Page 1


The American Orthotic & Prosthetic Association

APRIL 2012






Expert advice for treatment of cranial malformations

Is Outsourcing Fabrication Right for You? Navigating the Medicare Appeals Process

Time to make your move

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O&P Almanac APRIL 2012, VOLUME 61, No. 4


Cover Story

4 AOPA Contact Page

20 Shaping the Infant Skull

By Tora Estep As diagnoses of cranial malformations such as plagiocephaly, brachycephaly, and scaphocephaly become more commonplace, orthotists and the O&P profession must focus on early detection and coordinated treatment plans.



How to reach staff

6 At a Glance


Statistics and O&P data

In the News Research, updates, and company announcements

38 AOPA Headlines

News about AOPA initiatives, meetings, member benefits, and more

45 AOPA Membership Applications

28 The Outsourcing Decision

46 Marketplace

By Anya Martin While many practitioners today are opting to outsource fabrication of orthoses and prostheses, it’s important to weigh the pros and cons of central fabrication versus in-house production to determine which will best fit a practice’s individualized needs.

Products and services for O&P

48 Jobs

Opportunities for O&P professionals

53 Calendar


Upcoming meetings and events

55 Ad Index 56 AOPA Answers

16 Reimbursement Page

32 Facility Spotlight

Want a Taste of O&P History?

Navigating the Medicare appeals process Prosthetic Center of Excellence

Expert answers to your FAQs

Get your fill at— a digital archive of issues ranging from 1975 to 1988 of O&P Journal, predecessor of the O&P Almanac.

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: Yearly subscription rates: $59 domestic; $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: APRIL 2012 O&P Almanac



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


MEMBERSHIP and Meetings

Thomas F. Fise, JD, executive director, 571/431-0802,

Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808,

Don DeBolt, chief operating officer, 571/431-0814, O&p Almanac Thomas F. Fise, JD, publisher, 571/431-0802, Josephine Rossi, editor, 703/914-9200 x26,

Kelly O’Neill, manager of membership and meetings, 571/431-0852, Steven Rybicki, communications manager, 571/431-0835, Michael Chapman, coordinator, membership operations and meetings, 571/431-0843,

Catherine Marinoff, art director, 786/293-1577,

Stephen Custer, coordinator, membership operations and meetings, 571/431-0876,

Dean Mather, advertising sales representative, 856/768-9360,

AOPA Bookstore: 571/431-0865

Steven Rybicki, production manager, 571/431-0835, Stephen Custer, staff writer, 571/431-0876, Christine Umbrell, editorial/production associate, 703/914-9200 x33,

Government affairs Catherine Graf, JD, director of regulatory affairs, 571/431-0807, Devon Bernard, manager of reimbursement services, 571/431-0854, Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, Reimbursement/Coding: 571/431-0833, a

OP Almanac &

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

BOARD oF DIRECTORS Officers President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Orthopedic Group, Houston, TX President-Elect Tom Kirk, PhD, Hanger Orthopedic Group, Austin, TX Vice President Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Treasurer James Weber, MBA, Prosthetic & Orthotic Care, Inc., St. Louis, MO Immediate Past President James A. Kaiser, CP, Scheck & Siress, Chicago, IL Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

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

AOPA Member-Get-A-Member Campaign GROWING FOR


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Discover MORE HUGE BENEFITS—To enroll in the club and receive your Growing for the Future membership marketing kit, email and we’ll take it from there. You can help make it happen!


O&P Almanac APRIL 2012

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

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Plagiocephaly and Brachycephaly in the United States Since the “Back to Sleep” recommendations were introduced by the American Academy of Pediatrics in 1992, SIDS deaths have decreased dramatically. At the same time, the incidence of infant cranial malformations has risen.

SIDS Deaths Have Decreased in the United States…

Incidence of Plagiocephaly Has Risen in Texas…



Birth prevalence per 10,000

Deaths Per 10,000 Live Births































Source: CDC, National Center for Health Statistics


The percentage by which the incidence of plagiocephaly and other head shape diagnoses has increased since 1992.

20-25% Percentage of infants who sleep on their backs who are affected by plagiocephaly.

300,000 – 400,000 Number of babies born annually in the United States with cranial malformations.

Source: “Investigation Into an Increase in Plagiocephaly in Texas From 1999 to 2007,” Archives of Pediatric and Adolescent Medicine, Vol. 165, No.8, August 2011

4-8 Months Most effective age to conduct helmet therapy to correct cranial malformations.

4.5 Months

Average duration of treatment for helmet therapy in an infant.


Percentage of Down Syndrome patients who are diagnosed with brachycephaly.

Sources: Amputee Coalition of America, Centers for Disease Control and Prevention, American Academy of Pediatrics, Journal of Prosthetics and Orthotics, Archives of Pediatrics and Adolescent Medicine 6

O&P Almanac APRIL 2012


Task Force to Study Private-Sector Limb Loss Prevention over the past five years. The organization also has shown a reduction in the cost of pharmaceuticals by 48 percent, lab studies by 32 percent, and inpatient bed days by 44 percent. The potential for savings in the private healthcare system is significant. “We agree that the VA system offers much promise if translated to the private sector health-care system,” says Terrence Sheehan, MD, Amputee Coalition medical director and chief medical officer at Adventist Rehabilitation Hospital in Rockville, Maryland. “The next step is to create a demonstration project to test these limb-saving and costsaving measures. If we can save one person from having an amputation, that is a savings of $500,000—imagine the savings to our health-care system if we could achieve the approximately 50 percent reduction that the VA has realized.” The group ’s number one priority is to conduct a demonstration project in a civilian hospital, emulating the system of care in the VA. Task force members will collaborate on funding, resources, and research. A full white paper will be available this summer.

Researchers Aim To Improve Neural Control of Prostheses Researchers at Sandia National Laboratories are using off-the-shelf equipment to investigate methods to improve amputees’ control over prostheses with direct help from their own nervous systems. Organic materials chemist Shawn Dirk and robotics engineer Steve Buerger are leading the group in creating biocompatible interface scaffolds with the goal of improving prostheses with flexible nerve-to-nerve or nerve-to-muscle interfaces through which transected nerves can grow, putting small groups of nerve fibers in close contact to electrode sites connected to separate, implanted electronics. Sandia’s researchers have found that interfaces can monitor nerve signals or provide inputs that let amputees control prosthetic devices by direct neural signals, the same way they would control parts of their own bodies. The research focuses on biomaterials and peripheral nerves at the interface site. The idea is to match material properties to nerve fibers with flexible, conductive materials that are biocompatible, so they can integrate with nerve bundles. The researchers are looking at flexible conducting electrode materials using thin evaporated metal or patterned multiwalled carbon nanotubes. The work is in its early stages.


O&P Almanac APRIL 2012

Organic materials chemist Shawn Dirk focuses a projector during work on neural interfaces.

Robotics engineer Steve Buerger displays implantable and wearable neural interface electronics.

Photos: Sandia National Laboratories, Randy Montoya

Several U.S. health-care leaders met in February in Potomac, Maryland, at the Amputee Coalition Limb Loss Summit to review the Department of Veterans Affairs (VA) System of Care Preservation-Amputation Care and Treatment (PACT) program, which has shown compelling outcomes in limb loss prevention. The group, which included prosthetists, physicians, nurses, psychologists, and health-care policy leaders from the Centers for Disease Control and Prevention (CDC), the VA, the Agency for Healthcare Research and Quality, the National Institute on Disability and Rehabilitation Research, and civilian hospitals and health-care systems, examined elements of the VA program to develop a plan for limb loss prevention for the private sector health-care system. The VA’s initiative, which began in 1992, has demonstrated a dramatic reduction in rates of foot ulcers from diabetes and peripheral vascular disease, which are the leading causes of amputation. For example, the Veterans Affairs Medical Center in Nashville has demonstrated a 40 percent decrease in the number of lower-limb amputations

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ABC Releases Mastectomy Fitter Practice Analysis The 2011 Practice Analysis of ABC-Credentialed Mastectomy Fitters has been released by the American Board for Certification in Orthotics, Prosthetics & Pedorthics Inc. (ABC). ABC’s Practice Analysis Task Force and ABC Executive Director Catherine Carter worked with Professional Examination Service to create and implement a practice analysis of mastectomy fitters. ABC last conducted a practice analysis study of the mastectomy fitter profession in 2004. In 2011, the profession was resurveyed to identify changes in the industry related to the

delivery of care, the items and services available, and the technology in use today. The strategy included a validation study to determine current trends in patient care, technology, and practice

Senate Bill Would Curb Medicare O&P Fraud and Abuse AOPA applauds Senators Ron Wyden (D-Oregon), Olympia Snowe (R-Maine), and Charles Grassley (R-Iowa) for the introduction of S. 2125, the Medicare Orthotic and Prosthetic Improvements Act. The bill has two objectives: to reduce, and if possible eliminate, fraud and abuse in Medicare payments for orthotics and prosthetics; and to improve the quality of patient care for amputees and patients with significant limb impairment related to chronic diseases/conditions. “This bill can only be good for patient care,” says Tom DiBello, CO, FAAOP, president of AOPA. To accomplish the goals of the bill, the Medicare O&P Improvements Act would prohibit Medicare payment to unlicensed providers in O&P licensure states; require the same accreditations standard that were adopted by the Department of Veterans Affairs; and link eligibility for Medicare payment to the qualifications of the provider and the complexity of the patient’s needs. Senate bill S. 2125, (House counterpart is H. R. 1958) is in the first phase of the legislative process. It has the endorsement of the Amputee Coalition and currently has three co-sponsors: Sens. Snowe and Grassley—both as original co-sponsors—and Sen. Ben Cardin (D-Maryland). AOPA has been instrumental in getting this bill introduced in the 110th, 111th, and the 112th Congress.


O&P Almanac APRIL 2012


management in the provision of post-mastectomy items and services by ABC-certified mastectomy fitters. ABC will use the results of the practice analysis survey to ensure its mastectomy fitter credentialing exams are continually relevant for individuals entering the profession. The results also will be used to identify specific topics for in-service and/or continuing education programs as well as provide guidance for education providers in regard to curriculum review and/or program self-assessment. For a complete copy of the practice analysis, visit

people in the news

Medi USA in Whitsett, North Carolina, has promoted Marc Bechler to O&P district manager. Dan Berschinski has been elected to serve a threeyear term on the Amputee Coalition’s Board of Directors. Marsha Therese Danzig, a yoga instructor and below-knee amputee, has developed a workshop to assist practitioners, yoga teachers, and others who work with amputees in adapting yoga poses for individuals with all types of limb loss. Dawn Draayer has been named development director for the Amputee Coalition. Rick Fleetwood, CEO of Snell Prosthetic & Orthotic Laboratory, was honored with an Executive of the Year Award during the 2012 Arkansas Business of the Year Awards.

The American Board for Certification in Orthotics, Prosthetics and Pedorthics has hired Jim Lawson as outreach development manager. Ability Prosthetics & Orthotics, Inc., has announced the addition of two staff members: Eric Shoemaker, CPO, will operate the Ability Mechanicsburg patient-care office, and Mallory Feller, a resident orthotics and prosthetics student, works in the Hagerstown patientcare office. Hanger Clinic has announced the addition of several new clinicians. Roy Stafford, CO, has joined the patient-care clinic in Yuba City/ Oroville/Chico, California. Nichols Alberty, C.Ped, has joined the Tahlequah, Oklahoma, patient-care facility. James DiGiulio, C.Ped, has joined the Philadelphia patientcare clinic.


