Hayden, CP, LP

HISTORY:

31 years in business

36

O&P Almanac OCTOBER 2012

or a relatively small O&P facility, Kentucky Prosthetics and Orthotics has treated some high-profile patients.

Owner Matthew Hayden, CP, LP, recently saw photos of one of his patients, Stephanie Decker, walking on her two brand-new prosthetic legs with President Obama in the Oval Office. Decker is the Indiana mom who received widespread media attention after she lost her legs shielding her children from a tornado that devastated their home in March 2012.

Hayden and his team were able to quickly fit, fabricate, and deliver a transtibial and transfemoral prosthesis in time for Decker to meet her goal of taking a walk with the president.

Another patient, 2012 Paralympic rower and double amputee Oksana Masters, appeared in the pages of ESPN’s The Body Issue and Southwest Airlines Spirit magazines.

In spite of the publicity, Hayden sees Decker and Masters as just part of a bigger picture. “They have brought us a lot of exposure, and we’ve had to find the most advanced technology to keep up with them,” he says. “Our other patients want the same kind of care, and we say, ‘yes, it can be done.’ Everyone deserves that.”

Hayden began working at Kentucky Prosthetics and Orthotics in 1983, two years after it was established, and became owner in 2000. The 4,200-square-foot building houses two patient walking rooms, a consulting room, a casting room, and a lab that handles nearly all fabrication. The facility has wireless technology and seeks to be as paperless as possible.

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Facility Spotlight

In addition to Hayden and his partner, Sienna Newman, LPO, CPO, Kentucky Prosthetics employs two technicians and three administrative staff members, including Hayden’s wife, Dianna, who is herself an amputee. The facility’s business is about 90 percent prosthetics and 10 percent custom orthotics. Although patients come from all age groups, more active, younger prosthetic patients in their 40s and 50s comprise the largest segment.

In the Louisville area, Kentucky Prosthetics faces competition from a national O&P company, a regional facility, and three other small firms.

Hayden and Newman believe their team approach—which includes physicians, clinicians, physical therapists, and technicians—sets them apart.

Hayden and Newman are filmed by a camera crew in their office

“The biggest thing is that we put our patients first,” says Newman. “Whatever their needs are—getting back to work, competing in sports—we help them achieve their goals. We had one amputee who wanted to squat press 500 pounds.

Our reaction was, ‘let’s figure out how to do it.’”

Kentucky Prosthetics has a “never say ‘no’” policy, from working with insurance companies to secure coverage to including practitioners’ cell phone numbers on their business cards so patients can reach them at any time.

The result is a friendly, small-town-like relationship with patients.

“We are just as likely to attend a patient’s ball game as they are to support us,” says Hayden. “Three of my patients just drove 120 miles to attend my mother-in-law’s funeral.”

While Hayden expects to add another prosthetist and orthotist to his staff, he is reluctant to expand beyond one office. “The industry is becoming more and more mobile, so we can achieve the same reach without investing in additional space,” he says. “We see patients in outlying clinics around the state, and we can travel to them with everything we need in a couple of bags.”

Hayden has noticed a trend toward research and self-education among his patients. Many consult with physicians, hospitals, and rehabilitation specialists before a scheduled amputation, and many interview all the local prosthetists before selecting one.

“We encourage that,” says Newman. “It’s important to find a proper match. This is a lifelong relationship.” a The pair poses with a prosthetic leg fitted with a running shoe

38

O&P Almanac OCTOBER 2012

Deborah Conn is a contributing writer for O&P Almanac. Reach her at debconn@cox.net.

Patent Pending

Patent Pending

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Custom braiding prosthetic sockets allows you to braid directly over the modl, and conforms to the exact size and shape of the residual limb. This method ensures consistancy from socket to socket, eliminates resin pooling, allows for uniform and repeatable fiber orrientation, and has been tested to exceed ISO standards.

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AOPA HEADLINES

AOPA WORKING FOR YOU

It’s All in the Numbers Measure your facility’s profitability and revenues in comparison to like businesses with the 2012 Operating and Performance Report

O

&P practitioners are experts at taking the measurements of patients and then producing a custom device that matches those measurements. It’s quite another thing to measure where your business falls in relationship to others of like size and location. That’s why the annual AOPA Operating and Performance Report can be the perfect measurement tool to gauge how you perform on the business side.

How you perform in managing the business may, in fact, affect your ability to continue delivering that quality patient care.

The 2012 report, based on 2011 data, is the compilation of confidential financial and operating information submitted by 112 AOPA member patient-care companies operating 1,036 full-time locations and 64 part-time facilities. While the data in any given year isn’t the final word on performance, as it only reflects the results of those responding in a particular year, it does provide a helpful accounting of trends and can help you evaluate your company’s performance in comparison to others in that particular year.

42

O&P Almanac OCTOBER 2012

The dampened economy may in part explain the drop in profitability and a lower revenue increase than experienced in 2011 over 2010.

Revenue in 2011 was up 2.1 percent compared to 4.7 percent revenue growth in 2010 over 2009. Profits told

An interesting story will be told in next year’s report, when the impact of the productivity adjustment mandated by the Affordable Care Act is reflected in the data. the same lackluster story, with average profit for all respondents falling to 6.1 percent in 2011 from 8.9 percent in 2010.

An interesting story will be told in next year’s report, when the impact of the productivity adjustment mandated by the Affordable Care Act is reflected in

2012 data. The productivity adjustment lowered the 2012 fee schedule to 2.4 percent after the 1.2 percent productivity adjustment reduction was deducted from the 3.6 percent fee increase the Urban Consumer Price Index would have allowed.

The ratio of orthothic and prosthetic revenues remained about the same, with the typical company capturing 48 percent of its revenue in prosthetics and 44.9 percent in orthotics. The balance of 2011 revenue was from the following: pedorthics, 3.6 percent; durable medical equipment, 1.9 percent; and other, 1.7 percent. By comparison, the ratio in 2010 was 48.6 percent for prosthetics and 42.4 percent for orthotics.

The median square footage size per facility (including office space) for all respondents was 3,111 square feet, with sales revenue produced per square foot of $300. Profit leaders reported 2,775 square feet and $307 per-square-foot sales. All respondents in 2010 reported median square footage of 3,333 and $284 per-square-foot sales, with profit leaders reporting 3,500 square feet and $252 in revenue per square foot.

AOPA HEADLINES

AOPA WORKING FOR YOU

Median 2011 sales reported per facility for all respondents was $2.4 million compared with $2.2 million in 2010. The overall company revenues per employee for all respondents were $155,370 in 2011 and $156,591 in 2010. Company revenues per practitioner in 2011 were $400,000 in 2011 compared with $382,975 in 2010.

