April 2015 O&P Almanac by AOPA

The Magazine for the Orthotics & Prosthetics Profession

AP R I L 2015

Tips for Faster and Easier Collections P.18

Paying the Price for a Long Appeals Process P.22

Breaking Down the Medicare O&P Improvement Act of 2015 P.32

Beat the Clock on Medicare Deadlines

O&P Almanac Leadership Series: Niche Facilities Make a Comeback P.34

SELF-

EVALUATION HOW DOES YOUR FACILITY COMPARE WHEN IT COMES TO PATIENT ASSESSMENTS, FABRICATION, AND MORE?

P.40

E! QU IZ M EARN

BUSINESS CE

CREDITS

WWW.AOPANET.ORG

P.20 & 42

YOUR CONNECTION TO

EVERYTHING O&P

American Orthotic & Prosthetic Association The premier meeting for orthotic, prosthetic, and pedorthic professionals

Earn CE Credits

Save the Date! Mark your calendar October 7-10, 2015, to attend the countryâ&#x20AC;&#x2122;s oldest and largest meeting for the orthotic, prosthetic and pedorthic profession.

Experience an ideal combination of top-notch education, exhibits, and entertainment at the 98th AOPA National Assembly in San Antonio, Texas. We look forward to seeing you!

AOPAnet.org

For information about the show, scan the QR code with a code reader on your smartphone or visit www.AOPAnet.org.

The 98th Annual AOPA National Assembly and combined Texas Academy Chapter Meeting October 7-10, 2015 The Henry B. Gonzalez Convention Center On the Riverwalk in San Antonio, TX

2. 3.

Tr iFo

Available 3, 6, & 9 mm

rT ot

lC nt

lL Fo

in ili

contents

APR I L 2015 | VOL. 64, NO. 4

FEATURES

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

COVER STORY

Insights from AOPA President Charles Dankmeyer, Jr., CPO

Comments & Commentary .................6

Readers share their thoughts

AOPA Contacts........................................... 8 How to reach staff

Numbers..................................................... 10

At-a-glance statistics and data

Happenings................................................ 12

24 | Self-Evaluation

Research, updates, and industry news

What is your strategy for assessing patients, choosing appropriate components, and performing follow-up care? Practitioners from across the country share their processes—from self-created strength and range-of-motion assessments, to the six-minute walk and timed up-and-go tests, to the Amputee Mobility Predictor© and the K-PAVET™ form, and much more.

Transitions in the profession

By Christine Umbrell

32 | A Bill That Rights the Wrongs

Finding Your Niche

What are the advantages and challenges associated with running a “boutique” O&P facility? In this month’s Leadership Series section, the O&P Almanac speaks with three niche business owners to learn why some O&P professionals prefer to run facilities that focus on a select group of patients within the overall scope of orthotics and prosthetics.

Tips for collecting payments and minimizing loss of reimbursement

Be watchful of the deadlines associated with the Medicare billing and appeals processes

A new study finds that both the U.S. government and the O&P community will benefit if the lengthy backlog on administrative law judge hearings is resolved: Orthotists and prosthetists will receive their reimbursements faster, and CMS could save more than $10 million in mounting interest rates.

36 | O&P Almanac Leadership Series

Maximizing Your Accounts Receivable

Beat the Clock

The High Price of Appeals

By Don DeBolt

Reimbursement Page..........................18

Compliance Corner.............................. 40

22 | This Just In

The 2015 version of the Medicare Orthotics and Prosthetics Improvement Act is an all-encompassing bill with a number of provisions designed to improve conditions for O&P clinicians and patients. Among other issues, the legislation seeks to recognize orthotists’/prosthetists’ notes; resolve delays in administrative law judge hearings; and clarify the definition of “minimal self adjustment.”

People & Places........................................ 16

P. 22

Tech Tutor................................................. 44

Holding C-Fabs to High Standards

Learn how some central fabrication facilities seek accreditation

Member Spotlight.................................46 n n

Aspen Medical Products Mountain Orthotic and Prosthetic Services

AOPA News............................................... 50

P.32

AOPA meetings, announcements, member benefits, and more

Welcome New Members .................. 55 Marketplace.............................................. 56

Careers........................................................ 60

Professional opportunities

Calendar...................................................... 62

Upcoming meetings and events

Ad Index....................................................... 63

Ask AOPA...................................................64 Expert answers to your questions about dispensing orders

O&P ALMANAC | APRIL 2015

PRESIDENT’S VIEW

AOPA Takes on Capitol Hill Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.

VERY BIG “THANK YOU” to the more than 100 O&P

professionals who provided the energy and passion that were needed to move the O&P legislative agenda forward during the March 23-25 AOPA Policy Forum. The mantra, “If you don’t tell them what you want, you will never get it,” was in full force. There is no question that these face-to-face meetings have a positive impact on advancing legislation and policy that are in the best interest of your patients and the O&P profession. Yes, you can visit your representatives at home in their local offices, but nothing is more impressive to them than when you take the time and spend your hard-earned money to make a personal visit to their Washington, DC, offices. Great job everyone! The AOPA lobbying team and staff scheduled 362 appointments with members of Congress or their staff. This is an incredibly difficult task as all of the meetings must be coordinated within the two weeks prior to the Policy Forum. Next time you see an AOPA staffer, take a moment and thank that individual for all of the hard work AOPA does for you. Your AOPA team managed to secure space in the Rayburn Congressional Office Building for a Mobility Saves congressional briefing on May 1 from 11:30 a.m. to 1 p.m. Invitations were hand-delivered by all of the Policy Forum participants. A congressional briefing is another tool in the advocacy arsenal that has been used successfully by many organizations seeking to obtain a clear focus by policy makers and legislators on their unique challenges—or, in the case of Mobility Saves, the tremendous cost effectiveness of timely O&P intervention. Speaking of Mobility Saves, this past month the www.mobilitysaves.org Facebook page passed the 5,000 “likes” mark after only a few short months. Social media has been a growing force in reaching audiences today, and we are doing all we can at AOPA to stay in the game. And that’s something I would like to hear from you about—how you use or don’t use social media, and whether it has had any impact on your business or patients. Despite our pride at achieving 5,000 likes, what does that really mean for O&P and AOPA’s ability to serve you? Do you follow AOPA on Facebook and LinkedIn? Do you read AOPA In Advance SmartBrief? Have you subscribed to the new blog by Joe McTernan called AOPA’s Take? Or perhaps you read the O&P Almanac in its online version? Are you an avid user of Twitter or Instagram? There are many companies and organizations that send out information regarding CMS policies, coding, VA contracting, and trends in practice. Beware! Not all information is created equal. Think about it: How many companies have told you how you should code their unique spin on an Arizona ankle-foot orthosis, a knee orthosis, or a lumbosacral orthosis? Really? Do you want to take that chance? Did you ever feel a little queasy adding that ultralight code just because a manufacturer told you it was okay? AOPA has a panel of CPOs like you who review and provide expert judgment to properly code devices. AOPA works to help you avoid audit pitfalls, get appeals success at the first level, keep your nose clean, and walk the straight and narrow path to success. AOPA provides you with unbiased, accurate, and current information that affects your practice. It is in our DNA, and we won’t change that just to make a headline. In this day of value-based purchasing, I think that makes AOPA a genuine value for every practice. That’s my two cents. What’s yours? Email info@AOPAnet.org.

Charles H. Dankmeyer Jr., CPO, AOPA President 4

APRIL 2015 | O&P ALMANAC

Board of Directors OFFICERS

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

Support You Can Count On! AOPA’S INSURANCE PROGRAM— Practitioners trust us most because we know your business and we know insurance unlike any other program.

Call Cailor Fleming today and we’ll gladly customize a specific plan for you. We’ve been a trusted insurance company for years, let our experience and lasting service speak for itself.

800-796-8495 http://cailorfleming.com/OandP.asp

An Endorsed Member of AOPA

PROFESSIONAL LIABILITY | GENERAL LIABILITY | PROPERTY

| AUTO | UMBRELLA | WORKERS COMP & MORE

COMMENTS AND COMMENTARY

Poaching

HE MARCH ISSUE OF the O&P Almanac featured a

President’s View column by AOPA President Charles H. Dankmeyer Jr., CPO, titled “When Competitors Become Collaborators.” That column provoked some thoughtful comments. Excerpted from the March President’s View: One of the sessions at the AOPA Futures Conference covered the topic of “poaching.” We all know the drill—the pharmacy gets all of the back supports, the therapeutic shoe fitters get all of the partial foot prostheses, the athletic trainers do all of the knee trauma bracing, and the physicians do all of the CAM walkers and have “closets” to dispense off-the-shelf and customfit orthoses. Well, why is the O&P professional shut out? Were we too complacent? Were these nuisance devices we did not want to provide in the first place? Is it really poaching, or did we not see the changing delivery model? Below are responses from readers:

Off-the-Shelf Crossover

Congratulations on your President’s View column. From a truly cynical position, this OTS crossover change is perfect for the non-O&P suppliers of devices. For years we were the only people who “fitted” these devices anyway. The others got paid for not doing it, and now we aren’t going to be paid for doing it because no one really understands why it is important. Is it any wonder that 19 percent of patients are ultimately refitted with a custom-molded and -fitted AFO? I am surprised the percentage isn’t much higher! If an inappropriate design is not fitted to a patient with a problem for which the device is inadequate, it is no wonder that confusion abounds. —Don Shurr, CPO, PTO

I appreciate the question and possible concern. This has been going on since the late 1980s, early 1990s. At that time O&P was experiencing many changes due to research and development in prosthetics, which began CATCAM AK socket design and other designs. At that time we were still in the metal and leather age in orthotics, with plastic being the only positive progress, beginning in the mid to late 1970s. Now back to the early ‘80s. Sellers were smart and business savvy. They began selling direct to physicians when we would not market their product. We told them, as we told everybody, that it was their job to detail the physicians on their product and we will gladly fill the prescription if it states, ‘Use XYZ product.’ We would send them on their merry way. Well, their merry way evolved into stock and bill. No controls, no regulations, no real concerns from our national organizations. On a side note, about 25 years ago I was involved in a staff meeting and brought up the point that if orthotists wanted to survive, they better study prosthetics because one day everything will come in a box and the orthotists won’t be needed. I was laughed at. —Mick Holm, CPO, LPO Mick, thanks for your thoughts on poaching and the lack of new developments in orthotics. There are many in the profession who agree with you. Your view of what is poaching versus what did the professional orthotist simply abandon is right on the mark. During the AOPA Futures Leadership Conference this topic was brought front and center. If you look at it from all angles, it would certainly appear that the professional orthotist let many of the OTS and prefabricated orthoses be marketed and sold by others rather than embracing those devices that are suitable for the practice. The accrediting organizations will remind us that the certified orthotist is not the only player in this arena. There are certified fitters whom the accrediting organizations have deemed appropriate providers of prefabricated and OTS orthoses. Pharmacies, physician offices, DME stores, and physical therapy and occupational therapy clinics can all qualify for facility accreditation if they have the appropriate personnel on staff. Depending on your point of view, either the professional certified orthotist dropped the ball, or the manufacturers developed new accredited and certified delivery systems for prefabricated orthoses. AOPA continues to support the comprehensive O&P facility. —Charles Dankmeyer Jr., CPO, AOPA President

APRIL 2015 | O&P ALMANAC

MICROPROCESSOR KNEE

Stronger Smarter Submersible

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

To learn more about the Plié 3 MPC knee please contact Freedom Innovations at 888-818-6777

www.freedom-innovations.com

AOPA CONTACTS

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

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

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

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

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

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

APRIL 2015 | O&P ALMANAC

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

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

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

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

Beat the heat with AZ Breeze

KEEP YOUR PATIENTS COMFORTABLE, EVEN ON THE WARMEST DAY!

LIMITED TIME OFFER!

Until May 15th, order an Arizona Brace® sample in the AZ Breeze material for just $49 ($100 Value.) Use promo code AZB49

You already know that Arizona AFO is the leading fabricator of custom, premium-quality AFOs. What you may not realize is that every standard Arizona AFO style is also available in our new, incredibly lightweight and breathable material… AZ Breeze. Durable, moisture-wicking and even machine washable, AZ Breeze is the perfect choice for patients living in high heat and/or high humidity climates. Help your patients beat the heat and move them closer to full compliance with Arizona AFO-quality and AZ Breeze comfort!

Choose from two color options :

BLACK

TAN

(877) 780-8382 www.ArizonaAFO.com *AZ Breeze material should be air dried and not placed into a drying machine.

NUMBERS

U.S. Health Insurance Participation On the Rise Will more Americans seek O&P care as coverage becomes more universal?

UNINSURED RATE DROPS AMONG U.S. ADULTS

The uninsured rate among adults in the United States for the fourth quarter of 2014 decreased by more than 4 percent compared to the same period one year ago, according to Gallup. The rising number of insured adults is largely credited to the increase in Americans signing up for health insurance through federal and state exchanges in the wake of the implementation of the Affordable Care Act.

HIGHEST PERCENTAGE OF ADULTS AGES 18-64 COVERED BY EMPLOYER INSURANCE

12.9%

The uninsured rate for the fourth quarter of 2014 averaged almost 13 percent.

17.1%

The uninsured rate for the fourth quarter 12 months earlier was more than 17 percent.

MORE AFRICAN-AMERICAN AND LOW-INCOME AMERICANS NOW INSURED

The uninsured rate among African Americans dropped from 21 percent in the fourth quarter of 2013 to 14 percent one year later.

The uninsured rate among those making less than $36,000 per year declined from 31 percent in the fourth quarter of 2013 to 24 percent one year later.

26- TO 34-YEAR-OLDS

The uninsured rate dropped 5.6 points among those ages 26 to 34, to 23 percent.

35- TO 64-YEAR-OLDS

The uninsured rate dropped 5.2 points among those ages 35 to 64, to 13 percent.

% No 19 18.0

17.4

16.1

16.4

17.5 17.3

14.6

17.1

16.9

17.1

16.6 16.8

16.1 16.3

15.4

15.6

14.4

13.4

Q1 2009

Q1 2010

Q1 2011

Q1 2012

Quarter 1 2008-Quarter 4 2014, Gallup-Healthways Well-Being Index, GALLUP

APRIL 2015 | O&P ALMANAC

More than 15 percent have Medicaid or Medicare.

The uninsured rate dropped 6.1 points among those ages 18 to 25, to 17 percent.

Do you have health insurance coverage? Among adults aged 18 and older

16.1

More than one in five have self-paid insurance.

18- TO 25-YEAR-OLDS

Percentage of U.S. Adults Without Health Insurance, by Quarter

16.3

More than four in 10 have employer-affiliated insurance.

COVERAGE RISES AMONG YOUNG ADULTS

43% 21% 16%

Q1 2013

Q1 2014

12.9

“The uninsured rate declined sharply in the first and second quarters last year as more Americans signed up for health insurance through federal and state exchanges. The 12.9 percent who lacked health insurance in the fourth quarter is the lowest Gallup and Healthways have recorded since beginning to track the measure daily in 2008.” —“In U.S., Uninsured Rate Sinks to 12.9%,” Gallup, January 2015

K2 SENSATION WITH D/P FLEXION

K2 Sensation is a comfortable walking prosthesis that provides smooth progression from heel strike to toe-off. And now, with D/P Flexion, it offers up to 9° of dorsi and plantarflexion to help improve stability and reduce the risk of trips and falls. Add our zero-build-height Unity® pump module for the only sleeveless elevated vacuum solution for less active users.

Both D/P Flexion and Unity are retrofittable to existing K2 Sensation feet.

Visit www.ossur.com, or contact your Össur rep today to learn more.

FOLLOW ÖSSUR ON © ÖSSUR, 03.2015

TEL (800) 233-6263 CANADA (800) 663-5982 WWW.OSSUR.COM

Happenings RESEARCH ROUNDUP

Austrian Surgeons Fit Patients With Bionic-Reconstruction Prostheses at the Medical University of Vienna, together with engineers from the Department of Neurorehabilitation Engineering of the University Medical Center Göettingen. “The scientific advance here was that we were able to create and extract new neural signals via nerve transfers amplified by muscle transplantation. These signals were then decoded and translated into solid mechatronic hand function,” says Aszmann. The trial patients underwent nine months of intensive cognitive training, learning first to activate the muscles, then to use the electrical signals to control a virtual hand. They also practiced with a hybrid training hand. Three months postamputation, all three men reported a much higher level of functionality in the prosthetic hand. They were able to use their hands to complete everyday tasks such as picking up objects, using a key, and cutting food.

Oskar Aszmann, MD, developed the bionic-reconstruction technique used in conjunction with prosthetic hands.