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U.S. Credit Unions Collaborate in Afghan Prosthetic Hand Project A group of U.S. credit unions and supporting organizations have come together to assemble prosthetic hands to help civilians in northern Afghanistan who have lost limbs to land mines or through conflict, disease, and birth defects. With the World Council of Credit Unions’ assistance, the group will distribute the prostheses through Afghanistan’s Islamic Investment and Finance Cooperatives (IIFCs). Individuals who register with IIFC will receive the hands free-of-charge and do not need to be IIFC members. The Credit Union Helping Hands program, launched by the Credit Union Philanthropy Group (CUPG), has been assembling and distributing LN-4 transradial prosthetic hands for those in need through Rotary International for three years. The LN-4 prosthetic hand is a low-cost, light, durable, functional prosthesis that was developed by industrial designer Ernie Meadows and is distributed by the Ellen Meadows Prosthetic Hand Foundation. “The primary value of the hands is that they enable the user to grasp,” says Frank Hackney, CUPG founder. “The ability to grasp allows recipients to hold tools or utensils, steer a bike or an automobile, and, in many cases, increases their ability to work.” The LN-4 prosthetic hand

Celebrate National Limb Loss Awareness Month in April In 2011, 36 governors issued proclamations declaring April to be Limb Loss Awareness Month in their states. The Amputee Coalition has selected a 2012 campaign theme to celebrate the month: “Take a Seat; Check Your Feet.” Limb Loss Awareness Month designates a specific time to provide support for individuals within the limb loss community, raise public awareness about limb loss education, provide an opportunity for individuals to discuss quality of life, and recognize the contributions of military veteran amputees. The Amputee Coalition will add to the awareness campaign by holding a Limb Loss Education Day on April 21 in Atlanta. Activities will include educational seminars and interaction between support groups, health-care providers, and the limb loss community. For more information or to direct O&P patients to additional resources, visit or


O&P Almanac APRIL 2012

Physician Arrested in Health-Care Fraud Case Jacques Roy, MD, of Rockwell, Texas, was arrested by the FBI in February on charges that he defrauded Medicare for nearly $375 million in billings for nonexistent home health-care services from 2006 to 2011. Justice department officials, in what is being called the largest healthcare fraud case in U.S. history, also said that 78 home health agencies collaborating with Roy will be suspended from Medicare for up to 18 months. Roy and his office manager, Teri Sivils, who was also charged in the case, sent recruiters door to door asking residents to sign forms containing the doctor’s electronic signature. These forms stated that Roy had seen these residents professionally for medical services he never provided. It is also alleged that Roy went to a homeless shelter in Dallas and paid $50 to any resident of the shelter who signed the forms, according to the Los Angeles Times. Roy is facing life in prison, a $250,000 fine, and restitution of a large amount of the money he allegedly stole from the government. In testimony before a House Appropriations Committee on February 28, Attorney General Eric H. Holder Jr. stated he is placing a considerable amount of emphasis on health-care fraud, making it the centerpiece of the Department of Justice’s enforcement efforts.


Fish May Offer Insight Into Limb Regeneration The discovery of two species of Polypterus bichir fish found in Africa that can regenerate an amputated side (pectoral) fin with remarkable accuracy, in as little as a month, has the potential to provide insight into human limb regeneration. Bichirs are ray-finned, which means their fins comprise skin-like webbing stretched between bony structures connected directly to the skeleton. They also share traits, such as paired lungs, with both modern amphibians and very early four-limbed vertebrates. The bichirs’ regeneration powers suggest that appendage regeneration was a common property of vertebrates during the fin-to-limb evolutionary transition, according to a paper published online in the Proceedings of the National Academy of Sciences. The paper was written by Luis Covarrubias, a developmental biologist with the Department of Developmental Genetics and Molecular Physiology, Institute of Biotechnology, National Autonomous University of Mexico, Cuernavaca, Morelos, and his colleagues. Because bichir fins grow considerable fleshy tissue as well as bones similar to the internal skeleton, their comeback fins may prove useful for comparing regeneration systems, Ken Poss, PhD, an associate professor, cell biology, at Duke University, Durham, North Carolina, told a Science News reporter. Discovering why some animals and fish can regenerate body parts while others cannot might lead scientists to discover a way to cause limb regeneration to happen when it’s needed, as in the case of amputation.


ABC’s 2011 Annual Report Highlights Record-Breaking Accreditation and Certification News The American Board for Certification in Orthotics, Prosthetics & Pedorthics Inc. (ABC) has published its 2011 Annual Report on the ABC website. The report summarizes the organization’s successes and provides data on the total number of certified individuals and accredited facilities. Highlights from the report include the following: • ABC exceeded last year’s record for the number of accredited facilities choosing ABC, with 8,418 facilities applying for or renewing their existing accreditation. • More than 1,000 practitioners were newly certified by ABC in 2010, bringing the number of ABC-certified professionals to 13,638. • A total of 604 individuals met the requirements for and were granted the Certified Assistant credential. The complete report is available at www.abcop. org, under the Resources and Links section. a

BUSINESSES in the news

Ability Prosthetics & Orthotics Inc., in Gettysburg, Pennsylvania, has become a sponsor of Project Enduring Pride, which assists in programming for wounded warriors beyond the boundaries of the federal campus. The company also recently opened a new patient-care facility in Greenville, South Carolina. The new facility will be operated by Brian Kaluf, CP. The Centers for Medicare & Medicaid Services (CMS) has issued an updated booklet for its claim review programs. The booklet covers the Recovery Audit Program (formerly known as Recovery Audit Contractors or RACs) and includes information on Medicare Administrative Contractors and Program Safeguard Contractors/ Zone Program Integrity Contractors.

Central Brace and Limb, in association with Orthotic and Prosthetic Activities Foundation (OPAF) and the First Clinics, will host a First Dive Adaptive Scuba event in Avon, Indiana. Endolite North America has signed on as a 2012 gold-level sponsor for OPAF. Gulbrandson Orthotics & Prosthetics hosted a First Dance Clinic in Chrystal Lake, Illinois, in association with OPAF. Health Evolution Partners, a health-care private equity firm in San Francisco, announced that it has acquired a majority interest in Freedom Innovations, Irvine, California.

The National Association for the Advancement of Orthotics & Prosthetics (NAAOP) has released a new video webcast featuring NAAOP General Counsel Peter Thomas , JD, with an update on the federal budget proposals and Medicare payment reform. To view, visit The Northwestern University Rehabilitation Engineering Research Center for prosthetics and orthotics is conducting an anonymous survey to investigate the opinions of the O&P community regarding the direction that research in the O&P field should take during the next five to 10 years. The survey is funded by the National Institute on Disability and Rehabilitation Research.

APRIL 2012 O&P Almanac




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Reimbursement Page By Devon Bernard, AOPA government affairs department

Don’t Take ‘No’ for an Answer Persistence can pay off in appealing Medicare claims Here’s what cannot be appealed: • A denial that was the result of resubmitting a claim that was previously denied or is still under review; a duplicate claim. • A denial of an item or service that is statutorily not covered by Medicare and is not a Medicare benefit, such as a denial for orthopedic shoes that are not attached to a brace or for an ankle-foot orthosis used solely to treat ulcers. • A denial that resulted from a violation of the timely claim filing limit. In the past, you could appeal such a denial, but this changed in 2010, when the timely filing window was set at one year from the date of service.


our right to appeal the results of Medicare reviews is a valuable resource in protecting your revenue stream—especially given the increase in the number of reviews before and after payment. This month’s column provides a recap of the Medicare appeals process.

What Can Be Appealed? First, let’s review what can and cannot be appealed. For starters, you may appeal a claim for any item or service that is denied as not medically necessary (NMN), typically resulting in a Remittance Advice code of CO-50. “Not medically necessary” is something of a catch-all phrase and can mean several different things, depending on the claim and the situation. An NMN denial generally focuses on an item or service that is traditionally covered by Medicare as a benefit, but in this case, Medicare has determined that there


O&P Almanac APRIL 2012

is insufficient evidence to confirm its medical necessity. The denial could be specific to the patient—the patient didn’t have the required diagnosis, for example, or didn’t meet the coverage criteria for a custom item. Or it could be specific to policy, which clearly states that an item will be denied as NMN. The use of acrylic sockets on temporary prostheses is one example. An NMN denial could also be due to useful lifetime restrictions or the similarity of the item or service to one already provided. In some situations, a denial that is not related to medically necessity may be appealed. One example is missing, incomplete, or inaccurate information on the claim. This includes denials for not including a modifier, entering the wrong date of service, or entering the wrong number of units.

Level of Appeals Five levels of appeal are open to you—six, if you include reopening the case. Under Section 937 of the Medicare Modernization Act of 2003, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs), at its discretion, may allow a claim to be reopened rather than requiring the provider to enter the official appeals process. A reopening is typically available when the result of your denial was due to a minor clerical error, such as entering the wrong date of service or forgetting to include a modifier on the claim. However, you may not use the reopening process if you forgot to include modifiers that affect payment responsibility, such as the KX, GA, GZ, or GY modifiers. If the DME MAC refuses your reopening request or the claim is still denied, the claim will be eligible to enter the formal appeals process.

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Reimbursement Page

ALJ Mailing Addresses If The Patient’s Permanent Residence Is In:

The ALJ Request Should Be Mailed To:

Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New York, New Jersey, Puerto Rico, Virgin Islands, Delaware, Maryland, Pennsylvania, Virginia, West Virginia, District of Columbia, Illinois, Indiana, Ohio, Michigan, Minnesota, or Wisconsin

Office of Medicare Hearings and Appeals BP Tower & Garage 200 Public Square Suite 1300 Cleveland, OH 44114-2316

Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Arkansas, Louisiana, New Mexico, Oklahoma, or Texas

Office of Medicare Hearings and Appeals 100 SE 2nd Street Suite 1700 Miami, FL 33131-2100

Iowa, Kansas, Missouri, Nebraska, Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming, Arizona, California, Hawaii, Nevada, Guam, Trust Territory of the Pacific Islands, American Samoa, Alaska, Idaho, Oregon, or Washington

Office of Medicare Hearings and Appeals 27 Technology Drive Suite 100 Irvine, CA 92618-2364

Level 1: Redetermination. After you receive a determination denying a claim, you have 120 days to file an appeal. Keep in mind that this appeal must be done in writing, and you must use the Medicare approved redetermination form, which may be found on your DME MAC website or on the CMS website at cmsforms/downloads/cms20027.pdf. During this level of appeal, you can submit documentation that supports your assertion that the claim should not have been denied, as well as information that supports medical necessity. So take advantage of the 120 days and collect all the pertinent information. Once the request for redetermination is submitted, it will be reviewed by someone other than the person who made the initial determination, but it will still be reviewed by the DME MAC that processed the initial claim. You should receive a response within 45 days, although it frequently takes much longer. Because the same entity that denied the claim is reviewing it, however, it’s unlikely to be overturned at this point. Most likely, you will have to move onto the second level of appeal.