In 2011, 22.9 percent of those responding had sales revenue up to $1 million; 20 percent fell into the $1 to $2 million bracket; 31.4 percent were in the $2 to $5 million range; and 25.7 percent of those responding had more than $5 million in annual revenue.

For all respondents, the employee makeup breakdown by position shows office administration and marketing employees accounting for 40 percent of positions; nonowner practitioners, 25 percent; technicians, 14.1 percent; owner practitioners, 3.5 percent; nonclinical owners/managers, 2.5 percent; and other, 13.4 percent.

Industry Insights has been AOPA’s partner in producing the reports for more than a decade, and this longevity has helped keep the year-to-year data consistent. In addition to the AOPA members who share their operating data on a confidential basis, the report could not be produced without the overall coordination and data review of the Operating Performance Workgroup, chaired by Mike Hamontree of OrPro. Backing him up are Candy Carlson of Tillges Certified Orthotic Prosthetic Inc.; Avanindra Chaturvedi, Össur Americas Inc.; Mark Ford, oandp.com; Michael Oros, CPO, Scheck and Siress; Jim Weber, MA, Prosthetic and Orthotic Care Inc.; and Craig Wright, Hanger Inc. Participating members receive a copy of the complete 140-page report as well as a confidential Company Performance Report, which compares their individual performance with the reported norms for all respondents and then by company and community size. It’s an invaluable tool that a consultant would charge a significant fee to provide. Respondents also may schedule a one-on-one review of what their data means and suggested actions with an Industry Insights expert.

Members can purchase the full report for $185 for the hard copy or $85 for an electronic version. Nonmembers pay $325 and $185, respectively, proving once again it pays to play by submitting data for the report. a

Here’s how those revenues broke down by each segment of product or service compared with prior years.

Source of Revenue

2011

Prosthetics Orthotics

2010

2009

2008

32%

Contracted

26.5%

31%

30%

28%

Medicaid

14.8%

16%

13%

12%

Non-contracted

4.6%

4%

5%

5%

Hospitals

5.6%

7%

5%

8%

Veterans

4.3%

3%

4%

4%

Workers Comp

4.7%

5%

5%

4%

Vocational

3.8%

1%

1%

1%

Self Pay

3.8%

3.8%

4%

3%

Other

3.2%

3.2%

2%

1%

All Respondents Expense

45%

5%

1%

Pedorthics

3.6%

5%

4%

4%

Other

1.7%

3%

3%

2%

2011

2010

2009

2008

Sales/Billings

100%

100%

100%

100%

Cost of Goods

29.8%

27.5%

28%

29%

16%

17.8%

19%

21%

47.4%

45.5%

42%

42%

6.9%

9.2%

11%

8%

Production/Labor General and Administrative Operating Profit

Profit Leaders Only (Top 25% of Respondents) Expense

2011

2010

2009

2008

Sales/Billings

100%

100%

100%

100%

Cost of Goods

28.7%

25%

26%

30%

Production/Labor

17.5%

14%

14%

15%

35.6%

42%

42%

39%

18.3%

19%

19%

18%

Operating Profit

40%

2008

31%

48%

1%

2009

28%

49%

42%

2010

31.7%

49%

1.9%

2011

Medicare

48% 44.9%

O&P Almanac OCTOBER 2012

Source of Payment

General and Administrative

DME

44

These and myriad other facts are gleaned from the recently concluded Operating Performance and Compensation Report survey of 112 member companies representing 1,036 full-time locations and 64 part-time locations.

Payment source is another benchmark to watch closely.

Taken together, Medicare and Medicaid still top the list of payers for the typical O&P patient-care facility. Here’s the trending on payer sources for the past three years.

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AOPA HEADLINES

Anita Liberman-Lampear Elected AOPA’s President-Elect Anita Liberman-Lampear, MA, has been nominated and elected as AOPA’s 2013 president-elect. The election was held September 8 during the Annual Business Meeting at the 2012 AOPA National Assembly in Boston.

Liberman-Lampear consults and teaches in the areas of managed care, accreditation, and other health-system and O&P-related topics. She is a long-time board member and treasurer of the Michigan Orthotics and Prosthetics Association, and a member of the AOPA Board of Directors. She and her husband, Alan Lampear, were instrumental in creating the annual O&P PAC Wine Auction Fundraiser.

Liberman-Lampear holds a bachelor’s of science in medical technology from Wayne State University and a master of arts degree in allied health management from Central Michigan University. After many years in pathology at the University of Michigan Medical Center, Liberman-Lampear became the Medical Center’s assistant department administrator in physical medicine and rehabilitation.

In 1992, she was asked to manage the University of Michigan Orthotics and Prosthetics Center (UMOPC) and revitalize the division as its administrative director. Since then, UMOPC has grown and re-established itself as one of the premier academic sites for O&P.

AOPA OPTA Fabrication Contestants Showcase Swim Prostheses Students and professional contestants presented their below-knee prosthesis designs during the First Annual AOPA OPTA Technical Fabrication Contest at the 2012 AOPA National Assembly in Boston. Entrants were provided a digital file and specification sheet and given free rein in terms of the final shape and cosmetic finish of the device.

First-, second-, and third-place winners were selected in both the professional and student categories based on buoyancy of the device, finished look, quality of lamination, and additional criteria. Monetary prizes, certificates, and ribbons were awarded by sponsors OPTA, Ottobock, ABC, Cascade-USA, and AOPA. Winners in the professional category include the following: • 1st Place: Joseph Young, CPO—Francis Tuttle Technology Center • 2nd Place: Chris Carlson, CTP—Spinal Technology Inc. • 3rd Place: Svetoslav Terziyski, CPA—Rehabilitation Institute of Chicago

46

O&P Almanac OCTOBER 2012

Winners in the student category include the following: • 1st Place: Malerie Turner—Francis Tuttle Technology Center • 2nd Place: Michael Ruch—Spokane Falls Community College • 3rd Place: Tanner Brogden—Francis Tuttle Technology Center The Second Annual AOPA OPTA Technical Fabrication Contest will take place in Orlando during the 2013 O&P World Congress, September 18 -21 at the Gaylord Palm Resort.

AOPA HEADLINES

AOPA National Assembly Features Posters from ASB AOPA has partnered with the American Society of Biomechanics (ASB) to foster the dissemination of basic science research in orthotics, prosthetics, and rehabilitation to the clinical O&P community.

