OP
The American Orthotic & Prosthetic Association
MARCH 2013
&
WWW.AOPAnet.ORG
THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY
Washington
WATCH New and proposed policies put patient care at risk
Improved Outcomes for Bone Cancer Patients Get Ready for a CERT Audit Now!
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O&P MARCH 2013, VOLUME 62, No. 3
CONTENTS Cover Story
18 Washington Watch
By Adam Stone O&P business owners should pay close attention to some of the new and proposed policies—such as Medicare classification of back orthoses, overly aggressive RAC auditing, and competitive bidding—that focus on cost-cutting instead of optimal patient care. Find out how these important issues could affect you.
Feature
24 Winning the War on Cancer
By Jill Culora As tumor treatments become more advanced, bone cancer patients are faced with more options, including both limb salvage procedures requiring special orthoses and amputations involving fusion of amputated bones. O&P professionals must work closely with other members of the medical team to ensure the right device and fit for this unique population.
departments
4
AOPA Contact Page How to reach staff
6
At a Glance Statistics and O&P data
40 Jobs
In the News Research, updates, and company announcements
45 Calendar
08 COLUMNS
14
28
Reimbursement Page Prepare for a CERT audit by understanding medical policies Ask the Expert Getting into the details of the Supplier Standards
30
AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more
37 AOPA Membership 00 Applications
38 Marketplace
Products and services for O&P Opportunities for O&P professionals
Upcoming meetings and events
47
Ad Index
48
AOPA Answers Expert answers to your FAQs
O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: almanac@AOPAnet.org. Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.
MARCH 2013 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 & Meetings
BOARD oF DIRECTORS
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org
Officers
directors Jeff Collins, CPA, Cascade Orthopedic Supply Inc., Chico, CA
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
President Tom Kirk, PhD, Member of Hanger Inc. Board Austin, TX
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, production manager, 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
Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, landerson@AOPAnet.org
President-Elect Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Vice President Charles H. Dankmeyer, Jr., CPO, Dankmeyer Inc., Linthicum Heights, MD
Scott Schneider, Ottobock, Minneapolis, MN Mike Hamontree, Hamontree Associates, Newport Beach, CA Dave McGill, Ă–ssur Americas, Foothill Ranch, CA Ronald Manganiello, New England Orthotics & Prosthetics Systems LLC, Branford, CT
Communications
Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX
Steffanie Housman, content strategist, 571/431-0835, shousman@AOPAnet.org
Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO
Michael Oros, CPO, Scheck and Siress O&P Inc., Oakbrook Terrace, IL
Government affairs
Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA
Kel Bergmann, CPO, SCOPe Orthotics & Prosthetics Inc., San Diego, CA
AOPA Bookstore: 571/431-0865
Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org
Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA
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
Eileen Levis, Orthologix, LLC, Trevose, PA
James Campbell, PhD, CO, Becker Orthopedic Appliance Co., Troy, MI
O&P 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
Copyright 2013 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.
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O&P Almanac MARCH 2013
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AT IN THE A GLANCE NEWS
O&P and Bone Cancer Nearly 3,000 people are diagnosed with some form of bone cancer each year in the United States‌ Primary Bone Cancer by Type Most Common in Teens and Children:
Primary Bone Cancer by Type Most Common in Adults: Chondrosarcoma
56%
Osteosarcoma
41% 28%
Osteosarcoma
Ewing tumors
34%
10%
Chordoma Ewing tumors
8%
MFH/Fibrosarcoma
Chondrosarcoma
4%
All remaining types
All remaining types
6%
4%
9%
Source: American Cancer Society, www.cancer.org.
2,810
70%
Five-year survival rate among children with osteosarcoma.
Number of adults diagnosed with bone cancer in the United States in 2012.
1,410
Number of adults who died from bone cancer in the United States in 2012.
10-19
76% Percentage of cancer-related amputations that involve the lower limbs.
Ages at which patients most commonly contract osteosarcoma.
10%-20% Percentage of bone cancer patients who are treated by amputation rather than limb-sparing surgery.
Sources: National Limb Loss Information Center; American Cancer Society; American Academy of Orthopaedic Surgeons. 6
O&P Almanac MARCH 2013
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IN THE NEWS
A team of surgeons at Johns Hopkins Hospital in Baltimore successfully performed a bilateral arm transplant on Army veteran Sgt. Brendan Marrocco in January. Marrocco, 26, who lost both arms and both legs to a roadside bombing while serving in Iraq in 2009, is the first U.S. soldier from the wars in Iraq and Afghanistan to survive a quadruple amputation. The 13-hour transplant surgery was performed by a team of 16 surgeons, led by W.P. Andrew Lee, MD, director of the Johns Hopkins School of Medicine’s department of plastic and reconstructive surgery. Marrocco, who had previously been fit with lowerlimb prostheses, will remain in Baltimore for two to three months for recovery and therapy. After a major surgery, human nerves regenerate at a rate of an inch per month, according to Lee. It will take two to three years for actual functionality of the transplanted arms to be determined, but doctors are hopeful that Marrocco will gain improved functionality and control. He already has some sensation and movement in his arms. “[This surgery] has given me hope for the future. I feel like it’s a second chance to start over since I’ve been hurt,”
Photo: AP Photo/Gail Burton
Johns Hopkins Achieves Bilateral Arm Transplant
Brendan Marrocco (center) along with (from left) Johns Hopkins School of Medicine’s Department of Plastic and Reconstructive Surgery Director W.P. Andrew Lee, MD; Jamie Shores, MD; Patrick L. Basile, MD; and Johns Hopkins Medicine’s Scientific Director, Composite Tissue Allotransplantation, Gerald Brandacher, MD.
Marrocco says. “I am excited for the future. I’m looking forward to doing everything that I’ve wanted to do for the past four years.”
FSU Develops Advanced Prostheses for Veterans Florida State University’s High-Performance Materials Institute (HPMI) is leading a partnership to develop the next generation of prosthetic limbs for military-veteran amputee patients, under a new contract with the U.S. Department of Veterans Affairs. The two-year, $4.4 million VA Innovation Initiative project is aimed at addressing the shortcomings of current prosthetic socket systems through the development, testing, and delivery of “Socket Optimized for Comfort with Advanced Technology” (SOCAT) prototypes. The prototypes will be designed to address issues arising from poor fit, elevated temperatures, and moisture accumulation. The SOCAT project will deliver prototypes that will feature a unique combination of advanced composite 8
O&P Almanac MARCH 2013
materials and technology, some of which are cornerstone research and development initiatives of HPMI. These components, such as carbon nanotube buckypaper and auxetic materials, which have the unique property of getting thicker when stretched, will be used to enable an intelligent prosthetic socket system that monitors the socket environment and self-adjusts to increase comfort. In addition, vital information on the socket environment, such as pressure, temperature, and moisture, will be recorded by the system and wirelessly transmitted to O&P practitioners to facilitate better patient care. The first phase of the two-year contract will focus on developing and testing the specific technologies for individual socket components. The second phase will involve the refinement of each system/material and the complete production of the prototypes.
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IN THE NEWS
University of Denver Researchers Design Permanent Prosthesis Engineering students at the University of Denver’s Human Dynamics Lab are designing a permanent prosthesis that would attach to an amputated limb through a post in the bone. The design, which would eliminate the current socket technology, would be a “game changer,” according to Ronald Hugate, MD, the orthopedic surgeon who is leading the project at Presbyterian/St. Luke’s Medical Center in Denver. “You would just attach the prosthetic leg into something that’s at the end of your residual limb,” explains Hugate. He has been on the project since 2005, when he worked to implant a pair of artificial legs into the bones of a Siberian husky. The prostheses were later removed because of fit and infection. The newer design uses a special metal into which skin and tissue will grow. “The benefit is that it blocks infection,” Hugate says. The design may be ready in two years, according to the development team.
TRANSITIONS
people in the news
Jennifer Block, CPO, an instructor and director of the O&P technology program at Oklahoma State University Institute of Technology (OSUIT), has received the 2011–2012 National Outstanding Member Award from the Career Technical Education Equity Council for her success with recruiting women to OSUIT’s program. Marvin McKinney and Celisa Snellings have been hired as regional sales managers at Ability Dynamics LLC in Tempe, Arizona.
10
O&P Almanac MARCH 2013
Retired Army Colonel Paul F. Pasquina, MD, chief of the department of orthopaedics and rehabilitation at Walter Reed National Military Medical Center and director of the Center for Rehabilitation Science Research at the Uniformed Services University of Health Sciences (USU), has been selected to chair the newly established department of physical medicine and rehabilitation at USU’s F. Edward Hebért School of Medicine.
Study Focuses on How the Brain Moves Limbs A Queen’s University study, the results of which were published in the journal Neuron, is giving new insight into how the neurons in our brains control our limbs. Tim Lillicrap, PhD, a neuroscience researcher who worked on the study as part of his doctoral degree thesis at Queen’s and is now a postdoctoral fellow at Oxford University in England, says a better understanding of how the brain controls limbs will lead to improved designs of prostheses. The researchers used a novel network model, coupled with a computer biophysics model of a limb, to explain some of the prominent patterns of neural activity seen in the brain during movements. The findings refine previous notions of how neurons in the primary motor cortex fire and drive muscles. The primary motor cortex is the region of the brain that sends the largest number of connections to the spinal cord. When moving an arm or a leg, nerve impulses are sent along nerve fibers to control the movement of limbs. Different movements require different patterns of nerve impulses. The new study demonstrates that the patterns of activity are related to specific details of limb physics—for example, the patterns of neural activity are tuned (or optimized) for muscle architecture and limb geometry.
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IN THE NEWS
U.S. Practitioner, BOC Rep Visit O&P Facility in Haiti Jim Rogers, CPO, FAAOP, of Pinnacle O&P Services in Chattanooga, Tennessee, takes teams of practitioners and other helpers to Les Cayes, Haiti, several times each year to bring equipment, train staff, and assist at the Medical Teams International Advantage Program. The team visits a rehabilitation clinic, led by June Hanks, PT, PhD, DPT, CWS, CLT, where Hanks makes custom orthoses and prostheses in her workshop, and provides individuals with mobility aids like wheelchairs and crutches. This past fall, Carli Cohen, marketing and creative design coordinator of the Board of Certification/Accreditation, had the opportunity to take part in the program. While in Haiti, Cohen organized equipment and helped staff maximize use of their computerized database system. During this trip, team members from Global Research Innovation & Technology worked alongside Hanks to introduce a new wheelchair design, which helps patients with disabilities to traverse the difficult terrain.