TECH TRENDS

Researchers Develop Self-Adjusting Prosthetic Ankle A team of engineers at Michigan Technological University is developing a self-adjusting prosthetic ankle. The prototype has been designed to provide a more natural gait for amputees by incorporating a camera to scan the ground ahead and dynamically adjust to the terrain underfoot. The system comprises a prosthetic ankle, a low-cost camera, and a separate 12

APRIL 2015 | O&P ALMANAC

computer-controlled actuator, which adjusts the ankle’s position through a system of cables. As the user walks, the camera scans the ground and the actuator readies the prosthetic foot to take its next step. The actuator can be fixed to the prosthesis or made to slip inside a user’s pocket. “The camera can identify the profile of the ground while the computer knows where the next footstep will be,

based on how the user is moving the leg,” says lead researcher Mo Rastgaar, PhD, assistant professor of mechanical engineering. “Then the computer analyzes the information from the camera and applies the correct angle and stiffness to the ankle, just as you would with your biological foot and ankle.” The project remains in developmental stages, though Rastgaar hopes to bring the product to market soon.

PHOTOS: Upper image/DIETER NAGL/AFP/Getty Images; Lower image/Courtesy of Michigan Technological University

Surgeons in Austria recently performed voluntary amputations on three men with poorly functioning limbs, then fit the patients with the first “bionicreconstruction” prostheses. The patients are testing mind-controlled prostheses, which have been designed so that nerve and muscle transfers provide signals that are translated into mechatronic functions to animate the devices. Prior to surgery, each of the patients had suffered for many years with brachial plexus injuries, affecting the nerve that runs down through the armpit and into the arm, controlling movement. These injuries resulted in irreversible separation of the hand from neural control, leading to poor hand function. The bionic-reconstruction technique used in the procedures was developed by Oskar Aszmann, MD, director of the Christian Doppler Laboratory for Restoration of Extremity Function

HAPPENINGS

MEDIA MADNESS

Noah Galloway Debuts on DWTS

PHOTO: Dancing With The Stars

U.S. Army veteran and Men’s Health magazine’s “Ultimate Guy for 2014” Noah Galloway hit the small screen last month when he was cast as a member of season 20 of ABC’s Dancing With the Stars (DWTS). In 2005, Galloway lost his left arm above the elbow and left leg above the knee during an improvised explosive device attack while fighting in Operation Iraqi Freedom. He was unconscious for five days after being transported to a German hospital following the incident. After his amputations, Galloway underwent a long recovery and rehab process. Though he initially struggled with depression, Galloway vowed to get back in shape for the sake of his three children. He began competing in long-distance running and adventure races, and now works as a personal trainer and motivational speaker. Galloway rehearsed for the show with his partner, Sharna Burgess, in his hometown of Birmingham, Alabama.

DME MACs Revise Lower-Limb Prosthesis Policy

He received a new prosthetic arm suitable for dancing while preparing for the show, which premiered March 16. Galloway has said he hopes to be a positive role model for veterans during his tenure on DWTS. “The biggest challenge is going to be the dancing—you take out the injury, and I’ve just never danced,” Galloway told Good Morning America. Galloway is the second person with limb loss to appear on DWTS. Paralympian Amy Purdy, a bilateral below-knee amputee, was the runner-up during season 18 of the show.

CMS CENTRAL

OMHA Establishes ALJ Appeal Status Information Portal The Office of Medicare Hearings and Appeals (OMHA), the entity that handles all administrative law judge (ALJ) hearings and requests, has announced a new system for practitioners to track the status of appeal requests. This new tracking portal is called the ALJ Appeal Status Information System (AASIS) and may be accessed via the OMHA website at http://aasis.omha.hhs.gov/. The AASIS will inform users if an appeal has been received, assigned, in deliberation, decided, combined, or reopened.

The AASIS provides information on appeals and requests for appeals that have been entered into the OMHA system. OMHA has stated that due to the current backlog of appeals, it is expected to take at least 16 weeks, from a mailing/ requesting date, before OMHA can enter an appeal into its system and have it appear on the AASIS site. Contact Joe McTernan at jmcternan@ AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org with questions.

The durable medical equipment Medicare Administrative Contractors (DME MACs) have released a revised lower-limb prosthesis medical policy with an effective date of Jan. 1, 2015. AOPA is in the process of conducting an in-depth review of the revisions to determine how they may affect O&P facilities.

A preliminary review of the new policy indicates the revisions appear to be minor. For example, the policies have updated the code language for L7367, to reflect the code descriptor change that became active on January 1 of this year. Also, some standard documentation and medical necessity language revisions are included— revisions that are found in other Medicare documents. If AOPA’s in-depth review of the policy revisions identifies possible conflicts or concerns, AOPA will address those issues with the DME MACs. A copy of the revised lowerlimb policy is available on the DME MAC websites. Contact Joe McTernan at jmcternan@AOPAnet. org or Devon Bernard at dbernard@ AOPAnet.org with questions.

O&P ALMANAC | APRIL 2015

HAPPENINGS

INTERNATIONAL OUTREACH

Haitian Amputees Visit the Vatican Three Haitians who were among the thousands of individuals to undergo emergency amputations following the 2010 earthquake in Port-au-Prince had a private audience with Pope Francis in January. Wilfrid Macena, Mackenson Pierre, and Sandy J.L. Louiseme, who visited the Vatican at the pope’s invitation in recognition of the earthquake’s fifth anniversary, received care after the earthquake at the Össur International P&O Laboratory in Port-au-Prince. The men are the public face of Healing Haiti’s Children and are members of Team Zaryen, a volunteer amputee soccer team that

was formed to change the face and perception of disability in Haiti. The three Haitians’ prostheses were made possible through the Healing Haiti’s Children program, sponsored by the Knights of Columbus in collaboration with the University of Miamiaffiliated Project Medishare. The men were accompanied to the Vatican by Robert Gailey, PhD, PT; Jason Miller, MPT, CWS, Project Medishare’s director of rehabilitation; and Adam Finnieston, CPO, Project Medishare’s director of prosthetics. The story of the Healing Haiti’s Children program and the children it has served was captured in Unbreakable: A

Story of Hope and Healing in Haiti, winner of the most Inspirational Documentary Award at the DocMiami International Film Festival’s Florida Documentary Film Festival in September. The film also follows the story of the formation of Team Zaryen. Over the past five years, the Project Medishare rehabilitation team has provided rehabilitation for 25,000 patients and fabricated more than 2,000 orthoses and prostheses. Össur provided the initial funding for O&P laboratory in Haiti, which opened just 60 days after the earthquake and has continued to remain operational.

U.S. Practitioners Tour Cuban O&P Facilities

Dale Parkins, CPO, visits a Cuban facility. 14

APRIL 2015 | O&P ALMANAC

funding is not expected to increase dramatically. “Visiting Cuba was a great opportunity to see how an area with much fewer funds than the U.S. functions,” says Dale Perkins. “There is a lot of technology coming to our profession; however, there does not seem to be additional funding for the amputees themselves. If anything, payors are working hard to pay less, and in many cases amputees are ending up with coverage plans that include little to no prosthetic coverage. Finding ways to help those without funds obtain the highest tech and newest devices has long been an interest of ours, both as a patient care and a manufacturer.” “Creating extremely highfunctioning prosthetics using less expensive and lower-tech methods has been an interest to us, and we plan to work on more development in this area,” says Matt Perkins.

PHOTOS: Upper group image/ Courtesy Adam Finnieston; lower images/Courtesy of Coyote Design

Matt Perkins, Dale Perkins, CPO, and Mike Perkins traveled to Havana, Cuba, to tour the Cuban O&P industry.

The International Society of Prosthetics and Orthotics (ISPO) created a tour as an educational and cultural growth mission with O&P professionals of Cuba. Several U.S. practitioners took part in the tour, including Dale Perkins, CPO, and Matt Perkins from Boise, Idaho-based Rehab Systems and Coyote Design & Manufacturing. Participants explored Cuban health-care methods and policies and visited the largest fabrication facility in Cuba, the Centro Nacional de Ortopedia Tecnica, as well as two of the larger hospitals in Havana. Health care in Cuba is provided to all citizens at no cost; however, small fees are charged for prosthetic devices. A below-the-knee prosthesis typically costs an amputee four Cuban dollars. Access to a variety of basic products has historically been very limited in Cuba. Now that the U.S. embargo has been lifted, access may change, but

HAPPENINGS

CODING CORNER

AOPA Challenges Definition of ‘Substantial Modification’ AOPA has closely followed the issue surrounding which orthotic devices are considered to be “off-the-shelf” (OTS) items that may be subject to Medicare competitive bidding. What began as a small subset of Health-Care Common Procedure Coding System (HCPCS) codes that represented truly OTS orthotic devices that could reasonably be adjusted by the patient themselves, as stated in the law, and without any expertise from certified, trained professionals, has been repeatedly expanded through regulation and policies that are not consistent with the statute. Now we now have a set of more than 50 codes that CMS considers off the shelf, i.e., if they can be adjusted by the patient, caregiver for the patient, or by the provider of the device. A significant development occurred when the durable medical equipment Medicare Administrative Contractors (DME MACs) published revised medical policy that further defined the qualifications necessary to fit and provide custom fitted orthoses to Medicare beneficiaries. The medical policy was expanded to include the following definition of the term “substantial modification” as it relates to the provision of custom-fitted orthoses: “Substantial modification is defined as changes made to achieve an individualized fit of the item that requires the expertise of a certified orthotist or an individual who has equivalent specialized training in the provision of orthotics such as a physician, treating practitioner, an occupational therapist, or physical therapist in compliance with all applicable federal and state licensure and regulatory requirements. A certified orthotist is defined as an individual who is certified by the American Board for Certification in Orthotics and Prosthetics Inc. (ABC), or by the Board for Orthotist/ Prosthetist Certification (BOC).”

This definition fails to recognize the scope of practice of certified orthotic fitters, whether certified by ABC or BOC, and their role in the provision of custom-fitted orthoses, very typically working under the supervision of a certified orthotist. In addition, the definition that was published by the DME MACs was extracted essentially verbatim from a definition that was included in a CMS proposed rule (which, when published by CMS in July 2014, was intended to cover OTS, end-stage renal disease, and a range of other topics) in a DME MAC announcement before the open public comment period had concluded. Subsequently, CMS elected not to include anything relating to OTS orthotics in the final rule on several other topics that CMS ultimately published. Despite repeated communications from AOPA and others challenging the authority of the DME MACs to memorialize this definition in policy before the proposed rule was finalized, and despite the fact that CMS chose not to include the proposed definition of “substantial modification” in its final rule, a CMS Frequently Asked Questions document that was updated

on Feb. 18, 2015, indicates that the policy guidance regarding who may provide custom-fitted orthoses to Medicare beneficiaries remains in effect as the “DME MACs have discretion to define what constitutes custom fitting for accurate coding and payment of claims.” AOPA believes that CMS is not exercising appropriate control over the actions of its contractors. The DME MACs have repeatedly established policy without regard to the Administrative Procedures Act’s requirement for due process through the issuance of proposed rules with appropriate opportunity for public comment and input followed by the issuance of a final rule. When AOPA has challenged the DME MACs or CMS regarding the lack of due process, the response has always been that the contractors are acting within the right to establish local policy to govern Medicare coverage of specific items and or services. AOPA believes that that a contractor hired by the government cannot have authorities greater than the Congress has delegated and articulated for the agency that hires the contractor. In this case, if CMS initiates a rulemaking to establish what constitutes an OTS orthotic device and who may deliver custom-fitted orthotics, the requirement that Congress imposed on CMS—namely, that such rules may only be finalized after providing the opportunity for stakeholder input—cannot be circumvented by CMS claiming that these rules do not apply if the action or rules are advanced by a contractor hired by CMS. AOPA will continue to challenge this policy specifically, and more generally instances of policy overreach by contractors acting under CMS’s authority. For more information on this topic, contact AOPA’s Joe McTernan at jmcternan@aopanet.org. O&P ALMANAC | APRIL 2015

HAPPENINGS

CMS Issues New Code for Partial Hand Patients patients served by CMS who will now have access to partial hand prostheses. “We are pleased that patients covered by CMS will now have access to the i-limb digits technology, to help empower them with a solution to support their return to function and independence,” says Ian Stevens, chief executive officer of Touch Bionics. Joe McTernan, AOPA’s director of reimbursement services, says, “The new code will of course not only apply to the i-limb products, as there may be other products on the market that qualify for the new code.”

PEOPLE & PLACES PROFESSIONALS

IN MEMORIAM

ANNOUNCEMENTS AND TRANSITIONS

David N. Reed, CPO, CPed

Nick Ackerman, CP, director of prosthetics at American Prosthetics & Orthotics in Iowa, has been named to the Des Moines Business Record’s annual “40 Under 40” list of honorees. The list recognizes business and Nick Ackerman, CP professional leaders in the greater Des Moines community who are under the age of 40. Ackerman was selected based on his contributions to the O&P profession, including his support and mentoring of the amputee community and wounded service members. In addition to his patient-care achievements, Ackerman played an instrumental role in getting lawmakers to pass the Iowa Prosthetic Parity Law in 2009.

David N. Reed, CPO, CPed, passed away February 25 at the age of 56. Reed worked at Yanke Bionics in Akron, Ohio, for more than 35 years. A graduate of Northwestern University Prosthetic Orthotic Center, Reed was well versed in all O&P treatments, including cranial molding helmets and scoliosis management. He also was experienced in delivering Ottobock C-legs, upper-extremity myoelectrics, stancecontrol knee-ankle-foot orthoses, and scoliosis systems. In addition to O&P, Reed enjoyed building furniture, repairing antique clocks, traveling, and studying American history.

Emery J. Maloney, CO, has joined Align Clinic of Wisconsin and will oversee the new facility, which primarily focuses on scoliosis management. Additionally, Maloney will provide pediatric orthoses, cranial remolding orthoses, and other specialized devices.

APRIL 2015 | O&P ALMANAC

Michael J. Quigley, CPO Michael J. Quigley, CPO, passed away March 10 at the age of 67. Known throughout the O&P profession as an innovator and early leader in the modern world of O&P, Quigley served as a mentor to many young O&P professionals. Quigley was president of the American Academy of Orthotists and Prosthetists in 1979-80. He also published many O&P research papers and served as editor of Orthotics and Prosthetics and as chair of the editorial board of Clinical Prosthetics and Orthotics.

PHOTO: Touch Bionics Inc.

Until now, there has been no appropriate base code that can be billed in conjunction with the code relating to articulating digit technology (L6715). But CMS has issued a new code, L6026, that is specific to partial hand patients. The creation of this code increases patient access to prosthetic solutions for partial hands, including Touch Bionics’ i-limb digits. In addition, at the start of 2015, the allowables for all of the appropriate i-limb digit codes also were increased. The addition of the new base code for partial hand patients, plus the increased allowables available in 2015, create a new environment for

PEOPLE & PLACES

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Aetrex Worldwide Inc. has sold its Apex Foot Health & Wellness division to Orthotic Holdings Inc. (OHI). The new entity will be known as Apex Foot Health Industries LLC. Align Clinic LLC has announced the opening of Align Clinic of Wisconsin, located at Scoliosis Rehab in Stevens Point, Wisconsin. The facility will primarily focus on scoliosis management in addition to other O&P disciplines. The Board of Certification/ Accreditation has been awarded www.bocusa.org two Stevie Awards for 2015. The organization has received a silver award in the “Innovation in Customer Service” category (the third year the organization has won an award in this category), with a submission titled “Innovation Through Integration” that highlighted the unification of BOC’s certification and accreditation departments for the purpose of creating a consolidated approach to credentialing. BOC also has received a bronze award in the “Business Development Achievement” category for its submission titled “BOC’s Story of Growth During Industry Consolidation.” Curbell Plastics Inc. has introduced a new website that allows patients to explore transfer paper patterns and colors to personalize thermoplastic orthotic and prosthetic devices. The new site, www.myDesignOandP.com, hosts a transfer paper gallery that O&P practitioners can use with their patients to improve the selection process.

From left to right: Joe Martin, Freedom Innovations president and COO; Steven S. Choi, PhD, Irvine mayor; Maynard Carkhuff, Freedom Innovations chairman and CEO; and John Robertson, Freedom Innovations vice president of research and development

Freedom Innovations has expanded its headquarters in Irvine, California, by constructing a new 3,500square-foot manufacturing facility that will produce microprocessor-controlled and -powered prosthetic ankles Freedom Innovations’ and knees. The company held expanded manufacturing a reception and ribbon-cutting facility in Irvine, California ceremony on February 27, which was attended by City of Irvine Mayor Steven S. Choi, PhD, and other local dignitaries. Ottobock has announced it will be the exclusive distributor of the new Environmentally Managed Systems (EMS) inner-socket system developed by Carl Caspers, CPO. The EMS technology is fully compatible with the Harmony vacuum system Caspers developed and sold to Ottobock in 2003 but also offers a number of substantial improvements in socket fit and range of motion.