O&P Almanac APRIL 2012

Level 2: Reconsideration. At this level, your claim is no longer being reviewed by the DME MAC that processed your claim. Instead, it will be reviewed by a Qualified Independent Contractor (QIC). Since Nov. 15, 2011, the QIC for all Medicare reconsideration requests is C2C Solutions, Inc. All reconsideration requests must be made in writing and within 180 days of receipt of the redetermination decision. It is recommended that you use the Medicare reconsideration request form, cms20033.pdf, but you may submit a written request as long as it contains at least the following information: • the beneficiary’s name • the beneficiary’s Medicare health insurance claim number • the specific service(s) and item(s) for which the reconsideration is requested • the specific date(s) of service • the name and signature of the party or representative of the party • the name of the contractor that made the redetermination. Remember, this is the last level of appeal where you may submit additional or new documentation

supporting your assertion that the claim denial should be overturned. After this level, no new documentation can be submitted. The QIC must process all reconsiderations within 60 days of receipt. Level 3: ALJ hearing. If the request for reconsideration is unsuccessful, you can request a hearing by an Administrative Law Judge (ALJ). This is typically where most appeals are successful; most do not go past this level. An ALJ, one from a pool of judges under the jurisdiction of the Department of Health and Human Services, will perform an independent review of the case based only upon the information that is on the record— information and documentation that was sent in during the redetermination and reconsideration levels of appeal. ALJs are not bound by the rules or policies of a particular DME MAC. They review appeals based on their interpretation of the laws governing the Medicare program, and that is why most appeals are successful at this level. A request for an ALJ hearing must be made in writing within 60 days of the

receipt of the reconsideration decision, and you may request that the hearing be conducted in person before the judge, by videoconference, or by telephone. After the hearing, you should receive a decision within 90 days. Keep two key things in mind when requesting an ALJ hearing. First, all ALJ requests must be sent to the correct Office of Hearings and Appeals, based on the beneficiary’s/patient’s permanent address (see the chart at left). Second, you must meet a minimum “amount in controversy” (AIC); that is, a monetary threshold. The amount in controversy for 2012 must be at least $130; you may combine any number of claims to meet this amount. Level 4: DAB review. Next up is a review by the Departmental Appeals Board (DAB). In order for a DAB review to take place, there must be evidence that the ALJ did not properly interpret the laws governing the Medicare program, that there was an apparent abuse of discretion by the ALJ, or that policies and procedures were not followed properly. A request for a DAB review must be made within 60 days of receipt of the ALJ decision and must be in writing. The DAB must issue a decision within 90 days of receipt of the request for review. The board may decide to uphold the ALJ’s decision; it may determine that the ALJ should review the appeal again; or it may reverse the decision. Level 5: Judicial review. It is very unlikely that you’ll reach this level of appeal, which involves filing a civil lawsuit against the Medicare program in federal court. As this is an official court proceeding, you must be represented by an attorney. An AIC of $1,150 must be met, and all requests must be made within 60 days of receiving the DAB’s decision.

Hints on Appeals All good appeal strategies begin before you ever submit your claim to Medicare. Here’s my advice: • Document everything thoroughly. Be sure your documentation

supports the medical necessity for every item/service you provide, and be sure that this documentation is well organized and easy to locate in the patient’s chart. The windows for filing appeals are short, and you don’t want to waste time searching for a vital piece of documentation. Missing or incomplete pieces of documentation can derail the best planned appeal. • Begin gathering documentation early. Organize the information into coherent and logical groups, and remember that everything is relevant. Provide as much information as possible—no appeal has ever been denied because of too much documentation, but appeals have been denied for too little. So, besides submitting the basic must-have documentation (delivery slips, initial and detailed written orders, your notes, etc.), be sure to include notes and records from physicians, therapists, hospitals, nursing facilities, or any other health-care provider that may be treating or has treated the patient. Every little piece helps and creates a clearer overall picture. • Deal with each appeal individually. Be sure to identify what was denied and why, and then formulate your appeal request to address that specific denial. Don’t spend time formulating an appeal response to

a medical necessity denial when the claim was actually denied for incorrect date of service. • Be specific. State exactly why you are appealing the claim and your reasons for why the claim should be paid. For example, if you are appealing a denial because of it was judged to be the same as or similar to a previous claim, be sure to explain how the new device or item is different than the one previously provided, explain that the patient’s condition has changed, or explain that the patient’s original device was lost or stolen. • Watch your language. Quote Medicare policy whenever possible, keep the technical jargon to a minimum, and keep the claim as simple as possible. Remember, what you think is obvious may not be obvious to the person reviewing the claim. • Finally, the most important part of filing an appeal is to be persistent. The farther you go in the appeals process, the more likely you are to succeed. a

Devon Bernard is AOPA’s manager of reimbursement services. Reach him at

APRIL 2012 O&P Almanac


the Infant Skull Cranial malformations are increasing in babies, but the prognosis for correction is excellent


n various cultures, babies’ soft skulls have been shaped intentionally according to the customs and tastes of the times. Today, however, head shaping is done to correct deformities of the skull, primarily congenital. And unfortunately, these deformities are becoming more common. The incidence of plagiocephaly (asymmetry), brachycephaly (excessive width), and scaphocephaly (excessive length) is rising. Failure to treat these skull malformations can result in deformations of adjacent craniofacial structures, causing increased risk of ear infection, jaw misalignments, temporomandibular joint disorder (TMJ), and orbital asymmetries that cause vision and balance problems—to say nothing of the social stigma that can arise when a child has an unusual looking head and face. Fortunately, the outlook for correcting these skull malformations is excellent. Keys to a successful outcome are early detection and treatment and the family’s compliance with the treatment program.

Types of Malformation Plagiocephaly, brachycephaly, and scaphocephaly are congenital malformations of the skull that are distinguished by their characteristic shapes. Plagiocephaly presents


O&P Almanac APRIL 2012

“with significant asymmetry between the right and left side,” says Deanna Fish, MS, CPO, director of orthotics at Hanger Prosthetics & Orthotics in Draper, Utah. As Nicole Steele, CO, of Wright & Filippis: Pediatric Center in Madison Heights, Michigan, explains, plagiocephaly “results in a parallelogram-shaped skull where you have two bossed, or enlarged, regions that are opposite each other (anterior and posterior), and two opposite regions that are flattened.” Plagiocephaly often occurs in combination with congenital muscular torticollis—also called wry neck— in which an infant’s head twists to one side while the chin tips up toward the other side. Torticollis often exacerbates plagiocephaly because the neck twisting causes the child to continue to place pressure on the same side of the skull, thus further flattening an already flattened area. Brachycephaly and scaphocephaly are less about asymmetry than about proportional deformations of the skull. “Brachycephaly is more about lack of volume, or void, than it is about asymmetry,” says Blake Norquist, CO, LO, and cranial products manager for Orthomerica in Orlando, Florida. “It presents as a flat posterior; a lot of volume is missing posteriorly. Infants with this condition usually have some bossing in the anterior. Scaphocephaly, in contrast, presents as a lack of volume in the width, in the mediolateral (ML) axis; so they have a long anteroposterior (AP) axis and a narrow ML.”


By Tora Estep

APRIL 2012 O&P Almanac


Causes of Malformation Fish explains that many factors contribute to these congenital skull malformations, including restrictive in-utero positioning, breach positioning, vaginal deliveries, multiple births, sustained supine sleep positioning, congenital muscular torticollis, birth trauma, and premature births. To these factors, Norquist adds cervical abnormalities like Klippel-Feil syndrome and fusion. All of these factors create sustained pressure on the malleable skull of an infant, resulting in flattened areas. “And,” adds Norquist, “once it’s flat, the head stays flat. When the patient lies down, his or her head usually goes to the flat portion of the skull, which stays that way until some kind of device is made or some kind of therapy is applied to get off that area.” The actual number of infants with skull deformation is not known, Fish notes, but an estimated 300,000 to 400,000 babies are born each year in the United States with cranial deformations ranging from mild to severe. All three practitioners have seen increases in their practices. Part of the reason for the increase, Steele explains, is the Back to Sleep campaign, initiated by the American Academy of Pediatrics in 1992. The “Back to Sleep” campaign is a highly successful education program that


O&P Almanac APRIL 2012

teaches parents to put infants to sleep on their backs to prevent death from sudden infant death syndrome (SIDS). The problem, says Steele, is that with the emphasis on ensuring that babies sleep on their backs, too little attention is given to supervised tummy time and repositioning, which help prevent or alleviate skull deformations. Giving babies time on their tummies and plenty of interaction with their caregivers helps develop and strengthen neck muscles and prevent skull deformities. Another factor is the rise in the number of twins and triplets being born as a result of increased use of fertility drugs. Multiple births create more crowded conditions in the womb, which can put pressure on an infant’s skull and create asymmetries or twist the neck muscles.

Treatment “Early identification offers the opportunity for repositioning efforts,” says Fish. Treatment for cranial malformations varies. These efforts, she says, include “alternating the baby’s head to the left and right arm during holding and feeding, … on the table during diaper changes, … and at night in the crib; limiting time in supported seats and sustained supine positioning; daily supervised tummy time and play

activities; a home stretching program if congenital muscular torticollis or unilateral neck tightness is identified; and any other effort that limits the amount of time the baby places the weight of the head on one side of the back of the skull.” Such efforts “are most successful in a young infant—especially during the first 12 weeks but even up to six months of age,” she points out. Although repositioning and physical therapy can be effective in young infants or in infants with only mild skull flattening, they are usually insufficient when the flattening or asymmetry is severe or when the patient is more than 18 months old. In these cases, the most effective treatment technique is some kind of helmet or cranial band. The principle behind cranial orthoses is universal, Norquist says, although each manufacturer of the devices has its own preferences in terms of the plastics and foams it uses. These custom-molded helmets work by holding the heightened or enlarged areas of the infant’s skull and leaving room in the helmet for less-developed areas of the skull to fill into. The growing brain simply follows the path of least resistance and grows into areas of the skull that are not under resistance, resulting, over time, in a more rounded and even skull shape. This kind of directed growth appears to have no negative effects on brain development.

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It is important to note that helmet therapy is not recommended in the case of craniosynostosis, a condition in which the sutures in an infant’s skull close prematurely. These must be opened surgically before using a cranial remolding helmet. Three other contraindications for helmet therapy are hydrocephalus, whether shunted or unshunted; age below three months; and age above 18 months, says Norquist.

A Typical Protocol Steele notes that parents and caregivers are often more concerned about these deformations than their pediatricians are, and Fish agrees that parents are typically those who bring flattening, asymmetry, or disproportion to the attention of their pediatricians. From there, the pediatrician may prescribe a cranial remolding orthosis or refer the patient to a pediatric neurosurgeon or other specialist. Once the diagnosis is made and a prescription is written, the clinician

examines the infant thoroughly, evaluates the skull, and discusses repositioning efforts and the upcoming orthotic treatment program with the parents or caregivers, Fish explains. If a cranial remolding orthosis is indeed needed and positive outcomes are anticipated, the clinician scans the baby to get measurements for a custom orthosis. The baby continues or begins therapy treatment for congenital muscular torticollis if

indicated, and a coordinated treatment plan is maintained among the infant, parents, therapist, orthotist, and referring physician. Norquist describes a similar procedure, emphasizing the importance of taking measurements by hand in assessing the patient and building a case by asking the parents such questions as whether the baby was premature or one of a multiple birth, when the parents noticed the area of concern, and how long it took to get to the clinician. The answers help the clinician determine a course of treatment, after which the infant’s skull will be measured more precisely, either with a cast or with a scan, which will become the foundation for the design of the customized helmet. Within 14 days of the initial cast or scan, the infant should be fitted with a custom-built cranial orthosis, which he or she will wear anywhere for six weeks to six months, depending on the age when treatment was started and the severity of the deformity. The clinician typically follows up one week after fitting the patient with the helmet and then again every two

Head Shaping in History The same principles of head shaping in use in orthotic cranial devices— applying resistance in areas where the shape is to be restrained and leaving room for growth in areas where growth is desired—have been in use for thousands of years to create “ideal” head shapes. Wooden boards, leather straps, and manual methods have been used to shape the baby’s head. Similar to scarification, tattoos, foot binding, and other body modifications, skull shaping has had multiple meanings, including status, membership within a particular group, and adherence to a cultural aesthetic. Archeological evidence of skull shaping is found throughout the world, and the practice appears to have evolved independently in different places. Some examples have been found among the Maya, the Inca, and possibly the Egyptians in the form of skull elongation. The first documentation of this kind of deformation appeared in 400 B.C., in Hippocrates’ descriptions of macrocephali or long-heads. Many cultures practiced flattening the back of the head, including the Choctaw, Chehalis, and Nooksack Indians and among Australian aborigines.