TRANSITIONS
BUSINESSES in the news
The Amputee Coalition has announced its 2013 leadership team. Officers include Marshall J. Cohen, chairman; Dennis Strickland, vice chair; Dan Berschinski, vice chair; Jeffrey Lutz, treasurer; and Charles Steele, secretary. Directors include Mahesh Mansukhani; Leslie Pitt Schneider; Terrence P. Sheehan, MD; Michael Estrada; Ann Berdy; and Pat Chelf.
Hedges, secretary; William J. Powers, MBA, LFACHE, treasurer; and Sharon L. Nichelson, CMOF, immediate past chair. Mark L. Parris, Pharm D, Rph, COF, serves as member-at-large.
Touch Bionics, based in Livingston, Scotland, has opened a new facility in Newburgh, New York, which will be the primary location for the production of its livingskin division.
College Park Industries, headquartered in Warren, Michigan, is celebrating its 25th anniversary as a lower-limb prosthetic manufacturing company.
The Barr Foundation has announced the addition of two new board members, Jen Lacey and Chad Crittenden.
OPAF and The First Clinics has received the U.S. Tennis Association Wheelchair Tennis Grant for 2013. OPAF and The First Clinics also has announced that Allard USA, Rockaway, New Jersey, has become its first silverlevel sponsor for 2013.
The U.S. Agency for International Development has awarded the Ponseti International Association at the University of Iowa, Iowa City, nearly $2 million to increase access to treatment of clubfoot deformity for thousands of children in Peru, Pakistan, and Nigeria.
The Board of Certification/ Accreditation (BOC) has announced a new certification for durable medical equipment (DME) professionals, the Certified DME Specialist (CDME). Testing began Jan. 31, 2013. Visit www. cdme.org for details. The BOC also has announced the 2013 Executive Committee of its board of directors. Officers include John P. Kenney, MURP, BOCO, chair; James L. Hewlett, BOCO, vice chair; R. Jeffrey
12
O&P Almanac MARCH 2013
Ottobock North America, Minneapolis, acquired Bio Cybernetics International, doing business as Cybertech Medical, La Verne, California. Cybertech will maintain its current location and will become Ottobock’s new spinal bracing center. Ottobock will develop, produce, and market Cybertech products.
Wright & Filippis has acquired a controlling share in Carolina Orthotics & Prosthetics of North Charleston, South Carolina.
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Reimbursement Page By Joseph McTernan, AOPA government affairs department
ting Comprehensive Error Rate Testing ensive Error Rate Testing ComprehenS esting Comprehensive Error Rate Test Comprehensive Error Rate Testing Com ting Comprehensive Error Rate Testing
Seamless CERT Audits > What you don’t know can hurt you
CERT
ZPIC
RAC
14
O&P Almanac MARCH 2013
T
o say the reimbursement environment facing orthotic and prosthetic providers is a challenging one is an understatement. In the past 18 months, the number of Medicare audits has increased exponentially, creating tremendous pressures on businesses to maintain positive cash flow while ensuring the best possible clinical care for their patients. It is no longer the status quo to expect to be reimbursed for services that are clearly medically necessary without multiple challenges from a federally funded program that is under tremendous pressure to control costs and curb fraud and abuse. The layers of potential audits have become a virtual alphabet soup of acronyms, with terms such as RAC, ZPIC, and CERT becoming all too familiar in the everyday operation of an O&P practice. This month’s Reimbursement Page focuses on one particular type of Medicare audit that often is overlooked: the Comprehensive Error Rate Testing, or CERT, audit. The belief that CERT audits are any less important or have a lesser impact on your operations than other types of audits could not be further from the truth. Downplaying the significance of CERT audits may lead to disastrous consequences.
Understand the History The CERT audit program began with the passage of the Improper Payments Information Act of 2002 and has been strengthened over the years through the passage of additional legislation and the release of several executive orders. Prior to the passage of the 2002 legislation, the Office of Inspector General (OIG) for the Department of Health and Human Services calculated a single National Claims Payment Error Rate that was used to determine what efforts were needed to ensure Medicare was only paying for services that were medically necessary and reasonable. With the passage of the legislation, responsibility for calculating payment error rates shifted to the Centers for Medicare and Medicaid Services (CMS). CMS began calculating multiple error rates both nationally and by categories—including by contractor, by service, and by provider type. Calculating multiple error rates provided data that CMS and OIG could then use to further focus efforts to control fraud and abuse within the Medicare program. The central difference between CERT audits and other types of Medicare audits is that the primary
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focus of a CERT audit is the contractor who processed and paid the claim, not the provider. CERT audits are designed to measure the performance of the contractors that process Medicare claims and identify areas of vulnerability within their systems. While this may seem like a good thing, it truly is a double-edged sword as providers are required to refund payments that are determined by the CERT audit results to be improper. In addition, the results of CERT audits are used by the contractors to determine the service categories that will be subject to increased scrutiny going forward. When an area of vulnerability is established by CERT results, contractors are required to take corrective action to address the claims processing errors, usually resulting in increased scrutiny of claims on a prepayment basis. This increased scrutiny has been seen in recent announcements by the DME MACs regarding prepayment audits for high dollar DMEPOS items in Jurisdiction B, and widespread prepayment reviews for external breast prostheses and specific prosthetic feet in Jurisdiction D. Almost all prepayment review activity by the DME MACs begins as a result of unfavorable CERT reviews resulting in a high error rate for the contractor. These reviews usually begin as probe reviews, where a random sample of claims is selected for prepayment review. If the results of the probe review are unfavorable, a widespread review is initiated where most, if not all, of the claims for a selected category of service are subject to prepayment review. The financial impact of widespread prepayment review can be devastating as cash flow grinds to a halt and claims are denied for the slightest error in coding and documentation requirements.
Expect the Worst Preparing for a CERT audit is similar to preparing for any other type of postpayment review, with one very important exception: CERT audits are
16
O&P Almanac MARCH 2013
designed to establish contractor error rates on paid claims, so they are, by definition, always performed on a postpayment basis. Where they differ from other postpayment audits, however, is that if a CERT audit results in a determination that the claim should not have been paid, it counts toward the error rate for the contractor regardless of whether or not the decision is overturned on appeal. While a successful appeal will ultimately result in reimbursement for the service you provided, the error rate already will have been established based on the initial audit determination, which may lead to further audits. With this in mind, it is extremely important that you prepare every claim that you submit with the expectation that it will be subject to a CERT audit, and take appropriate measures to ensure that you do not contribute to an unacceptable error rate. One way to accomplish this goal is to ensure you have a complete understanding of the medical policies that govern the services you are providing. These policies usually consist of two equally important segments, the local coverage decision (LCD) and the policy article. These documents are readily available on each of the four DME MAC websites and contain very specific information regarding the types of documentation that must be maintained to support the medical necessity of the services you provide. It is important to remember that medical policy is not static; it frequently changes to reflect new requirements and regulatory shifts. At a minimum, you should review the LCDs and policy articles on a quarterly basis to ensure you are following the coverage requirements in effect at the time you deliver an O&P device. Outdated or incorrect information may lead to consistently noncompliant practices that not only put your claims at risk but contribute to a poor error rate for the contractor. A second way to ensure your claims make it through the CERT process
successfully is to improve communications with your referral sources. As we have seen over the past 18 months, practitioner documentation alone is no longer good enough to support the medical necessity of the services you provide. Medicare expects, and frankly demands, that documentation within the medical records of referring providers contain specific information that discusses the medical need for the services you provide. While this is often difficult to control, if you expect the documentation of your referral sources to contain necessary information to support your claim, you must make sure you communicate to them specifically what Medicare is looking to see. A third way to prepare yourself for CERT audits is to perform regular internal audits of your own files. It always is better to discover errors yourself than to wait for someone else to find them. Regular internal audits provide you with the opportunity to discover minor problems and correct them before they become major ones. Small errors that go undetected eventually become part of your common procedures and may result in tremendous exposure in an audit situation.
Hope for the Best CERT audits represent a unique subset of postpayment audits because their impact is twofold. Claims that are denied through the CERT audit process not only result in the potential of lost revenue for your business today, but may contribute to lost revenue long into the future as a result of corrective action and additional audits on a prepayment basis. There is an old saying: “You can be part of the problem or part of the solution.� Proper preparedness for CERT audits will help you be part of the solution. a Joe McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmternan@ AOPAnet.org.
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Watch An inside look at the latest threats to O&P
By ADAM STONE
A
s 2013 unfolds, legislative wrangling in Washington, D.C., brings a new crop of concerns for the O&P community. Devices may be wrongly categorized, driving up the cost of care. Over-eager auditors may press O&P for signs of Medicare fraud, and demand recompense for alleged lapses. Then there is the general state of political brinksmanship in Washington. “When the government creates artificial crises all the time, when it comes up against crazy deadlines requiring these slash and burn solutions, the risk to O&P as a niche market is that it gets caught up in enormous change that we fundamentally can’t control,” says David McGill, Össur America’s vice president of legal and reimbursement and AOPA board member. A few of the issues percolating on the national scene help to illustrate the industry’s concerns.
