OP
The American Orthotic & Prosthetic Association SEPTEMBER 2013
&
WWW.AOPAnet.ORG
THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY
World VIEW Of
O&P
Global practitioners who donate their time to international charity efforts examine their work, challenges, and opportunities
Basics of HIPAA Compliance The Rules for Completing Medicare Orders
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The Power Couple: Your formula for success with Stance Control Characteristics of Successful SCO Candidates: • • • • •
Patients who demonstrate lack of knee stability in single limb stance Patients who no longer demonstrate safe gait with a ground reaction AFO Patients who require improved gait stability for occupational/environmental needs Patients with a history of stumbling, falling or fatigue who require stability to improve confidence KAFO patients who desire improved function
Call our Stance Control Coordinator, Lori Constanzo, to learn more. 800.521.2192 • 248.588.7480 BeckerOrthopedic.com
O&P SEPTEMBER 2013, VOLUME 62, No. 9
CONTENTS Cover Story
Photo: Charles Dankmeyer
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Those Who Can, Travel By Jill Culora Every year, several U.S.-based practitioners spend a week treating patients at a nonprofit O&P center in Mexico. Using donated components, they volunteer their time and expertise to equip needs-based patients with life-changing devices—and come home feeling grateful for the experience.
Feature
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HIPAA Compliance for the Small Health-Care Provider By Kimberly J. Kannensohn, Esq., and Amanda L. Enyeart, Esq. Has your facility implemented a HIPAA compliance program? Follow these four steps to ensure you’re ready for the September 23 deadline.
departments
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AOPA Contact Page How to reach staff
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At a Glance Statistics and O&P data
08 COLUMNS
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53 Marketplace 56 Jobs
Opportunities for O&P professionals
In the News Research, updates, and company announcements
58 Calendar
AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more
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Ad Index
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AOPA Answers Expert answers to your FAQs
Reimbursement Page Control error rates when submitting Medicare orders
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Ask the Expert Where do your dollars go when you contribute to AOPA programs?
52 AOPA Membership 00 Applications
Upcoming meetings and events
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.
SEPTEMBER 2013 O&P Almanac
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AOPA IN THE Contact NEWS INFORMATION AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org EXECUTIVE OFFICES
MEMBERSHIP & Meetings
BOARD oF DIRECTORS
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org
Officers
directors
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org
Jeff Collins, CPA, Cascade Orthopedic Supply Inc., Chico, CA
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 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, 571/431-0810, 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 Kyle O’Connor, publication intern/ contributing writer, 703/914-9200 x32, koconnor@strattonpublishing.com
Stephen Custer, communications manager, 571/431-0810, scuster@AOPAnet.org Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, landerson@AOPAnet.org Betty Leppin, Project Manager, 571/431-0876, bleppin@AOPAnet.org AOPA Bookstore: 571/431-0865 Government affairs Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@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 Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX
Mike Hamontree, Hamontree Associates, Newport Beach, CA Dave McGill, Össur Americas, Foothill Ranch, CA Ronald Manganiello, New England Orthotics & Prosthetics Systems LLC, Branford, CT Eileen Levis, Orthologix, LLC, Trevose, PA
Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO
Michael Oros, CPO, Scheck and Siress O&P Inc., Oakbrook Terrace, IL
Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA
Kel Bergmann, CPO, SCOPe Orthotics & Prosthetics Inc., San Diego, CA Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA
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
Scott Schneider, Ottobock, Minneapolis, MN
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 SEPTEMBER 2013
AWARD WINNING
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AT IN THE A GLANCE NEWS
HIPAA Complaints Through the Years The Health Insurance Portability and Accountability Act (HIPAA) was put in place to protect the privacy of patient information. As of April 14, 2003, all covered entities—health plans, health-care providers such as O&P professionals, and health-care clearing houses—were required to comply with the Privacy Rule. The Office for Civil Rights is responsible for handling all HIPAA privacy complaints.
Privacy Rule Complaints on the Rise Two thirds of the total cases investigated resulted in corrective action:
Total HIPAA privacy complaints per calendar year: 2003
(Partial Year)
3,742
2004
6,543
2005
34%
6,866
2006 No violation: 9,548
Corrective actions obtained (change achieved): 20,674
7,362
2007
8,221
2008
8,730
2009
66%
7,587
2010
8,764
2011
9,028
2012
10,443
Source: www.hhs.gov/ocr/privacy/hipaa/enforcement.
92%
Percentage of complaints the Department of Health and Human Services has resolved since April 14, 2003.
No. 1
Ranking of health-care private practices among type of entities that have been required to take corrective action to achieve voluntary compliance— followed by general hospitals and outpatient facilities.
$11,000 180 Amount of civil money penalty, per violation, the Office of Civil Rights may impose.
915,000 Estimated number of patients affected by small breach reports between September 2009 and July 2013.
days
81,000 Estimated number of small breaches (affecting fewer than 500 patients) that took place between September 2009 and July 2013.
Sources: www.hhs.gov/ocr/privacy/hipaa/enforcement, www.melamedia.com/HIPAA.Stats.home.html.
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O&P Almanac SEPTEMBER 2013
Time period during which a complaint must be filed after knowledge that a violation has taken place.
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IN THE NEWS
New Portable Device Could Improve Socket Comfort
Left Photo: Mary Levin, University of Washington. Right Photo: Joan Sanders, University of Washington.
Researchers at the University of Washington have developed a portable circuit board that tracks how much a person’s residual limb shrinks and swells when inside a prosthetic socket. This research project is funded by a four-year, $2.6 million grant from the U.S. Department of Defense. The circuit board measures fluid increase and decrease in a patient’s limb through data it obtains wirelessly from electrodes placed in various spots on the leg approximately 15 times per second. The testing routine involves a series of 90-second exercises including sitting, standing, and walking. Over the past two years, the researchers have tested large, bulky prototypes, but this checkbook-sized circuit board and its electronic components fit into a waist pack worn by the patient. Researchers would eventually like to develop an even smaller circuit board capable of long-term usage, and hope this breakthrough device will inspire the creation of more comfortable sockets. The device fits in a fanny pack and thin wires feed data from electrodes into the device.
Scientists Create Sensor Capable of Replicating Sense of Touch Scientists at the Technion-Israel Institute of Technology have created a sensor capable of detecting simultaneous changes in touch, temperature, and humidity. This technology could potentially lead to a breakthrough in which an artificial “skin” composed of the sensors attaches to prosthetic limbs, creating some semblance of a sense of touch. The scientists created the sensors by combining flexible polyethylene terephthalate (PET)—the same plastic used in soda bottles—and gold nanoparticles. The combination of these sensors forms an ultrasensitive film that changes conductivity as it is bent and
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O&P Almanac SEPTEMBER 2013
is an extremely sensitive measure of physical force—the sensor’s sensitivity is 10 times greater than current models. The durability of the PET plastic ensures that the film is able to withstand many bending cycles, making it ideal for patient usage. The film has the potential to be a multi-functional application because it can operate at low voltages and is relatively inexpensive to produce.
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IN THE NEWS
Cost Savings of O&P Underscored in Groundbreaking Report Patients who receive orthotic and prosthetic services generally experience greater independence, better or comparable health outcomes, and lower Medicare payments than those patients who do not, according to a new study, “Retrospective Cohort Study of the Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries.” The study, commissioned by the Amputee Coalition and funded by AOPA, was conducted by Allen Dobson, PhD, health economist and president of Dobson DaVanzo. Dobson, who also authored the report, formerly served as senior vice president of The Lewin Group and director in the office of research at the Centers for Medicare and Medicaid Services (CMS), then called the Health Care Financing Administration.
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Calling the study “a clear win for patients and taxpayers,” AOPA President Thomas F. Kirk, PhD, says the targeted use of O&P services and physical therapy with patients leads to fewer emergency room and acute care hospital admissions. “This reduction in health-care utilization ultimately makes O&P services cost-effective for the Medicare program and increases the quality of life and independence of the patient.” The retrospective study explores the financial benefits of O&P interventions to both the government and American taxpayers. Using data sets provided by CMS, researchers analyzed 42,000 claims filed between 2007 and 2010 of patients who either received full prosthetic and orthotic care or did not receive such care. All
Thank You!
AOPA would like to send a special thank you to Tamarack Habilitation Inc. (Booth #827) and Cascade DAFO (#1631) for contributing to the O&P World Congress Travel & Scholarship Program. With their help we were able to provide travel support for individuals who otherwise would not be able to share their significant research or attend the show.
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O&P Almanac SEPTEMBER 2013
study participants were required to have received lower-extremity orthoses, spinal orthoses, or lower-extremity prostheses and to have a specified etiological diagnosis. When compared with those who did not receive O&P care, the study finds that patients who received lowerextremity orthoses experienced fewer falls and fractures, fewer hospital trips, and had 10 percent lower Medicare episode payments. Patients who received spinal orthoses not only had Medicare episode payments that were $93 lower, but also had a higher rate of ambulatory and home-based care. Those who received lower-extremity prostheses had 1 percent higher Medicare payments, but experienced improved quality of life, increased independence, and the likelihood of more home-based care. The findings were presented in a webinar jointly hosted by AOPA and the Amputee Coalition, August 27, which garnered interest and involvement from top media outlets, including NBC News, Kaiser Health News, Scripps Howard News Service, National Public Radio, and others. The full report is available online at www. amputee-coalition.org.
IN THE NEWS
Providers React to Recoupment of Payments for the Incarcerated There has been a flurry of activity regarding Medicare recoupment of payments made to providers on behalf of patients who were incarcerated on the date of service. Several AOPA members have reported recoupments they believe were made in error, as they do not believe the patient was incarcerated when services were provided. Each of the Durable Medical Equipment Medicare Administrative Contractors has provided guidance regarding what to do when there is a discrepancy regarding a patient’s incarceration status on a particular date of service. If the Medicare recipient failed to notify the Social Security Administration (SSA) of his or her release from custody, the recipient may resolve the situation by notifying the local SSA office and requesting a record update. Once this is complete, the claim should be reprocessed through the regular appeals process. If the provider and recipient contend that the recipient was not incarcerated on the date of service and believe that SSA records are correct, providers should contact their Centers for Medicare and Medicaid Services regional office to resolve the discrepancy. Questions regarding this issue may be directed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.
TRANSITIONS
people in the news
Nick Ackerman, CP, has been named director of prosthetics at American Prosthetics & Orthotics’s Des Moines office. Michael Burton has been named general manager for Aqualeg Inc. in Rock Hill, South Carolina. Pat Cannon has been named director of facility accreditation for the American Board for Certification in Orthotics, Prosthetics, and Pedorthics Inc. The University of Michigan Residency Program has welcomed four individuals into its residency program: Kimberly Gorbutt, Timothy Kunz, Rebecca Patterson, and Lesley Witt.
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O&P Almanac SEPTEMBER 2013
Matt Perkins has been promoted to president and chief executive officer of Coyote Design. Joe Hofmeister has been named Tamarack Habilitation’s chief operating officer. AOPA’s Kelly O’Neill has earned the Certified in Exhibition Management (CEM) credential from the International Association of Exhibits and Events. Michael A. Sotak is the new president and chief executive officer at PEL.
IN MEMORIAM Robert J. Baughman, a former vice president for government relations at AOPA (1979-1989), passed away on July 11. Baughman served three years in the U.S. Army, stationed primarily in Germany. He worked on Capitol Hill with several members of Congress and served as director of government relations for various Washingtonbased organizations.
SEPTEMBER 18-21, 2013
O R L A N D O, F LO R I DA , U S A
G AY L O R D PA L M S R E S O R T & C O N V E N T I O N C E N T E R
Visit us at AOPA 2013 O&P World Congress
BOOTH 1214
IN THE NEWS
CMS Solicits Feedback on Lower-Limb Prosthesis Physician Electronic Clinical Template
Jurisdiction A DME MAC Publishes Custom Addition Codes Reminder
The Centers for Medicare and Medicaid Services (CMS) held its second open door forum call to solicit feedback regarding data elements that should be included in the proposed lower-limb prosthesis electronic template for physicians to use in documenting and determining the medical need for prostheses. Moderators included Melanie Combs-Dyer and Michael Handrigan, MD, of CMS; Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Director Stacey Brennan, MD; and Jurisdiction A DME MAC Medical Director Paul Hughes, MD. AOPA was represented on the call, both by members and staff, and had an opportunity to provide comments regarding the lack of accountability for physicians who do not provide adequate documentation to support the medical need for prostheses they prescribe. The moderators did not directly answer the question but stated that this issue was addressed by statute and that CMS’s only choice is to pay or not pay the claim. Other issues discussed during the call were the role of physician documentation, the acceptability of therapist notes as part of the medical record, and requirements of prescribing physicians for functional level assessment.
The Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC) has published an article reminding O&P providers that addition codes that are designated for use with custom-fabricated orthoses only may not be used to describe additions to prefabricated orthoses. Jurisdiction A published this article as a result of claim reviews that identified patterns of billing for custom addition codes with prefabricated base codes. These three orthotic addition codes that are specifically designated for use with customfabricated orthoses only: • L2755—“Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only.” • L2861—“Addition to lowerextremity joint, knee, or ankle, concentric adjustable torsion style mechanism for custom fabricated orthosis only, each.” • L3891—“Addition to upperextremity joint, wrist, or elbow, concentric adjustable torsionstyle mechanism for custom fabricated orthosis only, each.”