O&P Almanac APRIL 2012

STARscanner for Starband Cranial Remolding Orthoses


MORE THAN 100 STARSCANNERS ARE IN USE AT PRESTIGIOUS INSTITUTIONS SUCH AS… • Altru Rehab Center, North Dakota • Carrie Tingley Hospital - New Mexico • Children’s Healthcare of Atlanta • Children’s Hospital & Medical Center - Omaha, NE • Children’s Hospital of Colorado - Denver, CO • Children’s Medical Center - Dallas, TX • Children’s Memorial Hospital - Chicago, IL • Marshfield Clinic - Marshfield, WI • Mary Free Bed Orthotics and Prosthetics – Holland, MI • Mary Free Bed Rehabilitation Hospital Grand Rapids, MI • Massachusetts General Hospital • Mayo Clinic - Rochester, MN • Medical City Hospital - Dallas, TX • Miami Children’s Hospital - Dan Marino Center • Tufts Medical Center- Boston, MA • Park Nicollet - Minneapolis, MN • Rehabilitation Medical Supply, South Dakota • Seattle Children’s Hospital • University of Rochester Medical Center • University of Texas Health Science Center at Houston • University of Texas Health Science Center at San Antonio • Wolfson’s Children’s Hospital - Jacksonville, FL

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In less than 2 seconds, the eye-safe laser collects the baby’s head shape data, replacing the need for plaster casting. 3-D data can be viewed in multiple planes with detailed analyses to document treatment progress, offering quantitative outcomes to insurance carriers, physicians and parents. This captured data is transmitted to Orthomerica for fabrication of the cranial remolding orthosis.

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to three weeks as needed. During each follow-up session, Fish says, the clinician takes and compares anthropometric measurements of the skull to continue directing the treatment program and making adjustments to the orthosis as needed. “Almost all infants show an improvement in head shape during the course of the treatment program,” she says, “with the greatest improvements most often occurring with younger infants.”  

Success Factors Understanding the definition of a successful outcome is the first step in treatment. Steele explains her definition of success this way: “If we see a 50 percent improvement in the symmetry or proportion of the head shape, I note that as a success. Frequently, parents who are compliant with helmet therapies get at least 50 percent correction, if not more.” Steele, Fish, and Norquist agree that compliance is one of the most important factors in a successful outcome. Families that consistently ensure that the patient wears the helmet 23 hours out of the day (the remaining hour is devoted to caring for the baby’s hygiene and washing the orthosis) simply have better outcomes

than families that don’t. When the baby wears the helmet for 23 hours out of the day, more cranial growth is captured and redirected into desired areas, resulting in faster improvement. Another important success factor is the age of the infant when starting the therapy. The “sweet spot” for helmet therapy is within the range of four to eight months of age—the period when the skull grows rapidly. A rounded head shape can be achieved with helmet therapy in as little as six to 12 weeks. However, all is not lost if parents cannot get their child to a specialist before this window of opportunity closes. Patients can still achieve significant results up to 18 months of age, although they will likely have to wear the helmet longer (anywhere from three to six months) and the improvement may not be quite as dramatic.

After 18 months, or when the sutures in the infant’s skull have closed, helmet therapy is no longer likely to have any positive effect. Technical advances have also resulted in successful outcomes, says Norquist, specifically the increasing use of scans and CAD technology to measure the skull and create precise helmet designs. In his practice, he has seen the use of scans increase from 20 percent to 80 percent, and he credits the improved accuracy of the scans with better results. “I think the results are probably better because of the scan quality, the quality of the negative that we have,” he says. “A cast can get deformed in shipping, but with a scan we have the patient’s whole head shape in front of us, so it’s a lot easier to make modifications to it. And it’s more accurate.” Another benefit is that scans cause the infant less distress than when skull measurements are taken—something any worried parent would applaud. a Tora Estep is a contributing writer to O&P Almanac. Reach her at tora.thurisaz@


O&P Almanac APRIL 2012

Reprinted with permission from the O&P Almanac published by the American Orthotic and Prosthetic Association



Decision Should you use a central fabrication lab or keep fabrication in-house? There are pros and cons to each approach.

By Anya Martin


O&P Almanac APRIL 2012


needs. The biggest benefit of outsourcing, the founders say, is that it has allowed Ability to focus on the patients and align the balance of its resources toward education, the physical practice, and marketing. “At Ability, our culture is very much that the device is about 30 percent of what we do,” Brandt says. “Certainly, delivering arms and legs and braces is what we do and how we make money, but we really challenge practitioners to be bigger and more dynamic than that.” Outsourcing allows superior patient care and satisfaction to be first and foremost in the promotion of the practice, too. “We’re out marketing ourselves and the practice’s capabilities, and not out solely marketing the product,” Brandt says. Another positive is reliability, he adds. If a “If you are outsourcing patient needs the same ankle-foot orthosis correctly, you are aiming three years later, it’s easy to request the for accuracy and precision same brand of device on the first fitting.” with the same adjustments. In contrast, if the item was made –Jeffrey M. Brandt, CPO in-house and the technician who built it is no longer employed with the company Below, five practices offer advice on or is out sick or on vacation, the capacity embracing central fabrication, keeping it to replicate the device is compromised, mostly within their own practice, or striking Brandt explains. a balance. In his view, outsourcing actually encourages the practitioner to take more time Outsourced Fabrication and care in writing the work order, which Working as technicians together in improves patients’ evaluations because the an in-house O&P lab convinced Ability aim is for accuracy and precision on the first Prosthetics & Orthotics, Inc., co-founders fitting. “If you are outsourcing correctly, you Jeffrey M. Brandt, CPO, and Jeffrey T. Quelet, are aiming for accuracy and precision on CPO, that outsourcing was the better route. the first fitting,” he says, “not designing the “We did our jobs happily, but we would device through repetitive ‘trips to the back’ to spend our down time and time spent at the converse with the technician.” router postulating that if we ever did own Outsourcing also increases Ability’s our business, we’d get rid of this facet,” says product offerings, a boon to patients and Brandt, president and COO. “We’d talk referral sources alike. While environmental about how [the practitioners] could see more issues may not be foremost in most practipatients a day if they weren’t in the back tioners’ minds, not having an in-house lab monitoring the jobs.” removes air-quality concerns for both patients Ability, which has 11 offices in five states and employees. When Brandt worked as (Kentucky, South Carolina, North Carolina, a technician, he recalls, smells from lab Maryland, and Pennsylvania), has used processing would seep into the waiting central fabrication labs since Day One, room, and he used to drive home with the car outsourcing to 30 different manufacturers windows open just because he craved fresh air. depending on the device and the patient’s n the past, making orthotic and prosthetic devices was largely an in-house craft, but today, practitioners increasingly are outsourcing to central fabrication labs. A majority (77.6 percent) of O&P practitioners use outside central fabrication, and 66.7 percent of the top 25 profit leaders say they do. What are the pros and cons of outsourcing to a central fabrication lab vs. doing the fabrication in-house? Do practitioners sacrifice quality and their ability to provide customized devices by outsourcing fabrication? Or does outsourcing save precious time that can be devoted to patient care? How can you work with your central fabrication lab to ensure high quality and outcomes?

APRIL 2012 O&P Almanac


To Brandt, the biggest limitation of central fabrication is delay in getting the device to a patient. (For example, if you are seeing patients in a hospital, treating a specific pathology that requires same-day or next-day fitting, but the device can’t be produced from a measurement or scan.) But considering the time it often takes now to procure insurance approval, Brandt has not found the wait to be a problem. “In eight years, I can’t think of too many situations when I could have made something in a day that would have had an authorization in a day,” he adds. Ability gets around this challenge by providing an off-theshelf device for the few days it usually takes for the fabrication lab to produce the permanent product. The company also educates hospitals against holding onto unrealistic expectations that were based on traditional or outdated O&P concepts.

In-House Fabrication Cornell Orthotics & Prosthetics Inc. takes the opposite approach, keeping most manufacturing in-house. Its three Massachusetts-based offices and four satellites include labs where practitioners can modify devices, and fabrication is done in a central lab in the main office in Beverly, Massachusetts.


O&P Almanac APRIL 2012

“At the bottom line, I still like having control, being able to see the quality, and making sure things are done right.” –Ricardo Ramos, CP, LP

The only times the company outsources, says Vice President Ken Cornell, CO, are for rare overflow that cannot be handled in-house and for specialty items such as spinal orthoses, which require a huge mold and models that take up a lot of space. Three of the top spinal labs are located in Massachusetts, he says, and can turn out models rapidly, usually with next-day shipping. The other exception is custom carbon composite AFOs, which require impregnated carbon that must be manufactured at a specific temperature and pressure. Cornell needs only a few such devices, so it is not cost-effective to purchase the required equipment. “We may be a dying breed here, but all our practitioners modify their own models because, by doing so, we can provide a better functioning device,” Cornell says. “When you send out [orders] to central fabrication, you tend to get back Big Macs. What it comes down to is, if the person modifying the model is the same person who evaluated the patient, then there are many subtle modifications which have a cumulative effect of providing a much better fitting and functioning orthosis.” Because practitioners work directly with technicians and can show them exactly what they are looking for, Cornell says, the practice is more likely to deliver a more individualized orthosis for each condition. As a result, practitioners can focus more on the fit of the brace than on its function, and that kind of

hands-on customization is unlikely with a lab that is hundreds or thousands of miles away. “It comes down to expectations,” Cornell adds. “If you want something that fits pretty well, then use central fabrication. If you want to fit something really outstanding or a difficult case, you have to do it yourself, because sometimes small things make the biggest difference.” To keep air-quality and noise problems from affecting patient care, Cornell has invested in a $60,000 air-exchange unit and uses a totally glassed-in fume hood, as well as sound-proofed walls. These features cost extra money, he says, but they’re simply a necessary cost of doing business. Premier Prosthetics, which has two offices in San Antonio, also does almost all its fabrication in-house, says Ricardo M. Ramos, CP, LP, president and CEO. The exception is hip-disarticulation prostheses because of their complexity and specialized materials and the small volume needed. “At the bottom line, I still like having control, being able to see the quality, and making sure things are done right,” he says. “And if there’s a problem, it’s very easy to make a change. Being a small practice, we’re not overly busy and we have sufficient staff.” Speed is paramount to Ramos. For example, he can see a patient at 9:00 in the morning, have a test socket ready to go by lunch time, and provide a prosthesis the next day. Premier employs three technicians; the lab is in one office, which is only a 20- to 30-minute drive from the other.

At the end of the day, though, Ramos simply enjoys the hands-on approach that in-house fabrication affords. “I’ve been in the field for 30 years, and I grew up in prosthetics as a technician,” he says. “Now with all the headaches of Medicare audits and the Texas licensure board that adds additional regulations on top of Medicare rules, I am personally having to deal with more management and paperwork. It’s not as much fun as 10-15 years ago, but it’s hard for me to let go of the hands-on part. That’s why I got into prosthetics.”

Splitting the Difference Some medium-sized and big companies, such as Hanger and Scheck and Siress, split the difference by operating their own central fabrication labs. Hanger has so many offices across the country and grows by acquisition, the company has tried to strike a balance by not only offering its own labs but also allowing some practitioners to continue to produce in-house or maintain existing relationships with central fabrication labs. One example of this arrangement is the Insignia CAD CAM program, says John Spaeth, MS, CP, Insignia’s director and Hanger Clinic Midwest Region vice president. Insignia’s approximately 700 users are encouraged to scan digital images, which are then sent electronically to a central design center. Designers work on device design using the digital image and in collaboration with the practitioner and other experts. About three quarters of the designs then get sent to four Hanger-run central fabrication labs across the country; the rest go back to the local market, where the orthotic or prosthetic device is either produced in-house or sent to a local lab. Centralizing CAD is significantly less expensive and quicker than making and shipping casts. Also, because the work is complex and difficult to learn, Spaeth says, it makes sense to have it handled by designated professionals. “It’s almost impossible



If you’re thinking of outsourcing, one concern may be selecting the right central fabrication lab. Michael Angelico, president of Advanced O&P Solutions, offers several tips: •

Find out how the lab handles mistakes or problems. At Advanced, if a mistake is made, the lab works with the practitioner until the product is to their satisfaction. No additional charges accrue for corrections, and devices come with a one-year warranty.