O&P ALMANAC | APRIL 2015

REIMBURSEMENT PAGE

By JOE MCTERNAN

Maximizing Your Accounts Receivables

E! QU IZ M EARN

CREDITS

Tired of payment delays? Follow these tips to promote timely reimbursement Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 20 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

APRIL 2015 | O&P ALMANAC

O BE SUCCESSFUL, an O&P prac-

tice must deliver excellent clinical service while running its operations efficiently to maximize the potential for profit. O&P facilities face many challenges in their daily operations. The ability to quickly and accurately bill for and collect reimbursement for services provided is an important task that can mean the difference between a profitable business and a nonprofitable one. This month’s Reimbursement Page focuses on some strategies to improve your company’s ability to collect payments and minimize the loss of reimbursement due to improper collection activities. The most basic principle of any business model is to maximize profits while containing costs. Companies that operate at a loss can rarely afford to continue to exist. Consider the traditional “mom and pop” nature of the O&P profession, and this principle carries even more weight. Small businesses tend to be more heavily affected by ebbs and flows in cash flow than larger businesses. The single most important asset for any business is liquid cash. It is what allows you to pay your staff, purchase your inventory, create new opportunities, and effectively operate your business on a daily basis. Without reasonable cash flow, even the most profitable business can quickly find itself in dangerous territory. Many businesses record revenue from a sale upon the exchange of merchandise or services. While this may paint an attractive picture on paper, the benefits of the revenue cannot be realized until money has

BUSINESS CE

P.20

actually been collected. Revenue that has been recorded but not collected is defined as accounts receivable (AR). The ability to collect AR efficiently and thoroughly is one of the signs of a healthy business. Once a debt is collected, the revenue can go to work for you instead of for the debtor. While a certain amount of outstanding AR has to be expected, the ability to maintain low AR balances is important to the success of your business.

Collect What You Can Up Front

The term “time is money” comes to mind when developing successful AR collection strategies. The longer it takes you or your staff to collect a debt, the less it is worth. One strategy that may help reduce your AR balance is to identify the “easy” collections and make them a priority. While this approach may require the investment of some front-end organization of outstanding debts, it may actually pay dividends: You and your staff will spend more time collecting real cash and less time chasing bad debt. While collecting a single large debt may create a big splash, collecting many smaller debts sometimes results in improved daily cash flow. Another strategy for decreasing AR is to attempt to collect coinsurance amounts and deductibles at the time the device is delivered. Medicare regulations allow you to do this, and it is an opportunity to collect the debt before it even gets to your AR balance. It may not always be realistic to collect the full coinsurance, especially for services that result in a high coinsurance for the patient, but you may encourage the patient to pay what

REIMBURSEMENT PAGE

he or she can at the time of delivery. Any amount that you receive at the time of delivery effectively reduces what you will have to collect later. The same strategy applies for nonassigned Medicare claims. If you choose to not accept assignment, the patient is financially liable to pay you as much as your full usual and customary charge at the time of delivery. Similar to coinsurance and deductibles, collection of all or some of the balance due from the patient at the time of delivery increases your cash flow and decreases your AR.

Cut Your Losses

No matter how a claim looks going into the system, there may be circumstances that result in what is known as “bad debt.” This type of AR is virtually uncollectible; leaving it on your books serves no real purpose other than to increase your outstanding AR balance. A good example of bad debt occurs when you provide a service to a Medicare patient that is denied as not medically necessary because of a lack of a valid prescription. There is little to no hope that Medicare will pay the claim because mandatory documentation requirements were not met. Without a signed advanced beneficiary notice on file, the patient cannot be held liable for payment. If you find yourself in such a no-win situation, it may be in your best interest to “write off,” or cancel, the debt. This will not improve your cash flow, but it will effectively reduce your outstanding AR and will allow your staff to refocus their energy to collectible debt.

Offer Credit

Think Big

It is sometimes better to have several small successes than one big one—but if the big one is out there, by all means go and get it. Once you evaluate your outstanding AR and organize the debts according to how easy they will be to collect, start with the largest amount. Once again, time is money and the overall goal is to collect the most amount of money in the least amount of time. If you have the luxury of having more than one staff member working on collection of outstanding AR, use your best talent to collect the higher debts. Their advanced experience and unique skills should be used to maximize returns.

The best time to collect coinsurance and/or deductibles is when the completed device is delivered to the patient. If there are circumstances where a patient simply cannot pay his or her full share of the cost of the item, you can do one of three things: You can document that the patient is experiencing financial hardship and write off the claim immediately; you can agree to a payment plan whereby the patient will pay his or her share of the cost directly to you over a predetermined period of time; or you can explore alternate sources of financial help for the patient. Credit card companies will process patient coinsurance and deductible payments as retail sales. The difference is that the credit card company has essentially purchased that debt from you and the debt now resides in the company’s AR account, not yours. Payment of the debt becomes a negotiation between the patient and the bank that issued the credit card. The only fee for which you are responsible is the small per-transaction

fee that credit card companies charge their merchant account holders. In addition to traditional credit card companies, other companies specialize in the financing of medical debts. These companies may offer attractive interest rates to patients for the specific purpose of financing medical expenses. AOPA does not endorse any particular company that provides such a service, but such services are easy to find on the Internet and may provide your company with an opportunity to increase your market share by offering multiple payment options to patients.

Build Relationships With Payors

The value of a friendly relationship goes a long way in the world of AR collection. Having a contact above the general customer service/call center level at payor companies can be a key to collecting AR that involves complex billing issues. The payor call center typically provides you with the status of a claim and not much more. This can lead to lengthy and often unnecessary delays in claim payment. If you have a professional relationship with an insurance company employee who is either a supervisor or is working in a specialty department (such as accounting), you may be able to obtain important details about specific claims. These relationships may mean the difference between a successful collection and an unsuccessful one. If you attempt to build these relationships before an issue arises, you will have an “inside track” to resolution when a challenging claim comes up. O&P ALMANAC | APRIL 2015

REIMBURSEMENT PAGE

One way to build these types of relationships is to determine if a payor has a provider education team. These are groups of experienced, specialized provider service representatives who are focused on communicating with the provider community. Even if they cannot assist you in solving a specific problem, they usually can direct you to someone who can. Also, if you have the opportunity to speak to a supervisor, document his or her name and ask if you may contact that individual in the future if you need additional assistance. Always be polite,

professional, and respectful, and you will find that people are much more willing to help resolve your issue.

Consult Outside Resources

Many collection agencies make their highest numbers of calls between the hours of 6 and 8 p.m. Why? Because collection agencies know that the best chance to reach somebody at home is to call during the traditional dinner hour. They know this because they are professional organizations that make their living collecting debt that has proven difficult to collect.

If you are considering contracting with a collection agency, remember that these companies do not specialize only in hard-to-collect debts. Some agencies will offer to purchase some or all of your company’s outstanding accounts receivables for a percentage of what it is worth on paper. For example, if your company has $10,000 of outstanding AR, the collection agency may offer you $8,000 to purchase that debt. If the agency is successful in collecting all of the AR, it will make a $2,000 profit. While the advantage to the collection agency is clear, the advantage to your company is two-fold. First, you receive immediate cash without having to spend valuable staff time and energy chasing paper trails. Second, the collection agency assumes the risk associated with collecting the debt. The company only realizes a profit if it collects more than what it paid for the AR. Many O&P companies feel that the benefits of collection agencies outweigh the cost and use outside resources to collect all of their AR. The decision to use an outside company to collect AR is truly a business decision but should always be considered as an option. The management of cash flow is crucial to the success of any business venture, including the management of an O&P practice. The AR strategies discussed in this month’s Reimbursement Page represent only a few ways to successfully manage your company’s accounts receivable balances. There is no right or wrong answer to the question of how to best manage your AR. Joe McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

www.bocusa.org

APRIL 2015 | O&P ALMANAC

lock it up! Three great locks Air-Lock Suction allows for less traction on the limb for increased comfort and decreased liner wear Expulsion valve or suspension sleeve are not needed to maintain suction in most cases Water-resistant CD103 | Air-Lock Patent No. 6334876

Easy-Off Lock Easy donning and doffing with lever release Self-lubricating materials reduce wear Can be used with elevated vacuum Water-resistant CD117 | Easy-Off Lock Patent No. 6334876. Other patents pending.

Proximal Lock ZERO CLEARANCE lock Controls rotation Larger attachment distributes more tension; flexible attachment rolls on easier

G PRODUCT CATALO 2015

Use with your choice of distal adapters CD116 | Proximal Lock

Need a catalog? Get a catalog!

Patent No. 6666894, 7431738, 7077868. Other patents pending.

Dowload our 2015 catalog at coyotedesign.com or call (800) 819-5980 to have one mailed to you.

Toll Free (800) 819-5980 Phone (208) 429-0026 www.coyotedesign.com

This Just In

The High Cost of Appeals New study finds both O&P professionals and the U.S. government pay the price for excessively long appeals process

HE CENTERS FOR MEDICARE &

Medicaid Services (CMS) could save more than $10 million by resolving the overwhelming backlog of administrative law judge (ALJ) hearings. This finding should sound a wakeup call to those not yet attuned to the staggering backlog of Recovery Audit Contractor (RAC) appeals. Though the law states that the administrative law judge should make a decision regarding an appeal within no more than 90 days, some O&P practitioners have been forced to wait three years or more to stand before the ALJ. Along the way, the government is tallying up interest that it will eventually pay out in successful appeals.

APRIL 2015 | O&P ALMANAC

These findings come from a landmark study commissioned by AOPA and carried out by Dobson-DaVanzo & Associates, Vienna, Virginia. The present system is not tenable: According to the report, Medicare receives some 15,000 ALJ hearing requests per week. Should an appeal succeed, CMS becomes responsible for reimbursing the provider for the submitted payment plus interest at above-market rates—as high as 30 percent—for the time period between provider repayment and the ALJ determination.

Worsening Crisis

“We are here today to warn you about a worsening crisis for small healthcare provider firms,” AOPA President Charles H. Dankmeyer Jr., CPO, said at a recent news conference. The fix AOPA has proposed, which is the subject of the new study, is that CMS delay recoupment of funds on audits until after the ALJ hearing decision. If the ALJ backlog were to be resolved, “Medicare could avoid rapidly mounting interest payments, saving over $12 million a year,” Dankmeyer said. “This is a crisis that should never have happened. We need to fix it in a way that saves the federal government money on needless interest payments.”

This Just In

At the same time, a solid fix would ease the pressure on small providers, many of whom already have folded under the pressure of RAC audits that might have been overturned on timely appeal. More than 100 O&P providers already have shut down due to audits and delays in the Medicare appeals process, according to AOPA. There is no end in sight to this monster backlog.

Potential Savings

The Dobson-DaVanzo study showed definitively how delays in the ALJ system are not only harming providers but also causing direct financial harm to CMS. Researchers found that CMS recouped $600,740 in potentially inappropriate Medicare payments in 2013, the most recent figures available. With a reported 51.9 percent success rate of O&P appeals for closed cases, CMS could only recoup $289,245 of the potential total. That’s a substantial savings for Medicare, until one takes into account the sum CMS paid out in interest for the time it held onto audited providers’ cash in between payment to the RAC auditors and the ALJ appeal. Accumulated interest payments totaled an estimated $85,661, which is equivalent to 30 percent of the remaining recouped funds. In other words, CMS is paying roughly a 13 percent bounty to its RAC auditors plus losing 30 percent of recouped funds due to required interest payments for successful appeals because of the long delays. “The appeals system at the ALJ level is totally broken,” says Alan Dobson of Dobson-DaVanzo. “You’d think the government would either want to fix it or get rid of it.”

Provider Impact

While the delays at the ALJ level may be taking their toll on the government coffer, the O&P community is equally concerned with the impact both on providers and on the patients who rely on them for care.

The present system, in which providers pay out RAC audit penalties long before given a chance to mount a (frequently successful) appeal, has put an untenable burden on small providers. So says Mary Palmer, business manager, Nelson Prosthetic and Orthotic Laboratory, a Buffalo, New York, clinic that has seen repeat layoffs as a result of dozens of RAC audits and related cash flow issues. By handing over cash in advance of appeals, O&P has effectively become a banker to the U.S. government, Palmer says. “We give them our money and wait years for them to give it back,” she says. “It’s a heavy burden for a small business like us to bear.” While O&P supports industry accountability, “there is a difference between accountability and persecution.” The true victim in all of this is ultimately the patient. “If they come to us and need that service, they need that service. It’s how they function in life,” Palmer says.

Uneven Playing Field

Despite the fact that O&P typically sees a 51.9 percent success rate in RAC appeals, which is a higher success rate than any other provider group, many practitioners are being driven out of business as they find their cash tied up in RAC proceedings. Here again, it’s the patients who suffer, says Audrey El-Gamil, a senior manager at DobsonDaVanzo. “Patients who have a longterm relationship with a particular provider may lose that relationship, because that person is no longer available,” she says. While much of the issue stems from the long-delayed ALJ hearings, part of the problem also lies in the nature of the RAC audits, where auditors are paid a commission (some say a “bounty”) on whatever moneys they are able to collect. This tilts the scales against O&P, where providers are more likely to bill a single $20,000 procedure than

multiple $300 procedures, thus making these practices a tempting target for auditors, Dankmeyer said during the news conference. The high-cost services in prosthetic procedures give auditors a good reason to pay disproportionate attention to O&P overall. That uneven playing field shows in the numbers, says AOPA Executive Director Thomas F. Fise, JD. “Orthotics and prosthetics represent just one third of one percent of Medicare spend—a very, very small percent of Medicare spend,” he says. Yet O&P makes up more than 10.5 percent of RAC Part B claims, and more than half, in terms of total dollars, of all RAC audits at the ALJ level. “So there is certainly a disproportionate explosion in the numbers as you move up the line,” Fise says. To alleviate this unfair burden on O&P professionals, AOPA and many representatives of the O&P community agree: RAC auditors shouldn’t be paid until all appeals have been exhausted, and the ALJ process should be shortened to fall within the legally required 90-day waiting period. In addition, the RAC auditors should not be paid on the bounty system. But at the very least, a dramatic revamp of the ALJ system to bring it in compliance with present laws would save the government millions, while ensuring best possible outcomes for patients as well as greater fairness for practitioners struggling under the current system. At the urging of Rep. Mark Meadows (R-North Carolina), H.R. 1526, the Medicare Audit Improvement Act of 2015, was unveiled at the AOPA Policy Forum, March 23-24. Meadows spoke at the Policy Forum and detailed how the bill would help alleviate cash flow pressures by limiting CMS to recouping no more than 50 percent of audit claims. It is not the 100 percent delay AOPA proposed, but clearly half the loaf is better than none. O&P ALMANAC | APRIL 2015

COVER STORY

Self-Evaluation How does your facility compare to O&P practices around the nation? Several practitioners share their strategies for assessing patients, fabricating devices, and providing follow-up care By CHRISTINE UMBRELL

APRIL 2015 | O&P ALMANAC

COVER STORY

Need to Know: • While most practitioners implement the well-known six-minute walk test and timed up-and-go test, many also make use of the Amputee Mobility Predictor© (AMP) and the K-PAVET™ form. Others also employ the Activity-Specific Balance Confidence (ABC) scale and self-created strength and range-of-motion assessments to determine patient mobility. • When choosing a device, practitioners consider a range of factors such as evidence-based literature; patient’s age, condition, and lifestyle; and payor constraints. • Some estimates report that as much as 90 percent of O&P clinical facilities use some type of central fabrication services, but the clinicians we spoke to say a significant number of O&P professionals still rely on inhouse fabrication, at least in part, to meet time constraints and to service patients in rural settings. • Ongoing assessments are equally critical, with some practitioners using the Prosthetic Limb Users Survey of Mobility (PLUS-M™) patient-reported outcome measure to evaluate patients at follow-up appointments.

S AN O&P PRACTITIONER, how

do you decide what assessment techniques to use to evaluate the potential functional levels of new patients? How do you determine which components to use? What makes you decide to outsource fabrication? And how do you make sure that patients who receive new devices are using their components correctly and are making progress in their rehabilitation? Making the right decisions can mean the difference between a successful practice with satisfied patients and a nonprofitable facility with patients who seek alternative care. Here, several O&P professionals from a wide range of O&P companies share best practices for patient treatment decisions.

Optimal Assessment Techniques

Prosthetists and orthotists agree on the importance of thorough assessment techniques to determine functional levels and appropriate componentry for patients. Standardized tests ensure a predetermined amount of information is collected, and also promote communication between clinicians and patients. Practitioners across the country rely on a number of tried-and-true measures to evaluate patients for initial prostheses and establish the appropriate K level as described by Medicare. While the practitioners we spoke to say they implement the well-known six-minute walk test and timed upand-go test, many also make use of the Amputee Mobility Predictor© (AMP) and the K-PAVET™ form.