TRANSITIONS
BUSINESSES in the news
Aqualeg Inc. has opened its first U.S.-based office, located in Rock Hill, South Carolina. College Park Industries is celebrating its 25-year anniversary. The International Paralympic Committee (IPC) and The London Marathon Ltd. have announced a four-year contract extension for the IPC Marathon World Cup. OPAF will introduce First Fit, the newest addition to the OPAF family of clinics, on September 21 during the O&P World Congress as part of Limb Loss Education Day.
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O&P Almanac SEPTEMBER 2013
PROTEOR marks its 100-year anniversary during the O&P World Congress, and will celebrate with a happy hour on Thursday, September 19, 5:30-6:30 p.m. at Booth 630. Therafirm, a Knit-Rite company, has relocated its textile manufacturing facility to Hamlet, North Carolina. Willow Wood is a 2013 Gold-Level Sponsor for OPAF & The First Clinics.
The submission of any of these three codes in conjunction with a prefabricated base code is not allowed under Medicare policy and will be denied by the DME MACs. a
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Reimbursement Page By Devon Bernard, AOPA government affairs department
The Rules for Proper Completion of Medicare Orders Avoid claim denials and high error rates with this review of current policies
E
veryone is aware of the Medicare prepayment reviews taking place throughout all the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) jurisdictions, and most everyone is aware that Medicare is reporting high error rates on all these pre-payment reviews. Some of the causes for these high error rates—such as physician documentation—are beyond the control of the facility providing care. But some of the reasons for the error rates, three in particular, are within the control of the facility. For example, the results of a recent Jurisdiction D DME MAC prepayment review for spinal orthoses L0631 and L0637 indicated that 26 percent of claims denied—contributing to an almost 83 percent error rate—were because people didn’t respond to the request for information. This means that the facility did not send in any information to support the provision of the L0631 or L0637. So, if you receive an additional documentation request from any entity, be sure to respond; failure to respond will result in an automatic denial. O&P providers also can control error rates by completing a valid proof of delivery for every item they provide. In the last Jurisdiction A DME MAC prepayment review for lower-limb prostheses, 15 percent of the denied claims were due to providers not providing a proof of delivery or providing an incomplete proof of delivery. These recent results showed a 62 percent overall error rate—the lowest to date and a 28 percent decline since the reviews began in 2012. If this overall rate dropped by an additional 15 percent, the rate might have been low enough to end the prepayment reviews for lower-limb prostheses.
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O&P Almanac SEPTEMBER 2013
Finally, providers can control error rates by producing proper, valid, and complete orders/ prescriptions. For example, the first results of the Jurisdiction D DME MAC prepayment review for AFOs L4360, L1970, and L1960 indicated that 54 percent of all the denials were due to missing or invalid orders/prescriptions. It’s clear that we all could benefit from a review of the rules regarding Medicare orders.
Determining Eligibility Before we discuss what constitutes valid orders for Medicare, let’s quickly review who, other than doctors, is eligible to sign prescriptions/orders for O&P services and items under the Medicare program. Nurse practitioners may write and sign Medicare orders for O&P items and services as long as they
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meet the following criteria: They are treating the patients for the condition for which the item is ordered; they are practicing separately from a physician or not directly under a physician’s supervision; they have their own NPI number and use that number to bill Medicare for other covered services; and they are allowed to practice in the state where the items/services are being ordered. Physician assistants also may write and sign Medicare orders for O&P items and services as long as they meet the following criteria: They are treating the patients for the condition for which the item is ordered; they are practicing under the direct supervision of a doctor; they have their own NPI number; and they are allowed to practice in the state were the items/ services are being ordered. With the clarification of who is MEMBER VALUE GUIDE eligible to write and/or sign a valid www.AOPAnet.org order for Medicare, let’s look at the key components of the dispensing order and the detailed written order (DWO). AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)
O&P providers also can control error rates by completing a valid proof of delivery for every item they provide.
The Dispensing Order The dispensing order, treating order, verbal order, or initial order—whatever you choose to call it—has the same purpose and function. This order is your permission slip, allowing you to see a patient, treat a patient, and deliver an item/service to a patient. However, the dispensing order does have some
Member Benefits
Reimbursement Page
limits. The dispensing order cannot be used, in most cases, to bill for an item or service. So what exactly constitutes a dispensing order? The dispensing order may be verbal, like a physician calling you on the phone or grabbing you in the hospital halls, or it may be written on a prescription pad. The order also may be as simple as the physician stating or writing “knee brace.” Whatever form the dispensing order takes, it must contain five key elements to be considered valid for Medicare purposes. First, the order must contain the beneficiary’s name. Second, the dispensing order must contain a description of the item or items being ordered. This description doesn’t have to be thorough or detailed; it may be generic and basic in nature, for example just stating or writing “AFO” would be sufficient enough to meet Medicare standards. Third, the ordering/prescribing physician’s name must be recorded. Fourth, the dispensing order must contain the date.
O&P Board Study Resources We can help you PASS your BOARDS All products updated to 2013 test standards.
Experience the Benefits of AOPA Membership
•
•
Challenging RAC and CERT audit policies implemented this past year by overly aggressive CMS contractors is AOPA’s number one priority. All options are on the table to eliminate these burdensome and patient harming practices. Your Voice in Washington. AOPA’s staff and the lobbying team of former CMS Administrator, Tom Scully of the Alston & Bird law firm and Nick Littlefield, former chief of staff for Sen. Ted Kennedy and now a partner in the Foley Hoag law firm bring years of healthcare knowledge and experience to the issues of O&P. AOPA’s efforts help assure equitable reimbursement policies in these uncertain financial times to ensure quality patient care.
MISSION
Experience the Benefits of AOPA Membership
•
The mission of the American Orthotic and Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.
Making Your Voice Connect. AOPA’s Annual Policy Forum brings O&P leaders to Washington to receive high level briefings and to deliver the O&P story personally to their members of Congress.
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Cost Effectiveness Research. The changing climate of health care is moving to a patient driven process and is demanding more and more evidence of cost effectiveness to measure outcomes. AOPA has funded the first in a series of research projects that will measure the cost effectiveness of timely O&P treatment of patients with the same diagnoses as patients who did not receive treatment. More cost effectiveness research projects will be necessary and are simply too expensive for individual O&P businesses to undertake. AOPA can aggregate the resources of the field to conduct this vital research.
Membership in AOPA is one of the
best investments that you can make • Expert Reimbursement and Coding Guidance. AOPA’s reimbursement specialists provide coding advice and keep you up-to-date on the latest Medicare quality standards, billing rules and regulations. Answer all of your questions related to O&P coding, reimbursement and compliance—via telephone or email. Members have unlimited access to AOPA staff experts.
in the future of your company.
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Making Your Voice Stronger. The O&P Political Action Committee supports candidates who understand the unique contribution the O&P community makes to restoring lives E hope. E GUID and MEMBER VALU rg
www.AOPAnet.o
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n Orthotic services; audit of the America regulation and RAC and CERT year The mission Challenging business in laws, of the O&P ented this past to e treatment g skills; and policies implem ve CMS contracfor favorabl and marketin management by overly aggressi priority. ion. s improve their number one the associat to help member tors is AOPA’s to elimiindustry and on the table nding of the All options are ss and understa ome and patient raise awarene nate these burdens s. h. harming practice eness Researc Cost Effectiv • health AOPA’s of ton. t. g climate in Washing The changin driven • Your Voice lobbying team of former • Making Your Voice Connec to a patient Policy Forum care is moving more staff and the Scully of ton AOPA’s Annual is demanding strator, Tom process and leaders to Washingand to CMS Admini and Nick e of cost effective s brings O&P Bird law firm and more evidenc level briefing for the Alston & outcomes. AOPA chief of staff to receive high story personally to ness to measure series of Littlefield, formery and now a partner deliver the O&P Congress. the first in a has funded s of Sen. Ted Kenned law firm bring that will measure their member Hoag research projects ness of timely O&P and in the Foley Coding re knowledge rsement and the cost effective years of healthca issues of O&P. with the same • Expert Reimbu reimbursement the t of patients e AOPA’s treatmen e. did not experience to equitabl Guidanc patients who help assure coding advice effecdiagnoses as AOPA’s efforts the specialists provide t. More cost policies in these up-to-date on receive treatmen projects will be reimbursement l times to ensure s, and keep you e quality standard tiveness research simply too expenuncertain financia latest Medicar regulations. Answer are care. and necessary and al O&P businesses quality patient billing rules s related to te r. sive for individu all of your question sement and Voice Stronge AOPA can aggrega tee reimbur to undertake. • Making Your to conduct email. Action Commit O&P coding, s of the field telephone or The O&P Politicaltes who understand the resource to compliance—via . unlimited access supports candida tion the O&P this vital research Members have the unique contributo restoring lives AOPA staff experts. makes community and hope.
MIS SIO N
•
2013 AOPA Annual Membership enrollment is now open. Call 571/431-0876 to request an application form, or visit www.AOPAnet.org.
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How Medicare Auditors Analyze Signature Requirements
Signature Requirement
Met
Signature Requirement
NOT Met
Legible full signature
X
Legible first initial and last name
X
Illegible signature where the letterhead, addressograph, or other information on the page indicates the identity of the signator. Example: An illegible signature appears on a prescription. The letterhead of the prescription lists three physicians’ names. One of the names is circled.
X
Illegible signature over a typed or printed name
X
Illegible signature NOT over a typed/printed name and not on letterhead, but the submitted documentation is accompanied by:
X
X
Initials over a typed or printed name
X
Initials not over a typed/printed name but accompanied by:
X
X
Unsigned typed note with provider’s typed name
X
Unsigned typed note without providers typed/printed name
X
Unsigned handwritten note, the only entry on the page
X
Unsigned handwritten note where other entries on the same page in the same handwriting are legibly signed
X
“Signature on file”
X
Notation of electronic signature
X
1. 2.
a signature log, or an attestation statement
Illegible Signature NOT over a typed/ printed name, NOT on letterhead and the documentation is unaccompanied by:
1. 2.
1. 2.
a signature log, or an attestation statement
a signature log, or an attestation statement
Initials not over a typed/printed name unaccompanied by:
1. 2.
18
a signature log, or an attestation statement
O&P Almanac SEPTEMBER 2013
This may be the date that is provided by the ordering physician if the order is written or it may be the date you are contacted by the physician if the order is verbal. There also may be times when you will have to record a second date on the dispensing order and that is when the start date, or the time you first see and evaluate the patient, is different from the date you received the verbal order or the date provided on the written order. Finally, in order to be considered valid by Medicare, the dispensing order must contain a signature. This signature may be the ordering physician’s if the order was written or it may be the signature of the provider or supplier if the order was verbal. The key to dispensing orders is that if they are verbal you will want to make sure you are recording all the key components as it is easy to let this slide in your files. How long is the dispensing order valid or how long does the clinician have to see the patient and dispense an item or service? This is a question AOPA receives on a regular basis. However, there is no clear-cut answer. AOPA recommends that a three month or 90 day window is acceptable. You should obtain a new order for any order older than 90 days. The rationale for doing so is that you want to verify that there is still a medical necessity or need for the item because the patient’s condition could have changed or the ordering physician may have decided on a different course of treatment.
The Detailed Written Order The DWO is sometimes referred to as a letter of medical necessity (LMN) or a certificate of medical necessity (CMN), however these terms should not be used interchangeably in order to avoid confusion. An LMN usually is a letter written by a physician to outline and support the medical necessity of an item/service or is written by a supplier or provider and signed by the physician. The LMN is not a required document by Medicare and typically doesn’t have all the
n
components of a DWO. The CMN, on the other hand, is an official Medicare document and is not required for O&P items or services. The DWO allows you to bill Medicare for the items or services you provided and must be completed properly and be on file before you submit any claim to Medicare. The ordering physician doesn’t have to create the DWO, you may create the DWO, however the ordering physician must review the DWO and agree with the item or services being provided. Also, as with the initial order, the DWO has five features that must be present in order for it to be considered valid by Medicare. The first and second elements that must be present on a DWO are the names of the patient and the ordering physician. Third, you must include the date of the order, and this has the same rules as the dispensing order. So you would include the date you were contacted by the physician and the date you started treating the patient if this date is different than the date you were contacted by the physician. Policy clearly states that a DWO is not considered part of the official medical record and thus, by itself, doesn’t prove or demonstrate medical necessity. Therefore, it is not required to put such things as the ICD-9 diagnosis code or any other information that may demonstrate compliance with coverage criteria on the DWO. However, if you decide to include this type of information, your DWO will still be considered valid. The fourth element of a valid Medicare DWO is the description of the items or services you are providing and intend to bill and, unlike the dispensing order, the information you provide must be detailed in nature, including the quantities of items being provided. This detailed description can be accomplished using one of three techniques. First, and the most straightforward, is to simply list the name, manufacturer, and model number of the item you are providing.