For the first time, a special exhibit of peer-reviewed scientific posters from the American Society of Biomechanics Annual Meeting was displayed at the 2012 AOPA National Assembly in Boston. More than 35 scientific posters related to orthotics and prosthetics were accepted for presentation at the ASB Annual Meeting held at the University of Florida in Gainesville in August. The authors of those posters also agreed to exhibit at the National Assembly as part of the new agreement between the two organizations.

ASB conducts a rigorous process to review scientific papers for oral and poster presentations at its annual meeting; its review committee comprises more than 70 scientists.

With the inclusion of the ASB scientific posters at this year’s National Assembly, AOPA showcased more than 50 posters, the largest exhibit of scientific posters of O&P research in AOPA’s history.

AOPAversity Mastering Medicare New Codes for 2013—Join the Audio Conference December 12 The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires all payers to use Healthcare Common Procedure Coding System (HCPCS) Codes. The end of the year marks the beginning of new codes and modifier changes that will take effect Jan. 1, 2013. Do you have a plan in place?

Ensuring your practice is sound may prevent unnecessary audits down the road. As we prepare for a new year, join AOPA December 12 for an AOPAversity Mastering Medicare Audio Conference that will focus on new codes and medical policy changes for 2013—and why those should be an important part of your business operation. An AOPA expert will address the following issues: • New HCPCS codes effective Jan. 1, 2013 • Verbiage changes to existing codes and how they may affect your business • Codes that will no longer be used as of Jan. 1, 2013 • Additional changes to the HCPCS system • AOPA’s interpretation of why the changes took place.

AOPA members pay just $99 to participate ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.

Register online at https://aopa.wufoo.com/forms/2012telephone-audio-conferences/. Contact Steve Custer at scuster@ AOPAnet.org or 571/431-0876 with registration questions.

OCTOBER 2012 O&P Almanac

47

AOPA HEADLINES

Master Medicare Enrollment Procedures— Join the Audio Conference November 14 Join AOPA November 14 at 1 p.m. EDT for an AOPAversity Mastering Medicare Audio Conference that will cover the basics of Medicare Enrollment Procedures. Learn strategies and techniques from an AOPA expert who will address these topics: • Reviewing new Medicare Enrollment Standards • Reviewing the Medicare Enrollment Application • PECOS vs. the 855S Form • Differentiating between a participating Medicare provider and a nonparticipating Medicare provider.

AOPA members pay just $99 to participate ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.

Register online at https://aopa.wufoo.com/forms/2012telephone-audio-conferences/. Contact Stephen Custer at scuster@AOPAnet.org or 571/431-0876 with registration questions.

Master Medicare in Las Vegas: Essential Coding & Billing Techniques Seminar

Discover Employment Opportunities at AOPA’s Online Career Center

Join your colleagues October 18-19 at the Mirage Hotel and Casino in Las Vegas for AOPA’s “Mastering Medicare: Essential Coding & Billing Techniques” seminar.

AOPA experts will provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more.

Meant for practitioners and office staff, this advanced two-day event will feature break-out sessions for these two groups to ensure concentration on material appropriate to each.

Basic material that was covered in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage.

Register online for the “Mastering Medicare: Essential Coding & Billing Techniques” seminar October 18-19 in Las Vegas at https://aopa.wufoo.com/forms/2012-mastering-medicarelas-vegas/ or contact Devon Bernard at dbernard@aopanet.org, 571/431-0854.

As an O&P professional, you can make a difference every day. Job opportunities abound throughout the country, and the need for O&P professionals is increasing rapidly. Currently, 100 percent of O&P program graduates find employment, and most choose to make it a lifelong profession.

If you’re seeking employment, access the most recent jobs available. If you’re recruiting, reach the most qualified candidates by posting your job on AOPA’s Online Career Center.

Visit http://jobs.AOPAnet.org, or email Steven Rybicki at srybicki@AOPAnet.org with questions.

48

O&P Almanac OCTOBER 2012

The Government Is Sending Amputees Mixed Signals.

The government is sending amputees conflicting signals. They say they support amputees receiving the prosthetics they need but then the bureaucracy makes it difficult to get prosthetics approved. Demands for more ill-defined physician documentation undermines any semblance of confidence that claims cost for custom fabricated artificial limbs will be reimbursed.

Consequently prosthetic wearers are left confused and isolated.

Let’s help disabled people get the prosthetics they need to lead full productive lives.

The first step is to go to AOPAnet.org.

AOPA Applications

The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership.

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999

Level 3: $2 million to $4,999,999 Level 4: more than $5 million.

Hi Tech Prosthetics 30 Avenue Severiano Cuevas Aguadilla, PR 00603 Puerto Rico 787/891-4805 Fax: 787/882-9045 Category: International Member Hector Mendez

Human Technology Inc. 2813 N. Highland Avenue Jackson, TN 38305 731/660-3340 Fax: 731/660-3641 Category: Patient-Care Member Ramesh Dubey, CPO, LPO

Biodesigns Inc.

Cox Medical Center

J&J Artifical Limb & Brace

880 Hampshire Road, Ste. B Westlake Village, CA 91361 800/775-2870 Category: Patient-Care Member Julie Alley

3801 South National Avenue Springfield, MO 65807 417/269-9898 Category: Patient-Care Member Fred Lerche

Childress Orthopedics

Footech Inc.

15644 Pomerado Road, Ste. 103 Poway, CA 92064 858/613-0958 Fax: 858/613-0959 Category: Patient-Care Member Esperanza Friedman, CO

14880 Central Avenue Chino, CA 91710 909/606-3237 Category: Affiliate Member Parent Company: Orange Coast Prosthetics Inc.

60 King Street Moncton, NB ElC 4M2 Canada 514/238-5091 Fax: 506/854-9466 Category: International Member Daniel Dumont

www.LCodeSearch.com

24/7 Expert Coding Advice 24/7

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

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

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This exclusive service is available only for AOPA members.

Contact Lauren Anderson at 571/431-0843 or landerson@AOPAnet.org.

Log on to LCodeSearch.com and start today.

Not an AOPA member? GET CONNECTED

Visit AOPA at www.AOPAnet.org.

Manufacturers: Get your products in front of AOPA members!

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

50

O&P Almanac OCTOBER 2012

Scuola Italiana Di Osteopatia Edizioni S.I.O. SRL Via Montegrappa, 2 Padua, Italy 35141 Italy (+39) 049-773-635 Fax: (+39) 049-773-635 Category: International Member Franco Migliozzi, PhD, DO

Superior Orthotics & Prosthetics, LLC 1823 Charlotte Avenue Nashville, TN 37203 615/340-0068 Fax: 615/340-0028 Category: Patient-Care Member Debbie Owen a

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PC or Mac

You make choices every day, based upon many factors. One of those choices is your O&P product supplier. PEL’s Power of One® service puts your practice on the worldwide web of success.