O&P ALMANAC | APRIL 2015

COVER STORY

The AMP tool, developed by Robert S. Gailey, PhD, PT, is designed to measure ambulatory potential of lower-limb amputees with prostheses (AMPPRO) and without prostheses (AMPnoPRO). It takes about 15 minutes to administer. Patients are asked to perform a wide range of tasks, such as sitting, reaching, standing and balancing, picking up objects, hopping, and ascending and descending stairs. Depending on how high patients score, they can be assigned K0 to K4 functional levels. More recently, an AMP-Bilateral tool has been developed to measure the ability of bilateral amputees to perform functional tasks related to participation in advanced skill activities.

Aaron Moles, L/CP

APRIL 2015 | O&P ALMANAC

Aaron Moles, L/CP, works with a patient to add flexion to increase step length during a follow-up visit.

for evaluating prosthetic patients. Phil Stevens, MEd, CPO, clinic manager for Hanger Clinic in Salt Lake City, relies on the PAVET protocol, which stands for Patient Assessment Validation Evaluation Test. K-PAVET uses a ranking system of 0 to 4 to evaluate patients in each of three separate categories (activities of daily living, functional requirements, and physical capabilities) to determine the correct K level. The K-PAVET provides a numerical score related to what the patient needs to be able to accomplish (activities of daily living) and what they are capable of accomplishing (functional requirement) and quantifies the strength

of the lower-limb joints (physical capabilities). “The K-PAVET allows us to evaluate the patients’ needs and functional capabilities and looks at their physical strength and abilities,” says Stevens. Though the K-PAVET form is copyrighted by Hanger, it may be used by other health-care professionals: “There are no restrictions for anyone outside of Hanger to use it,” says Hanger Clinic Vice President of Clinical Operations Dale Berry, CP, RPT, LP, FAAOP. At one time the form was patent-pending, but Hanger has released the patent application “because we wanted the form to be

PHOTO: Courtesy Aaron Moles, L/CP

Aaron Moles, L/CP, owner of Prosthetix Shop in Cincinnati, uses the AMP tool for every patient, in addition to range-of-motion and timed up-andgo tests. “The AMP is an excellent, thorough exam that can determine the specific functional level of a patient,” says Moles. “Without that test, sometimes you can over-predict someone’s potential functional level.” Moles also uses the Activity-Specific Balance Confidence (ABC) scale during initial assessments. The tool asks patients to indicate their level of selfconfidence in performing specific tasks without losing their balance using a percentage scoring system. By having patients fill out an ABC survey before they receive their prostheses, the tool can be used as a baseline for comparison after patients have started using their new devices. Another evaluation tool that is gaining acceptance is the K-PAVET™ form

It just doesnâ&#x20AC;&#x2122;t stack up Ottobock has more than 45 publications based on the results of more than 30 studies highlighting the positive outcomes the C-Leg, Genium and X3 deliver. The other stack barely casts a shadow. To get more detail, visit the C-Leg page at ottobockus.com and read the study summary.

www.professionals.ottobockus.com

COVER STORY

fully accessible to all and are promoting the adoption of this evaluation process by others. The K-PAVET is licensed by numerous national insurance companies here in the United States and a number of government agencies in other countries. We encourage and invite non-Hanger clinicians to apply the K-PAVET in day-to-day practice,” says Berry. He does note that because the form is copyright protected, it must be used

as-is, and non-Hanger facilities cannot modify or change the form. Dave Motycka, CPO, says that in addition to muscle testing, range-ofmotion testing, sit/stand evaluations, the PAVET form, and ambulation evaluations, his assessments involve communication with referring physicians and physical therapists. Motycka, a managing partner at New England Orthotic and Prosthetic Systems in Hamden, Connecticut, also says that

Dave Motycka, CPO

What the Schools Are Doing…

APRIL 2015 | O&P ALMANAC

PHOTO: University of Hartford students

O&P students at the University of Hartford focus on the fundamentals when learning evaluation techniques. Instructors “identify the global principles behind patient assessments so students learn to apply those principles to specific measures,” says Matthew Parente, MS, PT, CPO, clinical director of the university’s MSPO program. The students are trained in traditional strength and range-of-motion tests and techniques for identifying functional limitations. Instructors make sure students know how to use the Gailey Amputee Mobility Predictor (AMP) and are aware of the K-PAVET protocol, but the focus is on a greater foundational understanding. Parente notes that individual assessment tools may become obsolete over the years, so teaching the processes behind the currently accepted techniques prepares students to evaluate patients regardless of the tool. At the University of California, San Francisco (UCSF), practitioners routinely employ the AMP measurement tool as a means of determining University of Hartford students take part in functional level at the onset of rehabilitation training session. each new prosthetic treatment, says Matthew Garibadi, CPO, director of orthotic and prosthetic centers and assistant clinical profession in the department of orthopaedic surgery at UCSF. Once a device is provided, UCSF practitioners follow a rigorous protocol: “To determine the efficacy and functional benefit of services rendered, we administer either a six-minute walk test or the timed up-and-go test at initial evaluation for current prosthetic users and again at one month postdelivery,” says Garibaldi. “For new amputees, the six-minute walk test or timed up-andgo test are administered at one week postdelivery to establish a baseline.”

sitting and talking with a patient—and getting their honest feedback on their ambulatory abilities prior to amputation—“can go a long way toward establishing functional level.” Some practitioners rely on gut instinct in addition to the formal assessment tools. Jim Young, CP, FAAOP, founder of Amputee Prosthetic Clinic in Macon, Georgia, says that he uses the AMP, the six-minute walk test, and the timed up-andgo, but also uses something he calls the “toddler sizing assessment technique”: He asks patients to try to do what a toddler can do on the floor, including getting down on the floor, rolling around, and getting up off the floor. He watches as patients perform these tasks to get an idea of their mobility. As he assesses patients, Young analyzes five factors to determine how successful their ambulation will be: strength, balance, endurance, motivation, and confidence. On the orthotics side of patient evaluations, assessments rely heavily on input from physicians and physical therapists, says Motycka. Often a physical therapist starts with a patient, who is referred to the orthotist for appropriate support. When working with a new orthotic patient, Motycka performs a physical exam that involves muscle and strength testing, as well as a walking test for lower-extremity patients. He also fits patients with diagnostic off-the-shelf braces, as his facility stocks different types of devices to be used as trial components. With those trial devices, “I can tell right away if a custom brace is required,” says Motycka. At North Coast Orthotics and Prosthetics in Lorain, Ohio, Jeffrey Yakovich, CO/L, sees many lowerextremity ankle-foot orthosis patients.

COVER STORY

To evaluate these patients, Yakovich records a comprehensive patient history, conducts a basic neurologic exam, performs strength and range-of-motion exams, and considers family structures (to assess whether patients will have assistance in donning and doffing). These factors all influence his decision as to appropriate orthotic care.

Component Selection

Once a patient evaluation is complete and a functional level is determined, deciding which componentry to offer patients is the next challenge. Choosing products is “one part art

PHOTO: Courtesy Aaron Moles, L/CP

Jeffrey Yakovich, CO/L

and one part science,” says Stevens. “We stay abreast of new technologies—especially if there’s literature on it—so we can provide evidence-based care. But we also look at what has been successful in the past.” Moles says he tries not to consider a patient’s insurance plan when making his initial component decisions. “I like to keep an open mind at first, and try not to think about their insurance coverage,” he says. “I try to think of what will make them most functional. Then, I’ll look at their coverage and the local coverage determinations or policy article,” and make a final decision that will work within those parameters. For Yakovich, “the patient’s condition determines which component we select,” he says. “If three companies make a component that fits that patient’s needs, I will look at cost, quality, and reimbursement. We try to provide the most functional component within the constraints of the payors.”

New Soft Shell Technology Extreme protection for extreme use High tear, abrasion and puncture resistance Exceptionally heat resistant One prosthesis for all activities No need for foam underneath Water compatible

In s p ire d by p a t i e n t s

Toll free: 855.955.AQUA - www.Aqualeg.com - US Distributor and Scanning Center: Matrix Imaging. Toll Free 877 394 7603

O&P ALMANAC | APRIL 2015

COVER STORY

Motycka says he is willing to use any manufacturer, though he gravitates toward certain brands for specific types of residual limbs. “Some carbon or flex-feet accommodate residual limb heights differently,” he says. Patient characteristics also come into play: “For geriatric household ambulators, I lean toward lightweight components,” he says. “For little kids, I’ll choose durable devices that have warranties.” Some practitioners admit to favoring certain products, but most are not tied to specific manufacturers. “I’m guilty, as most clinicians are, of having my ‘go-to’ component selection that I feel comfortable with,” says Young. He has found certain products to be reliable over the years. However, he is open to new products when the situation warrants. “I’m not opposed to trying new things,” he says. In fact, since Young himself is an amputee, he tries almost every knee and foot that come to market. “If a patient comes in with a new idea and wants to try a different product, I will let them try it,” he says. Most manufacturers have 30-day trial periods, so Young works with patients to test different products to ensure they select the best component.

Young also chooses products that fit the lifestyle of his patient demographics. Many Georgians spend time outdoors on activities such as fishing or farming, so Young tends to select durable devices that can “handle dirt and grime.”

Jim Young, CP, FAAOP

Fabrication

As much as 90 percent of O&P clinical facilities use some type of central fabrication services, according to a report on central fabrication created by Fillauer President and COO Dennis Williams, CO, BOCO. But the clinicians we spoke to say that while many facilities outsource a portion of their fabrication work, a significant number still rely on in-house fabrication for some of their work.

Focus on Follow-Up In-house fabrication at AmPro Orthotics & Prosthetics Inc. in Las Vegas 30

APRIL 2015 | O&P ALMANAC

Both quantity and quality of follow-up appointments contribute to successful patient outcomes, say practitioners.

PHOTO: Marinoff Design LLC

Young, for example, does all fabrication in-house with the assistance of a master technician, which fits with his goal of treating patients in as few visits as possible. Young has been successful primarily because he has tailored his facilities to fit the needs of the surrounding communities. With three locations in primarily rural areas of Georgia, many of his patients travel up to 100 miles for O&P care. “So we offer same-day service once everything’s approved,” he says, which limits the number of trips patients must take. “If I used central fabrication, there is no way I could deliver care the way I do now. We can go from a cast to a test socket in one or one-and-a-half hours—that would take at least three days with a central fabrication facility.” Similarly, Yakovich does most fabrication in-house, with time constraints being the main determining factor. He services a high number of sports medicine patients, for whom time is of the essence. “We need to turn things around quickly so we don’t outsource a lot.” With three technicians on staff, “I have a tremendous technical team that has made the jobs of our practitioners much easier,” he says. For Moles, on the other hand, outsourcing is an important part of his business strategy. As a relatively new facility, Prosthetix Shop has chosen to focus on patient care and minimize fabrication, so he relies on central fabrication to complete his work orders quickly. “We use a digital scanner to take impressions, so we can get components back in two days,” he says. Motycka finds that a combination of in-house and outsourced fabrication best meets his needs. Having worked as a technician for several years before becoming a certified practitioner, Motycka fabricates all of his patients’ prostheses himself, but he outsources orthoses to his company’s central fabrication facility.

COVER STORY

Moles sees patients weekly and then monthly after they receive a new prosthesis. “For amputees to be functional, they need to be trained, and they need to understand their devices,” he says. “It takes a lot of time.” At follow-up appointments, Moles checks the components, watches patients ambulate, has patients perform twominute walk tests, and asks patients to fill out ABC surveys once again. “By doing these assessments, patients realize how much progress they are making over time, and realize what they can now do that they couldn’t do before.”

Stevens says his facility uses traditional 10-minute walk tests and the ABC scale when performing follow-up assessments. But more recently, he has started using the Prosthetic Limb Users Survey of Mobility (PLUS-M™) patient-reported outcome measure to evaluate patients at follow-up appointments. The survey, developed at the University of Washington Center on Outcomes Research in Rehabilitation, is a self-report instrument for measuring mobility of adults with lower-limb amputation. It measures prosthetic users’ mobility and assesses respondents’ perceived ability to carry out actions that require use of both lower limbs. The surveys provide a T-score that ranges from 17.5 to 76.6. The forms require two to three minutes to administer and one to two minutes to score. (For more information on the PLUS-M, see the article “Prosthetic Limb Users Survey of Mobility” in the July 2014 issue of the O&P Almanac (page 34), bit.ly/July14Almanac. Stevens says the benefit of using the PLUS-M during follow-up assessments is that “there is a database of results from more than 1,000 patients” that was compiled by the developers

PHOTO: Courtesy Aaron Moles, L/CP

Phil Stevens, MEd, CPO

of the survey, called the development sample. “So we see how data from our patients compares,” he says. The data also can be compared to those reported by subgroups, such as level of amputation, etiology of amputation, gender, and age, so “we can look at our patients’ data and compare it against scores from similar types of amputees. “As we’ve started using this form, it’s been very exciting for our clinicians,” says Stevens. “When we see most of our patients functioning in the 60th or 70th percentile, that’s very gratifying.” Motycka also believes in frequent follow-up evaluations. “We do weekly follow-ups with new patients,” he says. “I personally spend a long time doing gait training in my office so patients are prepared when they go to physical therapy.” He says this is especially critical for patients who hope to advance to a higher functional level. Once patients have passed the necessary milestones to advance, he shows evidence from O&P office visits and physical therapy appointments when referring back to the physician. “Being able to show a patient is walking well provides ammunition if we are ready to go to a higher level,” he says. Motycka has taken his follow-up plan one step further and has put a new process in place to ensure patients communicate the necessary feedback to their physicians after they receive their new components: His facility has created a form for patients to give to their doctors to make sure those doctors ask the questions required for complete documentation. The form has been adapted from the “Dear Physician” letter and includes “questions the physician should ask to ensure documentation requirements are fulfilled.” The goal is to prod physicians to gather the feedback necessary for documentation so practitioners can be fully prepared for any audits that may come up. Both orthotic and

prosthetic versions of the form are available. This is a new undertaking for Motycka, but he is hopeful that using this form will help ensure physician documentation is complete and accurate.

Finding What Works for You

There is no one-size-fits-all approach to providing optimal O&P care. Factors such as type of facility, geographical location, and patient demographics all play a part in determining the best methods for patient evaluations and device selection. But successful practitioners do agree on one guiding principle: Patients will have optimal results when practitioners communicate closely with their patients and use tested industry tools to determine the devices that will best enhance patients’ lives. Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com. O&P ALMANAC | APRIL 2015

By DON DEBOLT

A Bill That

Rights

the Wrongs By addressing a wide array of challenges currently facing O&P professionals, the Medicare O&P Improvement Act of 2015 seeks to improve conditions for both clinicians and patients

Need to Know: • The 2015 version of the Medicare Orthotics and Prosthetics Improvement Act is an all-encompassing bill introduced in the Senate as S. 829 and in the House of Representatives as H.R. 1530. • Among other issues, the legislation seeks to recognize orthotists’/prosthetists’ notes as part of the documentation; resolve the delays in administrative law judge hearings; clarify the definition of “minimal self adjustment”; and distinguish O&P from durable medical equipment. • Many of the provisions in this year’s Medicare O&P Improvement Act also made their way into separate pieces of legislation previously introduced in the 113th Congress or poised for introduction in the 114th Congress. • All O&P stakeholders are urged to contact their legislators via e-mails, letters, and facility tours and ask their senators and representatives to support the legislation.

APRIL 2015 | O&P ALMANAC

HAT’S DIFFERENT ABOUT THE 2015 version of the

Medicare Orthotics and Prosthetics Improvement Act? In a nutshell, it addresses almost every vexing challenge O&P has faced for decades—but especially the challenges of the last four years, headlined by the onerous Recovery Audit Contractor (RAC) audits. The legislation could make a huge impact on the quality of life and survival of O&P providers. And it’s all in one piece of legislation: S. 829, introduced by Sens. Chuck Grassley (R-Iowa) and Mark Warner (D-Virginia); and H.R. 1530, introduced by Reps. Glenn Thompson (R-Pennsylvania) and Mike Thompson (D-California). This year’s bill includes the former bill’s language that curbs fraud and abuse, re-enforcing the existing congressional mandate for CMS to limit payments to only licensed providers in licensure states or only qualified providers in nonlicensure states, relating the complexity of patient needs to the qualifications of the provider. The bill also: • Recognizes the value of the orthotist’s or prosthetist’s notes in the medical record, making them on par with other providers such as physical therapists • Restores due process rights and proper administrative law judge (ALJ) timeframes

• Reinstates the statutory definition of “minimal self adjustment” for off-the-shelf (OTS) orthoses and competitive bidding • Distinguishes orthotists and prosthetists from suppliers of durable medical equipment (DME) and supplies • Mandates greater accountability and transparency of RACs.