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Reimbursement Page
This technique, while simple, is not always effective, especially when you are providing custom fabricated items. If you are providing and billing for custom items, techniques two and three may be a better fit. Technique two is to provide a narrative description of the item(s) you are providing, and technique three is to list out all the Healthcare Common Procedure Coding System codes and their descriptors. Whichever technique you employ, make sure that all the unique features or components you are billing for on individual claim lines have been accounted for and included on the DWO.
When completing the descriptive part of the DWO, be sure to account for any supplies that you may have to replace or provide to the patient on a regular basis. If you have any of these types of items on your DWO, you must include not only the quantity originally dispensed but also how often you plan to replace them for the patient. When describing your replacement plan for supply items be as specific as possible. The last component of a valid written order is the inclusion of the ordering physician’s signature and the date he or she signed the DWO. For Medicare purposes, a valid signature must be legible or able to be authenticated and can be both electronic or traditional pen and ink.
20
O&P Almanac SEPTEMBER 2013
Signature Criteria What is legible or illegible may be a matter of opinion and is at the discretion of the auditor reviewing your claim, but there are things you can do to ensure that you meet the established signature criteria and avoid a denial. See the table on page 18 for a breakdown of what auditors are reviewing to determine if signature criteria has been met. If the signature criteria is not met and the signature is deemed illegible and that is the only reason for a possible denial, the auditor should not automatically deny your claim, but should instead provide you with a chance to authenticate the signature. The signature can be authenticated using a signature log, a pre-filled out document that lists the typed name of the signee associated with the illegible signature, or an attestation statement. Medicare has not released official rules on what constitutes a valid electronic signature, however it has released some guidelines. Medicare recommends that whatever format the electronic signature takes it also should be accompanied by a statement showing that the signature was provided electronically. Some examples of these accompanying statements include but are not limited to: electronically signed by, completed by, or validated by. Once the final DWO has been completed, signed, and dated, that order is considered valid for the lifetime of the item delivered. This means that any replenishment of supplies, repairs, adjustments, or replacement of minor parts is covered under the order and would not need a new order/prescription. The only time you would need a new set (dispensing and detailed) of prescriptions is if you are replacing the current orthoses/prostheses the patient owns or you are providing new orthoses/prostheses due to change in the patient’s condition. If you are replacing a major component of the prostheses/orthoses, a new set of orders also would be required.
Once the final DWO has been completed, signed, and dated, that order is considered valid for the lifetime of the item delivered. Final Considerations Is it required that you have both a dispensing order and a DWO on file? Medicare will not cover any O&P items or related services if only a dispensing order is on file at the time the claim is submitted for payment, indicating that a DWO also is required. However, if the dispensing order meets all the requirements of a DWO written order, then a separate DWO is not required and you may bill with just the initial order. If for any reason you realize you don’t have a DWO on file or have an invalid DWO on file at the time of claim submission, you may consider submitting the claim with the EY modifier. The EY modifier signifies that you don’t have an order on file for the items you are providing. The EY modifier will result in a claim denial based on medical necessity, and a medical necessity denial will allow you to appeal the claim and demonstrate medical necessity. For more information on initial orders and detailed written orders, be sure to read your supplier manuals, and Medicare’s Program Integrity Manual (chapter 5, section 2), or contact AOPA. For specific information on when an order is required, review the Medicare medical policies for the items or services you are providing. a Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.
The California® Catalina™ Orthosis is easy-to-fit and simple for the patient to don and doff. The orthosis limits motion and provides effective compression for the relief of lower back pain — making it ideal throughout rehabilitation. The Catalina 631 and 637 both deliver effective compression to the region of pain localizing the patient’s therapy while maintaining comfort for the patient. The Catalina 637 also contains rigid side panels which provide additional lateral support. The lightweight and low profile design of the Catalina product line allows for individuals to continue normal daily activities without impingement and interference from the orthosis. Indications •
Post-operative laproscopic disk replacement
•
Post-operative IDET procedures (Intradiscal Electrothermal Annuloplasty)
•
Post-operative lumbar laminectomy
•
Post-operative spinal fusion
•
Chronic low back pain
•
Mechanical back pain with activities of daily living
•
When spinal control of extension and flexion is desired/required
PDAC Coded L0631 & L0637 Size
Fits Waists
CA Catalina 631 CA Catalina 637
XS-SM
22"-30"
3386.631.01
3386.637.01
MD
30"-38"
3386.631.02
3386.637.02
LG
38"-46"
3386.631.03
3386.637.03
XL/2X
46"-54"
3386.631.04
3386.637.04
3X/4X
54"-62"
3386.631.05
3386.637.05
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Those Who Can,
Travel How O&P professionals from the United States provide care in Mexico
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O&P Almanac SEPTEMBER 2013
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COVER STORY
Pho
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Top and bottom: Range of Motion Project volunteers work with patients. Center: A volunteer with Phoenix Rising for Haiti fits a patient.
ir ticket purchased? – Done. Vacation form approved? – Done. Bags packed to the maximum capacity with an assortment of prosthetic and orthotic components and devices? – Done. This may not be your typical vacation checklist, but for a small group of prosthetists and orthotists who regularly travel to Queretaro, Mexico, for a week-long medical mission, it’s their norm. “I tell people it’s refreshment to your soul,” says Jim Hughes, CP, LP, president and primary owner of Atlanta Prosthetics and Orthotics, Inc. “As a clinician, we get so tied up in money—what our patients have to pay or if they can pay or if the insurance is going to pay. And it’s just fun to go somewhere and take care of people where money is not involved in the picture—it’s just pure care.” Hughes is among a team of volunteer prosthetists who make regular pilgrimages to CRIMAL—Centro para la Rehabilitacion Integral de Minusvalidos del Aparato Locomotor (Center for the Full Rehabilitation of the Disabled with Devices for Walking)—which earlier this year celebrated its 20th anniversary as a brick-and-mortar non-profit orthotic and prosthetic center. In its early years, CRIMAL treated patients in a temporary space in the wake of Mexico City’s major 1985 earthquake, which killed 40,000 and injured 9,600, many of whom became amputees.
SEPTEMBER 2013 O&P Almanac
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“The patients are the most grateful patients. It’s a great way to use our talents.”
Photos: Charles Dankmeyer
––Jeff Lutz, CPO
Charles Dankmeyer, CPO, often brings Baltimore Orioles gear for the patients, families, and crew. Volunteers in CRIMAL’s fabrication area.
Back then, Junior Odom, CP(E), Lexington, Kentucky, was among a group of 12 U.S. volunteer prosthetists, led by the late Roy Snelson, CPO(E), in coordination with the Liga International—the League of Flying Doctors—who treated 96 amputees during its first medical mission to the area. One of those patients was a bilateral transtibial orphan boy named Alverez. Treating this child had a profound impact on Odom, and he was moved to start a clinic in Mexico, teaming up with Mexico’s first and only ABC-certified CPO, FAAOP, Arturo Vasquez-Vela, and his brother, Eduardo Vasquez-Vela, an orthopedic surgeon, who also is a former secretary of Health, Civil Society, and Prevention of Accidents. In the immediate years that followed, Romulo O’Farril, Jr., a businessman, and the governor of Queretaro donated land and money to build the CRIMAL clinic, which opened in 1993. 24
O&P Almanac SEPTEMBER 2013
Grateful Patients, Skilled Volunteers Over the past 27 years, CRIMAL’s 75 volunteer prosthetists have fitted more than 2,500 needs-based patients, many of whom travel great distances in rural Mexico to reach the clinic. Today, most of the center’s patients are congenital or trauma cases from farming accidents. Patients are scheduled in advance of the quarterly week-long trips, where each volunteer practitioner treats 10 to 12 patients in five days. “It’s a very busy pace that’s necessary in order to accomplish things in these circumstances because you need to have the hand skills and the ability to do assessments quickly, be able to build, make your own molds, do most of your own fabrication, and these things need to be done within a short time frame,” says Charles Dankmeyer, CPO, CEO of Dankmeyer Inc., Linthicum Heights, Maryland, and vice president of AOPA.
On the sixth day of the mission, the clinic provides an educational symposium for local physicians. The clinic, which in earlier years functioned from a small, second floor apartment requiring patients to be carried up the stairs, today is a full-fledged center that has treatment space and gait labs, and also offers physical and occupation therapy. “The patients are the most grateful patients. It’s a great way to use our talents,” says Jeff Lutz, CPO, central zone vice president, Hanger Clinic, Lafayette, Louisiana. “The patients come in with great hopes and no prosthesis, and they leave with a prosthesis, and down there it makes a difference between being able to make a living or not being able to take care of their families.” Participating practitioners pay for their own airfare and volunteer their time, which sometimes means using up vacation days. All of the materials and components are donated.
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Most are used parts and devices for which there is no market in the United States. The team members hand carry supplies in their baggage because shipping used components is difficult. “Customs can be a real problem because they don’t know what these components are, and they are concerned it might be something that we are trying to make money from,” says John (Mo) Kenney, CPO, FAAOP, Kenney Orthopedics LLC, Lexington, Kentucky. “But via the airline, we just tell them it’s for a medical mission, and it’s for disabled children and adults in their country, and most of the time this helps.” Kenney says he imagines most clinics around the country would have a stockpile of used components—from patients who acquired new prostheses, a medical condition that required a different type of prosthesis, or a geriatric patient who passed away. “A family or amputee that donates a $5,000 knee has a much bigger impact than a $500 donation,” he says. Knowing in advance what type of patients they will see enables the practitioners to plan what type of components to bring. Sometimes a specific part isn’t available used, so manufacturers are contacted. “If it’s a complicated upper extremity, there aren’t used parts available, so the manufacturers have donated parts, and we are so thankful,” says Lutz. Other times, components are purchased at a deep discount, as was the case for Hughes, who funded and built a myoelectric arm for a teenaged girl who lost her arm in a lion attack at a zoo.
Charities Affecting Lives—and How You Can Help Disaster and need motivate global O&P charitable efforts
Cooperative Orthotic and Prosthetic Enterprise (COPE) Lao People’s Democratic Republic (PDR) Established: 1997
Centro de Miembros Artificiales Bolivia Established: January 2011 Mission: Provide new prosthetics devices to any and all low-income Bolivian amputees in need. Using designs from various international organizations and Bolivian technicians as well as materials created, this selfsustaining center produces high-quality prostheses. The center is fully supported and operated by the Rotary club La Paz San Pedro in La Paz, Bolivia. Why: The center fills a real need in the country. “Government sends their patients to us,” says founder Matthew Pepe. Need: Prosthetic-specific machines, durable and inexpensive foot design, technician training, and basic materials and accessories. Achievement: 100 walking amputees in less than 2.5 years.
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O&P Almanac SEPTEMBER 2013
Mission: Locally run, non-profit COPE works within the existing Government of Lao PDR infrastructure to provide access to physical rehabilitation services for people with disabilities and survivors of cluster munitions, including access to orthopedic and prosthetic devices, physiotherapy, and occupational therapy. Its goal is to support the evolution and development of the O&P sector in Laos. Why: COPE, in partnership with the Ministry of Health’s Center for Medical Rehabilitation (CMR), is currently the only provider of prosthetic, orthotic, and rehabilitation services in Laos. Need: Funding to help COPE train CMR staff, materials, and supplies and to fund outreach programs in rural areas. Achievement: COPE supplies patients access to more than 1,200 prosthetic devices every year.
Glencoe Foundation– support for Walk for Life Clubfoot Program Bangladesh Established: 2003
The FOOT Foundation Guatemala Established: 2007 Mission: Florida-based O&P outreach team provides orthotic and prosthetic services to children and adults of Guatemala and conducts charity efforts in Florida, improving lives one person at a time. Why: To provide educational opportunities to local Guatemala O&P providers. Need: New and used pediatric componentry—especially knees, pylons, and feet. Adult and pediatric orthotic components (such as sidebars, knee joints, and ankle joints) also are needed. Achievement: “We’ve been able to educate Guatemalan O&P providers to maintain care of the devices that we’ve fit. This education helps the locals provide for themselves for years to come,” says Dino Scanio, CO, LO, pediatric orthotist, clinical director and founder of the FOOT Foundation.
Georgian Foundation for Prosthetic Orthopedic Rehabilitation (GEFPOR) Tbilisi, Georgia Established: 2003 Mission: The Foundation aims to ensure that all disabled people in Georgia have access to appropriate, quality, and sustainable physical rehabilitation services (physiotherapy, prosthetic, and orthotic fitting) without any discrimination. Why: GEFPOR is the successor of an International Committee of the Red Cross joint effort that was formed in 1994 after internal warfare caused an overwhelming need for orthotic and prosthetic services. Need: Financial donations to help build a new rehabilitation center (project is partially funded) and for equipment. Achievement: 15,660 appliances delivered.
Why: No such services available in this area. Need: Donations. To date: 15 to 30 people treated every quarterly visit.
Mission: Every year in Bangladesh an estimated 4,500 children are born with clubfoot deformity. In Bangladesh, Walk for Life partners with the Ministry of Health to run clinics throughout the country.
Range of Motion Project (ROMP) Guatemala, El Salvador, Mexico, Haiti, Ecuador, and USA
Why: An alternative to corrective orthopedic surgery for clubfoot, the Ponseti Method, developed in the 1950s by Dr. Ignacio Ponseti, involves a gradual correction of one or both of the afflicted feet by casting them in a progressively closer-to-normal foot position. Essentially, the foot is slowly stretched back into a normal position. This takes time and is most successful while the child is still young and the tissues are soft and pliable.