Do you want everyday products, with quick shipment and low prices? But still need state-of-the-art products and exceptional values to make you the apple Rosetta Anzalone • Returns Specialist of your patient’s eye? PEL has • Temp positions for 10 years in diverse jobs gigabytes of products and an online • Joined PEL in 1996 • “I listen to the customer, then handle the ordering system that makes your return and let them know it will be OK.” • Dogs. Dogs. Dogs. And jigsaw puzzles. hard drive hum. Log on today!

ALPS Extreme Locking and Cushion Liner The ALPS Extreme liner is engineered with GripGel to assist in donning and suspension • Specifically designed for transfemoral and active transtibial amputees • Limited vertical stretch reduces movement of redundant tissue

SPT Technology Composite Matrix Resin • Carbon or Fiberglass compatible • Powder promoter, easy to mix • Up to 1 year shelf life • Ships ORMD - No Hazmat fees • 1, 2 or 4 gallon kits (best value)

Trulife Matrix Spiral • Smooth, dynamic transition from heel strike to toe off • Effective energy return • Flexible heel and toe plates • Lateral design naturally spirals around the lower leg Indications: Drop foot, peroneal palsy; suitable for bilateral use

Extreme Sleeve

Easy to Fit!

• Seals against skin without restricting circulation • GripGel helps prevent sleeve from rolling down patient’s limb

it Ask for ! e m a by n

PEL Supply Co. Orthotic & Prosthetic Components

®

pelsupply.com

4666 Manufacturing Avenue Cleveland, OH 44135-2638 USA

Ph 800-321-1264 Fx 800-222-6176

®

Experience the Power of One.

Marketplace

Friddle’s is now offering the FC2 Flexion Control Ankle Joint FC2 Flexion Control Ankle Joint features: • Patented, spherical-axis FC2 Ankle • FC2 provides up to 70 degrees of anterior-posterior range of motion using plantar-/ dorsiflexion-stop set screws • Unique design made of high-quality, heat-treated stainless steel • Allows for adjustments to be made while patient is wearing orthosis • FC2 pre-contoured design saves fabrication time while facilitating a low-profile finish • Availability of self-squaring molding dummy to reduce fabrication time.

Contact Friddle’s today at 864/369-2328, fax 864/3691149, or visit www.friddles.com.

Reformulated KISS® Adhesive: Amazing adhesion The reformulated KISS adhesive features increased flexibility and less time needed for bonding. The adhesive bonds porous and nonporous surfaces, and bonds flexible as well as rigid materials. It is packaged in two separate bottles for increased shelf life.

For more information, call 410/663-KISS (5477) or visit www.kiss-suspension.com.

Balance Knee by Össur®. The perfect balance.

For users with less active lifestyles who are engaged in low-impact activities and walk at a constant speed, Balance Knee by Össur offers the perfect balance of safety, adjustability, and durability. Adjustable stance control balances stability and swing initiation, while mid-swing shortening increases toe clearance to help prevent hip-hiking and reduce the chances of tripping. Plus, Balance Knee is maintenance-free, easy to align, and fully adjustable without disassembly.

To learn more about Balance Knee by Össur, call 800/2336263 or visit www.ossur.com today.

52

O&P Almanac OCTOBER 2012

Total Knee® by Össur®. Totally versatile.

With K2, K3, and K4 models to choose from, Total Knee enables a broad range of amputees to walk with a smooth, more natural, energy-efficient gait, enhancing their confidence and stability. Key features include geometric locking for stability, plus mid-swing shortening designed to prevent hip-hiking and reduce the chances of tripping. Each model fits a wide range of amputees and is lightweight and easy to cosmetically finish.

To learn more about Total Knee by Össur, call 800/2336263 or visit www.ossur.com today.

LimbLogic® Technology Evolves WillowWood’s LimbLogic VS is a popular choice with clinicians to provide patients with elevated vacuum. Now WillowWood is making this popular product even better. The new LimbLogic features a small, Bluetooth® Low Energy fob, inductive charging, and an improved four-hole controller design with field-serviceable exhaust filter. The simplified fob is more intuitive to use and is now smaller yet maintains the same functionality. New to the LimbLogic product line is the LimbLogic Sleeve. The controller and sleeve work together to make an airtight, secure system. This silicone sleeve has a repositionable cuff, allowing for greater sleeve longevity.

For more information, call 800/848-4930 or visit www. willowwoodco.com.

Marketplace

Fabrication Services from Ottobock Whether your fabrication job is simple or complex, you want the broadest range of services available, staffed by knowledgeable, caring people.

That’s why Ottobock Fabrication Services is a perfect partner for your business: We offer decades of expertise, exceptional customer service, and an unparalleled reputation for quality. Our expert services include water transfer, lamination, and pre-preg carbon fiber. You can count on timely turnaround, delivering the results you want.

Visit www.ottobockus.com or call 800/795-8846.

Aeris Performance Foot System from PEL Supply The Aeris Performance Foot System improves upon the successful foundation of the Ibex foot from Emotis. The foot uses compliant composite technology (CCT) derived by using multiple springs to increase the range of flexibility. The result is a unique advanced energy release (AER) pylon design composed of nested parallel springs that enable the foot to react in a compliant manner at heel strike, then work together to create a dynamic push-off at toe release. The independent spring action provides smooth, stable progression while increasing the axial rotation, which minimizes forces transmitted to the residual limb.

Features: • Innovative Micro-Slice pylon for multiaxial function • Enhanced plantarflexion for stability at heel strike • Improved axial rotation • Durable; meets ISO-22675 standard • Modular pyramid attachment • Patient weight: 275 lbs (125 kg).

For information on Aeris Foot System and all Fillauer LLC products, call PEL Supply at 800/321-1264 or email customerservice@pelsupply.com. Customers can order online at www.pelsuppy.com.

The NEW Triton Low Profile (LP) Foot from Ottobock We’ve added a new low-profile carbon fiber foot to the popular Triton family! Now patients with lower clearance (2.5 in) can take advantage of the same smooth rollover and robust function as the original Triton. The multiaxial Triton LP provides excellent dynamics and flexibility for above- or below-knee individuals. A titanium adapter makes the foot waterproof and especially robust (maximum weight 330 lbs, up to K4). With a split toe design for safety, stability, and control, the Triton LP is ideal for all your active patients.