Separate Asks

Many of the provisions in this year’s Medicare O&P Improvement Act also made their way into separate pieces of legislation previously introduced or drafted in the 113th Congress at the urging of AOPA with support from the O&P Alliance. Some of these separate bills from the prior Congress are poised for introduction in the 114th Congress as well. It’s a classic case of not putting all of your legislative eggs in one basket but building consensus and synergy by having multiple options that address the problems faced by O&P. While the Grand Slam for O&P remains the greatly expanded Medicare O&P Improvement Act of 2015 that embodies all of these solutions in one bill, everyone in O&P should be aware of these other legislative proposals that include pieces of the Medicare O&P Improvement Act and their congressional proponents. As an example, variations on recognizing the value of orthotists’ and prosthetists’ notes appear in legislative

proposals introduced last year by Rep. Renee Ellmers (R-North Carolina) and Rep. Kevin Brady (R-Texas), and in a bill recently introduced by Rep. Mark Meadows (R-North Carolina), H.R. 1526, the Medicare Audit Improvement Act of 2015. Restoring due process on ALJ appeals also is addressed in the Meadows bill. The Hospital Improvements Payment Act is a separate bill slated to be introduced by Brady that is expected to include language pertaining to the recognition of prosthetists’/orthotists’ notes in the medical record, and providing other solutions to address the appeals process delays, and would also apply to Part B providers.

What’s At Stake

One of the most important subjects included in the Medicare O&P Improvement Act of 2015 is the key issue of recognizing orthotists’ and prosthetists’ notes; such recognition acknowledges that many amputee and orthotic patients may not see the referring physician when they have issues or questions about their devices, and the bond between the patient and the O&P health professionals may be the major factor in regaining mobility and quality of life. Follow-up care is one of the factors that distinRick Fleetwood, left, and Sen. Chuck Grassley guishes O&P care from (R-Iowa), right, discuss O&P challenges. wheelchairs and other

DME. This step would greatly reduce unfavorable RAC audits and return the O&P provider notes to the status they properly enjoyed prior to the inception of the current CMS audit policy. Another key issue resolved by the bill is the two- to five-year delay in obtaining an ALJ hearing for RAC audit denied claims that have clawed back huge sums of money from O&P providers. The bill would delay at least 50 percent of the recoupment until after the ALJ decision is rendered, which would, according to independent research, save CMS money in the long run on recoupment claims overturned at the ALJ level, which requires CMS to return recouped funds and pay an annual rate of 10 percent or more in interest on the recoupment amount since date of recoupment. CMS has been unlawfully expanding the original statutory definition of “minimal self adjustment” pertaining to OTS orthoses, which limits any adjustment to only those that can be made by the patient to qualify as an OTS device. But CMS now says that minimal self adjustment includes adjustment by the beneficiary, caretaker, or supplier. This definition dramatically expands the number of OTS devices eligible for competitive bidding and includes many devices clearly not OTS and that run the risk of harming the patient in the absence of a qualified provider’s experienced care. Under S. 829/H.R. 1530, the text would be further clarified to say the term refers to an adjustment that could be made only by the “patient and no other person.” O&P ALMANAC | APRIL 2015

It would more clearly identify where fraud is taking place.

Show Your Support

This year’s AOPA Policy Forum clearly benefited from having an all-encompassing Medicare O&P The North Carolina delegation at the AOPA Policy Improvement Act as Forum, from left to right: Ashlie White and Eddie White, one bill number on CP, of Beacon Prosthetics and Orthotics; patient the Senate and House Stella Sieber; and O&P student Thomas Page side covering all of the truly burning issues that O&P has had A long-standing need of the O&P to deal with these past few years. The community is to be distinguished more than 100 passionate and commitfrom DME, and the Medicare O&P Improvement Act deals with this issue ted O&P professionals who attended as well as requires the Department of the event could make a simple “ask” Health and Human Services to create urging their senators and representaseparate categories for orthotics and tive to co-sponsor and support this prosthetics and for durable medisignificant legislation for the patients and providers of O&P services. cal equipment when compiling and But this “ask” can’t be limited to publicly reporting information on the O&P professionals attending the appeals filed and the success of appeals Policy Forum—every stakeholder in for providers at each level of appeal.

Ferrier Coupler Options!

O&P must step up to the plate. The ideal way to convey the message is to invite your legislators to tour your facility and try to have willing patients in attendance to provide the context of what you do to restore mobility and quality of life. Personal letters and phone calls are another avenue. Get acquainted with staff in the legislative offices that members of Congress maintain in their home states and districts. To make it really easy for you, the AOPAVotes website, www. AOPAVotes.org, has a letter all set to go that will automatically email to your legislators urging their support and co-sponsorship of the Medicare Orthotics and Prosthetics Improvement Act of 2015. Visit the website and take the next step to support this important legislation. Don DeBolt is AOPA’s chief operating officer. Reach him at ddebolt@ aopanet.org.

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

Enables a complete disconnect immediately below the socket in seconds without the removal of garments. Can be used where only the upper (above the Coupler) or lower (below the Coupler) portion of limb needs to be changed. Also allows for temporary limb replacement. All aluminum couplers are hard coated for enhanced durability. All models are interchangeable.

Model A5

Model F5

Model P5

The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.

The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component. The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.

APRIL 2015 | O&P ALMANAC

Model FA5

Model FF5

Model FP5

NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern. Female portion of coupler accepts a pyramid.

Model T5

NEW! The FF5 has a female pyramid receiver on both male and female portions of the coupler for easy connection to male pyramids.

NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.

The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb. The unit is waterproof and has a traction base pad.

You want a credentialing organization that guides you through the certification process

You Want More

Switch to BOC today for award-winning customer service and one-on-one, personal assistance. Weâ&#x20AC;&#x2122;re with you every step of the way! Karen Lawson, Credentialing Account Specialist

877.776.2200

bocusa.org/switch

LEADERSHIP SERIES

Finding Your

Niche

Specializing in a specific subset of O&P patient care offers more pros than cons for many business owners

ONG-TIME VETERANS OF THE profession can easily recall the days when

The O&P Almanac’s Leadership Series is a new feature in the magazine sharing insights and opinions from senior-level O&P business owners and managers on topics of critical importance to the O&P profession. This month, we investigate the topic of niche O&P facilities.

Meet Our Contributors

Jonathan Naft, CPO, is general manager of Myomo and president of Geauga Rehab Engineering in Chardon, Ohio. Geauga specializes in high-tech devices and upper-extremity myoelectric orthotics. Naft also served as a facilitator during a breakout session on “Boutique and Niche O&P Services” during AOPA’s Futures Leadership Conference in January. 36

APRIL 2015 | O&P ALMANAC

mom-and-pop shops ran the industry. Small, family-owned facilities were the norm, serving their local communities and passing businesses down through generations. Then came the rise of health maintenance organizations (HMOs) and preferred provider organizations in the 1980s, which sparked unprecedented levels of O&P consolidation. Many of the small facilities combined forces or were bought out by larger companies, finding strength in numbers to win managed-care contracts. Small, community-focused facilities became much less common. But even then, many “niche” facilities survived, and a healthy number of practices currently specialize in just one subset of O&P patient care. Today’s niche facilities are unique in that they cater to an even smaller population of O&P patients than the typical facility, and practitioners can hone very specific skills sets to become subject matter experts. Many niche practitioners enjoy focusing on one or two areas of expertise—and they believe their patients benefit from their specialized care. “A niche practice can become a center of excellence—and can market itself that way,” says Jonathan Naft, CPO, president of Geauga Rehab Engineering in Chardon, Ohio—a facility that specializes in high-tech devices and upperextremity myoelectric orthotics. Recently, O&P Almanac discussed with Naft and other niche business owners how the current O&P climate is favorable for niche practices and areas of concern for these types of businesses.

Megan McCarthy, CO, is owner of A Step Forward Orthotics & Prosthetics in Portland, Oregon. A Step Forward specializes in custom orthotic devices of all types. About 70 percent of the practice focuses on pediatrics.

Dennis Clark, CPO, is founder and partner at Limb Lab in Rochester, Minnesota, an independently owned and operated boutique prosthetic and orthotic company that provides solutions to the functional challenges of limb loss and injury. He also is president of Clark and Associates Prosthetics and Orthotics and president of Orthotic and Prosthetic Group of America.

O&P ALMANAC: How do you define

a “niche” O&P practice?

JONATHAN NAFT, CPO: Until

recently, I never thought of my practice as a “niche” facility. I provided the services I felt were most appropriate to my skill set and the population I was seeking to serve. But that’s what a niche facility is—a practice that manages a select group of patients within the overall scope of O&P. Within O&P as a whole, there are lots of subsets—for example, shoes, cranial, high-end prosthetics, custom orthoses, and spinal, to name a few. Niche facilities are a matter of matching the skill set of the provider with the needs of the community. MEGAN MCCARTHY, CO: I would classify it as specializing in a segment of O&P. A niche practice does not cover all aspects of the field, but concentrates on certain segments of it. I like to think of it as the part of the field in which I excel. DENNIS CLARK, CPO: A niche practice

provides a service at a very high level, that probably no one else in your market is providing—or you are providing it at a more complete level than others. O&P ALMANAC: How are conditions favorable to having a niche O&P facility in 2015? NAFT: This is an interesting switch in

trends. Back when HMOs came into O&P focus, there was more of a need for facilities to provide full services in orthotics and prosthetics. But now practitioners can focus more on one aspect—you can just do “P” or just do “O.” Someone who wants to provide just a subset of either orthotics or prosthetics can be successful. O&P used to be device-centric—it was all about the focus on the device. But now it’s more about the outcome to the patient. This theme is being echoed in the O&P schools today.

Boutique Fabrication: A Niche Manufacturer’s Perspective While several O&P facilities have found success in providing O&P care to a small subset of orthotic and prosthetic patients, manufacturers that fabricate devices for targeted populations within the O&P community also exist. One such company is Naked Prosthetics in Olympia, Washington, a manufacturer of biomechanical partial and complete finger and thumb prostheses. Niche manufacturers can be extremely successful if they set out to provide products for a previously underserved market, says Jon Bengtsson, the company’s chief operating officer. Naked Prosthetics has developed finger prostheses for individuals who would not otherwise have a functional prosthesis. Jon Bengtsson The Naked Prosthetics solution is 3D printed and has been approved by Food and Drug Administration. “Previously, the solution was to desensitize the residual finger and come up with a cosmetic solution,” says Bengtsson. “Material science has finally caught up, to the point where we can 3D-print a custom prosthesis for finger amputees, which restores function, provides protection, and prevents further injury to the bilateral digits.” Serving a niche market can be advantageous because “you’re able to be more nimble and steer your ship in the direction your patients are asking for,” Bengtsson says. “You’re not beholden to a large bureaucracy to make decisions.” Though Bengtsson’s company has tripled in size in the past year, he says the biggest challenge of being a niche manufacturer is awareness of the company’s existence. “We have to work hard to make sure the surgical community, the O&P community, and the hand therapy community are aware of our devices.” Strategic partnerships are one way niche manufacturers can improve their visibility and increase market share, suggests Bengtsson. The goal is to “look for strategic market partners to combine forces to serve a larger community.”

O&P ALMANAC | APRIL 2015

Students spend more time learning how to manage patients and be part of the overall care team. Niche practices can be laser-focused on patient care because they are truly experts in particular areas of specialty. MCCARTHY: In terms of today’s chal-

lenges, it does make quality control and document generation easier because you become really good at a very small segment of the field. This is true especially with Recovery Audit Contractor audits and making sure all your documentation is relevant and appropriate. CLARK: Conditions are favorable as

long as there’s a large enough patient population for your niche. For me personally, the niche is one part of a regular O&P practice. Our niche is high-end, upper-extremity orthotic and prosthetic technology. This is a good niche at this time because there’s so much new technology. It’s a great way to do business and keep your facility fresh and relevant. It also provides a pull-through effect—we gain ground in the niche market as we see patients from throughout the Midwest for the niche, which means we get referrals from a wide range of physicians for all of our O&P services.

O&P ALMANAC: What are some advantages to running a niche practice? NAFT: Focusing on a smaller number

of products helps with profit and loss. You can factor in what’s affordable to purchase. And a higher volume of one type of device can equate to a bigger discount: For example, a specialized running shoe store may get a larger discount because it purchases a higher quantity of a specific brand of running shoes than the full-service sports store down the street. This model translates to O&P devices as well. By increasing volume in a specific O&P space, one can negotiate better terms from an O&P supplier. In addition, a niche provider may be able to develop delayed payment terms with a manufacturer since it can consolidate purchases, which leads to increased cash flow. Another advantage is a niche provider can set itself apart to gain market share by private-labeling. For example, a spinal specialist may purchase products from an outside manufacturer that will label orthoses with the facility’s name and logo. MCCARTHY: I prefer it because I can

concentrate on doing what I do best;

in our case it’s custom orthotic devices and pediatrics. I feel confident that I can give an accurate evaluation and we can produce the best custom orthotic devices in our region. CLARK: The niche markets can be

profitable, partly because you generally don’t need to have a fabrication staff on board. With a high-tech niche practice, you can draw forward-thinking referral sources and patients to your door. O&P ALMANAC: What are some disadvantages or concerns when running a niche practice? NAFT: One concern for niche provid-

ers is that if you’re only providing a few products and one takes a hit—from a payor change, a policy change, or a dissatisfied customer who complains to your big referral source—it can be very risky. Also, some referral sources prefer to refer patients to one-stop shops, and it can be hard to convince these sources to send patients your way. Staff turnover is a potential concern for niche practices. It’s really critical to maintain a stable and long-term staff— patients come in expecting to see the same staff and expect a continuity of care. Turnover can be really detrimental to a niche. What’s more, it may be hard to hire recent graduates who are suitable for your practice since young practitioners typically seek exposure to a large variety of O&P services. For the same reasons, it may be hard to attract residents to your facility. out” on a potential patient load or market share. And of course, if an area in which you specialize becomes obsolete, you run the risk of becoming obsolete yourself. You are putting more of your eggs in one basket.

APRIL 2015 | O&P ALMANAC

PHOTO: University of Salford

MCCARTHY: I guess one might “lose

CLARK: Just like anything else, if the

entire practice is built around the niche, you can’t be stuck to one particular product—and you had better be growing within that niche all the time. When your niche is related to new technologies, you have to be willing to absorb some of the risks. With new technology, if it doesn’t work, you may have to absorb some of the costs as well. You’ve got to have a good relationship with referral sources. Also, not everybody is suited for niche practice. You have to be willing to put your ego off to the side, and you have to be willing to fall on your face a couple of times, then learn from those experiences. O&P ALMANAC: How can niche facilities prosper in today’s reimbursement climate? NAFT: In fact, niche providers can sur-

vive in today’s reimbursement climate, and they may even grow stronger than other facilities. Niche practices can develop relationships with local payors and establish themselves as providers as a small subset of services. For example, if you are a high-end upper-extremity provider in your region, you can reach out to localarea payors and prove yourself—with outcomes—as an expert in specific services in your area. A large local payor may pay millions of dollars in claims a year, but only a small number of those claims go to O&P. And an even smaller amount goes to the subset of high-end prosthetics and orthotics. That’s a much easier discussion to manage with payors. If you develop relationships with those local payors, that can be to your benefit when submitting claims. MCCARTHY: I think the best way to

be successful is to be efficient. There is very little room for waste, and margins are getting smaller all of the time.

It is also extremely important to stay educated on appropriate billing and coding techniques as these continue to change and the complexity increases. I don’t think there is a “magic pill” for success, but I know we, as a profession, will always be needed; we just need to be cognizant that our pay sources are currently in flux and probably will be for quite a while. CLARK: You have to be able to justify

your expertise in your niche through major improvements in function, health, and quality of life for your patients. You have to be able to document and measure your results, and clearly show why what you are doing is equating to superior outcomes for your patients. This involves lots of record keeping, data collection, and benchmarking. O&P ALMANAC: What strategies should niche owners put into place to ensure success and profitability? NAFT: Make sure you understand

the local environment and gear your strengths to your niche. If you’re next door to a huge pediatric hospital and you specialize in geriatrics, you won’t get a lot of referrals. If you’re in Colorado or Utah, you may have a practice that caters to bracing for injured skiers—but that won’t work if you’re in Florida! O&P owners should recognize that patients drive referrals in niche practices. Someone who needs a specialized prosthetic device may end up at a support group and connect with individuals with similar patientcare needs—and they may drive those patients to the niche practice. Boutique practices also need to recruit patients and physicians to serve as key opinion leaders to rave about your practice, to solidify your position in the niche. And O&P owners should promote and publish

niche-specific research with those key physician leaders. MCCARTHY: You need a good, solid

team of employees who believe in what you’re doing and know they contribute to the success or failure of it. Our company is really small, but we can cover for each other and support each other so we don’t need to overstaff ourselves. We also keep up on government policy changes and billing requirements. We all attend continuing education seminars yearly, especially in this challenging billing climate. I’ve always believed that if you do what you’re good at, and continue to provide sound advice and produce quality products, success should follow. Unfortunately, we are currently in a very challenging health-care environment for our field, and there is no “magic bullet” for success and profitability. CLARK: As a niche owner, I am

prepared with two ingredients: education and social media. We need to stay educated, to be sure that before we jump into new things, we first immerse ourselves in them. Social media is either your greatest friend or your worst enemy. You have to use social media well so your clientele can tell your story. You need to have a presence on the web with testimonials and information that is accurate and informative, so that those who are conducting a search on your area of expertise can find you. Niche practices can help the whole O&P profession succeed, because they allow for practitioners to become extremely educated about and focused on specific areas of practice. This leads to advanced knowledge of O&P specialties. O&P ALMANAC | APRIL 2015

COMPLIANCE CORNER

By DEVON BERNARD

Beat the Clock Make sure you comply with the deadlines for the many steps involved in the Medicare billing and appeals processes

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 42 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CREDITS

E! QU IZ M EARN

BUSINESS CE

CREDITS P.42

APRIL 2015 | O&P ALMANAC

Medicare has a number of timeframes and deadlines that you must take into consideration if you treat Medicare beneficiaries. The O&P Almanac’s March 2015 Reimbursement Page article briefly discussed the deadline of having to respond to additional documentation requests by Medicare within 45 days. But there are several more deadlines that are important to track—and there are significant ramifications for not complying with those established deadlines. This month’s Compliance Corner will focus on some of the common Medicare deadlines related to claims filing, claims appeals, and changes to enrollment information, and will explain why it’s important to stay on top of these deadlines and remain compliant with Medicare.