If you want a device made in a particular way, consider sending a sample to demonstrate that. If a practitioner will be contracting Advanced to make the product on a regular basis, the company will sometimes fly the practitioner in to show its technicians exactly what is wanted.

Don’t necessarily dump a lab that does not get it right the first time. Sometimes it takes a few tries on a device to become familiar with a practitioner’s specific design needs.

Look for a lab that prioritizes communication, and be open to ways to improve patient outcomes.

“We’re constantly on the phone, saying, ‘I know you’ve done it this way in the past, but we have experienced that this worked better. What do you think?’” Angelico says. “We’re able to give these kinds of suggestions because we are experts at what we do.”

for a clinician to learn CAD extremely well through only occasional use versus somebody doing it day in and day out,” he says. “Centralization has made it possible for occasional users, who do less than 1,000 scans a year, to utilize the technology successfully.” Hanger’s own central fabrication labs for non-CAD devices are preferred vendors. But exceptions are made for overflow, for custom-molded shoes (which are all outsourced), and when an individual practitioner has a particularly good working relationship and customerservice history with another facility, Spaeth notes. Scheck and Siress relies on a wholly owned subsidiary, Advanced O&P Solutions, for central fabrication for

its 12 offices. Advanced also services about 70 other O&P practices and its client output grows about 7 to 10 percent annually, says Advanced O&P President Michael Angelico. The O&P central fabrication sector started seeing a rise in outsourcing about nine years ago, he says, when Medicare started to cut reimbursements, requiring practitioners to double or triple patient loads. In addition, fabrication is no longer regularly taught in O&P educational programs. All in all, Angelico expects outsourcing will only increase in the future. a Anya Martin is a contributing writer to O&P Almanac. Reach her at anya99@ APRIL 2012 O&P Almanac



Facility Spotlight By Deborah Conn

Making a Difference At PCE, a mobile lab is just part of the company’s commitment to ongoing service


Prosthetic Center of Excellence

Location: Las Vegas, Nevada


Gwen Webb-Johnson, CPO


13 years in business


O&P Almanac APRIL 2012


he pivotal event in Gwen Webb-Johnson’s professional life occurred during her internship as a physical therapist in the early 1980s. “Someone came in who needed a prosthetic leg,” she recalls. “We were doing all the therapy we could, but that leg enabled him to walk. He was very emotional about it, and I could see what an enormous difference it made in his life.” Webb-Johnson wanted to make that kind of difference, so she decided to pursue O&P. As it happened, one of her father’s friends was Sam Hamontree, CP, head of Orpro Inc. in Irvine, California. “He

invited me to look at his facility,” she says. “Back then it was one of the biggest in the country, and he was a great inspiration to me.” Webb-Johnson worked as an O&P technician while she was in school, where, as she puts it, “I learned how to fabricate everything for a small company in Long Beach.” She was in the second graduating class of the Orthotics and Prosthetics Program at California State University, Dominguez Hills, in 1986, one of only two women in the class. After earning her bachelor’s degree, Webb-Johnson moved to Reno and began work at what was then OrthoPro, eventually rising to partner.

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Novacare bought OrthoPro (and was later itself purchased by Hanger Orthopedic Group in 1999), and Webb-Johnson became Novacare’s only female clinical director. “I learned a lot there,” she says, “but I finally decided to start my own practice. I wanted better control of how I cared for patients.”

On Her Own She and Robert Brooks, CPO, founded the Prosthetic Center of Excellence (PCE) in Las Vegas in 1999. Brooks died a few years later, leaving Webb-Johnson on her own. “It was a tough transition, but we made it through,” she says. Today, PCE has 17 employees, including five practitioners, three technicians, and nine office and administrative staff members. The facility does all its own fabrication in an on-site lab. Webb-Johnson estimates the company has a 60-40 split between


O&P Almanac APRIL 2012

prosthetic and orthotic care, with a wide range of patients. “We see a lot of seniors and a lot of people with diabetes,” she says. “But we also specialize in pediatrics, and we treat children with cerebral palsy and other conditions.” Despite a number of competitors in the area, the company is thriving. It has exclusive contracts with several local hospitals, including the University Medical Center in Las Vegas, which has the only trauma center in Nevada. “Accident victims from all over Nevada are heliported to UMC, and we see them 24/7, 365 days of the year,” Webb-Johnson explains. “Someone is always on call at the office.”

public transportation to get to their appointments. “The bus would drop them off in the morning but might not pick them up until late in the afternoon,” she says. “They had to just sit and wait for hours.” So Webb-Johnson purchased a diesel van and outfitted it with tools and grinding machines, enabling practitioners to visit patients in their homes for fittings and minor repairs. Not surprisingly, that kind of service has led to an increase in patients. PCE looks forward to increased growth through the combined efforts of practitioners, staff, and an active marketing department headed by Bernabe Duran. “As technology grows in the O&P field,” he says, “ so will we.” a

Ongoing Service That commitment to ongoing service took a different form two years ago. Webb-Johnson noted that many of her disabled patients used

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



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Lone Star Advocacy Two dedicated Texans show how persistence and organization pays off for O&P

Aerial of Austin, Texas, Capitol and city


udy Bindi, CPO (E) BOCPO, saw the item in the January 24 issue of AOPA In Advance, the association’s electronic newsletter: Texas Gov. Rick Perry (R) had signed SB 874 into law. The new law requires the Texas Health and Human Services Commission (HHSC) to recognize O&P Medicaid providers as separate from DME. “I think this is a landmark move by some creative thinkers,” Bindi wrote to AOPA. “Hopefully, all states that have licensure will progress along these lines. Possibly, that would finally encourage Medicare to follow suit in five years. Our field seriously needs to be separated from DME.”

One Man’s Crusade There’s a wonderful story behind what happened in Texas that we hope


O&P Almanac APRIL 2012

will inspire O&P leaders in other states to push for similar legislation. It began when AOPA member Mike Allen, CPO, FAAOP, chose not to sign the Texas Medicaid enrollment form that lumped Rep. Tom Craddick (R) O&P providers in with DME providers. When reenrolling his office after its provider identification number was mistakenly inactivated, the Texas Medicaid enrollment process refused to recognize the taxonomy code appropriate for O&P. The state officials’ only recommendation was to use the specialty code for in-home hyperalimentation supplies.

Allen endured almost two years without Medicaid reimbursements as he tried to work with the Texas Medicaid program to correct the error. Not only would his reenrollment have been fraudulent, but because the state’s provider directory is generated from enrolled providers, the public was prevented from searching for an orthotist or prosthetist. It was time to do something about such tomfoolery. Allen started with his legislator, Rep. Tom Craddick (R). The longestserving member of the Texas House of Representatives, Craddick was elected at age 25—more than 40 years ago. He served as speaker of the House from 2003 to 2009 and was just the right person to introduce HC 1264, which basically required Texas Medicaid


practitioners, especially those to recognize O&P as of Mark Kirchner, CPO, LPO, a separate provider who joined Allen in his cause. enrollment category for Kirchner’s political journey Medicaid services. began more than 15 years A companion bill, SB ago when licensure was 874, was introduced in the main issue for the O&P the Texas Senate by Sen. community. An initial failure Troy Fraser (R). This was to pass licensure heightened the bill signed into law by Kirchner’s interest and Gov. Perry on May 9, 2011. resulted in his appointment It requires the Texas Sen. Troy Fraser (R) to the TAOP Board of Directors HHSC to establish a separate and then as its legislative liaison. provider category for O&P providers The licensing law eventually passed, for enrollment as a provider under and Kirchner began attending every Medicaid. It also prevents O&P Licensing Board meeting in 2006. providers from being classified under the DME provider type by HHSC or any agency operating a segment of the Another Victory medical assistance program. Then in 2007, another issue hit the O&P community where it hurts the most. The state decided that Years of Effort O&P providers should pay a tax on Two things often influence successO&P medical device sales. The Texas ful outcomes: who you know and, of Department of State Health Services course, timing. In this case, the timing (DSHS) notified O&P providers that was perfect. The Texas legislature they needed to pay three years of was already considering two other back taxes on their gross sales of pieces of legislation proposed by the such devices. Kirchner was instruO&P community. H.B. 2703 corrected mental in helping create the Texas an omission in the state licensure law, Alliance—consisting of TAOP and which had failed to give prescriptive TCAAOP— which hired lobbyist authority to physician assistants and Snapper Carr. advanced practice nurses. The other The effort ultimately involved an legislative push was for workers’ investment of $100,000 to enact legiscompensation regulations to recognize lation overturning the DSHS taxing O&P professionals as a separate decision. The group also contacted category instead of again being lumped AOPA Executive Director Tom Fise, JD, in with strange bedfellows. and AOPA retained Larry Pilot, who Both pieces of legislation were was the first director of compliance for supported by the Texas Association the FDA Bureau of Medical Devices. of Orthotics and Prosthetics (TAOP), Testifying at the Feb. 13, 2009, DSHS which employed Snapper Carr as stakeholder meeting, Fise and Pilot its lobbyist. The Texas Chapter of drove home the point that states the American Academy of Orthotists have no authority to impose taxes on and Prosthetists (TCAAOP) also lent medical devices—that authority is its support to the effort. It was only reserved for FDA at the federal level. natural for both organizations to According to Kirchner, the expand their support to embrace the testimony was an eye-opener for the legislation initiated by Allen. DSHS director, who promised no O&P’s success in passing these opposition to mounting a legislative three critical pieces of legislation in initiative that would exempt O&P the Texas legislature’s most recent devices. It was a galvanizing issue. A session didn’t just happen. It was the successful grassroots campaign led culmination of years of effort and a to an educational effort and resulted strong commitment by many Texas

in O&P professionals testifying at committee meetings in favor of corrective legislation. Finally, in May 2009, Kirchner testified and lobbyist Carr also was present when a Senate health committee voted the bill out of committee—the only bill favorably acted on in that day-long session. It passed both houses of the legislature and was signed into law by the governor. It was the first major O&P victory since licensure and paved the way for the 2011 success story.

Licensure helped pave the way in Texas, identifying the O&P community as serious players. Activism and Commitment The moral of the story is that it isn’t a one-shot, one-issue advocacy program that marks a successful legislative result. It’s a long, long line of year-after-year efforts at visibility and education. Licensure helped pave the way in Texas, identifying the O&P community as serious players. But a state does not need to have licensure laws to mount a successful campaign to separate O&P from DME if that’s not already the case. Success depends on having an activist O&P community that digs into its wallets, commits the time, and is led by dedicated people like Kirchner and Allen. You’ll see some of these dedicated O&P professionals at the April 17-18 AOPA Policy Forum in Washington. More than 40 O&P practitioners have volunteered to be state reps, acting as the eyes and ears for what’s happening in their state that affects O&P. AOPA is hosting a special briefing and advocacy training for these dedicated colleagues on the morning of April 17. a

APRIL 2012 O&P Almanac



AOPA Accepting Membership Sales Proposals

Registration Begins May 1 for AOPA’s 2012 National Assembly Online registration is open at for the AOPA 2012 National Assembly and Northeast Chapter combined meeting at the Hynes Convention Center in historic downtown Boston. Experience the country’s largest, oldest, and most essential meeting for orthotic, prosthetic, and pedorthic professionals. This year’s National Assembly will feature extensive scientific programs on topics such as scoliosis, microprocessor knees, balance, and wound care. Experts in the O&P industry will offer unprecedented business education covering health-care reform, documentation, business management, accountable care organizations, FDA, reimbursement challenges, and more. Dedicated education tracks are offered for pedorthists, post-mastectomy fitters, and technicians. Visit for program updates and detailed registration information, or call AOPA headquarters at 571/431-0876.


e c a l P e! To B 40

O&P Almanac APRIL 2012

AOPA is now accepting proposals for collaboration in expanding the membership and sale of AOPA products, including publications and seminars. Every organization should continually search for ways to develop and expand its membership base. AOPA’s current membership is approximately 900 companies and suppliers that operate 2,037 affiliated locations. Of those members, 750 are patient-care companies, and AOPA seeks to expand its patient-care membership to a minimum of 1,500 companies operating 3,000 affiliated locations. Proposals should include the following: • specific products or services the submitter would market (Products and Services Catalog available upon request) in addition to AOPA membership • proposed method(s) of marketing AOPA membership and products • expected commitment of submitter’s resources • expected commission rate on membership, products, and seminar sales • estimated time frame for activity, including sales goals for memberships, products, or seminars • expected support needed from AOPA, such as any AOPA staff responsibilities. Submissions must comply with the following ground rules: • AOPA’s Board of Directors will consider proposals submitted at its regular meetings beginning in January 2012. • Timing of submission is at the discretion of the submitter. • Such arrangements will not be exclusive to any single party. • AOPA’s Board will act on each proposal as soon as possible after submission. • Action on any proposal will not preclude consideration of concurrent or subsequent proposals submitted. • Action on any proposal is at the sole discretion of AOPA and not subject to external review. AOPA reserves the right to decline to accept any and all proposals or accept more than one proposal. Submissions should be emailed to with a subject line “Growth Proposal.”