Contact your sales representative at 800/328-4058. a

O&P Board Study Resources We can help you PASS your BOARDS All products updated to 2012 test standards.

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

www.oandpstudyguide.com OCTOBER 2012 O&P Almanac

53

JOBS

Find your region on the map to locate jobs in your area.

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

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

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

1/2 page, color

Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140

Increase exposure and save!

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

O&P Almanac OCTOBER 2012

Clinical Marketing Representative Salt Lake City Seeking a person with excellent communication skills to provide marketing and educational services for myoelectric UL and advanced LE prostheses for prosthetists and other professionals throughout North America and international markets.

Successful candidate will be responsible for: • Developing and presenting educational and marketing programs; • On-site visits to evaluate candidates and assist with upper-extremity and lower-extremity fittings and training with company’s products; and • Extensive contact with customers via a variety of media, including telephone, email, Internet, and multimedia materials, including trade shows, educational seminars, printed materials, etc.

Experience in myoelectric prosthetics is preferred, but not essential; training will be provided.

Benefits include: • An excellent salary/benefit package is offered, and a great working environment.

• Certified Prosthetist (CP or CPO) preferred. Call us or email/fax resume to:

$482 $678 $634 $830

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

No orders or cancellations are taken by phone.

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

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

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

54

Inter-Mountain

Motion Control Inc. 115 N. Wright Brothers Drive Salt Lake City, UT 84116 Phone: 801/326-3434 Fax: 801/978-0848 Email: HumanResources@UtahArm.com Website: www.UtahArm.com

JOBS

Pacific

Northeast

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

Send resume to:

Certified Orthotist Vermont Yankee Medical, providing orthotic and prosthetic services for over 65 years, is looking for a certified orthotist ready to locate to Vermont. With five locations in some of the most scenic areas of the country, Yankee Medical offers a lifestyle that attracts professionals. Send your resume to:

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

www.AOPAnet.org

Attention: Human Resources Inland Artificial Limb & Brace Inc. Fax: 951/734-1538 Email: ialb720@hotmail.com

YOUR resource for the O&P Community

“ Six doctors came walking in my room, surrounded my bed and they told me I would not get up again.” Tina Mann Tina Mann

Today Tina Mann walks, hikes, rock climbs, bikes and lives life fully thanks to Hanger Clinic.

She was so inspired by her experience that she became an orthotic resident with us.

Clinic Manager

Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all are part of Hanger Clinic career offerings.

• 1,000,000+ patients treated annually • 270,000+ orthotic and prosthetic products • 4,500+ employees Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state or local law. Residency Program Info, contact: Robert S Lin, MEd, CPO, FAAOP Director of Residency Training and Academic Programs, Hanger Clinic, Ph. 860.667.5304; Fax 860-666-5386.

View our current positions and apply online at: www.hanger.com/careers or scan the QR code.

150 YEARS

700 CLINICS

Available Positions: Clinic Manager Stockton, CA Akron, OH Bartlesville, OK Waterville, ME

Orthotist

Lufkin, TX Seattle, WA Tacoma, WA

Mesa, AZ Jacksonville, FL Panama City, FL Springfield, IL Urbana, IL Portland, ME

Jackson, MS Columbia, MO Lancaster, PA Beaufort, SC Spartanburg, SC Waukesha, WI

Chico, CA Los Angeles, CA Brunswick, GA

Overland Park, KS Johnson City, NY

Prosthetist

Pedorthist Belleville, IL

Prosthetist / Orthotist New London, CT Newark, DE Tamarac, FL Des Moines, IA Bethesda, MD Buffalo, NY Johnson City, NY

Mooresville, NC Mayfield Heights, OH Portland, OR Wilkes Barre, PA San Antonio, TX Olympia, WA Morgantown, WV

1 VISION

OCTOBER 2012 O&P Almanac

55

JOBS

North Central

Southeast

Career CPO/CPED

Certified Orthotist

Twin Cities and Maplewood, Minnesota Tillges Orthotic and Prosthetic is growing! To help facilitate this growth we are currently accepting resumes for experienced orthotic and prosthetic practitioners as well as C.Peds. Our corporate office/clinic is located in Maplewood, Minnesota. Some local and regional travel could be required.

Immediate long-term opportunity for highly motivated CPO and C.Peds. Tillges Certified Orthotic Prosthetic Inc. believes that the future of our business depends on the quality of our staff. Therefore, we make it our business to hire the best…and treat them well. Our friendly staff operates in a fast-paced, team environment. All TCOP positions offer a competitive salary/ benefit package and advancement opportunities within our strong, and growing, company.

TCOP Inc. is an aggressive, ABC-accredited facility with an outstanding reputation in the Minneapolis/St. Paul metropolitan area.

For consideration, submit resume to:

Chattanooga, Tennessee Independent O&P business is seeking a certified or board-eligible orthotist. Candidate should have good communication skills and a strong desire for quality patient care. Future management and ownership interest considered for the right candidate. We offer competitive salary, benefits, and bonus opportunity.

Send resume to:

Certified Orthotist/Prosthetist Chattanooga, Tennessee Fillauer O&P, a Chattanooga, Tennessee-based patient-care facility, is seeking a certified or board-eligible CPO practitioner. We offer competitive salary, bonus opportunity, and a comprehensive benefit package.

M/F/D/V Equal Opportunity Company Tennessee Drug-Free Workplace Send resume to:

Email: humanresources@fillauer.com

American Orthotic

& Prosthetic

Association

DISCOVER more AOPA advertising opportunities.

(AOPA)

2013

Attn: COO TCOP Inc. 1570 Beam Ave., Suite 100 Maplewood, MN 55109 Email: a.holm@tcopinc.com or www.tcopinc.com

Email: lockedavis@comcast.net

mediakit Rates effective

Promoting

O&P Since

Jan. 1, 2013

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

1917

et.org

www.savewithups.com/aopa

www.AOPAn

56

O&P Almanac OCTOBER 2012

UPS Savings Program AOPA Members now save up to 30% on UPS Next Day Air® & International shipping, with additional savings starting at 70% on LTL Freight shipments.

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® 70% or more on UPS Freight®

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!

JOBS

Certified Orthotist / Technician ABC/BOC

Mid-Atlantic Prosthetics and Orthotics Faculty Position

Fredericksburg, Virginia Mobility Prosthetics and Orthotics is looking for an energetic, experienced, and motivated orthotist. If you possess strong orthotic clinical and technical skills, you might be good for this position. We have a full lab performing in-house fabrication. Acute-care and pediatric experiences are a plus.