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O&P Almanac MARCH 2013
Back Braces on the Block Here is a simple premise that Washington has managed to complicate: Back orthoses are not off-the-shelf (OTS) items. The problem springs to life with a December 2012 report from the Department of Health and Human Services, Office of the Inspector General (OIG), “Medicare Supplier Acquisition Costs for L0631 Back Orthoses.” The ostensible trigger for the study was a doubling in the number of claims submitted and the amounts allowed for paid claims from 2008 to 2011. At the same time, the study did not appear to account for the increase in Medicare enrollees during that same time period. Some call this a fairly glaring methodical oversight. Results found an average acquisition cost of $191 for each L0631 back orthosis included in the study, with an average allowable of $919. Although the description for code L0631 includes fitting and
COVER STORY
MARCH 2013 O&P Almanac
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adjustment services, the OIG’s data shows that for one third of claims, the supplier did not report providing fitting and/or adjustment services. With so few incidents of fittings and adjustments reported, OIG has suggested these back braces be classed as OTS items, subject to competitive bidding in the manner of any other commodity item. “Unfortunately, such universal reliance on competitive bidding would result in devastating interruptions and disorientation of the care of Medicare beneficiary amputees,” says AOPA Executive Director Thomas F. Fise, JD. AOPA and O&P advocates argue that the present recommendations do not reflect the true cost to patient or provider. Using supplier acquisition cost as its basis, the OIG report ignores the fact that the clinical component of fitting, trimming, and adjusting is currently provided when the device is delivered. The cost of the device itself represents a small portion of the overall service. The underlying problem may have to do with the intent of the report. In essence, any survey is apt to find what it seeks.
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O&P Almanac MARCH 2013
Many say aggressive auditing by contractors who are paid a commission based on how much they recover has jeopardized patient care, along with providers’ ability to deliver that care.
“There is obviously enormous attention being paid to cost, and when everything starts from a cost standpoint, you automatically end up with different solutions than you would have if you started from the perspective of patient care,” says McGill. In this case, “it’s clear what the focus was. This was first and foremost about acquisition cost,” he adds. To understand how the OIG reached its recommendations, it’s helpful to delve into the specifics of the study. The largest block of claims (61,495) from 2008 to 2011 came from suppliers
who designated themselves as medical supply companies without certified orthotists or prosthetists on staff. Further, the largest percentage-based increases in the provision of orthoses described by L0631 did not come from providers with orthotists or prosthetists on staff, but rather by other provider types, specifically occupational and physical therapists (53 percent) and physicians (52 percent). These figures help to explain the low percentage of respondents who provided fittings and/or adjustments. Without such services, of course, the braces in question would indeed appear to be commodity items—there seems to be a methodical error in the statistical sampling that by necessity excludes practitioners more likely to perform fittings and/or adjustments. Providers worry that the net result of the report’s recommendations would be a systematic reduction in reimbursement rates, which in turn will lead to lower quality of care for Medicare beneficiaries.
RAC Audits Jeopardize Care In its efforts to come down hard on suspected cases of Medicare fraud and abuse, the government has recouped billions of dollars in apparently erroneous billings. But the program also has had unintended consequences, according to O&P providers. Many say aggressive auditing by contractors who are paid a commission based on how much they recover has jeopardized patient care, along with providers’ ability to deliver that care. “This is fundamentally a crude tool that is being misused. It’s like trying to play the guitar with a hammer,” says McGill. While the intent of the audits is to curb misuse of the system, auditors instead are chasing “highly technical and arcane requirements,” McGill says. While this may be a good way to reclaim funds, it doesn’t address the main issue of fraud and abuse. “It’s a giant game of ‘gotcha.’ It’s fundamentally unfair.”
2013 Presidential Inauguration of Barack Obama in Washington, D.C.
How did we get here? The situation began with passage of the Affordable Care Act, which requires the CMS to find $700 billion to pay for expanded benefits. This spurred the new focus on fraud and abuse. Within this overall effort, in August 2011 the Health and Human Services’s (HHS) Office of Inspector General issued a report that threw a spotlight on O&P. The report declared Medicare reimbursements for lower-limb prosthetics had climbed 27 percent, while the number of beneficiaries declined about 2.5 percent. But the report overlooked some salient facts. O&P providers point out that new technologies have been delivering significantly improved results—and that costs money. Moreover, the OIG report inferred fraud, simply because there had been no recent office visit, or because of reporting variations in claims for multiple prosthetic limbs for bilateral amputees. Providers call this a misreading of the nature of care. The OIG report has had real consequences for O&P. A recent AOPA survey on RAC audits and related issues drew more than 200 responses,
of whom an extraordinary 66 percent said they had experienced six or more RAC audits in the past 12 months, while about 67 percent said they had undergone three or more, and 99 percent said they had experienced one or more. Nearly 46 percent said they had gone through at least one RAC audit in the past three months. AOPA has been addressing the “overly aggressive” search for fraud and abuse in the following ways: • AOPA went to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Directors challenging their interpretation on physician documentation. • AOPA joined with the O&P Alliance in a letter to then CMS Administrator Don Berwick and to Daniel Levinson, the HHS Inspector General, pointing out specific errors in the report and requesting a meeting and prompt intervention. • AOPA brought the matter to the attention of Senator Ben Cardin (D-Maryland), resulting in a letter to newly appointed CMS Administrator Marilyn Tavenner. Sen. Cardin questioned the new
policy and expressed concerns over its impact on delivery of timely care to Medicare amputee beneficiaries. • AOPA met with Peter Budetti, MD, JD, head of the CMS fraud and program integrity section. Again with the O&P Alliance, AOPA met with the CMS officials responsible for Medicare audit contractors and secured a commitment to correct one DME MAC error, namely that the prosthetist’s notes do constitute a legitimate part of the patient’s medical record.
Making Sausages In recent months, Americans have watched Congress bat around the budget like a child’s balloon. Crisis has followed crisis—sequestration, debt ceilings, fiscal cliffs—in what some have described as more performance than policy. As of press time, some of these “crisis” issues remained unresolved. But it still was not too early to begin drawing conclusions about the machinations of lawmaking and their impact on the O&P providers and patients who too often are the victims of hasty policy-making.
MARCH 2013 O&P Almanac
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“O&P is a bobber in the wake of a giant ocean liner. There are waves that result from these massive disturbances and we’re floating in the water and getting smacked around as that ship goes by,” says McGill. The specter of sequestration, for example, threatened to bring O&P to the brink. Mandatory $1 trillion in cumulative payment cuts over 10 years could have pared back the Medicare fee schedule by 2 percent, an immediate reduction of around $40 to $50 million annually in O&P spending. The risk of much deeper cuts also was apparent, as Congress pondered further provider payment reductions. Regardless of how sequestration plays out, some of the underlying forces that precipitated the crisis will remain very much intact. In particular, AOPA has expressed deep concern with the ideas emanating from the think-tank realm. “We have been very concerned with overly simplistic and under-informed communications, which have recently appeared in the name of the Center for American Progress,” says Fise. That group, also known as CAP, has argued for universal competitive bidding to encompass every medical device made available through the Medicare program, promising a government savings of $38 billion.
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The O&P community waves a red flag. “CAP clearly does not understand that prosthetics for an amputee is more than a simple commodity such as a walker or a cane,” says Fise. “It is a medical device that is attached to a person’s body and use of the prosthetic device involves a great deal of fitting as well as health-care intervention by a provider they trust and who understands their needs.” Observers say CAP’s proposals reflect the kind of fallout generated by the political brinksmanship that has dominated in Washington lately. The problem with sequestration and fiscal cliffs lies not in the outcomes—though these can be perilous indeed—but in the process itself. Brinksmanship makes for colorful politics, but also lousy policy, some contend. When politicians hold budgets hostage until the very edge of a crisis, McGill says, the result too often is legislation that is hurried, sloppy, and ill-informed. As the oft-overlooked stepchild of the Medicare system, O&P may be especially vulnerable to cuts when laws are being written in a hurry. a
Adam Stone is a contributing writer for O&P Almanac. Reach him at adam. stone@newsroom42.com.
colleagues March 12-13 Plan at theto Attend AOPA’s 20 Forum March 12-13, L’Enfant Plaza Hotel in Washington AND D.C., for the 2013 AOPA Policy BRING A PATIENT WIT Forum. This is your chance to educate legislators about how changes to Medicare could affect the O&P industry and your patients. Bring a patient at a reduced registration cost to further cultivate policy makers understanding of patient care. For more information and to register, visit www.bit. ly/2013policyforum. 2013 Schedule*:
3/12 TUESday 11:00 a.m. – 3:00 p.m. Registration Open 12:30 p.m.– 5:00 p.m. Policy Forum General Sessions 5:00 p.m. - 6:00 p.m. Congressional Fund-raiser 6:30 p.m. Attendee Reception & Dinner
3/13 WEDNESday 7:30 a.m. Attendee Breakfast and General Session 8:30 a.m. – 5:00 p.m. Congressional Appointments *This is a tentative schedule as of press time. Times and events may change.
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By Jill Culora
Winning the War on
cancer Better outcomes for patients means special care tactics for practitioners
C
ancer survival rates are at an all-time high, thanks to ongoing research and treatment advancements. But better outcomes for patients and their families come with complex challenges for the O&P community. Gone is the aggressive amputation. Instead, creative limb salvage, rotationplasty, tibia turn-up, and less aggressive amputations, coinciding with chemo and radiation therapies, mean practitioners today are having to use ingenuity to create custom devices to make this generally young population mobile again. Bone cancers are somewhat rare, accounting for less than 0.2 percent of all cancers but amounting to 2,900 new cases each year in the United States. There are many different types, but the most common—osteoO CP r, sarcoma—typically starts in bone owre Christopher M cells in the arms, legs, or pelvis and affects more males than 24
O&P Almanac MARCH 2013
females, most often between the ages of 10 and 30. Other sarcomas include chondrosarcoma (forms in cartilage cells), Ewing tumor (typically found in bone but also in muscle and tissue), fibrosarcoma and malignant fibrous histiocytoma (in tendons, ligaments, fat, or muscle), and giant cell tumor of the bone and chordoma (in the spine and skull), according to the Cancer Treatment Centers of America. Bone cancer treatments can vary widely but generally involve surgery to remove the tumor(s), combined with chemotherapy and/or radiation therapy. Increasingly, orthotists and prosthetists work with a patient’s orthopedic surgeon and oncologist before surgery to help determine the recommended course of action. “The orthopedic surgeon will want one thing; the oncologist is saying there’s another; and maybe there are other co-morbidities going on that overrule everything. It’s more of a team approach when dealing with orthopedic oncology cases,” says Christopher Mowrer, CPO, practice manager, Scheck & Siress, at Rush University Medical Center, Chicago.