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1.5 CE

Master ‘Contracting 101’—


Join the Audio Conference May 9 Negotiating favorable contracts can make a huge difference in the success of your business. Join AOPA May 9 at 1 p.m. ET for an AOPAversity Mastering Medicare Audio Conference that will cover the basics of negotiating contracts with insurance companies, hospitals, skilled nursing facilities, and other payers. Learn strategies and techniques. An AOPA expert will address the following issues: • understanding the impact of competitors in the marketplace • emphasizing quality over quantity • negotiating from a position of power • separating yourself from your competition • addressing unfavorable contracting terms. Don’t miss this valuable opportunity to learn important strategies before you enter a contract negotiation. The cost of participating is $99 for AOPA members ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within

30 days and scoring at least 80 percent. Contact Devon Bernard at or 571/431-0854 with content questions. Register online at Contact Steve Custer at scuster@ or 571/431-0876 with registration questions.

Master Medicare: Attend Essential Coding & Billing Techniques Seminars

Discover Employment Opportunities at AOPA’s Online Career Center

Join your colleagues April 23-24 in Chicago at the Westin O’Hare or August 6-7 at the Hyatt at Olive 8 in Seattle for AOPA’s Mastering Medicare: Essential Coding & Billing Techniques seminar. AOPA experts will provide the most up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Basic information that was covered in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts online at Register online for the Essential Coding & Billing Techniques seminar in Seattle at forms/2012-mastering-medicare-seattle/, or in Chicago at

As an O&P professional, you can make a difference every day. Job opportunities abound throughout the country, and the need for orthotic and prosthetic (O&P) professionals is increasing rapidly. Currently, 100 percent of O&P program graduates find employment, and most choose to make it a lifelong profession. If you’re seeking employment, access the most recent jobs available. If you’re recruiting, reach the most-qualified candidates by posting your job on AOPA’s Online Career Center. Visit, or email Steven Rybicki at with questions.


O&P Almanac APRIL 2012


Special Thanks to Our O&P PAC Contributors The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*: • George Breece • John Ruzich CP, LP. The O&P PAC recently made contributions to the following candidate(s)*: • Sen. Olympia Snowe (R-Maine): Co-sponsor of the Medicare O&P Improvement Act of 2012 (S.2125) • Rep. Pete Stark (D-California, 13th District): Ranking Minority Member of the Ways and Means Health Subcommittee.

Now Available 2012 AOPA Products & Services Catalog AOPA’s mission is to work for favorable treatment of O&P business in laws, regulations, and services to help members improve their management and marketing skills, and to raise awareness and understanding of the industry and the association. AOPA is proud to announce the 2012 Products & Services Catalog is available at


O&P Almanac APRIL 2012

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate to educate them about O&P issues and help elect those individuals who support the orthotic and prosthetic community. In order 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 *Due to publishing deadlines this list was created on March 15, 2012, and includes only donations received and contributions made between Jan. 1, 2012, and March 15, 2012. Any donations received or contributions made after March 15, 2012, will be published in a future issue of the O&P Almanac.

In Memoriam

Lothar Wehmeier Lothar Wehmeier, founder of Rehabilitation Technical Components Inc. (RTC), passed away on December 22, 2011, in Kailua Kona, Hawaii. Born in Berlin, Wehmeier came to the United States in 1957. He worked in O&P companies in both Germany and the United States during his career, settling in New Jersey in 1966. Employed by New York University for several years, Wehmeier worked with both the occupational therapy department and the O&P department to develop, modify, and engineer orthoses. He founded RTC in 1969 and is recognized for introducing thermoplastics to the profession in the United States. Wehmeier is survived by his wife, Yolanta Wehmeier.

AOPA Applications

The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that

patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or statelicensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million.

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Manfredi O&P Affiliates

South County Artificial Limb Co, Inc.

146 N. Canal Street, Ste. 100 Seattle, WA 98103 206/659-0614 Fax: 206/400-1596 Category: Supplier Level 1 Chie Kawahara

289 Broadway Long Branch, NJ 07740 732/222-0366 Fax: 732/222-0245 Category: Patient Care Facility Jean Manfredi

162 Main Street Wakefield, RI 02879 401/783-0063 Fax: 401/789-3190 Category: Patient Care Facility Lois James

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

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APRIL 2012 O&P Almanac


Marketplace Introducing a new addition to the KISS® family! KISS® has introduced an angled offset base, Part # CMP44/A, also available as KISS® Kits: KS4/A and KS4/B. The base is constructed of aircraft-grade aluminum and can be laminated into a socket with a single lamination. It is angled 12 degrees and has a four-hole pattern that is offset posteriorly .75 in for enhanced alignment for hip flexor tightness. Lamination plate and spacer screws sold separately  (CMP14/A). For more information, call 410/663-KISS (5477) or visit

ER2300 from Friddle’s ER2300 is the ideal component to use in conjunction with Friddle’s transfer paper. For an ideal transfer, all you need to do is apply a generous coating of ER2300 on the transfer side of the paper before rubbing the paper onto the plastic, place the plastic back into oven (with paper still applied) for 25 seconds, take plastic out of oven, and remove transfer paper. ER2300 allows for a clean transfer without paper sticking. Contact Friddle’s to order ER2300 for your c-fab today at 864/369-2328 or fax 864/369-1149, or visit

BT-4 from OTS Corp., A Fillauer Company Introducing the new Celsus K2 Foot from College Park Bringing College Park’s innovative composite technology into the K2 market, the Celsus combines proven durability with controlled stability. Its balanced design and natural motion provide smooth, stable transitions. The perfect lightweight design promotes confidence and security for lower impact patients. Key features include: • Smooth proportional response with integrated spring technology (iST) • Low profile design • High weight limit of up to 136 kg (300 lbs) • Maintenance-free design • Sandal toe feature • Same-day, custom built to order. For more information, call 800/ 728-7950 or visit

The BT-4 oven from OTS Corp. is the latest addition to the PDQ Infrared Oven equipment line. The eight 1000-watt emitters along with the dual electric fans allow bubble-forming plastics to be heated evenly and efficiently. The BT-4 Infrared Oven is big enough to heat most of your KAFO sheet plastic and has enough drop for even the biggest check socket, but it only takes up a corner space in your lab. • Eight 1,000-watt emitters; four on top and four on bottom • Programmable digital temperature controller • Dual electric fans for air circulation • Four interior lights and large viewing window • Access point for vacuum line • Tray with fitted Teflon® cover for sheet plastic • 18-in clearance for bubble forming Save up to $400 toward freight charges domestically on any PDQ oven purchased between March 21 and May 31, 2012. Contact OTS Corp. at 800/221-4769 or visit

Do You Need Temporary Orthotic and Prosthetic Services?

New Waterproof Prostheses from Ottobock: Dive in!

Want to go on vacation? Need help in your practice? Need a CPO to teach your course? As an ABC-certified, Florida-licensed, insured CPO with 30 years’ experience, I offer temporary O&P services to facilities and suppliers. For more information, contact Deb Sweeney, CPO, LPO, at 407/488-3887 or

Ottobock now offers a line of waterproof components! Designed specifically for use in the water, the Aqualine® waterproof prostheses provide waterproof protection for either belowknee or above-knee users. The Aqualine components are perfect for use as a shower leg or for other water activities. The Aqualine accommodates users who weigh up to 330 lbs and includes specially modified adapters, pylons, and a tube clamp along with the waterproof knee and foot. Call your local sales representative to learn more at 800/328-4058.


O&P Almanac APRIL 2012

Marketplace WalkOn Fit Kits from Ottobock: Assess Your WalkOn Patient Anywhere!

Alpha® Silicone Liner from WillowWood With the Alpha Silicone Liner and the retrofit options within the Alpha family, WillowWood is able to meet any liner needs you may have. Alpha Silicone Liners use proprietary platinumcured, medical-grade silicone that’s designed for comfort and performance. Liner benefits include: • A custom blend of silicone with Vitamin E and skin conditioners for a nongreasy and nontacky surface • One-way stretch Select fabric controls pistoning without using a distal matrix • A flexible knee panel provides enhanced knee flexion • A flared shape that contours to a limb’s surface For information, call 800/848-4930 or visit a

At hospital, clinic, home, or office—evaluate your drop-foot patients on the spot for a WalkOn AFO with either the 28T1N WalkOn Fit Kit or the 28T2 WalkOn Flex Fit Kit. Each kit comes in a handy carrying bag and contains four WalkOns (two small, L&R; two medium, L&R; plus four calf pads). With the smaller footplates, there’s no need for grinding needed to get them into the shoe. Get an instant check of the WalkOn function—and then take the order for a fit. To order your Fit Kits today, contact your local sales representative at 800/328-4058.

Kid-Dee-Lite™ Ankle Joint from PEL Supply PEL Supply now offers the smallest ankle joint available with 40 degree plantar and dorsal adjustment. The Kid-Dee-Lite™ from Allard USA enables a dynamic treatment of a child’s foot. The ankle joint is small and light enough to fit the ankle-foot orthosis for young children under five years of age or below 55 lb (25 kg). The ultra-small Kid-Dee-Lite joint allows early dynamic ankle/foot management for the child with neuromuscular disorders, such as associated with cerebral palsy or spina bifida. It helps to: • Maintain critical correction • Improve gait • Influence muscle tone • Prevent contracture The KID-Dee-Lite is lightweight, only 0.7 oz (20 g) when used in a thermoplastic or laminated orthosis. A curved upright (blank) is included to be used when the orthosis requires thermoplastic changes above the joints for tibia control. The tapered hinge can be turned to position the shorter upright up or down to accommodate orthosis requirements. The complete kit from PEL Supply includes alignment tube, curved (blank) and straight uprights, assembled joints, and mounting components. Contact PEL Supply customer service at 800/321-1264, fax 800/222-6176, or email

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Now Offering Customizable Orthotic and   Prosthetic Patient Device Instruction Sheets  in English AND Spanish APRIL 2012 O&P Almanac



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

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

Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color

$482 $678 $634 $830

Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to srybicki@, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate! $80 $140

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


O&P Almanac APRIL 2012

Mid-Atlantic Prosthetics and Orthotics Director, University of Pittsburgh Pittsburgh Tenure-stream prosthetics and orthotics director position now open at the University of Pittsburgh. Qualifications: ABC certification and PhD related area of orthotics and/or prosthetics. Minimum of three years’ teaching, clinical, administrative experience of an educational program preferred. Evidence or potential for productivity in scholarly activity, as shown through publications, grants, and presentations. Involvement in professional O&P organizations preferred. Responsibilities: Responsible for administration, education, and research in MS in O&P Program, including/ not limited to program/curriculum development, evaluation, accreditation, clinical education, recruitment, and O&P program policies and procedures. Develop/expand a research and development program. Participate in scholarly activity and secure independent research funding. Participate in teaching within the O&P Educational Program and serve as a student mentor. As part of the University of Pittsburgh, the School of Health and Rehabilitation Sciences is an affirmative action institution and welcomes applications from minorities, handicapped, and other categories of under-represented persons. Apply: Send CV to:

Rory A. Cooper, PhD Chair, Department of RST SHRS; University of Pittsburgh 5044 Forbes Tower Sennott and Atwood Streets Pittsburgh, PA 15260



If interested, please contact in confidence:

Linkia—Director, Clinical Services Rockville, Maryland The director, clinical services is a certified prosthetist responsible for clinical and quality management programs including: Professional Review of Orthotic & Prosthetic Services (PROPS), Utilization Review Accreditation Commission (URAC) accreditation, quality management committees, and credentialing. Directly reporting to the director, clinical services are PROPS program director, senior manager credentialing, and URAC coordinator. This individual is directly responsible for coordinating quality management program and meeting URAC accreditation requirements. Performs all duties of the chief case reviewer for PROPS. Works with direct reports to create and implement work flows to meet efficiency requirements; write standard operating procedures for all functions of responsibility; and support organizational goals.