Billing Deadlines

The deadline to submit a claim to Medicare for reimbursement is one of the most common deadlines, and one of the easiest to meet. In previous years, the timeframe and deadline to submit a claim to Medicare was a little difficult to follow: Typically, a claim must have been filed no later than the end of the calendar year following the end of the fiscal year (October 1 for the government), which sometimes meant you could have up to more than 20 months to file a claim. However, that all changed a few years ago, and now you have one year to file your claim. If you go past that timely filing deadline of one year, your claim will be denied. If you miss this one-year deadline, you will no longer have the ability to file an appeal; your claim will be denied, and denied without appeal rights. What is the timeframe for billing under each Medicare supplier number or provider transaction access number (PTAN)? At least one claim must be billed under each PTAN at least once

within four consecutive quarters to keep the billing privileges of that PTAN active. So, if you do not file at least one claim under each of the PTANs you operate at least once a year, the National Supplier Clearinghouse (NSC) will deactivate the dormant PTAN via a written correspondence to the address you have provided. To reactivate that PTAN, you will need to reapply—and you will be required to pay the application fee.

Appeals Deadlines

That brings us to the timeframes and deadlines associated with the appeals process—not just the timeline for

COMPLIANCE CORNER

submitting appeals, but also the deadlines in halting the recoupment process associated with Medicare overpayments. Although it is not technically one of the official levels of appeal, we will start with the timeframe for requesting a reopening. A reopening allows you to reopen a Medicare claim and correct minor clerical errors (e.g., wrong date of service, wrong number of units, etc.). You have one year from the date on your remittance advice, the date Medicare adjudicated the claim, to request a reopening for any reason. If the one-year deadline has passed, there is a small possibility you may be able to file a reopening if you can demonstrate a “good cause” for the need to reopen the claim. (See sidebar, “Showing Good Cause.”)

Showing ‘Good Cause’ After Missing a Deadline What constitutes “good cause?” If a reopening or appeal request is going to be reviewed after a missed deadline, here are the circumstances that may fall into the good cause category, which you will need to document: • Incorrect or incomplete information about the claim and/ or appeal was furnished by official sources (CMS, the contractor, or the Social Security Administration) to the facility; or, • There were unavoidable circumstances that prevented the facility from timely filing a request for redetermination. Unavoidable circumstances include situations that are beyond the facility’s control, such as major floods, fires, tornadoes, and other natural catastrophes. If these conditions have been met and documented, then you may have good cause for missing a deadline. A good cause exception may not be used when a missed deadline is the fault of your billing company (or any other entity hired by you to conduct business operations on your behalf). Also, negligence by you or your employees or being a new company, and not understanding the rules completely, are not valid reasons for a good cause extension.

There are several deadlines associated with the five official levels of appeals. The first level is the redetermination, and the clock for the redetermination deadline starts with receiving the official notice of denial, the recoupment request, or the initial determination of the claim. The official notice of initial determination is presumed to be received five days after the date provided on the notice unless you can show a different date. The request for redetermination must be filed within 120 days after you receive the notice. If you don’t file a redetermination within the 120-day window, you may not proceed to the next level because your appeal will not be processed unless you can show good cause.

Next up is the second level of appeal, the reconsideration: You have 180 days to file a reconsideration request. The 180 days begin with the receipt of the redetermination results notice; once again, 180 days is a hard deadline, and nothing can be filed after that timeframe unless you show good cause. The last three levels of the appeals process—the administrative law judge, the Departmental Appeals Board/ Medicare Appeals Council review, and the federal court review—all have the same deadlines. All of the appeals must be filed within 60 days of the official receipt of outcomes, the official letter from the previous level. If at any point you cannot meet the 60-day deadline, your appeal requests will be dismissed (unless you can document and demonstrate good cause). The exception to this is taking your appeal to the final level, the federal court review: If you cannot make the deadline, your appeal rights have ended. If during the appeals process you receive an overpayment/recoupment

demand letter, there are a few deadlines to remember. First is the deadline to make sure that you are not being charged any interest on the amount being recouped. If you repay Medicare within 30 days of receiving the overpayment demand letter, you will not have to pay any interest to Medicare. The next important deadline is the 40-day deadline: If after 40 days of receiving the overpayment demand letter no payments are made against the recoupment amount, Medicare will begin to offset your future claims until the recoupment amount and the interest have been paid in full. If you wish to delay the recoupment process, the offsetting of future claims, you have 30 days from when you first receive the overpayment/recoupment demand letter to take action. To delay any recoupment from starting, you must file your redetermination request (the first level of appeal) within 30 days of receiving the demand letter, rather than the traditional 120-day timeframe. If the request for a redetermination is O&P ALMANAC | APRIL 2015

letters, notices are being sent

want to verify if you are slated to receive a revalidation request letter, visit the CMS website and the “Revalidation” page. There you will see a listing of facilities that should have or will be receiving revalidation request letters.

to the proper locations.

Avoiding Missed Deadlines

…Be sure that you examine and read all of the mail you receive, and be sure all correspondence,

filed after these 30 days, the recoupment process will resume as normal but will be halted once the request has been submitted and received. As you proceed to the reconsideration level of appeal, the second level, you may continue to have the recoupment process postponed, as long as you file the reconsideration request within 60 days of receiving the redetermination decision letter. This is shorter than the previously discussed 180 days. If you file a reconsideration request after this the 60-day deadline has passed, the recoupment process will begin, but as soon as you file your request the recoupment process will cease. Even though you may postpone the recoupment process, you may not postpone or extend the accrual of interest deadline. Also, the ability to stop the recoupment process ends 30 days after your receive the reconsideration decision letter; this means that 30 days after the second level of appeals has concluded Medicare will continue with the recoupment process until the original debt and any subsequent interest have been paid in full, even if you continue to proceed through the appeals process. 42

APRIL 2015 | O&P ALMANAC

National Supplier Clearinghouse and Medicare Enrollment Deadlines

If you update or make any change to your business (e.g., adding or removing services, changing office hours, etc.) as it is reported on your most recent Medicare application on file, you are required to notify the National Supplier Clearinghouse (NSC) within 30 days. With the increased use of site visits to combat fraud and abuse, it is vital that all of your information is current. The ramifications of not updating your information in a timely manner will vary, but it can result in having your PTAN number revoked; in essence, you can lose your billing privileges. Medicare requires all enrolled suppliers to revalidate their supplier numbers on a routine basis, and will notify you in writing when it is your turn to revalidate. Once you receive the letter you will have 60 days to complete the revalidation process; if you don’t revalidate your information within those 60 days, Medicare will deactivate your Medicare supplier number and your billing privileges. If you have not recently revalidated your enrollment information with Medicare and you

There are four simple rules to follow to ensure you don’t miss important deadlines. First and foremost, make sure that you and your staff are aware of the deadlines. Second, since most of these deadlines involve some type of written notice, be sure that you examine and read all of the mail you receive, and be sure all correspondence, letters, notices are being sent to the proper locations. Third, don’t forget about the notices you receive, and don’t place them in a pile and say, “I will take care of this later.” If you put it off for too long, you can miss the deadline. Finally, be sure to follow the golden rule—document—especially if you need to demonstrate good cause. Although trying to meet all of the deadlines imposed and created by Medicare can be a burden, not complying can be more of a burden. It could cost you financially, and could cause undue stress on you and your billing/administrative staff. So be sure to avoid those stress-inducing moments by staying current on all of Medicare’s deadlines. Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org.

Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

www.bocusa.org

Materials for Milling Orthotics 17”

37”

40 dur Black Microcel Puff®

55 dur Natural Multicork™

SLSTRP-00693

SLSTRP-00396

40 dur White Microcel Puff® SLSTRP-00628

• 17” x 37” strip size • 31.5mm (~1¼”) slopes down to 6.5mm (~¼”) • Each Slope Strip will yield 3 pairs of orthotics! • Skived blocker reduces wasted material (less dust) • Faster milling time • More cost effective • Custom sizes available to fit your milling table

Call today for a free sample!

38mm MATERIALS

• 37” x 70” sheets • 38mm (~1½”) material, thickest available

40 dur Black Microcel Puff® PUFF-00693

www.acor.com

55 dur NaturalMulticork™ SDUR-00111

40 dur White Microcel Puff® PUFF-00628

Look for us:

You

Tube

Toll-free:

Go to www.acor.com to download our current catalogs

800-237-2267

TECH TUTOR

By BRAD MATTEAR, LO, CPA, CFO

Holding C-Fabs to High Standards Some central fabrication facilities seek ABC accreditation and compliance with FDA regulations

HEN OUTSOURCING TO A

central fabrication facility, what assurances do you have that the company fabricating your device has met standards? Has it attained accreditation as a central fabrication facility from the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC)? Does it follow good manufacturing practices (GMPs) that are enforced by the U.S. Food and Drug Administration (FDA)? Do you know what the GMPs are and how they affect your outsourced device? These are some of the questions that we will cover in this month’s Tech Tutor column.

APRIL 2015 | O&P ALMANAC

Central Fabrication Accreditation

Currently, the only opportunity to be accredited as a central fabrication facility in the O&P industry is by attaining central fabrication accreditation from ABC. This accreditation showcases to customers that a facility has met the highest standards for its business type. The accreditation “is reassurance that our quality and procedures are in line with the standards set forth by ABC,” says Craig MacKenzie CP, RTP(c), director of operations at Evolution Industries in Orlando. “It really was a check on us to reinforce that our structure and systems are appropriate for the industry.” O&P professionals who outsource fabrication of orthoses and prostheses to accredited central fabrication facilities (C-fabs) understand that those companies have met some level of standard. Estimates show that more than 90 percent of O&P clinical facilities use some type of central fabrication services. There are approximately 70 central fabrication facilities in the United States, and 12 of those have met the standards to attain ABC accreditation. For those wondering about percentages, that means that only 17 percent of central fabrication facilities hold ABC accreditation nationwide! MacKenzie says that accreditation communicates to his company’s customers that his facility maintains high standards, and it “allows the customer peace of mind in knowing

TECH TUTOR

FDA and O&P

“The future looks bright for fellow central fabrication facilities looking to gain the accreditation.” —Craig MacKenzie CP, RTP(c)

that Evolution is following proper policies and procedures.” ABC central fabrication accreditation standards create a minimum expectation for the physical environment and organizational function of orthotic, prosthetic, and pedorthic central fabrication facilities. Does this mean that your device will be fabricated differently than it would be fabricated it in house? Actually, what it means is that the company to which you have chosen to outsource your device has met the minimum standards set forth by ABC. Going forward, more C-fabs may seek ABC accreditation. “The future looks bright for fellow central fabrication facilities looking to gain the accreditation,” says MacKenzie. “The current structure allows smaller C-fabs the same ability as larger companies to obtain the accreditation. “It’s attainable by most, if not all, currently. I believe ABC will continue work to keep standards high but achievable,” MacKenzie says. The program could be of immense value as the O&P industry continues to evolve.

O&P is not exempt from compliance with the FDA. To repeat: O&P is not exempt from compliance with the FDA! Manufacturers have the responsibility to register complaint reports and, quite possibly, maintain compliance with the GMPs. We have seen an uptick in FDA investigations within and surrounding the O&P industry so it is your responsibility to do everything you can to protect yourself and your business. One of the things you can do is get a copy of AOPA’s FDA Compliance Manual. The manual is written to provide a better understanding of what compliance issues patient-care facilities, suppliers, and manufacturers may face from the FDA. Recommendations include but are not limited to the creation of a system that allows you to keep abreast of the Quality System Regulations (QSR) (21 C.F.R. Part 820) and the preparation of a quality manual for your facility that could assist you with complying with GMPs. Former FDA investigator Candace Tucker says, “Some companies are hesitant on the potential hard cost that it takes to get a quality system in place … but not having one could cost you more down road.” Tucker, who currently is with QARA Consultants LLC, adds: “initial up-front cost can be minimal compared to official actions the FDA has at its disposal for those found in violation during an inspection.”

AOPA’s Compliance Manual www.AOPAnet.org

Tucker identifies one ongoing concern for O&P: “The orthotic and prosthetic community is challenged with identifying the difference between Class 1 and Class 2 devices.” It’s important to define who is fabricating the device. “Those who are fabricating the device are certainly those that need to adhere to the Code of Federal Regulations (21 CFR 820), according to the classification,” says Tucker. The waters are still very murky when it comes to cleanly understanding how the FDA and O&P coincide. It’s important to educate yourself on the FDA and the impact it has on your business. “If and when the FDA has more of a presence in our field, we hope the ABC central fabrication accreditation will hold some weight,” says MacKenzie. In the future, MacKenzie hopes that “the industry becomes more proactive with regard to working with the FDA and identifying how we can both work together on creating standards that benefit both our customers and our patients.” Be prepared by getting your FDA Compliance Manual from AOPA and reading it from cover to cover to identify what applies to you and your business. You also may consider hiring a consultant to come in and evaluate your lab. Brad Mattear, LO, CPA, CFo, is central U.S. and national strategic account manager for Cascade Orthopedic Supply Inc. Reach him at bmattear@cascade-usa.com. Editor’s Note: To get your copy of AOPA’s FDA Compliance Manual, visit the AOPA website at www.aopanet. org. For more information on ABC’s central fabrication facility accreditation program, visit www.abcop.org. The information in the Tech Tutor column is intended to provide general information. It does not provide legal advice. Although our writers and editors have gone to great lengths to ensure the information is accurate and useful, it is recommended that readers consult with an experienced FDA lawyer for legal advice. O&P ALMANAC | APRIL 2015

MEMBER SPOTLIGHT

Aspen Medical Products

By DEBORAH CONN

Pillar of Support California manufacturer offers an array of spinal bracing products

AN WILLIAMSON, WHO FOUNDED Aspen Medical

APRIL 2015 | O&P ALMANAC

The Vista Lower Spine line

FACILITY: Aspen Medical Products OWNER: Dan Williamson LOCATION: Irvine, California HISTORY: 15 years

The Peak Scoliosis bracing system is designed to relieve pain associated with adult scoliosis.

presence overseas. Aspen has 130 full-time employees. For upper-spine needs, Aspen offers the the Vista Upper Spine line and the Classic Aspen line. The company also has four primary lower-spine product lines to accommodate a variety of patient conditions—Vista, Horizon, Summit, and Evergreen. It offers a full line of pediatric cervical orthoses, which “represents a commitment that Aspen has to pediatric care,” says Gray. In January, Aspen introduced the first “posture corrective” brace designed specifically for the immediate relief of pain associated with adult scoliosis, the Peak Scoliosis Bracing System. The intent of posture-corrective products, explains Gray, is to reduce or eliminate pain rather than address the underlying pathology—“although we have seen some improvements in curvature with this brace as well,” she notes. Upcoming posturecorrective products will address kyphosis and osteoporosis, again with the goals of pain reduction and support for healing. Aspen has an active research and development department, where 11 employees, including engineers and industrial designers, originate new products. “We have the only spinal-focused research and development department, which provides a strategic advantage in the industry,” says Gray. “Most competitors outsource design.”