Established: 2005
Achievement: 13,050 feet corrected.
Phoenix Rising for Haiti (PRH) Haiti Established: June 2010 Mission: A multidisciplinary rehabilitation team that provides care in one of the poorest regions of Haiti: Port-de-Paix, in the Northwest Department of Haiti. The effort restores functional mobility by providing comprehensive evaluation and treatment of orthopedic conditions, including prosthetics, orthotics, physical therapy, casting, and wound care. PRH’s goal is to create a network of sustainable rehabilitation clinics throughout rural Haiti run by local PRH trained Haitians. Why: Extreme need of O&P services in an area severely underserved, and “we fell in love with the area and its people,” says Gretchen Wellman, CO, director of orthotics, Phoenix Rising for Haiti and pediatric orthotist at Hanger Prosthetics and Orthotics, Inc. Need: Desperate need for an oven and more reliable equipment for its O&P lab. Also needed, more clinicians and technicians to volunteer to travel to Haiti. Achievement: Countless successes and stories.
Prosthetics in Nigeria Nigeria Established: January 2013 Mission: Oklahoma-based Progressive Orthotic & Prosthetic Services has partnered with Voice of the Martyrs to begin a five-year project in Nigeria to establish a prosthetic & orthotic industry. As a father and son team, Jeff, Brandon, and Michael Arnette are training Nigerians to meet the needs of their own community.
Misson: ROMP believes in a more equal distribution of prosthetic and orthotic care in the world. Its mission is to provide prosthetic limbs and orthotic braces to those who cannot afford or do not have access to these services, empowering them to actively contribute to their families and communities. Why: “ROMP believes that every patient is deserving of the highest level of prosthetic and orthotic care, regardless of their ability to pay for it,” says Patrick Mathay, director of Range of Motion Project. Need: ROMP’s donation center is accepting endoskeletal prosthetic components in good condition. Representatives ask that AOPA inform patients and families that organizations like ROMP exist, and that they accept donated prosthetic limbs that can be used to significantly improve the lives of people in need. Achievement: Provided more than 3,000 prosthetic and 5,000 orthotic devices to patients.
You Able Onlus Italy, and abroad (Etiopia, Tanzania, Ghana, R.D.Congo, Palestine, Syria, Perù, Haiti) Established: 2012 Misson: You Able Onlus is an international non-profit committed to improving the quality of lives of people with a disability by providing rehabilitation services, also for victims of wars, natural disasters or other emergency situations. Why: The main purpose was to form a task force of professionals with different skills (in the scientific, economic, medical and notfor-profit sectors) able to manage specific rehabilitation projects and to offer services for other organizations. Need: “Our aim is to provide training. We have a good doctor in rehabilitation who can manage medical direction. It’s hard in Italy to find a good P&O person that wants help for an international project,” says Elena Bonacini, president, You Able Onlus. ACHIEVEMENT: Successful projects in countries suddenly at war (Congo, Palestine, Syria).
SEPTEMBER 2013 O&P Almanac
27
Photos: Charles Dankmeyer
Volunteers work with patients and create devices.
“I had seen her a couple of times when she was young. She was wearing a conventional hook and cable. I felt if I could afford it, I would buy the components and make her a myoelectric arm because now, as a teenager, she could function with it, operate it, and understand how to take care of it. I felt strongly about it, and I wanted her to have that,” says Hughes.
Continuing Arturo’s Legacy
Photos: Phoenix Rising for Haiti
In between the quarterly visits from U.S.-based volunteers, local CRIMAL volunteers keep the clinic running by offering follow-up care, planning future trips, and providing physical therapy and occupational therapy. The center has tremendous support from the local community, with many businesses donating money, time, machinery, and materials. The day-to-day operation experienced a setback earlier this year when CRIMAL founder and sole local CPO Arturo Vasquez-Vela passed away suddenly. He was a linchpin to the organization, running his own practice and volunteering at CRIMAL. He was the point of contact for referrals, and he provided follow-up care. “He had a great deal of respect from other prosthetists in Mexico, and he maintained a registry of people in need,” says Dankmeyer. Since Vasquez-Vela’s passing, his brother,
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O&P Almanac SEPTEMBER 2013
Eduardo, has taken up this role temporarily and a locally based prosthetists is being sought to assume this position on a more permanent basis. CRIMAL also is in need of new U.S.-based prosthetist volunteers, as Odom, 82, and other long-term volunteers are nearing an age that may restrict them from continuing to participate. “We need new blood to come in and work with Jim, Jeff, and Mo, and to bring them up so they will create their own crews and continue to get down there to [Queretaro],” says Dankmeyer. “The center itself is one of the highlights of my life,” says Odom. “I did something I was able to do that nobody else took the time to do.” “It’s a really a good mission for people who think that God gave them their talents to use on people, not just those who can afford it,” says Lutz. “ So, you don’t withhold those talents. And it is such a long week and hard nights, but you come home, it’s really great personally to feel like you’ve taken care of people.” a Jill Culora is a contributing writer to O&P Almanac. Reach her at jillculora@ gmail.com. Editor’s note: Practitioners who would like to join CRIMAL’s volunteer efforts should contact John (Mo) Kenney at mkenney@kenneyorthopedics.com.
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HIPAA BY KIMBERLY J. KANNENSOHN, ESQ. AND AMANDA L. ENYEART, ESQ.
HIPAA Compliance
for the Small Health-Care Provider DETAILED DISSEMINATION IS THE KEY TO A SUCCESSFUL PROGRAM
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O&P ALMANAC SEPTEMBER 2013
A
A
s Sept. 23, 2013, the date for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Omnibus Final Rule approaches, now is a perfect time for a health-care provider to reevaluate its HIPAA compliance program to determine the extent to which the program succeeds in protecting the privacy and security of the protected health information (PHI). The Omnibus Final Rule mandates certain changes to a health-care provider’s information privacy policies and procedures, the development of an updated notice of privacy practices, and the execution of new agreements between healthcare providers and their business associates. However, to focus only on those changes without evaluating overall HIPAA compliance may turn out to be a false economy given the high cost of noncompliance. Although smaller health-care providers, including many O&P facilities, may not have the information technology expertise and resources available to large health-care providers, they still can design and execute a successful HIPAA compliance program. It starts with an understanding of the basics.
HIPAA Rules Explained The U.S. Department of Health and Human Services (HHS) promulgated rules to implement the requirements of HIPAA. Those regulations, referred to as the “HIPAA Rules,” were amended by the Omnibus Final Rule in order to implement the requirements of the Health Information Technology for Economic and Clinical Health Act (HITECH Act), which amended HIPAA in 2009. The HIPAA Rules include the Privacy Rule, Security Rule, Breach Notification Rule, and the Enforcement Rule. The Privacy Rule is designed to protect each individual’s rights with respect to his or her PHI. It limits the uses and disclosures of PHI that may be made without a patient’s authorization. It also grants patients certain
rights regarding their PHI, including the right to examine their health records, request corrections of their health records, and control certain disclosures of their PHI. The Security Rule protects PHI that is maintained in electronic format (ePHI). The Security Rule requires a covered entity to adopt certain administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and availability of ePHI and to protect it against reasonably anticipated threats or hazards and uses or disclosures that are not permitted by the Privacy Rule. The Breach Notification Rule requires a covered entity to notify an affected individual and HHS of a breach of unsecured PHI. The Omnibus Final Rule amended the Enforcement Rule by implementing the penalty structure mandated by the HITECH Act for violations occurring after Feb. 18, 2009, in which the amount of the penalty increases with the level of culpability, with maximum penalties for violations of the same HIPAA provision of $1.5 million per year. Prior to the enactment of the HITECH Act, the imposition of civil money penalties under HIPAA was limited to $25,000 for all violations of an identical requirement or prohibition occurring within the same calendar year. The prior penalty structure is still applicable to violations occurring on or before Feb. 18, 2009.
Implementing a Successful Compliance Program Whether a health-care provider is operating as a small orthotic practice with a handful of employees or a multi-office organization, the success of its HIPAA compliance program depends largely upon the dissemination of the program throughout the relevant divisions or sections of the organization. Of course, the program must fully comply with the direction provided by HHS through the HIPAA Rules. A truly successful HIPAA compliance program requires four key actions:
SEPTEMBER 2013 O&P Almanac
31
Designate a Privacy Officer and Security Officer to lead your HIPAA compliance efforts. Both the Privacy Rule and the Security Rule require the designation of leadership roles for the adoption, implementation, and maintenance of the relevant sections of a HIPAA compliance program. These are generally known as the “Privacy Officer” and the “Security Officer” with responsibilities related to the Privacy Rule and the Security Rule, respectively. The Security Officer may be the same person who serves as the Privacy Officer or may be a second individual. However, the Security Officer should be a person with experience with HIPAA security matters and should have a working knowledge of the health-care provider’s computer and electronic storage systems. HIPAA requires documentation of the designation of the Privacy and Security Officers.
1
Implement the requirements of the Security Rule to safeguard ePHI and reduce the risk of a breach or other security incident. The Security Rule gives covered entities and business associates the flexibility to reasonably and appropriately implement its requirements. This approach acknowledges that security measures that may be appropriate for a small health-care provider that does not maintain PHI on its premises may not be appropriate for a multi-state
2
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O&P Almanac SEPTEMBER 2013
health system. At a minimum, however, in addition to appointing a Security Officer, the Security Rule requires that health-care providers take the following actions: • Maintain policies and procedures to comply with the Security Rule requirements and maintain and retain appropriate written documentation when required by the regulations. • Conduct an accurate and thorough assessment of the risk to ePHI and implement security measures to reduce such risks. • Implement required physical, technical, and administrative safeguards to protect ePHI. • Evaluate whether “addressable” specifications within the security regulations are reasonable and appropriate for the operational environment and implement those deemed to be reasonable and appropriate. • Develop an ongoing risk management program that requires periodic reviews and updates to the risk analysis to address new technology and other factors which may affect the security of ePHI within the business associate. • Provide training regarding the Security Rule policies and procedures to those workforce members whose job responsibilities require access to ePHI. For more information regarding training, see section 4.
Health-care providers often use outside consultants for evaluating compliance with the Security Rule, particularly with the performance of the risk analysis noted above. However, the Office for Civil Rights (OCR) has issued extensive guidance related to Security Rule compliance (see http:// bit.ly/OCRsecurityrule) for use by the health-care industry. In particular, the guidance entitled “Security Standards: Implementation for the Small Health Care Provider” is designed to assist small entities in complying with the requirements of the Security Rule and includes sample questions related to each standard and implementation specification. Develop privacy and breach notification policies and procedures. The Privacy Rule requires a health-care provider to implement policies and procedures with respect to PHI that are designed to comply with the standards, implementation specifications, or other requirements of the Privacy and Breach Notification Rules. Regardless of whether PHI is held by a small practice or a large, multi-office organization, all patients have the same rights to their PHI, including the right to be notified of a breach of their PHI. However, the Privacy Rule clearly anticipates that small health-care providers may implement policies and procedures differently than large health-care providers. As noted in the Federal Register [45 C.F.R. § 164.530(i)(1)], the policies and procedures must be “reasonably designed, taking into account the size of and the type of activities that relate to protected health information undertaken by the covered entity, to ensure such compliance.”
3
Train your workforce to understand the general requirements of HIPAA and whom to consult when in doubt. Under the Privacy Rule, a health-care provider must train all members of its workforce on its policies and procedures with respect to protected health
4
information, as necessary and appropriate for the members of the workforce to carry out their functions within the health-care provider. The Security Rule also requires the implementation of a security awareness and training program for all members of its workforce (including management). Health-care providers should implement a HIPAA compliance training program that provides a foundation for understanding the health-care provider’s HIPAA compliance program as well as providing ongoing periodic training on relevant issues. Initial HIPAA training should take place as soon as possible if such training has not yet occurred, and new workforce members should be trained within a reasonable period of time after the person joins the workforce. When the provider materially changes its HIPAA policies and procedures, all workforce members whose job functions are affected should receive training within a reasonable time period after that change.
Through such a training program, workforce members should be able to develop an organic understanding of the specific policies and procedures that have been developed by the health-care provider and know the proper protocols for responding to patient inquiries as well as reporting suspected unauthorized activity related to PHI. Generally, off-the-shelf training will not be specific enough to address a health-care provider’s customized HIPAA policies and procedures. Thus, a health-care provider should either develop its own training (internally or with the help of legal counsel) or supplement any purchased training with health-care providerspecific training modules.