Because these cancers mainly affect a young population, a patient’s family also is a critical piece of the treatment puzzle. “It is a difficult time because we are telling them a lot of things at once: that they have cancer, and that it’s serious and there may be threats to their life. But when we recommend an extensive surgery or specifically an amputation, it takes a lot of work for patients and their families to come around and come to terms,” says Benjamin Miller, MD, MS, clinical assistant professor of orthopedics and rehabilitation at the University of Iowa in Iowa City, Iowa.
of the tibia, and now I’m providing an orthosis that has to be a little more intimately fitted to be able to stabilize the leg itself,” explains Mowrer. “But, we don’t want to stabilize it [too much] because you still want some stress going through the bone to try and get the bone to remodel and heal.” Mowrer says solutions often involve combining new and old principles and materials. “A lot of us younger practitioners haven’t had as much exposure to leather corsets and some of the metal constructs that [were] used much more in the past. So there are many cases where it ends up being maybe
after the amputation we get them up on the prosthesis and [they are] pleasantly surprised at how they are able to get up and move around.” That was the case for Helen Edmonds, 56, of Chicago, who had radiation treatment for a tumor in her right distal tibia when she was 13 years old. Decades passed before atrophy from the radiation set in and Edmonds started having difficulty with infections and pain. Finally, at the age of 50, she decided to have a belowknee amputation. “It was a blessing in disguise. I walk faster now and more easily with the prosthetic leg than I did with my own leg,” Edmonds says.
Amputation
Benjamin M
iller, MD, M
Limb Salvage More specific treatments for some cancers are leading to greater success in controlling tumors; as a result, more cancer patients are having limb-salvage procedures in place of an amputation. Limb salvage involves surgery to remove a tumor and usually some sort of reconstruction of tissue or bone to save the limb. “In the past [patients may have] felt they had no other option but to amputate the leg,” says Mowrer. “Today they are saying: ‘We don’t necessarily have to remove the whole bone.’” Limb-salvage procedures also are becoming more complex as surgeons use “out of the box” techniques— implants, cadaver bones—to save a patient’s limb. This often means orthotists are providing unique and irregular orthoses designed to accommodate details of a surgery. “I deal with some AFOs that we make because they removed a portion
S
two or three of us involved initially in the design of the device to get everything together and get the patient going. It’s definitely more of a team effort sometimes,” he says. In making a limb-salvage recommendation, two questions are asked, says Miller: “Can we get the entire tumor out? And is the patient’s limb function after salvage going to be better than after an amputation? If an answer to either question is ‘no,’ then an amputation is the better operation,” he says. But patients don’t always agree with an amputation recommendation. Social stigmas, Mowrer believes, cause some patients to want to keep their limb— despite a loss of function. “I’ve had cases where they keep their leg for five years, but it’s not quite as functional, and they continue to struggle with skin breakdown or infection. Maybe five years down the road if an infection gets bad enough, they say, ‘Look we have to take the limb.’ More times than not,
When an entire tumor can’t be removed, or a limb salvage surgery would leave a patient with a high loss of function, physicians will recommend an amputation to remove all or part of the bone where the tumor is located. Amputation also is recommended when a tumor affects nerves, arteries, or muscles. Patients who have surgeries for either amputation or limb salvage also commonly undergo chemotherapy and/or radiation therapy. “The classic example is a tumor that is below the knee, in the foot or the lower part of the leg, because the below-knee prosthesis is very functional and usually functions better than a bad foot, which doesn’t have good sensation or good vascularity,” says Miller. For cancers that affect the knee and above, it is important for patients to know their options ahead of surgery, says Kevin Carroll, MS, CP, FAAOP, vice president of prosthetics at Hanger Clinic in Oklahoma City, Oklahoma. “We’re in a unique position to introduce alternative procedures that may not require the patient to have an aboveknee amputation,” says Carroll, who regularly sees surgeon-referred patients prior to their surgeries. “I usually talk with the families about the various procedures: the Van Ness rotationplasty, the tibia turn-up procedure, or the regular above-theknee amputation.” MARCH 2013 O&P Almanac
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rman, CP
Nick Acke
Van Ness Rotationplasty Rotationplasty can give an aboveknee amputation patient a level of function equivalent to a below-knee prosthetic user. The procedure, called the Van Ness procedure, uses the functional ankle, tibia, and foot of the amputated leg, rotates the limb 180 degrees, and fuses the tibia to the femur. The ankle joint becomes the knee joint and a below-knee prosthesis is fitted to the foot. “It is crazy-wild to think about, but it’s not a difficult treatment,” says Nick Ackerman, CP, director of prosthetics at American Prosthetics & Orthotics, Clive, Iowa. “Children who [have this procedure] become hyper mobile [as they grow]... they get more flexible, their ankle becomes more mobile to allow more range of motion at their knee. So it is a really good functional option.”
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But the procedure can be met with resistance from prospective patients and their families who are not fully educated about the benefits and outcomes of living with a prosthesis after surgery. “If you are dealing with an 8-year-old who has a tumor in his knee and you tell mom and dad that you are going to turn his foot around and put it on backwards and it is going to give him a functional below-the-knee amputation, they’re going to have some hesitations about seeing their kid with his foot on backwards—even though it is a highly-functional, good design. So oftentimes the parents nix that [option],” says Ackerman.
Tibia Turn-Up Procedure A tibia turn-up provides an above-knee amputee with a longer and stronger residual limb for locking on a prosthetic socket. It works by using the tibia of the amputated leg, inverting it, and fusing it to the femur. This procedure can work for patients for whom a Van Ness is not an option, and results in a much longer residual limb to fit an above-knee prothesis. “The tibia turn-up is a very unique procedure, and the outcome is superior,” says Carroll. “The proximal tibia is placed where the anatomical distal femur once was, and the distal tibia is fused to the remaining femur. As a result, the
patient has broad distal bone to bear weight on, and the muscles that have been dissected away from the femur can be reinserted and sutured back to the tibia, resulting in a strong residual limb.” Carroll recently treated a patient with osteogenic sarcoma in the proximal third of the femur for whom a regular above-the-knee amputation would have meant a very short residual limb and, as a result, a hard-to-control prosthesis. Instead, the patient opted for a tibia turn-up procedure. “This person can walk incredibly well because of this particular surgery,” says Carroll. “If you saw this person walk, you wouldn’t be able to determine [the individual is] wearing an above-theknee prosthesis.”
Unique Treatment Considerations Cancer patients, by and large, tend to be both young and motivated, and treating them can be extremely rewarding for O&P practitioners. But a number of factors must be taken into consideration when working with this unique population: • Dynamic fitting—Postsurgery cancer patients often undergo chemotherapy or radiation therapy, which deteriorates the patient’s body in a number of ways, says Ackerman. “The prosthesis isn’t fitting because he’s either swollen or shrunk down. His body is being changed significantly so it makes fitting difficult; he has a very dynamic limb that is changing because of chemotherapy or radiation, or something else that is treating the cancer.” So, more acute follow-up care is necessary for these patients. • Fitting—Special attention must be paid to the details of the specific surgery for cancer patients as often there will be irregularities that create challenges in fitting an orthotic or prosthetic device. “Sometimes there’s a problem with
soft tissue coverage, where there’s not as good of a healthy stump with which to bear weight onto a prosthesis. Sometimes there can be issues with healing and skin sloughing over time,” says Miller. • Van Ness fitting—Fitting prostheses for patients who have undergone the Van Ness procedure requires a unique device and a lot of clinical skill from the prosthetist. “Alignment is difficult, and getting the fit exactly the way it should be takes time,” says Carroll. He recommends asking an O&P colleague who has experience with Van Ness fittings to come up with an optimal outcome. • Patient support networks—Cancer patients have the benefit of strong support groups. Encourage your patients to get involved. • Tumor spread—Osteosarcoma survival rates have climbed from
20 percent in the 1970s to about 70 percent today, but tumors do spread about 30 percent of the time, says Miller. Spreading tumors is typically how patients die, and practitioners must learn to cope with that reality, says Ackerman.
A Personal Approach Working with this motivated population, practitioners have the opportunity to both expand their skill set and make significant, positive changes to a person’s life. “With the oncology patients, we wear many hats,” says Mowrer. He finds he often spends more time with these individuals than with his other patients, due to the special considerations in making and fitting their components, as well as in making adjustments. “You have more time to spend with them where you can talk—and actually talk things through. You just have to listen
Kevin Carroll,
MS, CP, FAAO
P
and give them a sounding board for them to vent and bounce some ideas.” Being a good prosthetist to these patients means more than fitting the best device. “As you work in the field, you get better at it,” says Mowrer. “A lot of the time, it just comes down to being a good listener.” a Jill Culora is a contributing writer for O&P Almanac. Reach her at jillculora@ gmail.com.
MARCH 2013 O&P Almanac
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n
Ask the Expert By Devon Bernard
Sifting Through Supplier Standards Dissecting some of the standards can ensure you stay in compliance
I
n the February issue of the O&P Almanac, the Reimbursement Page article discussed the importance of understanding the Medicare Supplier Standards, including how they apply to your facility and the effect they can have on your revalidation or site inspection. This installment of Ask the Expert examines more of the Supplier Standards.
Q:
In regard to Supplier Standard 26, are we required to have a surety bond?
Are we mandated to be accredited, as Standards 22 through 24 would suggest?
A:
A:
No. There is the possibility that you may be exempt from having to obtain a surety bond, but only if you meet all of the following criteria: 窶｢ Your facility is solely owned by O&P personnel. 窶｢ You are only providing orthotics, prosthetics, and supplies窶馬o durable medical equipment (DME), standalone diabetic shoes, or mastectomy products. 窶｢ You are providing custom devices.
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O&P Almanac MARCH 2013
Q:
The answer depends on the type of services you provide. Currently, there is an exemption for O&P providers from having to be accredited, but this exemption applies if you provide only O&P items. If you provide any type of DME items (e.g., dynamic splinting, the WalkAide, the Bioness, canes, crutches, etc.), you would not be fully exempt and you would have to be accredited for these items.
Do I have to be open for at least 30 hours a week to be compliant with Supplier Standard 30?
Q:
number, and two DMEPOS supplier numbers cannot share the same space and address.
A:
May we contact our current and/or previous patients and not violate Supplier Standard 11?
Q:
Remember, the intent of this standard is to eliminate unsolicited calls to the patient to drum up potential sales.