We offer competitive salary, bonus opportunity, and comprehensive benefits package.

Please fax your resume to:

School of Medicine School of Pharmacy School of Medicine

Matthew Garibaldi C.P.O. Director, Orthotic & Prosthetic Centers of UCSF University of California, San Francisco 1500 Owens Street, Box 3004 San Francisco, CA 94143-3004 Garibaldim@orthosurg.ucsf.edu UCSF seeks candidates whose experience, teaching, research, or community service has prepared them to contribute to our commitment to diversity and excellence.

UCSF is an Equal Opportunity/Affirmative Action Employer.

School of Nursing

School of Medicine

School of Medicine

School of Nursing

Applicants should submit a letter of intent and CV to:

School of Nursing

University of Pittsburgh 5044 Forbes Tower Sennott and Atwood Streets Pittsburgh, PA 15260

This is a unique opportunity to be a part of a rapidly expanding, multi-center practice. We look forward to hearing from you.

School of Pharmacy

Rory A. Cooper, PhD, Chair, Department of Rehabilitation Science and Technology School of Health and Rehabilitation Sciences

fabrication techniques; ability to work efficiently. Medical benefits and pension plan are included. Salary will be commensurate to applicant’s qualifications and experience.

School of Medicine

School of Nursing

CERTIFIED ORTHOTIST, CERTIFIED ORTHOTIST / PROSTHETIST

School of Nursing

Pittsburgh, Pennsylvania Tenure-stream prosthetics and orthotics faculty position now open at the University of Pittsburgh.

Qualifications: ABC certification and PhD related to orthotics and/or prosthetics. Minimum of three years of teaching, clinical, and/or research experience. Prior experience in teaching and/or research preferred.

Evidence of and/or potential for productivity in scholarly Fax: 540/899-0129 activity, as shown through publications, research grants, Email: ctaylor.mobilitypando@verizon.net and presentations.

Responsibilities: Responsible for teaching, service, and research in MS in O&P program, including/ not limited to, program/curriculum development, evaluation, accreditation, clinical education, student University of California at San Francisco recruitment, and developing/ expanding a research and development program. Participate in scholarly activity and secure independent research funding.

Participate in professional service within the orthotics and prosthetics profession, service to RST and Department of Orthopaedic Surgery university at large. Participate in Assistant/Associate/Full Specialist teaching and serve as a mentor Incumbent will work as a full-time clinician in the Orthotic and Prosthetic Center in a large to students. medical university setting which includes several Intensive Care Units, Rehabilitation Units, As part of the University of Acute Care Units and many Out-Patient Clinics for service of patients with a wide variety of Pittsburgh, the School of Health and medical diagnoses.

Rehabilitation Sciences is an affirCandidate will be responsible for clinical evaluations, implementation of a wide assortment mative action institution and welcomes of orthotic / prosthetic treatment modalities, and technical fabrication of orthotic / applications from military veterans, prosthetic devices. Required qualifications: ABC Certified Orthotist or Orthotist/Prosthetist; people from unrepresented minorities, prior experience providing direct patient care in an orthotic and prosthetic facility with people with disabilities, and other demonstrated skills, knowledge and abilities essential to the successful performance of categories of underrepresented persons. duties in a patient care setting. Demonstrated excellent communication and team-building / People from throughout the world are interpersonal skills. Preferred qualifications: Knowledge of disease processes and associated encouraged to apply. orthotic / prosthetic intervention; familiarity with current treatment modalities, materials and To apply, send curriculum vitae to:

School of Pharmacy OCTOBER 2012 O&P Almanac

57

SEPtEmbEr 18-21, 2013 |

O r l a n d O, F l O r i d a , U S a Gay l o r d Pa l m s Reso r t

don’t miss the opportunity to participate in an expanded national assembly in 2013 as aOPa and partners from around the world work to create an O&P World Congress experience for practitioners in the Western Hemisphere and around the world.

Visit www.opworldcongressusa.org for more information.

Expand your knowledge, grow your market presence and advance your career at this unique, global gathering of high visibility and importance.

Why you should plan to attend: • Research and development expenditures in the United States are more than $95 billion, making the United States the leader in medical innovation and creating the ideal location for a unique gathering of high visibility and importance.

• Superior Clinical Education featuring the best speakers from around the world. Hear from physicians, researchers, and top-notch practitioners.

• Practical learning and live demonstrations.

• Preparation for the massive changes that U.S. healthcare reform is sure to bring, and its influence on global health policy.

• Networking with an elite and influential group of professionals.

• Largest display of exhibits in the United States for the orthotic, prosthetic, and pedorthic profession • Ideal U.S. location chosen for travel ease and popularity.

Join Us next Year!

World Congress Esteemed Planning Committee represents the brightest minds in O&P from around the world USA Rep David Boone, Ph.D., Chairman Africa Mr. Masse Niang, CPO Bogota, Colombia Jose Miguel Gomez, MD China Dr. Aaron Leung, Ph.D. Europe Dr. Nerrolyn Ramstrand, Ph.D. Europe Klaas Postema, MD, Ph.D. German Assoc. Rep. Urs Schneider, Dr.-med.

Germany/USA Stephanie Olivo Germany/USA Rep Karen Lundquist, MBC India Ms. Ritu Ghosh Italy Andrea Giovanni Cutti, Ph.D. Panama Marlo Ortiz Vazquez del Mercado P.O US-ISPO Rep Robert Kistenberg, CPO US-ISPO Rep Diane Farabi USA Rep Jim Campbell, Ph.D. USA Rep Thomas DiBello, CO, LO, FAAOP USA Rep Thomas Gavin, CO USA Rep Mark Geil, Ph.D. USA Rep Geza Kogler, Ph.D. USA Rep Michael Orendurff, MS USA Rep Jack E. Ullendahl, CPO USA Rep Jason Wening, MS, CPO, FAAOP

CALENDAR

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

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

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

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

UtahArm.com.

■■

■■

design for maintaining and improving muscle length.

Presenter: Keith Smith, CO, LO, FAAOP. Register at www. ultraflexsystems.com or call 800/220-6670.

2012 ■■ October 10 AOPAversity Audio Conference–What Every O&P Facility Needs to Know about the FDA. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.

■■ OCTOBER 10 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 5–6 PM ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic

PROMOTE Events in the O&P Almanac

CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Words

Member Rate

Nonmember Rate

25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$3.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org.

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

For information on continuing education credits, contact the sponsor.

Questions? Email scuster@AOPAnet.org.