• • • • • •

• •

Essential functions: Ensures policies, practices, and procedures comply with administrative, legal, and regulatory requirements Participates in developing and implementing Linkia’s strategic direction for clinical operations and programs Performs all duties of chief case reviewer PROPS program clinical lead Consults with all constituents (internal and external) as clinical expert Oversee credentialing and compliance functions Coordinates quality management program and documents QI/UM/Credentialing Plan, QI Indicators, QI committees Writes SOPs for all areas of responsibility as appropriate Performs other duties as assigned

Required skills and abilities: • Demonstrated ability to lead and manage through influence and change • Strong interpersonal skills emphasizing flexibility and diplomacy • Exceptional presentation and public speaking skills • Strong analytical and creative problem-solving skills • Ability to prioritize and manage multi-task functions • Knowledge of Microsoft Office Suite • Demonstrate excellent time management, organization, prioritization, research, analytical, negotiation, communication (verbal and written), and interpersonal skills

Mike Phelan Hanger

Northeast Certified Orthotist, Certified Orthotist and Board-Eligible Prosthetist, or Certified Prosthetist/Orthotist New York State Privately owned and growing multi-site ABC-accredited P&O practice in upstate New York is seeking a certified orthotist with a minimum of two years’ experience and/or a certified orthotist and board-eligible prosthetist, or certified prosthetist/orthotist. We are looking for individuals with strong orthotic backgrounds and we may entertain an NCOPE prosthetic residency if needed. Our offices in the historic and scenic Hudson Valley and Catskill Mountains of New York are located from Saratoga to Poughkeepsie, with immediate openings in Kingston and Poughkeepsie. The ideal candidate must be self-motivated, a team player, possess good communication and technical skills, and be willing to excel for performance-based objectives. Competitive salary and benefits package offered. Submit resume to:

David Misener, CPO Clinical Prosthetics & Orthotics, LLC Email: Fax: 518/432-0686

Required credentials: • 5-10 years’ clinical experience as certified prosthetist (CP) • Education: BA/BS • 3-5 years’ supervisory/management experience preferred

APRIL 2012 O&P Almanac



Northeast CPO, CP, CO, C.PED, & TECHNICIAN New Jersey Career opportunity for highly motivated New Jersey licensed CPO, CP, CO, C.Ped, and technician in our many locations throughout New Jersey. Pro-Fit offers a comprehensive benefits package that includes a competitive salary commensurate with experience, an IRA plan, health, prescription, dental, long-term and short-term disability, and life insurance. Possible ownership opportunity for qualified practitioner. Submit your confidential resume to:

Email: or Fax: 856/809-9954

Prosthetist/Orthotist, Certified Prosthetist, Board-Eligible/Certified Orthotist Southern Maine Do you want to be more than a number? We are a terrific, patient-oriented company looking for some awesome practitioners. Is this you? Our well-established O&P facility is seeking self-motivated, energetic practitioners. Our Southern Maine locations are in close proximity to the coast and mountain region. Our comprehensive compensation package includes bonuses commensurate with productivity. Learn more about joining our team of dedicated specialists by contacting:

Certified Orthotist/Certified Fitter Long Island/New York City We are a well-established practice offering an excellent opportunity for a driven person with a positive attitude. We offer benefits including 401(k), health, and profit sharing. Send resume to:

O&P Ad 1111 C/O: The O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

O&P Ad 0611 C/O: The O&P Almanac 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

Help Shape Babies’ Lives! Full-Time & ParT-Time PosiTions available Be part of a unique career opportunity treating babies up to 18 months of age. If you are looking for a new challenge and want to specialize in a non-traditional, niche area, CranialTech may be the place for you. This is a unique opportunity to treat patients in a child-friendly, state-of-the-art clinic. As a Clinician, you will treat infants from 3–18 months of age, using the DOC Band® to correct abnormal head shapes. Pediatricians and parents alike look to our Clinicians as the experts in the diagnosis and the treatment of plagiocephaly.

noW HirinG orTHoTisTs in: austin, TX | Charlotte, nC los angeles, Ca | orange, Ca Pasadena, Ca | san Diego, Ca

Clinicians at CranialTech enjoy: • Direct patient care and visible patient progress within 2–3 weeks • No productivity/patient quotas, long days, weekends or holidays and minimal paperwork • Future opportunities available nationwide in training, mentoring and travel • Formal training program and one year of mentoring with a company that has specialized in plagiocephaly for more than 25 years • Competitive salary and generous benefits package, including 3.5 weeks paid time off and quarterly incentive bonuses

Learn more about this opportunity by visiting, or by calling (866) DOC-BAND!


O&P Almanac APRIL 2012




Northeast Certified/Board-Certified Orthotist New York City Area O&P practice seeks a motivated ABC-certified or boardcertified orthotist, and an orthotic fitter with good people skills, for full-time position. Responsibilities include day hours in clinical, hospital, and home settings in the five boroughs of New York. We offer salary commensurate with experience. Send resume to:


International Technical / Sales Manager Freedom Innovations, a leading manufacturer of high technology lower-limb prosthetic devices, is looking to expand our international team. Freedom Innovations is a rapidly growing company that is pushing the boundaries of prosthetic technology. We currently provide advanced technology carbon fiber foot products as well as the industry leading PliÊ 2.0 microprocessor controlled knee. We also have a robust R & D pipeline of high technology products for the future. Freedom’s products are manufactured in the United States and sold worldwide in 41 countries. Candidates will have the opportunity to be part of an industry respected team of professionals. We are seeking a high achiever with a combination of clinical, technical and marketing/sales skills who has the ability to conduct technical training as well as effectively communicate and bring resolution to business issues in a timely manner. This position will provide marketing support and technical training for international distributors and their customers. Requirements include candidates that are a Certified Prosthetist with a minimum of 4 years experience in prosthetics and business or sales, candidates must have excellent verbal and written skills. The position will ideally be based at our corporate headquarters in Irvine California and will require up to 65% international travel. We offer an excellent compensation and benefits package. Please e-mail your resume to: Shawn Crane at

AVAILABLE POSITIONS Orthotist Springdale, AR Springfield, IL Urbana, IL Indianapolis, IN Grand Rapids, MI Cape Girardeau, MO

W. Orange, NJ Oneonta, NY Spartanburg, SC Galveston, TX Parkersburg, WV Waukesha, WI

Orthotist / Prosthetist W. Orange, NJ

Prosthetist Hazel Crest, IL

Prosthetist / Orthotist San Francisco, CA Naples, FL Tamarac, FL Indianapolis, IN Mayfield Heights, OH Tallmadge, OH

Bartlesville, OK Brooklyn, NY Portland, OR Austin, TX Houston, TX San Antonio, TX

Certified Pedorthist Bangor, ME Grand Rapids, MI

Cape Girardeau, MO Roseburg, OR

APRIL 2012 O&P Almanac



Southeast Orthotist/Eligible for Florida Licensing Ocala/Gainesville, Florida Career opportunity for highly-motivated licensed or certified (Florida License eligible) orthotist to join our growing practice. Great opportunity to handle a diverse patient base while working with great co-workers. If you have strong communication skills and excellent patient care skills, contact us today. We offer a very competitive salary, bonus plan, health insurance, and IRA savings plan. Learn more about joining Mid Florida Prosthetics & Orthotics and the team of dedicated care providers by contacting:

Frank Vero or Rick Page Mid Florida Prosthetics & Orthotics 2300 SE 17th Street, Suite 401 Ocala, FL 34471 Fax resume: 352/351-3267 Email:

O&P_almanac_whydafo_apr2012.indd 2


O&P Almanac APRIL 2012

CO or CPO Marshfield Clinic is one of the largest patient care, research and educational systems in the United States. The Marshfield Clinic’s Orthotic and Prosthetic department is dedicated to helping patients regain their active lifestyles and live life without limitations. Our department offers the newest advancements in orthotic, prosthetic and pedorthic technology combined with friendly, highly skilled and experienced staff that is committed to the highest quality patient care.

Discover Marshfield, Wisconsin & enjoy: • Low cost of living • Clean, safe environment • Short commutes with low traffic volume • Excellent educational opportunities for both you and your family • Recreational & cultural activities during all four seasons • Easy access to urban centers at Chicago, Madison, Milwaukee or Minneapolis/St. Paul • Competitive total compensation package

ABC Certified in Orthotics & Prosthetics and 3 years of experience preferred. Experience in Pediatrics would be helpful.

Join us and see how your career can shine. To apply, please visit: Reference Job Number MC110156 Marshfield Clinic 1000 N. Oak Avenue Marshfield, WI 54449 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

2/16/2012 12:08:13 PM


Orthopadie + Reha-Technik 2012: Leipzig, Germany Exhibit space. A few choice locations are still available in the U.S./Canadian Pavilion sponsored by the AOPA at O+R 2012 Leipzig this coming May 16-18. If you are interested in exhibiting, please contact Mark Alt at Kallman Associates, Inc., U.S. representative. Call 201/ 652-7070 or email mark@ ■■


■■ YEAR-ROUND TESTING Multiple Choice Examinations. BOC has yearround testing for Multiple Choice Examinations; candidates can apply and test when ready. Orthotist and prosthetist candidates can take the Clinical Simulation Examination in February, May, August, and November. Applications are accepted any time, although seating is limited. For more information, visit or email

On-site Training Motion Control, Inc. On-site Training Course is focused on the expedited fitting of your first patient. Course Length: 3 days, CEUs: 19.5 hours (estimated). Recommended for prosthetists with a patient ready to be fit immediately. For more information, call 888/696-2767 or visit ■■

PROMOTE Events in the O&P Almanac

CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to for content deadlines. Words Member Rate Nonmember Rate 25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$3.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit Calendar listings for space and style considerations. For information on continuing education credits, contact the sponsor. Questions? Email

2012 ■■ April 11 AOPAversity Audio Conference–Network and Market Your Way to Success. For more information, contact Stephen Custer at 571/4310876 or ■■ APRIL 11 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 5-6 PM ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length.  Presenter:  Keith Smith, CO, LO, FAAOP. To register, call 800/220-6670 or visit ■■ APRIL 14 Ultraflex: Pediatric UltraSafeGait™ Continuing Education Course, via WebEx, 9-10 AM ET.  Covers assessment of pediatric pathological gait and influencing shank kinematics with the new Adjustable Dynamic Response™ (ADR™) technology.  Presenter:  Keith Smith, CO, LO, FAAOP. To register, call 800/220-6670 or visit www.ultraflexsystems. com. ■■ April 17–18 AOPA Policy Forum. Washington, DC. L’Enfant Plaza Hotel. To register, contact Stephen Custer at 571/432-0876 or scuster@

■■ April 23-24 AOPA: Essential Coding & Billing Seminar. Rosemont Hyatt, O’Hare Airport, Chicago. To register, contact

Stephen Custer at 571/4320876 or ■■ APRIL 24 Ultraflex: Adult UltraSafeStep® Continuing Education Course, via WebEx, Noon–1 PM ET. Focuses on normalizing adult pathological gait with the utilization of Adjustable Dynamic Response™ (ADR™) knee and ankle technology.  Presenter:  Mark DeHarde or Marc Kaufman, CPO. To register, call 800/220-6670 or visit ■■ APRIL 24 WillowWood: Take the Guesswork Out of Elevated Vacuum Suspension via WebEx, 1:30 PM ET. Course covers background information and theory on the concept of elevated vacuum. Appropriate clinical applications and components discussed. 2012 Credits: TBD. ■■ April 24-26 WillowWood: OMEGA® Tracer® Training. Mt. Sterling, OH. This hands-on class covers both orthotic and prosthetic software tools, scanner applications and tasks, ‘by measurement’ shape creation, advanced tool usage, and creating custom liners. Attendees work with patient models. Must be current OMEGA Tracer facility to attend. Credits: 18.5 ABC/18.5 BOC. ■■ APRIL 26 WillowWood: LimbLogic® VS for Technicians via WebEx, 1:30 PM ET. Learn essentials of elevated vacuum socket fabrication using available socket adaptors with LimbLogic VS. Learn how to deal with airtight issues, unit operation, and diagnostics that will keep the system optimal for patient use. 2012 Credits: TBD. www.