A:
Q:
Once again, the answer depends on the type of services you provide. If you provide solely orthotics and prosthetics, then you are exempt from having to be open at least 30 hours a week. However, if you provide services in addition to orthotics and prosthetics, then the exemption no longer applies and you must be open at least 30 hours a week.
Q:
Can I share space with another Medicare provider (for example, a physician, chiropractor, or therapist) and still be compliant with Supplier Standard 29?
A:
Once again, it depends. If the other Medicare provider does not bill Medicare for DMEPOS services, then yes, you can share a location space. However, if he or she bills for these types of services (e.g., canes, crutches, walkers, etc.), then you cannot share a location, because he or she also has a DMEPOS supplier
The answer depends on the type of contact and when you last saw the patient. The prohibition of contacting your patients as stated in Supplier Standard 11 only applies to contact via telephone, meaning any other form of contact (for example, mailing postcards) is permitted at any time. This standard does not eliminate your ability to contact patients via telephone; you may still contact a patient via telephone if one of the following criteria has been met: • The patient has given you written consent to contact him or her concerning the furnishing of a Medicare-covered item; • You are contacting the patient to coordinate delivery of a Medicarecovered item; or • You provided a Medicare-covered
SEPTEMBER 18-21, 2013
item to the patient within the previous 15-month period from when the call is made.
Do patients have to physically sign a form stating they received a copy of the Supplier Standards, as per Supplier Standard 16?
A:
No. The standard states only that the Supplier Standards must be disclosed to patients anytime they receive a Medicare-covered item. However, the best way to demonstrate that you are meeting this standard is to have each patient sign a form, which may be combined with your delivery slip, indicating that he or she has received a copy of the Supplier Standards or that the standards have been disclosed to the individual. a Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.
Why you should plan to attend:
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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.
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Superior Clinical Education featuring the best speakers from around the world. Hear from physicians, researchers, and top-notch practitioners.
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Practical learning and live demonstrations.
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Preparation for the massive changes that U.S. healthcare reform is sure to bring, and its influence on global health policy.
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Expand your knowledge, grow your market presence and advance your career at this unique, global gathering of high visibility and importance.
For more information, contact us at worldcongress@AOPAnet.org or visit www.opworldcongressusa.org. MARCH 2013 O&P Almanac
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AOPA HEADLINES
AOPA WORKING FOR YOU
Getting To Know the AOPA Coding and Reimbursement Committee A new chairman takes the lead
E
very organization has them: The unsung folks who work tirelessly behind the scenes with little want for accolades or recognition. These are the individuals who are willing to go the extra mile and dedicate both their time and energy for the overall good of an organization. When these efforts are done on a volunteer basis, it becomes even more special. AOPA has a group like this—a collection of volunteers who dedicate their time and energy to serve as members of the AOPA Coding and Reimbursement Committee.
Multiple Responsibilities AOPA’s Coding and Reimbursement Committee is tasked with the responsibility to develop and implement AOPA strategy on all issues related to the proper coding of O&P devices and challenges to fair and equitable reimbursement from payers. The committee meets via conference call on a monthly basis and has three or four face-to-face meetings each year. The members of the committee have more than 150 years of combined experience in orthotics and prosthetics and represent the full gamut of the AOPA patient-care facility 30
O&P Almanac MARCH 2013
membership—from large multistate operations to small family-owned practices. The members of the committee serve with the utmost integrity and are able to set aside the individual interests of the companies they represent and act only in the best interest of the entirety of the AOPA membership. One of the most important regular tasks of the committee is the responsibility to review the coding suggestions for products that have been submitted to AOPA’s LCodeSearch.com website. This website is a quick and easyto-use reference where AOPA members can obtain coding guidance for specific products. While manufacturers bear the responsibility to upload their products to the site, no product is published on the website until the Coding and Reimbursement Committee has reviewed and approved the specific L codes that are listed. AOPA members can rest assured that coding recommendations listed on LCodeSearch.com are fully supported by AOPA.
Role of the Committee Chairman The chairman of the AOPA Coding and Reimbursement Committee is a position reserved for an individual within the O&P industry who is of the highest integrity and who possesses knowledge of the complex issues involving O&P coding and reimbursement. His or her role is one of oversight. The chairman is charged with keeping the committee discussions on track and relevant to the question at hand. For the past eight years, the role of AOPA Coding and Reimbursement chairman was held by Michael O’Donnell, CPO, a practitioner with Hanger Inc. in Parkersburg, West Virginia. Prior to assuming the role of chairman, O’Donnell served on the committee since the mid 1990s. His knowledge, experience, and dedication to the AOPA membership have been remarkable as he has led the committee through some of the most crucial years for AOPA.
AOPA WORKING FOR YOU
AOPA HEADLINES
After more than 15 years of service to AOPA and its members, O’Donnell has decided to step down from both the committee and his role as chairman. His contributions to the committee will certainly be missed, and AOPA would like to thank him for his countless hours of volunteer service to the organization. AOPA President Thomas Kirk, PhD, recently announced that Mark Porth, CPO, FAAOP, has been nominated and has accepted the role of chairman of the AOPA Coding and Reimbursement Committee. Porth has been a longstanding member of the Coding and Reimbursement Committee and also serves as compliance officer for the Mary Free Bed Rehabilitation Hospital in Grand Rapids, Michigan. His wealth of knowledge regarding O&P coding and reimbursement will serve him well as he assumes his new role as chairman of the committee.
The New Roster The remainder of the committee is made up of a virtual who’s who of the O&P industry. The current committee roster, including AOPA member company affiliation, is listed below. William Beiswenger, CPO Abilities Unlimited, Colorado Springs, Colorado
Mitchell Dobson, CPO, FAAOP Hanger Inc., Grain Valley, Missouri
O&P Board Study Resources We can help you PASS your BOARDS All products updated to 2013 test standards.
Dennis Ebbing, CPO Clinical Prosthetics & Orthotics LLC, Poughkeepsie, New York Brian Gustin, CP Forensic Prosthetic and Orthotic Consulting, Suamico, Wisconsin Jason Jennings, CPO, FAAOP Hanger Inc., Houston, Texas
Introducing our NEWEST Study Guide in PEDORTHICS
Pamala Filippis Lupo, CO Wright & Filippis Inc., Rochester Hills, Michigan Jonathan Naft, CPO Geauga Rehabilitation Engineering Inc., Chardon, Ohio
The AOPA Coding and Reimbursement Committee looks forward to continuing to serve the needs of the AOPA membership. If there are any issues that you would like the committee to review, please forward them to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.
The ONLY Comprehensive Study Guides Specifically for Orthotics and Prosthetics
Now Offering Customizable Orthotic and Prosthetic Patient Device Instruction Sheets in English AND Spanish
Our Products NOW available for IMMEDIATE DOWNLOAD! No need to wait, BEGIN your STUDIES NOW!
www.oandpstudyguide.com MARCH 2013 O&P Almanac
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AOPA HEADLINES
Contracting With the VA: Hints for Landing the Contract—Join the Audio Conference March 13 Learn how to prepare for contract opportunities with the U.S. Department of Veterans Affairs (VA)—and why this should be an important part of your business operation. Join AOPA March 13 for an AOPAversity Mastering Medicare Audio Conference. The following topics will be covered: • How should I prepare for contract opportunities? • How do I find available VA contracts? • How does the VA contract process work? • How are VA contracts administered? 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 www.bit.ly/2013audio. Contact Steve Custer at scuster@AOPAnet.org or 571/431-0876 with registration questions.
Be Heard in Washington at the AOPA Policy Forum The 2013 AOPA Policy Forum will take place March 12-13 at the L’Enfant Plaza Hotel in Washington, DC—just a few minutes’ walk from the U.S. Capitol and the Senate and House office buildings. Beginning at 12:30 p.m. on Tuesday, March 12, this event will provide attendees with up-to-date briefings from key congressional lawmakers, the AOPA lobbying team, and other experts about critical issues confronting the O&P community. Further guidance on how to use this information effectively in lobbying members of Congress will conclude the first day. The Tuesday evening reception and dinner will offer a terrific networking and further learning
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experience. The meeting will culminate on Wednesday, March 13, with advocacy visits with your elected representatives and their staff on Capitol Hill. AOPA’s staff and lobbyists will schedule these meetings for you. Make your visits more effective by bringing a patient with you. A modest patient registration fee of only $25 applies. The attendance fee is $125. Register online here at http://bit.ly/AOPA2013policy. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854, with any questions.
AOPA HEADLINES
www.savewithups.com/aopa
ARIZONA
Join your colleagues at the “Mastering Medicare: AOPA’s Essential Coding & Billing Techniques” seminar this spring. 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 both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage. AOPA will be offering the seminar twice this spring. The first will take place April 8-9, 2013, at the Hyatt Regency Columbus in Columbus, Ohio. Register online at www. bit.ly/AOPAcol, or contact Devon Bernard at dbernard@ AOPAnet.org or 571/431-0854. The second takes place June 13-14 at the Renaissance Phoenix Downtown Hotel in Phoenix. Register online at www.bit.ly/AOPApho, or contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854.
OHIO
Mastering Medicare: AOPA’s Essential Coding & Billing Techniques
UPS Savings Program AOPA Members now save up to 30% on UPS Next Day Air® & International shipping! Sign up today at www.savewithups.com/aopa! Take advantage of special savings on UPS shipping offered to you as an AOPA Member. Through our extensive network, UPS offers you access to solutions that help you meet the special shipping and handling needs, putting your products to market faster. AOPA members enjoy discounts for all shipping needs and a host of shipping technologies. Members save: • Up to 30% off UPS Next Day Air® • Up to 30% off International Export/Import • Up to 23% off UPS 2nd Day Air®
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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!
MARCH 2013 O&P Almanac
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AOPA HEADLINES
Handling Adversity: Coping With Difficult Patients Join the Audio Conference April 10
Ever have difficulty communicating with a patient’s dispute or disapproval? Join AOPA on April 10 for an AOPAversity Mastering Medicare Audio Conference that will focus on learning how to handle patient complaints, and why it’s an important part of your business operation. The following topics will be covered: • How to handle patient complaints. • How to communicate with difficult patients. • What makes a patient difficult. • How to discharge a patient from your care.