Enforcement The federal government has substantially increased its HIPAA enforcement activities during the past several years, and it is expected that after the compliance date of the Omnibus Final Rule, the OCR and
state attorneys general will further increase efforts to enforce the obligations placed on covered entities and their business associates by HIPAA. In fact, Section 13410(e) of the HITECH Act grants state attorneys general the authority to file a civil suit to enjoin violations of HIPAA that threaten or adversely affect a resident of the applicable state and to obtain damages. In addition, investigations by the OCR related to compliance with HIPAA will soon no longer be initiated only by complaints and self-reported breaches. The HITECH Act requires the performance of periodic audits of covered entities’ and business associates’ compliance with HIPAA’s standards. While the audits aren’t intended to be investigations, an audit could potentially reveal a serious compliance issue that could lead to a separate enforcement action by the OCR. Smaller health-care providers should take note that the OCR does not reserve HIPAA enforcement for the
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34
O&P Almanac SEPTEMBER 2013
largest entities whose conduct affects a significant number of people. For example, on April 17, 2012, the OCR sent a strong signal to health-care providers that it intends to enforce the HIPAA Rules aggressively, and it does not intend to give a pass to small health-care providers or practices. HHS announced that it had entered into a $100,000 settlement and executed a resolution agreement with a physician practice with offices in Phoenix and Prescott, Arizona. The investigation was triggered by a report that the cardiology practice was posting clinical and surgical appointments for its patients on an Internet-based calendar that was publicly accessible. However, the OCR investigation soon expanded into a full review of the entity’s HIPAA compliance. That review resulted in a series of findings, including the following: • The practice failed to implement adequate policies and procedures to safeguard protected health information appropriately.
• The practice failed to document that it had trained its employees regarding its privacy and security policies and procedures. • The practice failed to appoint a security official and to conduct a risk assessment. • The practice failed to obtain business associate agreements with Internet-based email and calendar services where the provision of the service included storage of and access to its ePHI. In announcing the settlement, Leon Rodriquez, director of OCR, strongly cautioned the healthcare provider community not to disregard HIPAA: “This case is significant because it highlights a multi-year, continuing failure on the part of this healthcare provider to comply with the requirements of the Privacy and Security Rules. We hope that healthcare providers pay careful attention to this resolution agreement and
understand that the HIPAA Privacy and Security Rules have been in place for many years, and OCR expects full compliance no matter the size of a covered entity.” The case clearly illustrates that the OCR has no intention of enforcing HIPAA differently when a provider is a small entity and is not sympathetic to health-care providers who have a history of non-compliance. a Kimberly J. Kannensohn , Esq., is a partner in the Health Care Department of McGuireWoods LLP. She focuses her practice on the provision of corporate and regulatory counseling to healthcare providers, including furnishing guidance to clients regarding HIPAA, the HITECH Act, and state data privacy laws. Amanda Enyeart, Esq., is an associate in the Healthcare Department of McGuireWoods LLP. She advises clients in connection with federal and state health-care laws and regulations, including HIPAA, the HITECH Act, and state data privacy laws.
SEPTEMBER 2013 O&P Almanac
35
n
Ask the Expert By Devon Bernard, AOPA government affairs department
Following the Money Donations to AOPA serve specific purposes in advancing the O&P profession
Over the past year, you may have received notices or requests for assistance in helping AOPA spread the word about the importance of O&P on Capitol Hill, and for assistance in the legal fight against the Centers for Medicare and Medicaid Services (CMS). AOPA’s fight on Capitol Hill, and in the courtroom, is carried out by three separate branches of the AOPA government relations programs: • Capitol Connection • O&P PAC • AOPA Litigation & Research Fund.
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O&P Almanac SEPTEMBER 2013
CH
TI LITIGA
FUND
These three groups work together to accomplish the primary goal of advocating for O&P, but are funded separately and achieve their goals differently. With three groups working independently, yet working together, for a common goal it can get confusing. This edition of Ask the Expert will help explain some of the differences between the groups.
AN
D RESE
AR
Q: A:
What is Capitol Connection?
Capitol Connection is a fund established by AOPA to supplement or aid its government relations program and to cover any costs or expenditures that may not be covered by the general government relations budget. Typically, funds from Capitol Connection help finance studies that support AOPA’s legislative and regulatory positions. The funds also are used to create and distribute educational materials, such as the 2012 AOPA Key Issues book and the report “2013: A Compendium of Key Documents, and Actions: Related to RAC and Other CMS Audit Activities.” In addition, the funds help cover costs related to hosting the annual AOPA Policy Forum. Capitol Connection funds cannot be contributed to the federal campaigns of key legislators that support the O&P community. They may only be used to create the educational materials we provide to these key legislators.
Q: A:
Who may contribute to Capitol Connection?
Anyone may contribute to Capitol Connection. Since Capitol Connection funds are not used to directly support or endorse political candidates, corporate funds also may be used when making a a contribution to Capitol Connection. Corporate funds used as a Capitol Connection contribution may be deductible as a business expense; however, they are not deductible as a charitable expense.
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Ask the Expert
Q: A:
What is the O&P PAC?
The O&P PAC is AOPA’s federally registered bipartisan political action committee (PAC) representing the O&P profession on Capitol Hill. O&P PAC funds are used to ensure that your voice is heard during pertinent discussions and/or debates on legislation that may have an effect the future of O&P. The O&P PAC makes sure your voice is heard by actively seeking out key legislators on key committees who have demonstrated an interest and concern for the issues facing the O&P community. The O&P PAC then supports these legislators and their election efforts with a donation to their campaign funds and/or will help sponsor a fundraising event for these candidates.
Q: A:
Who may contribute to the O&P PAC?
Since the O&P PAC is federally registered, it must comply with all of the rules and regulations of the Federal Election Commission (FEC). The FEC has very specific rules on who may contribute to a trade association’s political action committee. All O&P PAC contributions must be voluntary and come from eligible employees of AOPA member companies, including O&P practitioners, executive and administrative personnel, board of directors, stockholders, and their family members. All contributions from these eligible individuals also must be made with personal funds. The O&P PAC may not accept contributions from corporate accounts and may only solicit contributions from individuals designated by an O&P PAC authorization card.
Q: A:
What is the AOPA Litigation & Research Fund?
On May 13 of this year, AOPA filed suit against the U.S. Department of Health and Human Services/Medicare in the Federal District Court for the District of Columbia, seeking relief from the unfair and unauthorized actions of CMS contractors in the claims auditing process. Filing suit, or suing the government, is a lengthy and expensive proposition; AOPA estimates that the lawsuit will cost upwards of $500,000. To help offset those costs, AOPA created the temporary Litigation & Research Fund. All of the money collected for the Litigation & Research Fund will be used in the following ways: • replenishing AOPA reserves for the lesser of its 2013 annual deficit or its actual litigation costs paid in 2013
O&P PAC Authorization Card
3
YES! I want to spread the word about the O&P PAC! I authorize O&P PAC to share information with me and any other executive, administrative, and professional personnel associated with the company designated by me below.
To help O&P PAC contact these individuals,
here are their names: ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________
Instead, I’ve attached a list of their names. Return completed form to: 330 John Carlyle St., Suite 200, Alexandria, VA 22314 OR Fax 571/431-0899 OR drop it off at Booth #1119 As required by federal law, my company has not authorized a federal PAC solicitation by another trade association during any calendar year in which this “authorization” is granted to O&P PAC. Signing this card in no way obligates me or others to contribute; it just gives them the opportunity to do so.
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O&P Almanac SEPTEMBER 2013
Authorized Signatures: AOPA must obtain the signature of a corporate officer, or a person that can authorize for their company. Signing multiple dates eliminates the need to contact you for authorization approval in upcoming years and reinforces your commitment to the O&P PAC.
2013___________________________________________ 2014___________________________________________ 2015___________________________________________ 2016___________________________________________ 2017___________________________________________ Print Name_____________________________________________ Title___________________________________________________ Company_______________________________________________ Address________________________________________________ City/State/Zip__________________________________________ Signature______________________________________________ Date___________________________________________________
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ze • Fits •
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Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dberndard@AOPAnet.org.
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Si
A
A:
Anyone is welcome to contribute to the Litigation & Research Fund, including AOPA members or nonmembers, and individual or corporate donations. For more information about the AOPA Litigation & Research Fund, visit the AOPA website, www.AOPAnet.org, and click on the Legislative & Regulatory tab. You also may contact AOPA directly by calling Devon Bernard at 571/431-0854. AOPA will continue to reach out to key members of Congress about the importance of O&P services, will continue to inform the membership about current legislative issues, will fight for O&P on Capitol Hill and in the courtroom, and will reach out for your assistance in achieving our legislative goals, as we cannot do it alone. If you want to learn more about these government relation programs,visit the AOPA website, www.AOPAnet. org, or contact us directly at 571/4310876. Better yet, if you are attending the O&P World Congress, stop by the AOPA booth—you’ll also hear about some special government relations events happening during the World Congress. a
ca
• payment of costs after 2013 for either this litigation on RAC and prepayment audits, or for costs of any new litigation in which AOPA engages on behalf of O&P.
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AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)
s s e n i s u B r u o Y
AOPA Helps Run
AOPA helps you run your business by providing the high quality tools you need to succeed.
AOPA members have access to free white papers and monographs, including our “Improve Practitioner Skills” series, and other tools such as our Charting Guidelines reference card and FDA Compliance Guide.
What are you waiting for? Join now at www.aopanet.org/join with code “Business” or call 571/431-0843 for more information.
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SEPTEMBER 2013 O&P Almanac
39
AOPA HEADLINES
AOPA WORKING FOR YOU
Trends By the Numbers AOPA performance and salary reports reflect challenging environment for O&P providers
T
he “2013 AOPA Operating Performance Report” and the “2013 Compensation and Benefits Report,” based on 2012 data, continue to track the important financial and personnel metrics in the O&P field and provide the most comprehensive picture of how providers are coping with an increasingly complex health-care system. In today’s challenging health-care environment, knowing where you stand in comparison to other providers can be a significant factor in your business decision making. The 98 AOPA member companies operating 1,011 full-time locations and 62 part-time locations responding to this year’s survey will receive a free copy of the full report as well as a free personalized company report that profiles their results compared with companies of like size in similar population areas. This invaluable tool serves as a “thank you” to participants for making the survey results possible. Member pricing for each report is $85 for an electronic version or $185 for the hard copy. Nonmember pricing is $185 for the electronic or $325 for the hard copy version of each study.
Results Reflect Reimbursement Changes Not surprisingly, Medicare and Medicaid reimbursements both represented a lower percentage of net sales in 2012, with Medicare dropping to 28.4 percent compared with 31.7 percent in 2011. Medicaid also dropped to 13.2 percent from 14.8 percent. Contracted and noncontracted private insurance reimbursements increased from a combined 31.1 percent in 2011 to 34.4 percent in 2012. Department of Veterans Affairs (VA) payments increased as a percent of net sales from 4.3 percent in 2011 to 5.9 percent in 2012, as did self-pay, from 3.8 percent in 2011 to 5.5 percent in 2012. Sales per square foot dropped slightly from $300 in 2011 to $291 in 2012. Number of years in business increased from 21 years in 2011 to 24 years in 2012.
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O&P Almanac SEPTEMBER 2013
Net profit margin before taxes as a percentage of net sales continued to reflect the strain of unusual conditions in O&P reimbursements, increasing only slightly to 6.4 percent in 2012 from the worst-in-adecade 2011 profit margin of 6.1 percent. Median sales volume for all respondents was $1.7 million, down from $2.4 million in 2011. The 2010 operating profit was 9.2 percent; 2009 registered 11 percent; and 2008 was 8 percent. While these trend figures are important, it must be noted that each year different companies may participate in the survey; this difference has some impact on the numbers. The median facility sales volume is one such number that would suggest a different mix of respondents as other measures do not confirm that kind of 30 percent downward change in revenue.
In today’s challenging health-care environment, knowing where you stand in comparison to other providers can be a significant factor in your business decision making. Revenue per employee for all respondents dipped to $150,315 in 2012 from $155,370 in 2011, and the number of full-time employees remained steady at 29.9 compared with 29.8 in 2011. Total company revenues per non-owner practitioner remained pretty much the same at the $440,000 level, while revenue per total number of practitioners slipped to $375,987 in 2012 from $400,000 in 2011. Raw materials/components costs as a percentage of sales increased to 13.4 percent in 2012 from 10.5 percent, while operating supplies dropped to 7.5 percent from 8.7 percent in 2011. Total production
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AOPA HEADLINES
AOPA WORKING FOR YOU
Historical Comparisons These tables summarize key information and trends for the past five years. Note that expenses, even more than revenue, can be the key to increased profitability.