■■ OCTOBER 13 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 9–10 AM ET. Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology. Presenter: Keith Smith, CO, LO, FAAOP. Register at www. ultraflexsystems.com or call 800/220-6670.

■■ OCTOBER 13-14 POMAC (Prosthetic and Orthotic Management Associates Corporation) Continued Education Seminar, Co-Sponsored with PEL Supply Co. New York.

LaGuardia Airport. For more information, contact Drew Shreter at 856/273-9636 or dshreter@pomac.com.

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

■■

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

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

■■ OCTOBER 18-19 Mastering Medicare: Essential Coding and Billing Seminar. Las Vegas. Mirage Hotel & Casino. To register, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.

■■ OCTOBER 18-19 University of Michigan Orthotics and Prosthetics Center: Centennial Celebration and Education Seminar. Making a difference for 100 years, providing service, education, and research in O&P. For details and information about registration, visit www.med. umich.edu/pmr/op/index.htm.

■■ OCTOBER 19-20 The Academy’s OneDay Seminar Certificate Programs. Chicago.

Embassy Suites Hotel O’Hare-Rosemont. For more information, visit www.oandp. org/education/seminars/one-day.

■■ OCTOBER 25 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon–1 PM ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function.

Presenter: Jim Rogers, CPO, FAAOP. Register at www. ultraflexsystems.com or call 800/220-6670.

■■ OCTOBER 30 Ultraflex: Adult UltraSafeStep® Continuing Education Course, via WebEx, Noon–1 PM ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology. Presenter: Marc Kaufman, CPO. Register at www.ultraflexsystems.com or call 800/220-6670.

OCTOBER 2012 O&P Almanac

59

CALENDAR

■■ NOVEMBER 6-8 WillowWood: OMEGA® Tracer® Training. Mt. Sterling, OH. This hands-on class covers both orthotic and prosthetic software tools, scanner applications and tasks, ‘by measurement’ shape creation, advanced tool usage, and creating custom liners. Attendees work with patient models. Must be current OMEGA Tracer facility to attend. Credits: 18.5 ABC/18.5 BOC. Visit www. willowwoodco.com.

NOVEMBER 7 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 8–9 AM ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length. Presenter: Keith Smith, CO, LO, ■■

FAAOP. Register at www. ultraflexsystems.com or call 800/220-6670.

■■ NOVEMBER 7-9 New Jersey Academy of Orthotists & Prosthetists 2012 Annual Meeting.

Atlantic City. Bally’s Hotel and Casino. For details, contact Lisa Lindenberg at 973/609-2263 or visit www. njaaop.com.

■■ NOVEMBER 10 7th Annual Academy Golf Invitational & Wine Tasting.

Phoenix. Raven Golf Club at South Mountain. For more information, visit www.oandp. org/golf/ or contact Manisha Bhaskar at 202/380-3663, x210, or mbhaskar@oandp.org.

■■ NOVEMBER 12-17 ABC: Certification Exams.

ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy

Motion Control

SuperCourse Fall 2012 October 15 - 19, 2012

at Fillauer Headquarters, Chattanooga, TN • In-depth training of Utah Arm / U3+ / Hybrid / ProControl2.

• Hands-on experience with UI-software. Bring your laptop.

• CEUs: 34 (estimated) awarded by ABC.

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

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

fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. The application deadline for these exams was Sept. 1, 2012. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification.

NOVEMBER 14 AOPAversity Audio Conference–Medicare Enrollment Procedures.

For more information, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org.

■■

■■ NOVEMBER 15 WillowWood: LimbLogic® VS Applications Practitioners Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.0 ABC/7.0 BOC. Registration deadline is Oct. 25. Contact 877/665-5443 or visit www. willowwoodco.com.

■■ NOVEMBER 16 WillowWood: LimbLogic® VS Applications Technicians Course. Mt. Sterling, OH. Learn all aspects of fabricating LimbLogic VS for various applications: socket materials, controller configurations and care, fob operation, troubleshooting.

Fabricate sockets following recommended techniques for airtight socket designs.

Credits: 9.75 ABC/9.75 BOC. Registration deadline is Oct. 25. Contact 877/665-5443 or visit www.willowwoodco.com.

DECEMBER 1 ABC: Certification Exam Application Deadline.

Applications must be received

by Dec. 1 for individuals seeking to take the winter 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic ■■

Motion Control Inc. 115 N. Wright Brothers Dr. • Salt Lake City UT 84116 Phone: 801/326-3434 • FAX: 801/978-0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com 60

O&P Almanac OCTOBER 2012

fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/8367114, email info@abcop. org, or visit www.abcop.org/ certification.

■■ DECEMBER 6-8 Rehabilitation Institute of Chicago: Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management.

Chicago. Featuring Elaine Owen. 21.25 ABC Credits.

Contact Melissa Kolski at 312/238-7731 or visit www.ric. org/education.

■■ DECEMBER 7-8 ABC: Prosthetic Clinical Patient Management (CPM) Exam. The application deadline for this exam was Sept. 1. Contact 703/836-7114, email info@abcop.org, or visit www.abcop.org/certification.

■■ December 12 AOPAversity Audio Conference–Are You Ready for the New Year? 2013 New Codes and Policies.

For more information, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org.

2013 ■■ JANUARY 4-5 ABC: Prosthetic Clinical Patient Management (CPM) Exam. The application deadline for this exam was Sept. 1. Contact 703/836-7114, email info@abcop.org, or visit www.abcop.org/certification.

■■ February 20-23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/3803663, x208, or email dragusa@ oandp.org.

Simple As :

1.

3.

2.

Visit www.kiss-suspension.com or Call 410-663-KISS (5477) Š 2011, U.S. Patent, Patent Pending Worldwide KISS is a registered trademark

The O&P Business Management Certificate Program addresses skills that are fundamental to the success of an O&P business.

O&P Business Management: This unique leadership learning experience will provide business owners, managers and practitioners an opportunity to experience fresh insights, new tools and proven techniques as a pathway for developing better business practices, while creating ongoing returns for your company.

■ REFRESH YOUR KNOWLEDGE ■ DEVELOP BETTER BUSINESS PRACTICES ■ ADVANCE YOUR CAREER ■ CREATE ONGOING RETURNS FOR YOUR COMPANY

Earn Your Certificate in

O&P BUSINESS MANAGEMENT

Through a joint partnership between AOPA and the University of Virginia School of Continuing and Professional Studies

How to get started: 1.

Complete the online sign up form: https://aopa.wufoo.com/forms/earn-acertificate-in-op-business-management/

2.