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 www.bit.ly/2013audio. Contact Steve Custer at scuster@AOPAnet.org or 571/431-0876 with registration questions.
2013 AOPA Audio Conferences: Mark Your Calendar Educate yourself and your staff during one-hour sessions in the comfort of your office on the second Wednesday of each month at 1 p.m. EST. This series provides an outstanding opportunity for you and your entire staff to stay abreast of the latest hot topics in O&P, as well as gain clarification and ask questions. It’s the most cost effective way for each member of your business to earn CE credits.
2013 Topics March 13:
Contracting With the VA: Hints for Landing the Contract
April 10:
Handling Adversity: Coping With Difficult Patients
May 8:
Navigate the Maze: Get to Know the Appeals Process
June 12:
Clinical Documentation: Dos & Don’ts
July 10:
Networking for the Future: Building Relationships With Referrals
August 14:
Don’t Get Stuck With the Bill: Medicare Inpatient Billing
September 11: Read Between the Lines: The Medicare Lower-Limb Prosthetic Policy
Buy the Series and Get Two FREE! Visit the AOPA Bookstore, buy the series, and get two audio conferences free. AOPA members pay $990 to participate in all 12 sessions ($1,990 for nonmembers). If you purchase the entire year’s worth of conferences, all conferences from months prior to your purchase of the set will be sent to you as CDs. Seminars are priced at just $99 per line for members ($199 for nonmembers).
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October 9:
What’s the Word: A Health-Care Reform Update and What You Can Expect
November 13: Advocacy: A Potent Weapon for Change December 11: What’s on the Horizon: New Codes for 2014
Register online at www.bit.ly/2013audio. Contact Steve Custer with questions at scuster@AOPAnet.org or 571/431-0876.
AOPA HEADLINES
Follow AOPA on Facebook and Twitter Follow AOPA on Facebook and Twitter to keep on top of latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities. Like us on Facebook at: www.facebook. com/AmericanOandP with your personal account and your organization’s account! Follow us on twitter: @americanoandp, and we’ll follow you, too! Contact Steffanie Housman at shousman@ AOPAnet.org or 571/431-0835 with social media and content questions.
Top 5 Reasons To Follow AOPA: • Be the first to find out about training opportunities, jobs, and news from the field. • Build relationships with others working in the O&P field. •
Stay in touch with the latest research, legislative issues, guides, blogs, and articles—all of the hot topics in the community.
• Hear from thought leaders and experts. • Take advantage of special social media follower discounts, perks, and giveaways.
Now Available: 2013 AOPA Products & Services Catalog AOPA’s mission is to work for favorable treatment of 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. AOPA is proud to announce the online 2013 AOPA Products & Services Catalogue, available at www.bit.ly/ AOPA2013productcatalog.
Discover Employment Opportunities at AOPA’s Online Career Center 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 Stephen Custer at scuster@ AOPAnet.org with questions.
Coding Questions Answered 24/7 AOPA members can take advantage of a “click-of-the-mouse” solution available at LCode-Search.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways––by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.
24/7 MARCH 2013 O&P Almanac
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AOPA HEADLINES
O&P PAC Update The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*: • • • • • • •
Sherrie Anderson, CP Donald Buethorn Ron Hercules Clyde Massey, CPO Steven Mirones, CO, FAAOP Paulette Vaughn James Young Jr., CP, FAAOP
The O&P PAC advocates for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@AOPAnet.org. *Due to publishing deadlines this list was created on Feb. 4, 2013, and includes only donations received between Jan. 3, 2013, and Feb. 4, 2013. Any donations received or made after Feb. 4, 2013, will be published in the next issue of O&P Almanac.
Log On to AOPAversity Online Meeting Place for Free Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you. For a limited time, AOPA members can learn and earn for FREE at the new AOPAversity Online Meeting Place: www.AOPAnetonline.org/education. Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn CE credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis. AOPA also offers two sets of webcasts: Mastering Medicare and Practice Management. 36
O&P Almanac MARCH 2013
• Mastering Medicare: Coding & Billing Basics: These courses are designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare. • Practice Management: Getting Started Series: These courses are designed for those establishing a new O&P practice. Register online by visiting http://bit.ly/AOPAwebcasts.
AOPA Applications
Centers for Mobility-Prosthetics
Welcome new members!
7777 SW Freeway 107 Houston, TX 77074 713/773-0969 Fax: 713/773-0923 Category: Patient-Care Member Jessica Falknor
Children’s Orthotics & Prosthetics in Duluth 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.
Bill Merletti Brace Company Inc. 131 E. 8th Avenue Homestead, PA 15120 412/462-7181 Category: Patient-Care Member William Merletti, CO
2270 Duluth Highway 120, Ste. 200 Duluth, GA 30097 404/785-2540 Fax: 404/785-2541 Category: Affiliate Member Parent Company: Children’s Healthcare of Atlanta, Atlanta, GA
Colaizzi Pedorthic Center 617 Forest Avenue Pittsburgh, PA 15202 412/761-8100 Fax: 412/761-1944 Category: Patient-Care Member Michael Rees, C.Ped, CFo
Human Designs Prosthetic & Orthotic 8734 Cleta Street, Unit C Downey, CA 90241 562/490-2831 Category: Affiliate Member Parent Company: Human Designs Prosthetics & Orthotics, Long Beach, CA
Hurley/Binson’s Medical Equipment Inc./dba H-Care G4433 Miller Road Flint, MI 48507 810/733-0280 Fax: 810/733-0270 Category: Patient-Care Member Peggy Gourd
Hurley/Binson’s Medical Equipment Inc./dba H-Care 5599 Bay Road Saginaw, MI 48604 989/791-9490 Category: Affiliate Member Parent Company: Hurley/Binson’s Medical Equipment Inc./dba H-Care, Flint, MI
Hurley/Binson’s Medical Equipment Inc./dba H-Care 9171 Lapeer Road Davison, MI 48423 810/653-9188 Fax: 810/658-2742 Category: Affiliate Member Parent Company: Hurley/Binson’s Medical Equipment Inc./dba H-Care, Flint, MI
Orthotics & Prosthetics Laboratories Inc. 300 Birnie Avenue, Ste. 303 Springfield, MA 01107 413/737-2404 Fax: 413/733-1389 Category: Patient-Care Member James Haas, CO
Orthotics & Prosthetics Laboratories Inc. 163 South Street, Unit 2 Pittsfield, MA 01201 413/442-0017 Fax: 413/442-0020 Category: Affiliate Member Parent Company: Orthotics & Prosthetics Laboratories Inc., Springfield, MA
Orthotics & Prosthetics Laboratories Inc. 241 King Street, Ste. 123 Northampton, MA 01060 413/585-8622 Fax: 413/587-3773 Category: Affiliate Member Parent Company: Orthotics & Prosthetics Laboratories Inc., Springfield, MA
Spectrum Orthotics & Prosthetics Inc. 866 Plumas Street, Ste. F Yuba City, CA 95993 530/591-3212 Category: Affiliate Member Parent Company: Spectrum Prosthetics & Orthotics LLC, Grants Pass, OR
Tyler Prosthetics Inc. 701 Turtle Creek Drive Tyler, TX 75701 903/595-2600 Fax: 903/595-2604 Category: Patient-Care Member Pia Bayly a
MARCH 2013 O&P Almanac
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Marketplace Prepreg from Ottobock
Motion Control—From Motion Control
Give your patients the most advanced KAFO technology combined with the most advanced fabrication! Ottobock’s line of KAFOs is now available in prepreg, creating KAFOs up to 40 percent lighter than laminated alternatives. Prepreg also creates more consistent fabrication outcomes that avoid unwanted buildups. Ottobock Fabrication Services offers decades of expertise, exceptional customer service, and an unparalleled reputation for quality. Our expert services include water transfer, lamination, and prepreg carbon fiber. You can count on timely turnaround delivering the results you want. Visit www.ottobockus.com, or call 800/795-8846.
TRIAD Preamp: • Three mounting options • Water-resistant case • High interference rejection • Gain adjustments on preamp Compatible for use with: • Utah Arm 3 and 3+ (kit: p/n 3010782) • Utah Hybrid Arm (kit: p/n 3010782) • ProControl Systems (kit: p/n 3010784) • OttoBock electrode cables For more information, visit www.UtahArm.com, call 888/696-2767, or email info@UtahArm.com.
The new Triton family of feet from Ottobock
Comfort, security, reliability! Now your patients have more options to meet the demands of their active lifestyle. The Triton Low Profile (LP) and the Triton Heavy Duty (HD) are especially robust and waterproof, ready for the most challenging conditions. Or choose the lightweight Triton carbon fiber foot; the Triton Vertical Shock (VS); or the Triton Harmony® with integrated vacuum technology for outstanding flexibility and support. Contact your sales representative at 800/328-4058 or visit www.ottobockus.com.
Patented KISS® Superhero™ Reusable Test Socket Plate
Vista® Lower Spine Line from PEL Supply Versatile by design, the Vista Lower Spine Line from Aspen Medical Products provides support and relief options for the patient from post op to pain relief. Now available from PEL Supply, the Vista line is a one-size adjustable product that offers multiple back panels and integrated anterior support to provide a comfortable environment for healing. Products can be stepped down from a TLSO down to a simple Lumbar support. Configurations Include: • Vista 464 TLSO • Vista 637 LSO (shown here) • Vista 631 LSO Lo Pro • Vista 627 Lumbar For more information about the individual Vista Lower Spine Line products, or any popular Aspen medical products lines available from PEL Supply, call a friendly PEL customer service rep at 800/321-1264, or email customerservice@ pelsupply.com. Registered customers may order online at www.pelsupply.com.
Total Knee® by Össur®. Totally versatile. The unique design of this plate allows for easy casting tape removal, without damage. Damage-free casting tape removal allows this plate to be reused, saving costs. Visit www.kiss-suspension. com or call 410/663-KISS for more information.
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O&P Almanac MARCH 2013
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.
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
$482 $678 $634 $830
Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to srybicki@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140
& Prosthetic
Association
(AOPA)
DISCOVER more AOPA advertising opportunities.