PHOTOS: Aspen Medical Products

Products in 2000, honed his business skills at American Hospital Supply, which later became Baxter International. The corporate life had no long-term appeal for Williamson, so his next step was to join a small business marketing an immobilizing cervical collar. After the sale of that company in the late 1990s, Williamson launched Aspen Medical Products in Irvine, California, which produces spinal orthotic devices, including a new brace for adult scoliosis, cervical collars, cervical thoracic orthoses, thoracolumbar sacral orthoses, lumbosacral orthoses, lumbar orthoses, and a sacral orthoses (SI belts). “Our goal is to continue to be the leader in spinal bracing technology,” says Chief Administrative Officer Kathryn Gray. Williamson anchored his new business on three guiding principles, Gray says: to create products that improve people’s lives, to offer the best—not the cheapest—products on the market, and to create a company culture where employees are valued and involved. The company’s growth and 10 years of being named one of the best companies to work for in California and Orange County have validated the strength of Williamson’s principles. From its main facility in Irvine, Aspen serves four sales regions covering the United States and is poised to open an office in the Netherlands to further support international customers. About 10 percent of the company’s sales originate abroad, and the Netherlands facility will represent its first brick-and-mortar

A direct sales force focused solely on spinal braces handles most sales activities, as do a few select distributors that carry Aspen’s products. Two of the company’s sales representatives are orthotists, and Aspen has developed relationships with orthotic clinicians around the country who serve as an informal advisory board. In addition to using sales representatives to educate customers on the use and fitting of Aspen products, the company contracts with teams of nurses and orthotists to offer in-service training at hospitals and other clinical facilities. “We are also actively involved in developing programs for practitioners that earn continuing educating units,” says Gray. Aspen’s website features a number of videos with information and fitting instructions for many of its products. Additional plans for the near future include expanding the distribution network, speeding delivery to customers in the eastern United States, and continuing to increase its sales force both domestically and internationally. Aspen’s plans do not include selling the business, Gray says, in spite of a steady stream of offers. “We have built a company with a strong foundation and continue to grow each year. Our goal is to continue offering the best products in the market and to do the best we can to service our customers and our end users. Aspen products help to improve patients’ lives, and that’s what it’s ultimately all about.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

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 For more information on the program, please visit bit.ly/BizCertProgram.

How to get started: 1.

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

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.

Complete a Module specific quiz for each program.

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.

MEMBER SPOTLIGHT

Mountain Orthotic & Prosthetic Services

By DEBORAH CONN

Environmental Adaptation Lake Placid facility focuses on adaptive sports devices in addition to general O&P care

EFF ERENSTONE, CPO, AND

APRIL 2015 | O&P ALMANAC

Jeff Erenstone, CPO, helps teach children how to bike with prostheses at Camp No Limits.

FACILITY: Mountain Orthotic & Prosthetic Services OWNERS: Jeff Erenstone, CPO, and Debbie Erenstone LOCATION: Lake Placid and Plattsburgh, New York HISTORY: 8 years

A Mountain Orthotic & Prosthetic Services patient displays his new arm and his new motorcycle.

Paralympic sports federations to design specialized devices. “Lake Placid [which hosted the 1980 Winter Olympics] is a winter sports capital, and there is an Olympic training center about a mile from my office,” he says. “I do a certain amount of designing outside, using the surrounding environment and facilities to test and refine the devices.” Erenstone often houses adaptive sports patients in an apartment above the Lake Placid office while he works on their equipment. He has designed a hockey skate for a below-knee amputee, a skeleton sled for a double arm amputee with paraplegia, and a cross-country sit-ski for Dan Cnossen in the 2014 Paralympic Winter Games in Sochi, Russia. One of his inventions is the ADK rock climbing foot, featuring a board front and pointed tail for wall climbing, which can be rotated 180 degrees for crack climbing. It uses special climbing-shoe rubber for a firm grip and incorporates flex

points that allow it to grip the rock from multiple angles. He also designed a binding system for sit-skis that uses a universal attachment so that athletes can more easily swap skis. In addition to his work in adaptive sports, which accounts for many hours a week, Erenstone believes his commitment to follow-up care is a large factor in the success of his facility. “Because we don’t have a major hospital nearby, we have to help connect local doctors with patients. We work closely with primary care docs and physical therapists,” says Erenstone. “They know we are not just going to supply a leg, we are going to connect the dots and provide the care our patients need. Physicians really like that.” Erenstone has a passion for volunteering, and is active in Camp No Limits, a summer camp based in Maine for children with limb loss. He also volunteers for the Extremity Games, which are organized by the Athletes With Disabilities Network. Erenstone’s plans for the future include bringing on at least one more practitioner and one or two technicians. He and Debbie Erenstone have two young children, ages 6 and 2, so it’s a little early to anticipate whether they will want to step into the family business one day. But if they do, they are likely to be joining a thriving enterprise. Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Mountain Orthotic & Prosthetic Services

his wife, Debbie, own a classic mom-and-pop O&P facility— with some extras. Erenstone grew up in upstate New York, in the Adirondack North Country. He completed his orthotic residency at Northwest O&P in Provo, Utah, and his prosthetics residency in Boston and Leominster, Massachusetts, returning to the Adirondacks to open his own practice in 2007. Mountain Orthotic & Prosthetic Services has two offices, one in Lake Placid and another in Plattsburgh. The area is rural—“There are more trees than people around here,” says Erenstone—so the practice serves a wide geographic region, with some patients driving up to three hours for an appointment. The facility has 12 employees, including a certified orthotist finishing his prosthetic residency and two certified fitters, one of whom also is a certified pedorthist. Patients range from children to adults. As in most facilities, orthotic work is more common than prosthetic, although, says Erenstone, “we spend more time on prosthetics, so it all evens out.” Trauma cases are rare since the nearby area has no trauma hospital. The “extras” for Erenstone involve his work in adaptive sports devices. An avid athlete himself, Erenstone is a former cross country skier and still competes in triathlons and bike races. He has a passion for adaptive sports, working with individuals and international

Have you Heard the News That Mobility Saves?

A major new study has proven that prosthetic and orthotic care saves money for payers and improves lives for patients.

The Study A major new study shows that Medicare pays more over the long term in most cases when Medicare patients are not provided with replacement lower limbs. The study was commissioned by the Amputee Coalition and conducted by Dr. Allen Dobson, health economist and former director of the Office of Research at CMS. The study used Medicare data to compare patients with similar conditions who received prosthetics with patients who needed but did not receive prosthetics, over an 18 month period.

The Results

Lower Extremity Prostheses Cumulative Medicare Episode Payment by Cohort (18 Month Episodes from 2008-2010) EXHIBIT 4.9

Lower Limb Prosthetics

•

The prosthetic patients could experience better quality of life and increased independence compared to patients who did not receive the prosthesis at essentially no additional cost to Medicare or to the patient.

100000

Study Group Average Cumulative Medicare Payments

•

The slope of the cumulative cost curve indicates that had the period of evaluation been longer the break-even would have been reached.

To learn more about the campaign, visit

80000

40000

20000

www.MobilitySaves.org.

Comparison Group

60000

9 10 11 12 13 14 15 16 17 18

Months from Index (Receipt of O&P)

Video and add your own experiences like Queen’s story!

Make Sure the Insurance Companies and Health Care Providers Know This Too! Get Involved and Submit Your Testimony to the Public Relations Campaign Spreading the Word.

Upload your 1-3 minute video or write your story about how your prosthetic has improved your life, like helping you get back to work, take care of your family, rejoin the community, etc. Upload your testimony at bit.ly/yourmobility or scan the QR code on left.

AOPA NEWS

Lower-Limb Prostheses Policy: Learn the Policy Inside and Out

Mastering Medicare Webinar, April 8 Are you making the right adjustments and repairs? Join AOPA on April 8 for an AOPAversity Mastering Medicare webinar that will cover the details of the Medicare lower-limb prosthesis local coverage determinations and policy article. Learn what is covered and when. An AOPA expert will address the following issues during the audio conference:

• Prosthetic functional levels • Coverage of initial, preparatory, and definitive prostheses • Skilled nursing facility prospective payment system exemptions • Adjustments and repairs • Replacements • Useful lifetime restrictions

Have You Joined Mobility Saves on Social Media? The Mobility Saves Facebook campaign has reached more than 5,000 followers! This is your community. Please continue to pass along the Mobility Saves message to your colleagues and friends. Join Mobility Saves on Facebook and help raise awareness, provide support, and educate payors, regulators, referral sources, practitioners, and consumers. • Visit MobilitySaves.org to learn more and utilize the cost-effectiveness study. Download the brochures, PowerPoints, and white papers. • Follow Mobility Saves on Facebook, Twitter, YouTube, and LinkedIn. • Spread the word to practitioners, payors, and referral sources. • Submit testimony in the form of a video clip, photo, or personal story—visit MobilitySaves.org for details. Get Social with #MobilitySaves.

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register online at bit.ly/aopawebinars. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Contact Betty Leppin at bleppin@ AOPAnet.org or 571/431-0876 with registration questions. 50

APRIL 2015 | O&P ALMANAC

AOPA NEWS

PROSTHETICS 2020:

An Invitation to AOPA Members

The O&P profession has endured a veritable sea of change in the past five years, impacting which prostheses and orthoses are available to our patients, as well as how and at what rate our services are paid for by payors. What do the next five years hold in store? What will prosthetics be like five years from now, and what can be done to permit us to help participate and shape that future? It is clear that evidence, outcomes, and research are keystones. All three were front and center at the January AOPA Futures Leadership Conference. A new program, initiated under the title “Prosthetics 2020,” is a collaborative effort to operate as an adjunct to AOPA’s ongoing Survival Imperatives. Prosthetics 2020 is a partnership open to interested companies that want to take a strong, proactive role in shaping the drivers of prosthetic patient care five years down the road. If you share a commitment to protect, fortify, and enhance the recognized, scientifically substantiated value of prosthetic care in the minds of payors, patients, and the general public, consider making an investment to be part of Prosthetics 2020. AOPA will be managing this effort with the assistance of a small expert steering committee to be appointed by AOPA’s president. We are inviting interested AOPA member companies to join in the effort. The program will include establishing an AOPA Medical Advisory Board to help identify the essential endpoints of measuring value in prosthetic care, and in conveying our scientific messages to payors, both in government and in the private commercial insurance community. AOPA envisions that new prospective clinical research studies will need to be developed and funded, to be conducted by the best and the brightest in the prosthetic research world. New rock-solid science may well portend new payment models and better reimbursement. Companies considering participation should recognize that the mission of Prosthetics 2020 goes well beyond AOPA’s annual dues. Each participating company will be required to commit to an initial financial commitment of $35,000, and it would be anticipated that participating companies would need to provide in the range of $35,000 per annum for the next three years largely to sustain the Medical Advisory Board. In the event that the project results in also funding one or more new prospective research studies in prosthetics, additional financial outlays would be needed. Any AOPA member company, and especially those companies with strong engagement in prosthetics, can join in Prosthetics 2020 provided they are willing to contribute their fair share of the costs. This will entitle participants to receive regular detailed reports and invitations to provide advisory input on the progress of the effort. While it is

likely that representatives from a few of the participating companies may be among the members of the steering committee that AOPA’s president appoints to guide the project, that group needs to be comprised as a small, flexible, hard-working group. A small steering committee will be formed and will include a physician, researcher, representatives from one or two of the participating companies, and an AOPA leadership representative. All supporting companies will have input in an advisory role. The steering committee will meet, advance research proposals, coordinate with the Medical Advisory Board and make other recommendations/decisions, subject to the overall AOPA governance framework via the AOPA Board of Directors. General reports on the group’s progress will be shared in the form of updates to all AOPA members. The new framework is being undertaken first in the prosthetics profession. Based on the success of the prosthetics initiative, AOPA will consider the prospects for a subsequent parallel effort in the orthotics profession. The success of Prosthetics 2020 will depend on consistently gathering a cohesive working group and substantial resources on a relatively long-term basis, with the doors open to both large and small patient-care facilities and manufacturers. In principle, key premises will include the following: 1. Maintaining equal contributions from each participant 2. Recognizing that accomplishing the purpose of the Prosthetics 2020 initiative will require substantial financial support 3. Abiding by a participation agreement that addresses the long-term nature of the endeavor, termination, etc. For example, funding the Medical Advisory Board alone will likely require more than $100,000 per year. The likelihood is that there will be one or more prospective research studies that evolve, with costs likely to run into the mid six figures for each study. While we need to balance all of these factors, we also need to retain flexibility. One way we can do that is to suggest that as to patient-care facilities and companies that are not engaged at all in the manufacture or prosthetic knees or feet (all manufacturer participants who have any products in either or both of these product lines need to have the same financial stake), we would be open to “pooled” participation—for example, up to three companies may want to join together over multiple years to meet the annual participation fee. AOPA will share details as the committees form and the Prosthetics 2020 initiative advances. O&P ALMANAC | APRIL 2015

AOPA NEWS

AOPA Announces 2015 RFPs AOPA has prepared request for proposals (RFPs) inviting research proposals in multiple areas. Grants range in size from up to $15,000 to up to $60,000 and possibly higher amounts. The deadline for the comparative effectiveness study and systematic review grants was April 1, 2015, and the $15,000 grant deadline is April 30, 2015. Subject areas include the following: Comparative Effectiveness Studies (Jointly Funded—Dollar Amounts Open) • Prosthetic Feet, Emphasis on Lower Function • Cranial Remolding • Off-the-Shelf (OTS) Versus Custom-Fit and Custom-Made Ankle-Foot Orthoses Systematic Reviews (Up to $60,000 Each) • Cost Efficacy for Transtibial Interventions • Adolescent Idiopathic Scoliosis • Alternate Assessment Tools or Category Systems—Candidacy for Prosthetic Technology • Partial Foot in the Diabetic Population: Is Transtibial Amputation a Better and More Viable Option? Small Pilot Grant Topics (Maximum of Four Can Be Funded, Up to $15,000 Each) • Microprocessor Knee—Stumble Recovery Benefit for Nonvariable Cadence Ambulators, and Does Restricted Access for K-1 and K-2 to Hydraulic Controls Adversely Impact Patient Safety? • TLSO/LSO: Utilization and Comparative Effectiveness of TLSO/LSO (Pre- and Postoperative Use) • Efficacy of Custom Versus OTS Relating to Clinical Outcome, Analyses of Providers’ Credentials • Socket Interface: Methods for Measuring Proper Socket Fit and Alignment • Vacuum-Assisted Socket Suspension Systems 52

APRIL 2015 | O&P ALMANAC

• AFO/KAFO: Utilization and Comparative Effectiveness of Custom Versus OTS AFOs and KAFOs (Investigation and Analyses of Patients Who Receive Custom Orthosis Subsequent to OTS AFO Fitting) • L0631 Bracing—Performance and Outcomes Data That Differentiate Patient Results From What Could Be Achieved With an OTS Orthosis That Is Provided Without Any Fitting, Trimming, or Clinical Care • Quality of Life, Wellness, Patient Satisfaction, and/ or Outcomes Studies of Patients Who Have Received O&P Care Versus Those Who Have Not • Outcomes Measures, Evaluation, and Qualityof-Life Metrics Related to Orthotic Management (Note: Submissions should be pathology and/ or condition related, e.g., stroke, cerebral palsy, multiple sclerosis, polio, or osteoarthritis.) • Open Topics—Beyond the Above Priorities, Top Quality Clinical O&P Research Topics Considered For details and complete RFPs, visit http://www.aopanet.org/ resources/research/. Submission deadlines range from April 1, 2015 (larger grants), to April 30, 2015 (small pilot grants).

AOPA NEWS

AOPA’s monthly webinar series is the regulatory and business education that you can count on. No one in the O&P profession knows the ins and outs of Medicare, coding, billing, or Veterans Administration contracting like AOPA. Sign up for all 2015 webinars for only $990 for members, which includes two free webinars. If you missed one, we will send you the recording. The monthly webinars are a great way to bring your staff together for lunchtime learning by AOPA experts. Don’t miss any of the important topics in the webinars planned for the rest of the year:

Earn CE Credits by Reading the O&P Almanac!

E! QU IZ M EARN

BUSINESS CE

CREDITS P. 20 & 42

BECAUSE OF THE HIGHLY EDUCATIONAL content of the O&P Almanac’s Reimbursement Page and Compliance Corner columns, O&P Almanac readers can now earn two business continuing education (CE) credits each time you read the content and pass the accompanying quizzes. It’s easy, and it’s free. Simply read the Reimbursement Page column (appearing in each issue) and Compliance Corner column (appearing quarterly), take the quizzes, and score a grade of at least 80 percent. AOPA will automatically transmit the information to the certifying boards on a quarterly basis.

April 8

Lower-Limb Prostheses Policy: Learn the Policy Inside and Out

May 13

The New Player in Town: Understand the Recovery Audit Contractor Contract

Find the digital edition of O&P Almanac at: • www.AOPAnet.org/publications/digital-edition/

June 10

Building a Medicare-Approved Compliance Plan

July 8

Who’s on First? Medicare as a Secondary Payor

Be sure to read the Reimbursement Page article and Compliance Corner in this issue and take the April 2015 quizes. Access April’s quiz and previous monthly quizzes at: • bit.ly/OPalmanacQuiz

August 12

Off the Shelf Versus Custom Fit: The True Story

September 9

Prior Authorization, How Does It Work?