Key Revenue by Product or Segment Information Source of Revenue
2012
Prosthetics Orthotics
2011
2010
2009
2008
46%
48%
49%
49%
48%
44.2%
44.9%
42%
40%
45%
1.4%
1.9%
1%
5%
1%
DME Pedorthics
5.5%
3.6%
5%
4%
4%
Other
2.8%
1.7%
3%
3%
2%
Payer Source Trends Source of Payment
Medicare
2012
Contracted Pr. Insurance Medicaid
2011
28.4%
2010
31.7%
2009
28%
2008
31%
32%
28%
26.5%
31%
30%
28%
13.2%
14.8%
16%
13%
12%
6.4%
4.6%
4%
5%
5%
Non-Contract Insurance Hosp/Nursing Homes
5.5%
5.6%
7%
5%
8%
VA
5.9%
4.3%
3%
4%
4%
Workers Comp
4.9%
4.5%
5%
5%
4%
Vocational
0.7%
0.7%
1%
1%
1%
Self-Pay
5.5%
3.8%
3%
4%
3%
Other
1.5%
3.2%
2%
2%
1%
Expense Trends Expense
2012
2011
2010
2009
2008
Sales/Billings
100%
100%
100%
100%
100%
Cost of Goods
31.6%
29.8%
27.5%
28%
29%
Production/Labor
16.5%
16%
17.8%
19%
21%
Gen/Admin
45.2%
47.4%
45.5%
42%
42%
6.4%
6.1%
9.2%
11%
8%
Operating Profit labor costs inched up to 16.5 percent in 2012 from 16 percent, and total costs of goods sold increased to 48.1 percent from 45.8 percent. Thus, it’s no surprise that gross profit also dropped in 2012 to 52.0 percent from 54.3 percent in 2011. Office salaries and bonus payments increased to 11.1 percent, but other employee salaries and wages dropped to 11.8 percent in 2012 from 2011’s 12.9 percent. This finding may suggest decreasing employee body counts in the facilities, which is counter to the number of full-time employees reported in 2012 of 29.9 compared with 29.8 in 2011.
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O&P Almanac SEPTEMBER 2013
A key question in studying these numbers is: How did the Recovery Audit Contractor and other audits affect the operations of AOPA members in 2012? One telling metric is days outstanding for accounts receivables, which jumped from 49.5 days in 2011 to 60.9 days in 2012. That shift is bound to be reflected in how cash is being handled. As an example, asset turnover is down (from 3.8 percent in 2011 to 2.8 percent in 2012); return on net worth is down (22.2 percent in 2011 to 18.3 percent in 2012) even though net profits are up and liquidity and cash
ratios are up. These findings suggest that operators are holding their cash, not looking to take on debt and not considering expansion in light of the exposure to the claw backs and other devastating cash disruptions. Another anecdotal observation is that the mix of respondents last year was weighted toward higher-revenue companies; this year, the mix returned to what is a more “typical” mix, which is confirmed by the lower sales per location. Look for excerpts from the “Compensation and Benefits Report” in a future issue of the O&P Almanac. a
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AOPA HEADLINES
AOPA Files Response to Government’s Motion to Dismiss
A
OPA filed its legal brief opposing the government’s Motion to Dismiss the litigation challenging the Recovery Audit Contractor (RAC) audits. Here’s a quick overview of the brief and related materials filed on AOPA’s behalf by Winston & Strawn.
A.
AOPA summarizes the government’s argument on why the lawsuit should be dismissed: The government’s motion to dismiss is predicated largely on disputing that the August 2011 publication of a “Dear Physician” letter changed the standards for validating Medicare claims for prosthetic devices. As a comparison of the “Dear Physician” letter to CMS manuals and local coverage determinations shows, the letter altered the basis for reimbursement—no longer would prosthetist notes be accepted to determine the medical necessity of the prosthetic device.
B.
AOPA’s brief counters these government assertions. The “Dear Physician” letter was not actually sent to physicians or prosthetic suppliers. Even worse, it was published without offering affected AOPA members or physicians, much less the public, any advance notice or the opportunity to comment. Consequently, no stakeholders participated in the development of the new standards. In addition, neither CMS nor the Durable Medical Equipment Medicare Administrative Contractors offered any detailed explanation for CMS’s change of position on the documentation standards. The only justification tendered was the assertion in one sentence of the “Dear Physician” letter that “corroboration” of the prosthetist’s records by information in the physician’s records is necessary because the
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O&P Almanac SEPTEMBER 2013
prosthetist is a supplier. However, the prior system already provided corroboration, as physicians had to sign both prescriptions and detailed work orders for the prosthetic devices.
C.
Related key points/commentary from legal argument within AOPA brief: The core problem is that—whether with the recent “Dear Physician” letter, or with the longer standing local coverage determinations (LCD)—neither CMS nor its contractors has observed the requirements of due process. They have never bothered to promulgate a regulation on these matters, or to provide a bona fide opportunity for notice and comment. The underlying LCD is subject to the same process deficiencies under the Administrative Procedure Act as has been leveled at the “Dear Physician” letter. Here is what AOPA said about this in its litigation against Medicare, challenging the “process” it has used to make fundamental changes in its coverage and payment standards: “The ‘Dear Physician’ letter reflected a material change in the documentation standard for prosthetic devices… The ‘Dear Physician’ letter thus states, for the first time, that, ‘It is the treating physician’s records, not the prosthetist’s, which are used to justify payment.’ Contrary to the government’s assertions, Mot. 19, this level of detail was not demanded either in the MPIM or the LCDs. Indeed, one can find no indication in either of these documents that cardiopulmonary, musculoskeletal, and neurological examinations are a necessary condition of an amputee receiving an artificial limb. “.…(e)ven if the government were correct that the ‘Dear Physician’ letter merely restated existing standards, it would not cure the legal infirmity. The
government alleges that the standards by which claims for prosthetic devices are evaluated are set forth in ‘the statute, Program Integrity Manual, and common local coverage determinations.’ Mot. 16. But the statute merely says that the prosthesis for a Medicare patient must be ‘reasonable and necessary.’ Thus, under the government’s theory, the only concrete standards for determining whether a prosthesis is ‘reasonable and necessary,’ are set forth in the MPIM and LCDs— none of which was promulgated by regulation. …The government can pick its poison—either it set or it changed the standard without going through the required rulemaking.”
D.
What happens now? According to AOPA’s attorneys, here’s what comes next: “The government will have seven days to file a reply brief, though we expect the government will ask for more time. If the judge is going to have oral argument on the motion, we probably will hear from the judge’s clerk in October or November. If he is going to rule on the papers, I would not expect a ruling until early next year.” So, obviously, the wheels of justice do not turn quickly.
Plays well with others
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AOPA HEADLINES
AOPA Applauds House Insurance Fairness for Amputees Act of 2013 AOPA supports the introduction of the Insurance Fairness for Amputees Act of 2013 in Congress. This important legislation will ensure access to appropriate orthotic and prosthetic devices by providing fair insurance coverage. The House Insurance Fairness Bill, HR 3020, was introduced by the bipartisan team of Rep. Charles Dent (R-Pennsylvania) and Rep. Robert Andrews (D-New Jersey). Plans are progressing toward introduction of a counterpart Senate version of the bill. If passed, the Insurance Fairness for Amputees Act will require those insurers that offer orthotic and prosthetic coverage to provide benefits equal to their other medical and surgical benefits in their policy. This should reduce access barriers to appropriate patient care such as restricted insurance coverage and payment caps on prosthetic and custom orthotic devices. Increasing insurance coverage of and patient access to the appropriate orthotic and prosthetic device will enhance patient mobility and limit secondary health issues stemming from improper care, thus lessening the burden on Medicare and Medicaid. “One in every 200 Americans has decreased mobility due to injury, amputation, or life event,” says AOPA President Thomas F. Kirk, PhD. “Those Americans face significant health insurance inequities, an issue that deserves Congress’ attention. AOPA commends Representatives Dent and Andrews for leading this important legislative endeavor.”
AOPA is partnering with the Amputee Coalition and other stakeholder groups to champion passage of this critical piece of legislation. Thanks to the advocacy efforts of the Amputee Coalition and other partners, the issue of inequities in O&P insurance coverage also has gained importance across the country at the state level. A total of 20 states have passed state prosthetic parity legislation so far. In most of the state enactments, there is no mandate of coverage, but rather a truth-in-advertising type provision, requiring that if an insurer chooses to include coverage of custom orthotics and prosthetics in a policy, that coverage must be on the same basis as the plan’s general medical coverage. Those states that have enacted comparable legislation have found minimal or no increases to insurance premiums and also have reduced Medicaid and Medicare costs. For more information, contact AOPA headquarters at 571/431-0876 or email info@AOPAnet.org.
Read Between the Lines: The Medicare Lower-Limb Prosthetic Policy— Join the Audio Conference September 11 Are you making the right adjustments and repairs? Join AOPA on September 11 for an AOPAversity Mastering Medicare Audio Conference that will cover the details of the Medicare Lower-Limb Prosthesis Local Coverage Determination and Policy Article. The audio conference will help you gain a better understanding of what is covered and when. The following topics will be covered: • Prosthetic functional levels • Coverage of initial, preparatory, and definitive prostheses • Skilled nursing facility prospective payment system exemptions 46
O&P Almanac SEPTEMBER 2013
• Adjustments and repairs • Replacements • Useful lifetime restrictions. AOPA members pay just $99 ($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 Betty Leppin at bleppin@AOPAnet.org or 571/431-0876 with registration questions.
AOPA HEADLINES
What’s the Word: A Health-Care Reform Update— Join the Audio Conference October 9 Join AOPA on October 9 for an AOPAversity Mastering Medicare Audio Conference that will cover the details of health-care reform, also known as Obamacare or the Affordable Care Act. Whatever you call it, things have changed, and it’s important for you to be in the know. The following topics will be covered: • What has changed? • What will be changing? • Is O&P considered an essential health benefit? • What do O&P facilities need to know about accountable care organizations?
AOPA members pay just $99 for AOPA members ($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.
Mastering Medicare: AOPA’s Advanced Coding & Billing Techniques Mirage Hotel & Casino October 22-23, 2013, Las Vegas Join your colleagues October 22-23 at the Mirage Hotel & Casino in Las Vegas for AOPA’s “Mastering Medicare: Advanced Coding & Billing Techniques” seminar. AOPA experts will provide up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Designed 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.
Register online for the “Mastering Medicare: Advanced Coding & Billing Techniques” seminar in Las Vegas at http:// bit.ly/aopaLV13. Questions? Contact Devon Bernard at dbernard@aopanet. org or 571/431-0854.
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AOPA HEADLINES
Log On to AOPAversity Online Meeting Place for Free Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you. For a limited time, AOPA members can learn and earn for FREE at the new AOPAversity Online Meeting Place: www.AOPAnetonline.org/education. Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn continuing education credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis.
AOPA also offers two sets of webcasts: • 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.
Welcome to AOPA Jobs AOPA’s Online Career Center gives you access to a very specialized niche. The Online Career Center is an easyto-use, targeted resource that connects O&P companies and industry affiliates with highly qualified professionals. The online job board is designed to help connect our members with new employment opportunities. • Job Seekers: Post your resume online today, or access the newest jobs available to professionals seeking employment. Whether you’re actively or passively seeking work, your online resume is your ticket to great job offers. • Employers: Reach the most qualified candidates by posting your job opening on our Online Career Center. Check out our resumes and only pay for the ones that interest you. • Recruiters: Create and manage your online recruiting account. Post jobs 48
O&P Almanac SEPTEMBER 2013
Coding Questions Answered 24/7
to our site and browse candidates interested in your positions. The AOPA Online Career Center is your one-stop resource for career information. Create an account and learn about opportunities as a job seeker, an employer, or a recruiter. Get started at http://jobs.aopanet.org. In addition, take advantage of O&P Almanac’s Jobs section to post or browse an employment opportunity, and advertise to AOPA’s 2,000+ member organizations! Regardless of your staffing needs or budget, we have an option that is right for you. For more advertising opportunities, please contact Dean Mather, advertising sales representative, at 856/768-9360 or dmather@mrvica.com.
AOPA members can take advantage of a “click-of-the-mouse” solution available at LCodeSearch.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways––by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.
24/7
AOPA HEADLINES
About the Congress
You Can Still Participate in the Second Annual AOPA OPTA Technical Fabrication Contest! Even though it is too late to enter the second annual technical fabrication contest—it is not too late to participate. We hope you will take time on-site in Orlando to help select the “People’s Choice Award.” The 2013 contest was to fabricate a prosthesis—a combination orthotic/ prosthetic device for a partial foot amputee. The organizing workgroup will select a first place winner and runner up from the following categories: • Practitioner • Technician • Student/Resident.
The 2013 O&P World Congress already is the most talked about event for 2013—the premier destination for the worldwide O&P community. Register today to participate in an expanded National Assembly as AOPA and partners from around the world work to create an O&P World Congress experience for orthotic, prosthetic, and pedorthic professionals in the Western Hemisphere and around the world. Learn more or register for the congress atSPONSORED www.opworldcongressusa.org. BY ABC, OPTA, OTTOBOCK, CASCADE-USA AND AOPA
These individuals will be awarded cash prizes and certificate/trophy recognition. Additionally, special recognition in the form of a trophy and press release announcement will be awarded to the school representing the winning students. In addition, one entry will be recognized as the Attendees’ Choice Award. The devices will be on display just outside the technical fabrication laboratory in the exhibit hall. The contest is sponsored by ABC, OPTA, OttoBock, Cascade-USA, and AOPA.
Gain inte compete from arou
fabrica
a combin device fo
Register to http://bit.ly
Learn more or register for the congre www.opworldcongress.org or contac Steve Custer at scuster@AOPAnet.or or 571/431-0810.
O&P Almanac Magazine— Don’t Miss an Issue! If you aren’t receiving and reading AOPA’s official magazine every month, you don’t know what you’re missing. The O&P Almanac is the most respected source for industry insight and association news in the O&P industry. Featured topics include emerging technologies, coding and reimbursement education, premier meetings, people and businesses in the news, and industry modernization.