2013
American Orthotic
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.AOPAn
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O&P Almanac MARCH 2013
Northeast C.Ped/Cert. O&P Technician Turnersville, New Jersey Diabetic Athletic Foot Center We are a fast growing company located the Turnersville area that manages patient services in comprehensive pedorthic, therapeutic, and diabetic footwear. For the position of technician, this candidate should be well versed in the discipline of fabrication in orthotics and prosthetics. Candidate must have three years’ experience within their scope of practice, be in good standing with ABC, and be a dependable and reliable individual. Domains, Tasks, Knowledge and Skills Requirements: • Dependent upon scope of practice patient assessment, evaluation of patient’s medical history, formulation of treatment plan, biomechanical evaluation and range of motion, pedorthic treatment plan, evaluation and documentation of patients skin, sensitivity and circulation, document patients compliance or noncompliance • Documentation of patient(s) goal, include patient education and/or patient(s) schedule, communication with patient(s) caregivers, physician therapist, consult with referring physician when appropriate • Review of device for structural safety precautions’ prior to patient receiving device, upon delivery establish that device fits properly and document in patient chart • Adjusting and modifying of device(s), maintaining and repairing devices must be documented in patients chart • Fitting criteria, knowledge of impression-taking techniques, materials, devices and equipments, pedorthic measurement tools, forms and materials, ability to fabricate devices • CAD/CAM, item warranty limitations, human development and aging, pediatric to geriatric • Use of safety equipment, hand and power tools, materials and components, and use of alignment devices Applications accepted by:
Resumés for: C.Ped, Certified O&P Technician Attn: Daniel Dalsey, C.Ped, Cert. O&P Technician Fax: 856/809-9945 Website: www.pro.fit@comcast.net
JOBS
Southeast
Inter-Mountain
CO/BOCO or CPO/BOCOP
CPO/LPO
Meridian, Mississippi Methodist Orthotics and Prosthetics, a division of Methodist Rehabilitation Center, is looking for a certified orthotist or certified prosthetist-orthotist for our facility in Meridian, Mississippi. Located only minutes from the Alabama line, Meridian is a growing town with three major hospitals within ½ mile of our office. Meridian offers many outdoor activities and is only three hours from the Gulf Coast. Ideal candidate should be a self-starter with solid fabrication skills who wants professional growth with an exciting orthotics and prosthetics company. Clinical skills in office and hospital environment as well as the ability to function as a team player are vital. Methodist Rehabilitation Center is a progressive orthotics and prosthetics facility with five locations throughout Mississippi and Louisiana. Competitive salary and benefits including 403b retirement with employer matching, continuing education, paid vacation and more. Please forward resumes in confidence to:
Beaumont, Texas Great opportunities await you in Texas. A Houston-based established practice is looking for a practitioner to run an affiliate office in Beaumont with an opportunity of ownership. If you like small communities with fabulous outdoor activities and a relaxed environment to operate out of, then this is your place. The ideal candidate is an energetic, self-starting, motivated practitioner who processes excellent patient care and communication skills to conduct comprehensive patient evaluations to deliver the best in O&P services and follow-up patient care. If you have a great personality and can conduct in-services and marketing whilst practicing your craft, then this is your amazing opportunity. We offer a competitive salary and benefits including health care coverage, continuing education, paid vacation and more. Send resume to:
Email: LegFixr@aol.com
Chris Wallace, CPO, FAAOP Director, Department of Orthotics and Prosthetics 1 Layfair Drive, Ste. 300, Jackson, MS 39232 Fax: 601/936-8896 Email: cwallace@mmrcrehab.org
Tina Mann
Clinic Manager
“Six doctors came walking in my room, surrounded my bed and they told me I would not get up again.” 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 Hanger Clinic. Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all available through a career at Hanger Clinic.
View our current positions and apply online at: www.hanger.com/careers or scan the QR code.
Hanger was recently named one of Forbes Best Small Companies in America.
Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state or local law. Residency Program Info, contact: Robert S Lin, MEd, CPO, FAAOP Director of Residency Training and Academic Programs, Hanger Clinic, Ph. 860.667.5304; Fax 860.666.5386.
Available Positions: Clinic Manager Morgantown, WV
San Mateo, CA
Orthotist Beaufort, SC Columbia, MO Parker, CO Urbana, IL Fairfield, OH Grand Rapids, MI Taos,NM Hammond, IN Cary, NC Richmond, VA
Glendale, AZ Springfield, IL Camp Hill, PA Jacksonville, FL Olympia, WA Pensacola, FL Tallahassee, FL Longview, WA Richland, WA
Prosthetist / Orthotist Portland, OR Amherst, NY Johnson City, NY Grand Junction Springfield, IL Holland, MI Williamsport, PA
Vancouver, WA Waterville, ME Buffalo, NY Mayfield Heights, OH Wilkes Barre, PA Kissimmee, FL
Prosthetist Waterbury, CT
Wichita, KS
MARCH 2013 O&P Almanac
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JOBS
Inter-Mountain CPO Boise, Idaho After some restructuring and rebranding, Rehab Systems Boise is now Boise Prosthetics. We have been serving orthotic and prosthetic patients in Boise, Idaho, since 2005, operating a small but effective patient-care facility alongside our sister company, Coyote Design & Manufacturing. Currently we are seeking an experienced, driven CPO interested in helping us to continue our growth. This offering also includes a low-risk ownership opportunity in the business. Grow along with the company in an amazing place to live! Qualified applicants may submit a resume to:
Email: boise@rehabsystems.ws Fax: 208/342-4106
A unique opportunity to be a part of a rapidly expanding, multi-center practice.
CERTIFIED ORTHOTIST, OR CERTIFIED ORTHOTIST / PROSTHETIST Department of Orthopaedic Surgery Functional Title: Academic Administrator Multiple positions available
Incumbent will work as full-time clinician in the Orthotic and Prosthetic Center in a large medical university setting which includes several Intensive Care Units, Rehabilitation Units, Acute Care Units and many Out-Patient Clinics for service of patients with a wide variety of medical diagnoses. Candidate will be responsible for clinical evaluations, implementation of a wide assortment of orthotic/ prosthetic treatment modalities, and technical fabrication of orthotic / prosthetic devices. Candidate will also be responsible for assuming a supervisor role of two or more clinicians ensuring efficient clinical flow and quality of care. Applicant will be required to create and present informative educational presentations to allied health providers. Candidate will serve as resident instructor, which includes relaying techniques and clinical knowledge in a clear and concise manner. Required qualifications: ABC Certified Orthotist or Orthotist/Prosthetist; prior experience providing direct patient care in an orthotic and prosthetic facility with demonstrated skills, knowledge and abilities essential to the successful performance of duties in a patient care setting. Demonstrated excellent communication and team-building / interpersonal skills. Preferred qualifications: Knowledge of disease processes and associated orthotic / prosthetic intervention; familiarity with current treatment modalities, materials and fabrication techniques; ability to work efficiently. Medical benefits and pension plan are included. Salary will be commensurate to applicant’s qualifications and experience. Applicants should submit a letter of intent and CV to: Matthew Garibaldi C.P.O., Director, Orthotic and Prosthetic Centers 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. The University is an Equal Opportunity/Affirmative Action Employer. All qualified applicants are encouraged to apply, including minorities and women.
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O&P Almanac MARCH 2013
You want the certification exam process to be convenient.
we CARE.
With BOC you can take your O&P practical exam where you practice at a time that works for you. Karen Lawson, Accounts Receivable & Continuing Education Coordinator
877.776.2200
www.bocusa.org
S e p t e mb e r 1 8 - 2 1 , 2 0 1 3 O r l ando , F l o r i da , U S A G AY L O R D PA L M S R E S O R T & CONVENTION CENTER
Don’t miss the opportunity to participate in an expanded National Assembly in 2013 as AOPA and its international partners 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. health-care 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.
For more information, contact us at worldcongress@AOPAnet.org or visit www.opworldcongressusa.org.
World Congress Esteemed Planning Committee represents the brightest minds in O&P from around the world Africa Masse Niang, CPO Bogota, Colombia Jose Miguel Gomez, MD, LO China Aaron Leung, Ph.D. German Assoc. Rep. Bernhard Budaker, Dipl. Ing. Urs Schneider, Dr.-med. Germany/USA Reps Karen Lundquist, MBC Stephanie Olivo Karen Peters India Ritu Ghosh, BPO Italy Andrea Giovanni Cutti, Ph.D. Mexico Marlo Ortiz Vazquez del Mercado P.O Netherlands Klaas Postema, MD, Ph.D. Sweden Nerrolyn Ramstrand, Ph.D. US-ISPO Reps Jon Batzdorff, CPO Diane Farabi Robert Kistenberg, MHP, CPO USA Reps Lisa Arbogast David Boone, Ph.D., CP, Chairman Frank H. Bostock, CO, FAAOP Jim Campbell, Ph.D., CO Thomas DiBello, CO, LO, FAAOP Mark Geil, Ph.D. Thomas Kirk, Ph.D. Geza Kogler, Ph.D., CO Brad Mattear, CPA, CFo Michael Orendurff, Ph.D. Jack E. Ullendahl, CPO Jason Wening, MS, CPO, FAAOP Linda Wise
CALENDAR
YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations; candidates can apply and test when ready. Candidates can apply and test when ready, receiving their results instantly for the multiple-choice and clinicalsimulation exams. Apply now at http://my.bocusa.org. For more information, visit www. bocusa.org or email cert@ bocusa.org. ■
2013 ■ MARCH 4-5 AOPA: Essential Coding & Billing Seminar. Doubletree by Hilton at Atlanta Airport. Atlanta. To register, contact Stephen Custer at 571/4320876 or scuster@AOPAnet.org.
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March 9-10 ABC: Orthotic Clinical Patient Management (CPM) Exam, University of Texas Southwestern Medical Center, Dallas. The application deadline for this exam was Jan. 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■
March 11-16 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was Jan. 1, 2013. Contact 703/8367114, email info@abcop. org, or visit www.abcop.org/ certification. ■
PROMOTE Events in the O&P Almanac
CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Words
Member Rate
Nonmember Rate
25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$5.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email 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.