October 14

Understanding the LSO/TLSO Policy

November 11

Make a Good Impression: Marketing Yourself to Referrals

December 9

Bringing in the New Year: New Codes and Changes for 2016

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

www.bocusa.org

O&P ALMANAC | APRIL 2015

AOPA NEWS

Mastering Medicare Essential Coding & Billing Techniques Seminar

AOPA Coding Experts Come to Seattle in April

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

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

APRIL 2015 | O&P ALMANAC

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

AOPA O&P PAC

HE O&P PAC WOULD like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*:

• • • • • • • •

George Breece Maynard Carkhuff Rick Fleetwood, MPA Wendy Miller, BOCO, CDME Ted Muilenburg, CP, FAAOP James Young, CP, LP, FAAOP Pamela Young Claudia Zacharias, MBA, CAE

The O&P PAC advocates for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in the O&P PAC, federal law mandates that you must first sign an

authorization form. To obtain an authorization form contact Devon Bernard at dbernard@AOPAnet.org . The O&P PAC recently made contributions to the following members of Congress: • Rep. Mike Thompson (D-California), a member of Ways & Means Subcommittee on Health and one of the orginal sponsors of the O&P Improvements Act in the 113th Congress • Rep. Glenn Thompson (R-Pennsylvania), one of the original sponsors of the O&P Improvements Act in the 113th Congress • Rep. Dutch Ruppersberger (D-Maryland), a member of the Appropriations Committee and a co-sponsor on key pieces of O&P legislation in the 113th Congress. *Due to publishing deadlines this list was created on March 4, 2015, and includes only donations/contributions made or received between Jan. 1, 2015, and March 4, 2015. Any donations/contributions made or received on or after March 4, 2015, will be published in the next issue of the O&P Almanac.

WELCOME NEW MEMBERS

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

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

Orthocare Solutions Inc. 6101 Executive Blvd., Ste. 330 Rockville, MD 20852 301/940-1640 Category: Patient-Care Facility PK Ltd. P.O. Box 171 Dillon, CO 80435 970/389-8434 Category: Patient-Care Facility Reliable Prosthetics and Orthotics LLC 1505-C S. Glenburnie Road New Bern, NC 28562 252/638-8989 Category: Patient-Care Facility

Spectrum Prosthetics & Orthotics LLC 2510 NW Edenbower, Ste. 148B Roseburg, OR 97470 571/673-1275 Category: Affiliate Member Parent Company: Spectrum Prosthetics & Orthotics LLC, Grants Pass, OR Spectrum Orthotics & Prosthetics LLC 2231 N. Eldorado Klamman Falls, OR 97601 541/884-5348 Category: Affiliate Member Parent Company: Spectrum Prosthetics & Orthotics LLC, Grants Pass, OR

O&P ALMANAC | APRIL 2015

MARKETPLACE

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

Slope Strips Now Available From Acor Slope strips are now available from Acor! This newly designed EVA slope strip is 37” x 17” and has a thickness of 1.25” in the heel, which tapers down to .25” in the forefoot. Custom sizes are available on request and can be made to fit any mill. This new size and shape allows for reduced material waste and faster milling times. Each slope strip will yield at least three pairs of orthotics and has quickly become the industry standard for milling. See our ad on page 43 of this issue and call today to try one! For more information, contact Acor Orthopaedic Inc. at 800/237-2267 or visit www.acor.com.

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

APRIL 2015 | O&P ALMANAC

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

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

MARKETPLACE ePAD: The Electronic Precision Alignment Device

Silicone, Urethane, and Copolymer Liners

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

The com with orth St K

K Th that main

Ottobock • 800.328.4058 www.professionals.ottobockus.com

New Sure Stance Knee by DAW

SHOWCASE

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

EMS Socket Exclusively From Ottobock

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

The EMS flexible inner socket provides up to 100 percent more surface area for better force distribution and 400 percent more coefficient of friction for better linkage to socket. All of that translates into an advanced socket with superb connection for your patients who use Harmony vacuum suspension. In addition to the enhanced connection, EMS includes lower definitive socket trim lines for greater range of motion and reduced wear on sleeves. The EMS is available exclusively from Ottobock by calling your local sales rep at 800/328-4058 or logging onto www.ottobockus.com.

medi USA Introduces the 4Seal TFS Liner Freedom Foot Products Just Got The new medi 4Seal TFS Liner combines a Better

revolutionary sealing technology with a unique self-gliding surface, providing extraordinary suspension, comfort, and ease of use for those with transfemoral amputations. Features and benefits include: K Integrated seals for easy inversion and a highly secure fit. K Easy Glide PLUS outer surface—no donning aids or sprays required. Now, with the broadest range of sandal-toe options available K Excellent tissue control due to a highly anywhere, you can focus first on performance and rest assured effective, full-length matrix. that your patient’s desire to wear sandals can be easily satisfied. K Optimal radial stretch for greater comfort. Achieve improved clinical outcomes by delivering a product K Simple to use gel-grip spacer socks for easy designed to meet your functional objectives. Whether it’s application (available separately).

shock absorption, hydraulic ankle motion, heel height adjustmedi USA • 800.633.6334 ability, or multiaxial ground compliance, the new sandal-toe www.mediusa.com product line delivers form and function—unrestricted. Circle # 196 Choose from 13 high-performance designs: • Highlander® • Kinterra® • Pacifica® & Pacifica® LP • Renegade® & Absolute Suspension Sleeve from Fillauer • Runway® & Runway® HX Renegade® LP • Agilix™ The Absolute • Thrive® Suspension Sleeve optimizes • WalkTek® • DynAdapt™ comfort, durability, and range of motion. • Sandal-Toe Foot Shell • Sierra® The sleeve is made of thermoplastic elastomer and covered with a reinforced

Lycra®-type material.Foot The preflexed design in Our second-generation Sandal-Toe Shell is available rangetones of motion and sizes 22-28 cm and inallows threemaximum different skin (light, medium, alleviates posterior bunching when the and dark). knee is flexed. The Absolute Suspension For additional information, contact customer service at Sleeve is available in multiple sizes and 888/818-6777 or email us at info@freedom-innovations.com. your choice of beige or black.

O&P ALMANAC | APRIL 2015

Fillauer LLC • 800.251.6398 www.fillauer.com

Hers custo mate ogy duro the a abso Plast tive activ or so M Cert have

Whi stab rout bene flexi ORI fit th give in m softw and indi

MARKETPLACE

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

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

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

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

APRIL 2015 | O&P ALMANAC

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

Össur Iceross® Seal-In® X. Make Your Move! With a moveable seal ring to ensure optimal seal positioning, Seal-In X offers both maximum comfort for users with uniquely shaped or sensitive limbs and easier donning and doffing for users with compromised hand dexterity. Seal-In X also features seamless Anatomy Conforming Fabric, a durable yet flexible weave that comfortably controls soft tissue and elongates over the knee without bunching in the popliteal region. Plus, Seal-In X is Unity® compatible, so your patients can experience all the benefits of sleeveless vacuum, as well. For more information, visit www.ossur.com or contact your Össur® representative today.

2015 AOPA Coding Products Get your facility up to speed, fast, on all the O&P HCPCS code changes with an array of 2015 AOPA coding products. Ensure each of your staff has a 2015 Quick Coder, a durable, easy-to-store desk reference of all the O&P HCPCS codes and descriptors. (Coding Suite includes CodingPro single user, Illustrated Guide and Quick Coder): $350 AOPA members, $895 non-members. • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 non-members. • CodingPro CD-ROM (network version): $435 AOPA members, $695 non-members. • Illustrated Guide: $185 AOPA members, $425 non-members. • Quick Coder: $30 AOPA members, $80 non-members. Order at www.AOPAnet.org or by calling AOPA at 571/431-0876.

Products & Services

For Orthotic, Prosthetic & Pedorthic Professionals

2014 OPERATING PERFORMANCE REPORT AOPA Helps Run

s s e n i s u B r You 2014 OPERATING PERFORMANCE REPORT

AOPA Operating Performance Report

2014

(Reporting on 2013 Results)

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

HOW TO ORDER BY FAX: 571/431-0899

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

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

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Southeast

Job location key:

Certified Prosthetist-Orthotist

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

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

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

Member $482 $634

Nonmember $678 $830

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

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

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

Member Nonmember $80 $140

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

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

APRIL 2015 | O&P ALMANAC

Email: sethwalters@excel-prosthetics.com

Pacific Here We Grow Againâ&#x20AC;Ś Openings: CPO, CP, and CO

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

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

CAREERS “START THE CAREER OF A LIFETIME”

Northeast Certified Orthotist/Certified Prosthetist-Orthotist

Long Island, New York Wanted: CO/CPO for busy Long Island, New York, practice. Excellent pay and comprehensive benefits package. Must be professional, knowledgeable, and caring. Upbeat practitioners only need apply. Please apply by email to: Email: mgpolab@gmail.com

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

The Source for Orthotic & Prosthetic Coding

VA NEW YORK HARBOR HEALTHCARE SYSTEM

ORTHOTISTS The Department of Veterans Affairs (VA) NY/NJ Veterans Healthcare Network VISN 3 is seeking highly motivated Orthotists to serve those who have served us. These positions are for very busy offices with daily walk-in traffic located throughout the NY/NJ area. Current vacancies exist at the Bronx, Manhattan and East Orange VAMCs, future vacancies are anticipated. The primary job duties include the fitting of off-the-shelf soft goods such as braces, LSOs, stockings, and diabetic footwear. Candidate must be proficient in custom lower limb orthotics, custom molded shoes and custom molded foot orthotics. Additionally, the candidates must be knowledgeable of ABC, and BOC professional standards and requirements in the field of Orthotics. Certification is preferred but not required. Computer knowledge is necessary. US Citizenship and English Language proficiency are required. Applicants are eligible to apply for the Education Debt Reduction Program (EDRP), which assists in the payment of student loan debts. Come join a dynamic team of likeminded, professional individuals. EOE. Send resume and cover letter to Nelly.Hernandez@va.gov

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

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

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

NEW

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

www.AOPAnet.org

O&P ALMANAC | APRIL 2015

CALENDAR

2015

April 30-May 2

April 8

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

April 9-10

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

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

May 1

ABC: Application Deadline for Certification Exams. Applications must be received by May 1, 2015, for individuals seeking to take the July ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians. For more information call 703/836-7114, or send email to certification@abcop.org, or visit www.abcop.org/certification.

April 9-11

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

April 13-14

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

May 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, orthotic and prosthetic assistants, and technicians in 250 locations nationwide. For more information call 703/836-7114, or send email to certification@abcop.org, or visit www.abcop.org/certification.

May 13

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

April 24-25

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

Year-Round Testing

Online Training

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

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

www.bocusa.org

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

APRIL 2015 | O&P ALMANAC

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

CREDITS

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

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

$40

$50

1/4 page Ad

$482

$678

26-50

$50

$60

1/2 page Ad

$634

$830

51+

$2.25/word $5.00/word

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

CALENDAR June 10

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

September 9

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

June 11-12

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

June 19-20

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

July 8

Whoâ&#x20AC;&#x2122;s on First? Medicare as a Secondary Payer. Register online at bit.ly/aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

October 1-3

2015 NC/ SC Annual Meeting. The Ballantyne, Charlotte, NC. More information online at www. ncaaop.com/joinrenew-membership. For exhibitors and sponsorship opportunities, contact Jennifer Ingraham jingraham@spsco.com or 800/767-7776, x.1173, or contact Skyland Prosthetics at 828/684-1644.

October 7-10

98th AOPA National Assembly. The Henry B. Gonzalez Convention Center, San Antonio. More information at bit.ly/2015assembly. For exhibitors and sponsorship opportunities, contact Kelly Oâ&#x20AC;&#x2122;Neill, 571/4310852, or koneill@AOPAnet.org. General inquiries, contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

October 14

Understanding the LSO/TLSO Policy. Register online at bit.ly/ aopawebinars. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org. Webinar Conference

July 13-14

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

August 12

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

November 9-10

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

ADVERTISERS INDEX Company 4tellSoftware Inc.

Page Phone

Website

888-261-7113

www.4tellsoftware.com

ACOR Orthopedics Inc.

800-237-2276

www.acor.com

Aqualeg Inc.

855-955-2785

www.aqualeg.com

Amputee Coalition

888/267-5669

www.amputee-coalition.org

Arizona AFO Inc.

877-780-8382

www.arizonaafo.com

Board of Certification/Accreditation

877-776-2200

www.bocusa.org

Cailor Fleming Insurance

800-796-8495

www.cailorfleming.com

Coyote Design

800-819-5980

www.coyotedesign.com

DAW Industries

800-252-2828

www.daw-usa.com

Ferrier Coupler Inc.

810-688-4292

www.ferrier.coupler.com

Freedom Innovations

888-818-6777

www.freedom-innovations.com

Hersco

800-301-8275 www.hersco.com

Ossur Americas Inc.

800-233-6263

www.ossur.com

27, C4

800-328-4058

www.professionals.ottobockus.com

Ottobock

O&P ALMANAC | APRIL 2015

ASK AOPA

From Start to Finish What are acceptable formats for starting orders, and who can write them? Does the dispensing or starting order have to be written? What type of information should be included on the starting order?

An initial/dispensing order does not need to be a written document; it may take the form of a verbal request from the physician treating the patient. If you receive a verbal order, you should document in your records that you received a verbal order, and document all of the information that is required to be included in a dispensing order. The dispensing order should contain at least the following information: a description of the item requested (this does not need to be detailed; it can be as basic as simply stating “AFO”); the names of the patient and the physician ordering the item; and the date the item was ordered.

Do we need both a dispensing order and a detailed written prescription?

Typically the answer is yes, but there is one instance before you bill when it is acceptable to have only one of the documents on file. This is when the initial/dispensing order meets all of the criteria of a detailed written order. For example, you can dispense the item and bill for it with only the initial order if you received the initial order from a physician and it contained all of the following information: the name of the patient, the physician’s signature and the date the order was signed, and a detailed description of the item to be provided.

Once an item has been delivered to a patient, when is a new prescription required?

APRIL 2015 | O&P ALMANAC

A new prescription is required when you are providing a replacement item for the patient due to a change in the patient’s condition or if the original item was lost or stolen. A new prescription is not required when you are providing only a repair or adjustment to the original item you provided. A new prescription also is not required when you are replacing items that are considered supplies, as long as you noted on the original detailed prescription that you would be replacing the supplies. When listing supply items on the detailed written order, it is good practice to list the quantity of the items provided and an estimated schedule of when you will be replacing the supply items. Simply stating “Replace as needed” may not be sufficient. If you are uncertain on whether you need a new prescription, review the medical policies; each policy outlines when a prescription is required.

Can nurse practitioners and physician assistants write a dispensing order and sign the detailed prescription?

Yes. Nurse practitioners (clinical nurse specialists) and physician assistants are eligible under Medicare guidelines to order orthotic and prosthetic items/services and sign the detailed prescriptions. However, there are some criteria that must be met. A nurse practitioner may prescribe an item and sign the detailed prescription under these conditions:

• The nurse practitioner is treating the patient for the condition for which the item is needed. • The nurse practitioner practices independently of a physician. • The nurse practitioner bills

Medicare for other services under his or her own National Provider Identifier (NPI) number. • The nurse practitioner is allowed to do the above in the state in which the item is being delivered. A physician assistant may prescribe an item and sign the detailed prescription under these conditions: • The individual meets the definition of a physician assistant as defined in the Social Security Act. • The physician assistant is treating the patient for the condition for which the item is needed. • The physician assistant practices under the supervision of a physician, either a doctor of medicine or a doctor of osteopathy. • The physician assistant has his or her own NPI number. • The physician assistant is permitted to perform services in accordance with state law. Even though nurse practitioners and physician assistants are eligible to write prescriptions and sign detailed prescriptions for O&P services, they may not sign the certifying statement for diabetic shoes and inserts. Also, remember that it is acceptable for you to complete the detailed written order and have the nurse practitioner, physician assistant, or physician sign the order. AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

Amputee Coalition 2015 National Conference

amputee-coalition.org/2015-national-conference

Tucson

Arizona

JW Marriott Starr Pass Resort & Spa Thursday, July 23 â&#x20AC;&#x201C; Saturday, July 25, 2015 Contact us at 888/267-5669 or visit amputee-coalition.org for more info.

Michelangelo is the natural choice Natural design and incredible freedom of movement Give your patients the intuitive, responsive functionality of Michelangelo that brings them closer to a natural hand than any other myoelectric. The Michelangelo difference is more than cosmetic. It offers seven different hand positions and a powerful grip function. Along with its flexible wrist, unique fingertips, and electronically movable thumb, Michelangelo can open up a whole new world of possibilities for your upper limb patients. Ask your local sales rep to trial a Michelangelo today and see how it has become the natural choice.