As a member of AOPA, or a credentialed practitioner with ABC or BOC, you receive a print copy of the O&P Almanac monthly. Your print issue features all of the latest O&P news, regular departments, and special features on hot topics. A digital version of each issue also is available on AOPA’s website at www.aopanet.org under “Publications.” If you are not a member of AOPA, or a credentialed practitioner with ABC or BOC, you may purchase a year subscription of the O&P Almanac at AOPA’s Online Bookstore, www.aopanetonline.org/store.
SEPTEMBER 2013 O&P Almanac
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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 Steve Custer at scuster@ 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. a
O&P STUDENT-RESIDENT
POSTER AWARD
Congratulations!
These awards have been made possible by a special endowment by Becker Orthopedic and WillowWood.
NEW FOR 2013
Special recognition will be given to the school the student/resident is affiliated with.
On behalf of AOPA, Becker Orthopedic, and Willow Wood, congratulations to Georgia Institute of Technology as the affiliated school of both award winners. Be sure to join us on Friday, September 20 at 7:30 AM as we honor Darren Bolger, Kier Book, and Georgia Institute of Technology.
2013 Edwin and Kathryn Arbogast Award Winner Darren Bolger
A Tale of Two Legs: Maintaining Dynamic Stability in A-P and M-L Directions in Persons with Unilateral Transtibial Limb Loss Georgia Institute of Technology
For further information, contact Tina Moran at 571/431-0808 or tmoran@AOPAnet.org. Visit our website at www.opworldcongressusa.org.
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O&P Almanac SEPTEMBER 2013
2013 Otto and Lucille Becker Award Winner Kier Book
The Influence of Dorsiflexion Resistance on Ankle Joint Kinematics during Treadmill Walking Georgia Institute of Technology
Visit www.kiss-suspension.com
KISS® Technologies, LLC Tel: (410) 663-KISS (5477) Fax: (410) 665-2405 © 2011, U.S. Patent, Patent Pending Worldwide KISS is a registered trademark
AOPA Applications
Welcome new members! 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
MedEast Post-Op and Surgical Inc.
University of Delaware
3001 Irwin Road, Ste. E Mt. Laurel, NJ 08054 856/829-2030 Fax: 856/829-2070 Category: Supplier Member John Krier
5 Innovation Way, Ste. 300 Newark, DE 19711 302/831-3496 Category: Education Institution Member Rachel Strickland
Ortho Plus
1251 S. Cedar Crest Blvd., Ste. 105 Allentown, PA 18103 610/770-1515 Fax: 610/770-1522 Category: Patient-Care Member Susan Carter
Patton Medical Prosthetics, Orthotics, & Diabetic Shoes
Walkabout Orthotics & Prosthetics Inc.
3004 Bienville Blvd. Ocean Springs, MS 39564 228/872-8685 Fax: 228/872-8688 Category: Patient-Care Member Keith Wade, BOCP
402 N. 28th Avenue Wausau, WI 54401 715/849-8703 Fax: 715/849-9353 Category: Patient-Care Member Glenn Barclay, PhD, CO a
Level 4: more than $5 million.
8255 Wright Street Merrillville, IN 46410 219/756-0901 Fax: 219/756-1901 Category: Patient-Care Member Scott Sutter
District Orthotics and Prosthetics, Amputee Care Center 730 24th Street NW, Ste. 5 Washington, DC 20037 202/338-0770 Fax: 201/315-3176 Category: Patient-Care Member David Fenton, CP
O&P Almanac SEPTEMBER 2013
Valley Prosthetics & Orthotics Inc.
7823 Fortune Drive San Antonio, TX 78250 210/373-4368 Category: Patient-Care Member David Berardelli, BOCO
Ped-Lite
Didrick Medical Inc.
True Design P&O & Mobility Clinic Inc. 70 Smart Avenue Yonkers, NY 10704 914/968-1370 Fax: 914/968-1371 Category: Patient-Care Member Antony Matthew, CO, BOCPO, LPO
Level 3: $2 million to $4,999,999
999 Vanderbilt Beach Road, Ste. 200 Naples, FL 34108 877/343-7425 Fax: 888/569-1478 Category: Supplier Member Scott Zajaczkowski
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LOTH Fabenim BV De Liesbosch 14 G Nieuwegen, 343GLC Netherlands +31302732506 Fax: +3132711045 Category: International Member D. Van Gelder
Synergy Orthotics & Prosthetics LLC 44081 Pipeline Plaza, Ste. 220 Ashburn, VA 20147 571/442-8514 Fax: 571/442-8519 Category: Patient-Care Member Johnny Baskin
Marketplace ARTech Laboratory Inc.
WillowWood DuraWalk™ Foot from PEL Now available from PEL Supply is the WillowWood DuraWalk™ Foot. Offering outstanding performance at an exceptional price, the new DuraWalk™ Foot from WillowWood is an advanced low-activity foot, available in a more modern design that is usually reserved for high-activity level feet. The new DuraWalk™ Foot utilizes a highly flexible toe spring, which allows for a smooth gait cycle; while the integrated design of the toe pad, urethane heel, and foot shell provide multiaxial function for increased patient stability on uneven terrain. Suitable for both transtibial and transfemoral amputees, the DuraWalk™ Foot is available in three shades, Buff, Tan or Medium Brown, and carries a patient weight limit of 350 lbs. (160 kg). For more information on the WillowWood DuraWalk™ Foot or any of WillowWood’s other high-quality products, contact PEL Supply at 800/321-1264, or email customerservice@pelsupply.com. Registered customers may order online at www.pelsupply.com.
ARTech Laboratory Inc. Midlothian, TX 888/775-5501 www.artechlab-prosthetics.com The loss of a limb causes deep emotional trauma. Apart from the obvious difficulties with mobility and self-care, the disturbance in body image requires significant emotional readjustment. Our objective is to eliminate the stigma associated with the disfigurement. As opposed to the robotic or mannequin look of traditional prostheses, our restorations have a natural appearance since they are sculpted and painted to match the opposite limb. Without close examination, ARTech’s prostheses are virtually undetectable. It is our privilege to work in an industry that gives self-sufficiency, mobility, and self confidence back to those with amputations and birth defects. For more information, call 800/775-5501 or visit www.artechlab-prosthetics.com.
The C-Brace from Ottobock The world’s only orthotronic mobility system, the C-Brace is breakthrough technology designed for those users that require stability and mobility on level surfaces and uneven terrain, regardless of ambulatory level. Using microprocessors and sensors, the C-Brace never locks and adapts to changes in cadence and stride length in real time. Whether it involves slow or fast walking, potential stumbling situations, walking on uneven terrain or inclines, or going down stairs step-overstep, the C-Brace makes it possible. Contact your sales representative or call 800/328-4058.
Provel Cad/CAM A complete system for cost-effective automation in facilities of all sizes. Scan, modify, carve, and thermoform. The cordless S1 Scanner allows fast, accurate three-dimensional shape capture with unmatched ease of use and low cost. Newly released ProvelCAD modification software is easy to use and template based. The C7 Carver is not only fast and precise, its self-contained dust collection system is extremely quiet. The T7 Thermoformer, now with IR sensing, consistently produces high-quality thermoplastic sockets from industry standard preforms. AOP, OBJ, and STL file compatible. Provel Inc. can be contacted at 509/857-2009 or visit www.provel.us.
SEPTEMBER 2013 O&P Almanac
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Marketplace
New Harmony E2 Electronic Vacuum Pump The quietest electronic pump on the market, the new E2 offers high vacuum levels and resistance to dust and sweat, and is submersible in water. It’s also the first removable vacuum solution: Whether for charging, weight reduction, or switching between legs, the integrated valve keeps the vacuum secure. The Harmony E2 provides ideal volume management, enhanced suspension, and reduced forces in the socket. Add an Anatomic 3D Liner, a ProFlex Sleeve, and a Triton foot for comfort and confidence in one super package. Contact your sales representative or call 800/328-4058.
Go sleeveless with the Unity™ Sleeveless Vacuum System by Össur® Until now, all advanced vacuum systems have required a sleeve to maintain vacuum. The problem is, sleeves are bulky. They bunch behind the knee, restricting range of motion. They can also puncture, leading to a loss of vacuum. Enter Unity. Building on established Seal-In® technology, the Unity Sleeveless Vacuum System by Össur is the first advanced vacuum solution to generate 15-22 in. Hg of vacuum without a sleeve. Visit AOPA Booth #1401 to learn how to get certified and check out the entire line of Unity-compatible Flex-Foot® feet, including low-profile and microprocessor solutions. To learn more about the Unity Sleeveless Vacuum System by Össur, stop by AOPA Booth 1401 or call 800/233-6263.
bebionic3—advanced multi-articulating hands designed to improve your life Booth 713 bebionic3 is the latest addition to SteeperUSA’s upper-limb product portfolio, which includes state-of-theart myoelectric prosthetic hands and control systems, robust body-powered components, and lightweight cosmetic systems. Pioneering technology and innovative design features combine to make bebionic3 the most lifelike, functional, and easy-to-use multi-articulating hand commercially available. bebionic3 offers unrivalled simplicity with 14 easily accessible grip patterns, robust design and materials, smart electronics, individual finger motors, sleek aesthetics, and a natural profile. One-step programming with bebalance software makes clinical assessment and adjustment easier than ever before. Contact SteeperUSA customer service at 210/481-4126 or visit www.steeperusa.com.
KISS® WrapStrap-R® Now available in brown, the Wrapstrap-R by KISS is residue-free and offers removable linkage. This product prevents: • Sleeve doffing inversion • Sleeve doffing dislodging • Under sleeve air leakage This product provides: • Reliable and strong support • Low profile, full adjustability • Tapeless, removable linkage. CMP24/G: Single brown CMP24/H: 10-pack brown For more information, call 410/663-KISS (5477) or visit www.kiss-suspension.com. U.S. Patent 8,182,546, and Patent-Pending Worldwide. a
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O&P Almanac SEPTEMBER 2013
JOBS CALENDAR
Find your region on the map to locate jobs in your area.
- Northeast - Mid-Atlantic
Mid-Atlantic CPO Bowling Green, Kentucky Growing O&P facility in southern Kentucky is looking for an orthotist/prosthetist. Must have five years’ experience minimum as well as ABC and/or BOC certification. Send resume to:
Email: llawrence.fsp@insightbb.com.
- Southeast - North Central - Inter-Mountain - Pacific
Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color
$482 $678 $634 $830
Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to scuster@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140
& Prosthetic
Association
(AOPA)
DISCOVER more AOPA advertising opportunities.
2013
American Orthotic
mediakit Rates
Promoting
O&P Since
1, 2013 effective Jan.
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 SEPTEMBER 2013
CO Norfolk/Virginia Beach and Newport News, Virginia We are a well-established prosthetic and orthotic company in Norfolk/Virginia Beach and Newport News areas of Virginia. We are seeking an individual with a minimum of three years of experience who is self-motivated. This individual must be able to service our local hospitals and nursing homes, as well as in-office patients. We offer a competitive benefits and salary package. Send resume to:
Coastal Prosthetics & Orthotics Fax: 757/892-5303 Email: tmerlin1023@msn.com
Southeast CP/CPO Augusta, Georgia Midlands Prosthetics and Orthotics is looking for a practitioner to work in our Augusta, Georgia office. Candidate must have excellent patient-care and communication skills to conduct comprehensive patient evaluations to deliver the best in O&P services and follow-up patient care. Candidate should have experience conducting in-services and developing marketing strategies in the communities we serve. We offer competitive salary and benefits. Send resume to:
Arthur M. Bremer, CPO, President Midlands Prosthetics & Orthotics 1018 Druid Park Avenue Augusta, GA 30904 Email: abremer@midlandsprosthetics.com
CALENDAR JOBS
Live and work, where you can play.
Pacific Technician Downey, California The orthotic department at Rancho Los Amigos National Rehabilitation Center in Downey, California, has an opportunity for an experienced technician. Full benefits. Call or send your resume to:
Orthotist/Prosthetist-Certified
Shelley Taji, CO Phone: 562/940-7655 Email: staji@larei.org All submissions kept confidential.
Evaluate, design, fabricate and fit devices for patients that have a limb or segment of a limb missing due to congenital or traumatic reasons, or with disabling conditions of the extremities and spine. Must be a graduate of Orthotic or Orthotic/Prosthetic Practitioner Program. BA/BS preferred. Formal training must include basic design principles and fitting skills in lower and upper extremity prosthesis and orthoses. Thorough knowledge of anatomy, kinesiology, developmental philosophy, mechanics and biomechanics. ABC Certification in Orthotics or Orthotics/ Prosthetics. A minimum 3 years of experience as a CO or CPO preferred. Experience in Pediatric Orthotics would be helpful.
Apply online at: www.marshfieldclinic.jobs Search by position number MC130328 1000 North Oak Avenue, Marshfield, WI 54449 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.
Tina Mann
Clinic Manager
View our current positions and apply online at: www.hanger.com/careers or scan the QR code.
“Six doctors came walking in my room, surrounded my bed and they told me I would not get up again.�
Available Positions: Clinic Manager Wilkes Barre, PA
Valdosta, GA
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.
Morgantown, WV
Herndon, VA
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. 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.