MARCH 13 AOPAversity Audio Conference–Contracting With the VA: Hints for Landing the Contract. For more information, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org. ■
■ 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. ■ March 15-16 ABC: Prosthetic Clinical Patient Management (CPM) Exam, University of Texas Southwestern Medical Center. Dallas. The application deadline for this exam was Jan. 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■ March 18 WillowWood: Alpha DESIGN® Liners. Mt. Sterling, OH. Half-day course teaches how to use OMEGA software files to create custom liners. Attendees can practice with all aspects of the software, including file import, liner creation, liner fabrication and Design liner options. Credits: TBD. Visit www. willowwoodco.com. ■ MARCH 19-21 WillowWood: OMEGA® Training. Mt. Sterling, OH. Course covers basic and advanced software tool use and shape capture with OMEGA Scanner. ‘By Measurement’ shape creation and custom liners discussed. Includes extensive hands-on practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: TBD. Visit www.willowwoodco.com.
■ MARCH 21-23 2013 Annual Meeting of the International AfricanAmerican Prosthetic Orthotic Coalition. Georgia Tech Hotel and Conference Center, Atlanta. Contact Tony Thaxton Jr. at 404/875-0066 or email thaxton.jr@comcast.net. Visit www.iaapoc.org for more information. ■ April 1 ABC: Practitioner Residency Completion Deadline for March Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114; email info@abcop.org; visit www. abcop.org/certification. ■ APRIL 8 WillowWood: LimbLogic® Practitioners. Mt. Sterling, OH. Course focuses all the clinical aspects of LimbLogic from operation to appropriate usage. Work with patient models and complete a fully operational LimbLogic socket to an initial dynamic fitting stage. Credits: TBD. Registration deadline was Feb. 8, 2013. Contact 877/665-5443. Visit www. willowwoodco.com. ■ APRIL 8-9 AOPA: Essential Coding & Billing Seminar. Hyatt Regency Columbus. Columbus, OH. To register, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■ APRIL 9 WillowWood: LimbLogic® Technicians. Mt. Sterling, OH. The course focuses on elevated vacuum socket fabrication. Includes basic operation and hands-on fabrication of LimbLogic adapters. Work with patient models and fabricate a LimbLogic socket. Credits: TBD. Registration deadline was Feb. 8, 2013. Contact 877/665-5443 or visit www. willowwoodco.com.
MARCH 2013 O&P Almanac
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CALENDAR
■ APRIL 10 AOPAversity Audio Conference–Handling Adversity: Coping With Difficult Patients. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■ MAY 8 AOPAversity Audio Conference–Navigate the Maze: Get to Know the Appeals Process. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■ APRIL 16 WillowWood: Intro to OMEGA®, via WebEx, 1:30PM ET. Potential CAD users have opportunity to investigate OMEGA and find out how the system benefits a growing O&P practice. Credits: TBD. Visit www.willowwoodco.com.
■ May 13-18 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was March 1, 2013. Contact 703/836-7114, email info@abcop.org, or visit www. abcop.org/certification.
■ APRIL 18-19 New York State AAOP: Chapter Meeting. Albany Marriott. Albany, NY. For more information, visit www. nysaaop.org/. ■ May 1 ABC: Application Deadline for Certification and Clinical Patient Management (CPM) Exams. Applications must be received by May 1, 2013 for individuals seeking to take the July 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians or July/August CPM exams for orthotists and prosthetists. Contact 703/8367114, email info@abcop. org, or visit www.abcop.org/ certification. ■ MAY 3-4 2013 Northwest Continuing Education Conference. Hilton Hotel, Bellevue, WA. Visit www.nwaaop.org for more information or contact Julie at 206/948-6239.
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O&P Almanac MARCH 2013
■ MAY 16-18 PA Chapter AAOP Spring Conference. Sheraton Station Square Hotel. Pittsburgh. Contact Beth Cornelius at 814/455-5383 or Joseph Carter Jr. at 814/455-5383. ■ MAY 16-18 Western Mid-Western Orthotics and Prosthetic Association. WAMOPA Annual Meeting. Peppermill Resort & Casino. Reno, NV. 24 CEU Credits with the best value in our industry. Visit www.wamopa.com for program and golf tournament updates, or call Steve Colwell at 206/440-1811. ■ June 1 ABC: Practitioner Residency Completion Deadline for March Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/8367114, email info@abcop.org, visit www.abcop.org/certification.
JUNE 12 AOPAversity Audio Conference–Clinical Documentation: The Dos & Don’ts. For more information, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org. ■
■ JUNE 13-14 AOPA: Essential Coding & Billing Seminar. Renaissance Phoenix Downtown Hotel. Phoenix. To register, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■ JULY 1 ABC: Application Deadline for Certification Exams. Applications must be received by July 1, 2013, for individuals seeking to take the September 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■ JULY 8-13 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams is May 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification.
■ JULY 10 AOPAversity Audio Conference–Networking for the Future: Building Relationships With Your Referrals. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■ JULY 26-27 ABC: Orthotic Clinical Patient Management (CPM) Exam. Georgia Institute of Technology, Atlanta. The application deadline for this exam is May 1, 2013. Contact 703/836-7114, email info@abcop.org, or visit www.abcop.org/certification. ■ AUGUST 1 ABC: Practitioner Residency Completion Deadline for September Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703-836/7114, email info@abcop.org, or visit www. abcop.org/certification. ■ AUGUST 2-3 Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. Grand Hyatt on the Riverwalk, San Antonio. Contact Katie Brinkley at 940/243-4198, email secretarytreasurer@txaaop.org, or visit www.txaaop.org. ■ AUGUST 2-3 ABC: Prosthetic Clinical Patient Management (CPM) Exam. Georgia Institute of Technology, Atlanta. The application deadline for this exam is May 1, 2013. Contact 703/836-7114, email info@ abcop.org, visit www.abcop.org/ certification.
CALENDAR
August 14 AOPAversity Audio Conference–Don’t Get Stuck With the Bill: Medicare Inpatient Billing. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org. ■
■ SEPTEMBER 11 AOPAversity Audio Conference–Read Between the Lines: The Medicare Lower Limb Prosthetic Policy. For more information, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.
September 18-21 O&P World Congress. Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org. ■
OCTOBER 9 AOPAversity Audio Conference–What’s the Word: A Health-Care Reform Update and What You Can Expect. For more information, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org. ■
■ DECember 11 AOPAversity Audio Conference–What’s on the Horizon: New Codes for 2014. For more information, contact Stephen Custer at 571/431-0876 or scuster@ AOPAnet.org.
2014
■ OCTOBER 22-23 AOPA: Essential Coding & Billing Seminar. Mirage Hotel & Casino, Las Vegas. To register, contact Stephen Custer at 571/431-0876 or scuster@AOPAnet.org.
■ November 13 AOPAversity Audio Conference– Advocacy: A Potent Weapon for Change. For more information, contact Stephen Custer at 571/4310876 or scuster@AOPAnet.org.
■ AUGUST 6-9 CAPO Conference. World Trade & Convention Centre. Marriott Halifax Harbourfront. Halifax, Nova Scotia. Visit www. prostheticsandorthotics.ca/ for more information. ■ 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 ■ 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 SEPTEMBER 15-18 99th AOPA National Assembly. Orlando, FL. Gaylord Palms Resort. For more information, contact AOPA Headquarters at 571/431-0876 or info@ AOPAnet.org. a
AD INDEX Company
Page
Phone
Website
ALPS American Board for Certification in Orthotics, Prosthetics & Pedorthics Becker Orthopedic BOC International DAW Industries Dr. Comfort Ferrier Coupler Inc. FLO-TECH® O & P Systems, Inc. Hersco Ortho Labs KISS Technologies LLC Motion Control Orthotic and Prosthetic Study and Review Guide Össur® Americas Inc. Otto Bock HealthCare PEL Supply
9, C4
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17 703/836-7114 13 800/521-2192 43 877/776-2200 1, 39 800/252-2828 5, C3 800/556-5572 27 800/437-8597 31 1-800/356-8324(FLO-TECH) 11 800/301-8275 15 410/663-5477 2 888/696-2767
www.abcop.org www.beckerorthopedic.com www.bocinternational.org www.daw-usa.com www.drcomfortdpm.com www.ferrier.coupler.com www.1800flo-tech.com/ www.hersco.com www.kiss-suspension.com www.utaharm.com
31 7 C2 23
www.oandpstudyguide.com www.ossur.com www.ottobockus.com www.pelsupply.com
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MARCH 2013 O&P Almanac
47
AOPA Answers
Billing, Benefits, and Beyond Answers to your questions regarding SNF Part A stays, and more
AOPA
receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.
Q.
Is there a way to receive prior approval from Medicare before we deliver an item?
A.
The answer is yes and no. There is a Medicare program, Advanced Determination of Medicare Coverage (ADMC), which allows a supplier/provider or a beneficiary to request prior approval of items. However, this program is only available for select codes (items), and at this time it doesn’t include any orthotic or prosthetic codes.
Q.
Have the rules for billing prosthetic items to a patient in a skilled nursing facility (SNF) Part A stay changed?
A.
No, the SNF consolidated billing rules have not changed. Most prosthetic codes are still exempt from the SNF Prospective Payment System (PPS), or consolidated billing, and should be billed to Medicare. However, it is important to note that not all prosthetic codes are exempt from the SNF PPS, and these codes must be billed to the SNF, if the patient is in a Part A stay. The L5987 is a prime example of one of these outlier codes. The other nonexempt codes include supply items such as socks and shrinkers, but also include the parts and labor codes (L7510 and L7520), codes for postsurgical application of rigid dressings (L5400– L5460), partial foot codes (L5000–L5020), and partial hand codes (L6000–L6020). To view a full list of exempt and nonexempt codes for a prosthetic patient in a Medicare Part A SNF stay, visit the AOPA website at www.AOPAnet.org and click on the Coding & Reimbursement tab.
48
O&P Almanac MARCH 2013
Q.
Can we bill a claim to both Medicare and the Veterans Administration (VA) if the patient is eligible to receive benefits from both?
A.
It is possible for a patient to be eligible to have coverage from both the VA and Medicare, and use both insurances for different aspects of their care. However, they must choose one of the agencies to handle their orthotic and prosthetic services, and they may not use both insurances at the same time. A claim can’t be submitted to both agencies for the same date of service and for the same items; this includes any potential balance billing. a
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