APRIL 2012 O&P Almanac



■■ APRIL 26 Ultraflex: Complex Orthopedic Rehabilitation Continuing Education Course, via WebEx, Noon– 1PM ET. Focuses on Ultraflex combination dynamic and static stretching orthosis for addressing complex orthopedic rehabilitation goals and restoring range and function.  Presenter:  Jim Rogers, CPO, FAAOP. To register, call 800/220-6670 or visit

612/203-0936, email nwaaop@, or visit www.

April 26-28 International AfricanAmerican Prosthetic Orthotic Coalition Annual Meeting. Hyatt Regency Jacksonville. Riverfront. Jacksonville, FL. For more information, contact Reginald Mays at, call 904/444-3970, or visit

May 9 AOPAversity Audio Conference–Contracting 101. For more information, contact Stephen Custer at 571/431-0876 or scuster@


■■ May 1 AOPA National Assembly. Online Registration Open. For more information, visit ■■ MAY 2 Ultraflex: Pediatric Spasticity Continuing Education Course, via WebEx, 8–9 AM ET. Covers clinical assessment of the pediatric neuromuscular patient with spasticity and using R1 and R2 for determining orthotic design for maintaining and improving muscle length.  Presenter: Keith Smith, CO, LO, FAAOP. To register, call 800/220-6670 or visit www. ■■ May 2-5 Northwest Chapter of the American Academy of Orthotists & Prosthetists Meeting. Bellevue Courtyard by Marriott Hotel. Seattle, WA. Meeting will host Elaine Owen for a three-day course in pediatric gait analysis and orthotic management and will include a fourth day of exciting prosthetic content. For more information contact Tim Shride, CPO, LPO, at


O&P Almanac APRIL 2012

■■ May 3-5 Rehabilitation Institute of Chicago: Advances in Rehabilitation for the Patient With a Lower Extremity Amputation. Chicago. Approved for 19.0 ABC credits. Contact Melissa Kolski. For more information, call 312/238-7731 or visit


May 10 WillowWood: LimbLogic® VS Applications Practitioners Course. Mt. Sterling, OH. Course covers various clinical aspects of LimbLogic VS applications: static and dynamic socket fitting, vacuum pump configurations, fob operation, system evaluation, liner options, alignment, and troubleshooting. Credits: 7.25 ABC/7.75 BOC. Registration deadline is April 19. Contact 877/665-5443 or visit ■■

■■ MAY 11 WillowWood: LimbLogic® VS Applications Technicians Course. Mt. Sterling, OH. Learn all aspects of fabricating LimbLogic VS for various applications: socket materials, controller configurations and care, fob operation, troubleshooting. Fabricate sockets following recommended techniques for airtight socket designs. 2012 Credits: TBD. Registration deadline is April 19. Contact 877/665-5443 or visit www. ■■ May 14-19 ABC: Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists,

orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. The application deadline for these exams is March 1. Phone 703/836-7114, email, or visit ■■ May 17-18 New York State Chapter Meeting. Marriott, Albany. For more information visit ■■ May 17-19 PA AAOP Chapter Annual Spring Conference. Pittsburgh, Sheraton Station Square Hotel. For more information, contact Beth or Joe at 814/455-5383. ■■ May 17-19 WAMOPA: Western and Midwestern Orthotic and Prosthetic Association. Annual Meeting at Peppermill Hotel, Reno, NV. Best CEU credit value available! Contact Steve Colwell 206/440-1811 or Sharon Gomez 530/521-4541 or visit ■■ June 1 ABC: Certification Exam Application Deadline. Applications must be postmarked by June 1, 2012, for individuals seeking to take the summer 2012 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/8367114,, or visit

June 1-2 ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg, FL. The application deadline for this exam is March 1. Contact 703/836-7114, info@abcop. org, or visit certification. ■■

June 4-6 LAOP: Annual Educational Conference. Hilton Riverside, ■■

New Orleans. Earn up to 13 credits in O, P, and Administrative tracts. Come enjoy summer family fun, unique city culture, cuisine, and all that jazz. Contact Sharon at 504/464-5577,, or visit ■■ June 7-8 Michigan Orthotics & Prosthetics (MOPA) Continuing Education Meeting. Soaring Eagle Casino & Resort in Mt. Pleasant, MI. Contact Mary Ellen Kitzman at 248/615-0600 or email her at ■■ June 8-9 ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg, FL. The application deadline for this exam is March 1. Contact 703/836-7114,, ■■ June 13 AOPAversity Audio Conference–Improving Your Bottom Line. For more information, contact Stephen Custer at 571/431-0876 or ■■ june 15-16 PrimeFare East Regional Scientific Symposium 2012. Nashville Convention Center, Nashville, TN. For more information, contact Jane Edwards 888/388-5243 or visit ■■ July 11 AOPAversity Audio Conference–Perfecting the Intake Process. For more information, contact Stephen Custer at 571/431-0876 or ■■ AUGUST 3-4 Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. Sheraton Austin Hotel at the Capitol, Austin, TX. Contact Robb Walker at 325/793-3480, email

secretary-treasurer@txaaop. org, or visit


■■ August 6-7 AOPA: Essential Coding & Billing Seminar. Hyatt at Olive 8, Seattle. To register, contact Stephen Custer at 571/4320876 or ■■ August 15 AOPAversity Audio Conference–The Ins and Outs of Advance Beneficiary Notices (ABNs). For more information, contact Stephen Custer at 571/431-0876 or ■■ September 6-9 AOPA National Assembly & NE Chapter Combined Meeting. Boston. Hynes Convention Center. The 2012 AOPA National Assembly will be held jointly with the NE Chapter Meeting. Please plan to join us for this significant event. Exhibitors and sponsorship opportunities available: contact Kelly O’Neill at 571/431-0852 or koneill@ To register, contact Stephen Custer at

571/431-0876 or scuster@

Seminar. Making a difference for 100 years, providing service, education, and research in O&P. Visit http:// op/index.htm for details and registration.

■■ September 12 AOPAversity Audio Conference–How to Get Paid for Orthopedic and Diabetic Shoes. For more information, contact Stephen Custer at 571/431-0876 or scuster@ ■■ October 10 AOPAversity Audio Conference–What Every O&P Facility Needs to Know about the FDA. For more information, contact Stephen Custer at 571/431-0876 or ■■ October 18-19 University of Michigan Orthotics and Prosthetics Center Centennial Celebration and Education

November 14 AOPAversity Audio Conference–Medicare Enrollment Procedures. For more information, contact Stephen Custer at 571/4310876 or ■■

■■ December 12 AOPAversity Audio Conference–Are You Ready for the New Year? 2013 New Codes and Policies. For more information, contact Stephen Custer at 571/431-0876 or

2013 ■■ February 20–23 39th Academy Annual Meeting & Scientific Symposium. Orlando. Caribe Royale Orlando. Contact Diane Ragusa at 202/380-3663, x208, or ■■ September 18-21 O&P World Congress. Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or scuster@AOPAnet. org. a

AD INDEX Company




Allard USA Inc. ALPS American Board for Certification in Orthotics, Prosthetics & Pedorthics BOC International Cascade DAFO College Park Industries Inc. Custom Composite DAW Industries Dr. Comfort Fillauer Companies Inc. Friddle’s Orthopedic Appliances Hersco Ortho Labs KISS Technologies LLC KNIT-RITE OPTEC Orthomerica Products Orthotic and Prosthetic Study and Review Guide Otto Bock HealthCare PEL Supply Company

7 23

888/678-6548 800/574-5426

17 33 52 9 2 1 5, C3 C4 43 27 41 35 14, 15, 36, 37 25

703/836-7114 877/776-2200 800/848-7332 800/728-7950 866/273-2230 800/252-2828 800/556-5572 800/251-6398 800/369-2328 800/301-8275 410/663-5477 800/821-3094 888/982-8181 800/446-6770

47 C2 11

800/328-4058 800/321-1264 APRIL 2012 O&P Almanac


AOPA Answers

PDAC Problem-Solving Answers to your questions regarding orthoses, diabetic shoes, and PDAC coding

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


Which spinal orthosis codes require Pricing Data Analysis and Coding (PDAC) coding verification in order to be billed to Medicare?


Any prefabricated spinal orthoses described by codes L0450, L0454-L0472, L0488-L0492, L0625-L0628, L0630, L0631, L0633, L0635, L0637, and L0639 require PDAC coding verification. Any custom fabricated spinal orthoses fabricated by a central fabrication facility or manufacturer described by codes L0452, L0480-L0486, L0629, L0632, L0634, L0636, L0638, and L0640 also require PDAC coding verification. If you fabricated a custom LSO or TLSO in-house and provide it directly to the patient, you don’t have to have the product verified by PDAC. However, you must be able to provide a list of materials used and a description of your fabrication process if requested.


Are there any other devices that require PDAC coding verification in order to be billed to Medicare?


A double upright knee orthosis described by code L1845, a pneumatic knee splint described by code L4380, a cervical collar described by code L0174, and a functional electric stimulator described by code E0770 all require PDAC coding verification. In addition, as of April 1, 2012, a multiligamentous support described by code L1906 requires PDAC coding verification.


O&P Almanac APRIL 2012

Q. A.

Which diabetic shoe codes require PDAC coding verification in order to bill Medicare?

All prefabricated diabetic shoe inserts, A5512, must be reviewed and verified by PDAC. Custom fabricated inserts, A5513, also require PDAC coding verification if fabricated by a central fabrication facility or manufacturer. If you fabricate a custom insert in-house and provide the product directly to the patient, you don’t have to have the insert verified by PDAC. However, you must be able to provide a list of materials used and a description of your fabrication process if requested.


If an item requires PDAC verification and the product I wish to provide is not listed on the PDAC website,, how do I bill Medicare for the item?


The answer will depend on the specific Medicare Medical Policy or PDAC coding guidelines announcement that required the item to be verified and listed on the PDAC website. Typically, you would have to use the code A9270 (noncovered item or service). a




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Profile for AOPA

April 2012 Almanac  

American Orthotic & Prosthetic Association (AOPA) - April 2012 Issue - O&P Almanac

April 2012 Almanac  

American Orthotic & Prosthetic Association (AOPA) - April 2012 Issue - O&P Almanac