Select and complete four required core modules and four elective modules within three years.

A NEW AOPAversity OPPORTUNITY! Another addition to the valuable education, products and services offered by AOPA that you need to succeed.

3.

Complete a Module specific quiz for each program.

4.

Participants that successfully complete the program will be awarded a certificate of completion, in addition to being recognized at the AOPA National Assembly and the O&P Almanac.

CALENDAR

2013 ■■ MARCH 1-2 Oklahoma Association for O&P Annual Meeting.

Tulsa, OK. Marriott Southern Hills. For more information, visit www.okaop.org or contact Jane Edwards at 888/388-5243 or email at jledwards88@att.net.

■■ MARCH 15-16 PrimeFare West Regional Scientific Symposium 2013.

New Location. Denver. Denver Marriott City Center. Contact Jane Edwards at 888/388-5243 or visit www.primecareop.com.

September 18-21 O&P World Congress.

Orlando. Gaylord Palms Resort. Attend the first ■■

U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org.

■■ September 3-6 97th AOPA National Assembly.

Las Vegas. Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@AOPAnet.org.

2015 2014 February 26–March 1 40th Academy Annual Meeting & Scientific Symposium. Chicago. Hyatt Regency Chicago. For more information, contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■■

■■ February 18–21 41st Academy Annual Meeting & Scientific Symposium. New Orleans.

Hyatt Regency New Orleans.

For more information, contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

■■ October 7-10 98th AOPA National Assembly.

San Antonio. Henry B. Gonzales Convention Center. For more information, contact AOPA

Headquarters at 571/431-0876 or info@AOPAnet.org.

2016 ■■ March 9–12 42nd Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. For more information, contact Diane Ragusa at 202/380-3663, x208, or dragusa@oandp.org.

September 15-18 99th AOPA National Assembly and Scientific Symposium. Orlando.

Gaylord Palms Resort. Attend the country’s oldest and largest meeting for O&P Professionals.

Contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org. a ■■

AD INDEX

Company

Page

Phone

Website

Ability Dynamics

11

855/450-7300

www.abilitydynamics.com

Allard USA Inc.

13, 37

888/678-6548

www.allardusa.com

ALPS

25

800/574-5426

www.easyliner.com

American Board for Certification in Orthotics, Prosthetics & Pedorthics

19

703/836-7114

www.abcop.org

Cailor Fleming Insurance

9

800/796-8495

www.cailorfleming.com

College Park Industries Inc.

27

800/728-7950

www.college-park.com

Custom Composite

15

866/273-2230

www.cc-mfg.com

DAW Industries

1

800/252-2828

www.daw-usa.com

Dr. Comfort

5, C3

800/556-5572

www.drcomfortdpm.com

Fillauer

2

800/251-6398

www.fillauercompanies.com

Friddle’s Orthopedic Appliances

39

800/369-2328

www.friddles.com

Hersco Ortho Labs

33

800/301-8275

www.hersco.com

KISS Technologies LLC

29, 61

410/663-5477

www.kiss-suspension.com

KNIT-RITE

45

800/821-3094

www.knitrite.com

Motion Control

43

888/696-2767

www.utaharm.com

OPTEC

20, 21, 40, 41

888/982-8181

www.optecusa.com

Orthotic and Prosthetic Study and Review Guide

53

www.oandpstudyguide.com

Össur Americas Inc.

7, C4

800/233-6263

www.ossur.com

Otto Bock HealthCare

C2

800/328-4058

www.ottobockus.com

PEL Supply

51

800/321-1264

www.pelsupply.com

WillowWood

insert

800/848-4930

www.willowwoodco.com

®

OCTOBER 2012 O&P Almanac

63

AOPA Answers

Understanding the ABN Form 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.

Can the Advance Beneficiary Notice of Noncoverage (ABN) form (CMS-R-131 (03/11)) be used to notify a patient that an item is noncovered by Medicare and that the patient will be responsible for payment?

A.

Yes. In March 2008, Medicare combined the traditional ABN form with a form called the Notice of Exclusion from Medicare Benefits (NEMB) form. That allows you to provide the ABN form to the patient as a voluntary notification of financial liability. I say “voluntary” because Medicare does not require you to provide a patient with written notification that an item is noncovered. Although written notification is voluntary, it’s still a good idea to provide the patient with the NEMB, so you have a record of informing the patient Medicare will not pay for the service.

The NEMB should only be used if the item you are providing is a statutorily noncovered item, never considered a Medicare benefit, and never paid for by Medicare (such as elastic braces, shoes not attached to a brace, compression garments, etc.).

Q.

If the ABN can be used for two different purposes and is sometimes mandatory and sometimes voluntary, how does Medicare know how you used the form?

A.

Medicare will know how the form was used depending on which modifier you use with your claim submission. If you are providing services that are statutorily noncovered

by Medicare and you used the ABN form as a voluntary NEMB, you must use—and only use— the GY modifier when you submit your claim.

If you used the ABN to notify the patient that the item you are providing may be denied, you must use the GA modifier if the patient signed the ABN form, or the GZ modifier if the patient didn’t sign the ABN form.

64

O&P Almanac OCTOBER 2012

For more information on ABN forms, see the Reimbursement Page article on page 14 of this issue.

Q.

Can I have the patient sign an ABN if I am accepting assignment on the claim, or can I only have the patient sign the ABN on non-assigned claims? If the patient signs the ABN, can I ask for payment at the time of delivery?

A.

An ABN may be issued and signed by the patient on both assigned and unassigned claims, and the ABN does allow you to collect from the patient at the time of delivery whether you are accepting or not accepting assignment on the claim. However, keep in mind that if you collected from the patient and had him/her sign the ABN, if Medicare pays you for the claim you may have to reimburse the patient.

Q. A.

How do you bill for an upgraded item with an ABN?

When submitting a claim for an upgraded item, you must use the two-line billing method, and the two claim lines must be one right after the other on your claim. On line one, place the upgraded item’s HCPCS code or the actual item you provided to the patient along with the appropriate cost of the item. You would attach the GA modifier if you had the patient sign an ABN or the GZ modifier if the patient didn’t sign the ABN. On line two, place the HCPCS code for the reasonable and necessary item, or the non-upgraded item, along with the appropriate cost for that item. You will also include the GK modifier, which will indicate that item as medically necessary.

When the claim is processed, Medicare will pay you based on the item on line two, and the patient is responsible for the difference in cost between line one and line two. It is important to remember that, when billing for an upgraded item, your claim must include information about why the item you provided is considered an upgrade. a

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