Prosthetist / Orthotist Annapolis, MD
Salinas, CA
Bellevue, WA
Seattle, WA
Burbank, CA
Thomasville, GA
Columbus, OH
Wilmington, NC
Dayton, OH
Tamarac, FL
Englewood, CO
Johnson City, NY
Redding, CA
Buffalo, NY
Orthotist Evansville, IN
Richland, WA
Louisville, KY
Wichita, KS
Panama City, FL
Hammond, IN
Grand Junction, CO
Cary, NC
Prosthetist Carmichael, CA
Stockton, CA
Hattiesburg, MS
Jackson, MS
Jackson, MS
Williamsport, PA
SEPTEMBER 2013 O&P ALMANAC
57
CALENDAR
■ YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiplechoice and clinical-simulation exams. Apply now at http://my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.
2013 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 16-21 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was July 1, 2013. Contact 703/8367114, email info@abcop.org, or visit www.abcop.org/ certification. ■ 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.
PROMOTE Events in the O&P Almanac
CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Words
Member Rate
Nonmember Rate
25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$5.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email scuster@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations. For information on continuing education credits, contact the sponsor. Questions? Email scuster@AOPAnet.org. 58
O&P Almanac SEPTEMBER 2013
■ OCTOBER 1 ABC: Practitioner Residency Completion Deadline for November 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. ■ OCTOBER 3-5 The Virginia Orthotic & Prosthetic Association 2013 Annual Meeting and Scientific Sessions. Hyatt Fairfax at Fair Lakes, Fairfax, Virginia. Online registration and hotel reservations were available beginning May 18, 2013. Calling for papers for the orthotics, prosthetics, and technical tracks as well as for the Compliance Clinic. Abstract submission deadline was June 15. Send abstracts to vopainfo@gmail.com. ■ 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.
■ OCTOBER 12 POMAC (Prosthetic and Orthotic Management Associates Corporation) Continuing Education Seminar, Co-Sponsored with PEL Supply Co. New York LaGuardia Airport Marriott. Contact Drew Shreter at 800/946-9170 or visit www.pomac.com. ■ OCTOBER 18-20 National Pedorthic Services Educational Course— Pedorthic Extremes: Managing Difficult and Challenging Feet. Milwaukee. For more information, please contact Brian Dalton at 414/438-6662, email bdalton@npsfoot.com, or visit www.npsfoot.com.
■ 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.
■ OCTOBER 29-30 Using Closed-Cell Foams: Understanding, Techniques, Hands-on. From Jon Fogg, C.Ped, Mike Jakob Orthopaedieschuhmeister. Nora Systems Inc. Salem, NH. Approved CEUs: 4 ABC/4 BOC CEs. Contact Jon Fogg at 770/880-9786 or email Jonathan.Fogg@nora. com. The course, hotel, airport transportation as well as meals are provided.
■ NOVEMBER 1 ABC: Application Deadline for Certification Exams. Applications must be received by Nov. 1, 2013, for individuals seeking to take the January 2014 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/8367114, email info@abcop.org, or visit www.abcop.org/ certification. ■ NOVEMBER 6-8 The New Jersey Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. Bally’s Hotel and Casino. Atlantic City. For more information, visit www.oandp.org/ membership/chapters/new_ jersey/.
Join us!
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.
SE PTEM BE R 1 8 - 2 1 , 2 01 3 Orlando, Florida, USA Gaylord Palms Resort & Convention Center
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.
• Preparation for the massive changes that U.S. healthcare reform is sure to bring, and its influence on global health policy. • Networking with an elite and influential group of professionals. • Largest display of exhibits in the United States for the orthotic, prosthetic, and pedorthic profession • Ideal U.S. location chosen for travel ease and popularity.
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.
STAND UP for your
PROFESSION! It was said that Caesar fiddled while Rome burned. Our profession is on fire and at threat of being diminished to a state that will make it impossible for us to accomplish our mission. The stakes are high and the risks of our ability to provide quality care are becoming more and more difficult. Yet, we still have those who say it is not my business or I can not make a difference. What will it take to get those who stand on the sideline involved so they will help those who carry the ball? Will it require that... A
our service be constantly backed up with physician notes?
A we face our business doors being closed? A
we be questioned about whether or not our service is essential?
A
we be faced with encroachment from other professions?
A
we spend more time doing the paperwork required to provide a service than the time it takes to do the service?
A
we receive reimbursement that is so poor it becomes more and more difficult to keep the doors open?
A
individuals change professions due to the complexity of operating in our present environment?
I could go on but it would do no good. We all know what the problem is and yes, we know what the answer is. You need to say I am mad as hell and I am not going to take this anymore. How you can have a voice is thru the AOPA Political Action Committee.
Being at the AOPA Wine Tasting and Auction Fundraiser shows your support for AOPA government relations efforts. Therefore, we ask that you help in these Healthcare battles by BIDDING HIGH AND BIDDING OFTEN!!!
Our PAC is fighting all those problems listed above and many more. The only problem is that it is too small and does not have enough funds to do the job we need done. I once made the statement “you donate to your church, your school and to other charities, but you do nothing to insure that you can continue to support those causes”. By that I mean, donate to your PAC to insure that your profession and livelihood will be represented and protected. But to insure these rights, it costs money to educate our legislatures and representatives. If our elected officials do not understand who we are and what we do, then that is our fault. It is the responsibility of everyone who is associated with this industry to stand up and be counted by their numbers and funds. Liberty is not cheap and the right to practice your profession is not either. All of us must stand up and be counted with our time, talents and funds. You can no longer stand by and watch our profession go up in flames. Please do this for yourself, your family,and your future. If you have not signed a PAC authorization form - DO IT NOW. The law says you must agree to be solicited for a contribution. If you have signed an authorization form, then you know what to do next! But Please DO IT NOW. Rick Fleetwood, PAC Chair
This year’s event will be on Thursday, Sept. 19, during the 2013 O&P World Congress in Orlando. For more information, contact Devon Bernard at dbernard@aopanet.org.
CALENDAR
■ NOVEMBER 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 is Sept. 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■ November 13 AOPAversity Audio Conference—Advocacy: A Potent Weapon for Change. For more information, contact Stephen Custer at 571/4310876 or scuster@aopanet.org.
NOVEMBER 15 National Pedorthic Services Educational Course— Therapeutic Shoe Fitters Course. Milwaukee. For more information, contact Brian Dalton at 414/438-6662, email bdalton@npsfoot.com, or visit www.npsfoot.com. ■
■ NOVEMBER 21 Bio-Mechanical Composites, Inc. Fall 2013: Learning and Leisure “Dynamic Response Orthotic System” Certification Course. Holiday Inn at the Orlando International Airport, Orlando. Workshop fulfills requirement for Phase I toward certification as a “Dynamic Response Systems Specialist.” 7.25 CEUs. For registration information, visit www.phatbraces.com. For more information, call 515/554-6132.
■ 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.
■ DECEMBER 12-14 Rehabilitation Institute of Chicago—Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago. Featuring Elaine Owen. 21.50 ABC credits. Contact: Melissa Kolski at 312/238-7731 or visit www.ric.org/education.
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. Gaylord Palms Resort. For more information, contact AOPA Headquarters at 571/431-0876 or info@AOPAnet.org.
2014 ■ JANUARY 26-29 U.S. Member Society of ISPO: Pac Rim 2014: Learning Beyond Our Horizons—A Biennial Symposium on Prosthetics, Orthotics, & Rehabilitation. Wiakoloa Beach Marriott Resort and Spa on the Big Island of Hawaii. Learn about progressive treatment options and innovations and hear from recognized physical rehabilitation professionals while enjoying attractions on the Big Island. Contact Dianne Farabi at 614/659-0197 for more information. Submit abstracts at www.usispo.org/pacrim14.
AUGUST 6-9 CAPO Conference. World Trade & Convention Centre. Marriott Halifax Harbourfront. Halifax, Nova Scotia. Visit http://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.
Motion Control
SUPERCOURSE FALL 2013 OCTOBER 7 - 11, 2013
at Fillauer Headquarters, Chattanooga, Tennesee • In-depth training of Utah Arm / U3+ / Hybrid Arm / ProControl 2 • Hands-on experience with UI software - bring your Windows laptop • CEUs: 34 (estimated) awarded by ABC
Overview of: NEW LI-Ion Battery for Utah Arm / U3+ / Hybrid Arm NEW MC Wrist Rotator NEW TRIAD Preamps PLUS Karl Lindborg, CPO from Touch Bionics - Interfacing i-limb hands with Motion Control Products
The 5-day SuperCourse is $1,350.00 For more information or to register for the SuperCourse, email: info@UtahArm.com
115 N. Wright Brothers Dr. • Salt Lake City UT 84116 Phone: 801.326.3434 • FAX: 801.978.0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com
SEPTEMBER 2013 O&P Almanac
61
The O&P Business Management Certificate Program addresses skills that are fundamental to the success of an O&P business.
O&P Business Management: This unique leadership learning experience will provide business owners, managers and practitioners an opportunity to experience fresh insights, new tools and proven techniques as a pathway for developing better business practices, while creating ongoing returns for your company. ■ REFRESH YOUR KNOWLEDGE ■ DEVELOP BETTER BUSINESS PRACTICES ■ ADVANCE YOUR CAREER ■ CREATE ONGOING RETURNS FOR YOUR COMPANY
Earn Your Certificate in
O&P BUSINESS MANAGEMENT
Through a joint partnership between AOPA and the University of Virginia School of Continuing and Professional Studies
How to get started: 1.
Complete the online sign up form: https://aopa.wufoo.com/forms/earn-acertificate-in-op-business-management/
2.
Select and complete four required core modules and four elective modules within three years.
A NEW AOPAversity OPPORTUNITY! Another addition to the valuable education, products and services offered by AOPA that you need to succeed.
3.
Complete a Module specific quiz for each program.
4.
Participants that successfully complete the program will be awarded a certificate of completion, in addition to being recognized at the AOPA National Assembly and the O&P Almanac.
AD INDEX
Company
Page
Phone
Website
Ability Dynamics
11
855/450-7300
www.abilitydynamics.com
ALPS
7, 37
800/574-5426
www.easyliner.com
American Board for Certification in Orthotics, Prosthetics & Pedorthics
29
703/836-7114
www.abcop.org
ARTech Laboratory
53
888/775-5501
www.artechlab-prosthetics.com
Becker Orthopedic
2
800/521-2192
www.beckerorthopedic.com
Board of Certification/Accreditation
25
877/776-2200
www.bocusa.org
Cascade Dafo
33
800/848-7332
www.cascadedafo.com
College Park Industries Inc.
C4
800/728-7950
www.college-park.com
DAW Industries
55, 1
800/252-2828
www.daw-usa.com
Delcam
35
1-877-DELCAM
www.delcam.com
Dr. Comfort
5, C3
800/556-5572
www.drcomfortdpm.com
FLO-TECH® O & P Systems, Inc.
19
1-800/356-8324(FLO-TECH) www.1800flo-tech.com/
Hersco Ortho Labs
15
800/301-8275
www.hersco.com
KISS Technologies LLC
13, 51
410/663-5477
www.kiss-suspension.com
Motion Control
45
888/696-2767
www.utaharm.com
OPTEC USA
39
888/982-8181
www.optecusa.com
Orthomerica Products
21, 41
800/446-6770
www.orthomerica.com
Orthotic and Prosthetic Study and Review Guide
17
www.oandpstudyguide.com
Össur Americas Inc.
9
800/233-6263
www.ossur.com
Ottobock
C2
800/328-4058
www.ottobockus.com
PEL Supply
43
800/321-1264
www.pelsupply.com
WillowWood
Insert
800/848-4930
www.willowwoodco.com
www.savewithups.com/aopa
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SEPTEMBER 2013 O&P Almanac
63
AOPA Answers
Payment Problems
Answers to your questions regarding Medicare nonparticipation, rehab hospitals, 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.
If we are nonparticipating providers with Medicare and we are not accepting assignment on a claim, are we still subject to audits?
A.
Yes, your claims will still be subject to audits even if you are not accepting assignment on the claims because the claims are still being sent to, adjudicated by, and paid by Medicare. Thus, you are required to adhere to all Medicare policies and procedures, and this includes making sure you have the proper documentation to support medical necessity. The choice of being a participating or nonparticipating provider and accepting or not accepting assignment only relates to how you bill the patient and how much you may collect from the patient.
64
O&P Almanac SEPTEMBER 2013
Q.
Do rehab hospitals follow the same rules as acute care hospitals and other types of hospitals?
A.
Yes. Even though rehab hospitals are paid under a separate prospective payment system than acute hospitals, the rules regarding the rehab hospital’s responsibility to provide or pay for medically necessary care remain exactly the same as they are for acute care hospitals. From the O&P provider perspective, the same payment rules that apply to acute care hospitals also apply to rehab hospitals.
Q.
Can a nurse practitioner write or sign a prescription/order for Medicarecovered items?
A.
Yes, with a few restrictions. The nurse practitioner must be treating the beneficiary for the condition for which the item is needed, and the nurse practitioner must be practicing independently of a physician. In addition, the nurse practitioner must be billing Medicare for other services using his or her own provider number and must be allowed to practice in the state where the item/service is being ordered. a
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