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Breaking News: AOPA Contests CMS’ Motion to Dismiss Lawsuit PAGE 54


The American Orthotic & Prosthetic Association







Technology breakthroughs are reinventing the industry and offering patients unmatched mobility



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O&P AUGUST 2013, VOLUME 62, NO. 8


18 O&P’s New Frontiers Photo: John’s Hopkins Applied Physics Lab

By Deborah Conn Recent technological breakthroughs are pushing the boundaries of what’s possible in O&P. From 3-D printing to thought-controlled prostheses, explore how cutting-edge technology is granting patients unprecedented opportunities for mobility and support.


26 A Whole New World

By Adam Stone The 2013 O&P World Congress, to be held September 18-21 in Orlando, promises one of the largest exhibit halls in the western hemisphere and top-notch education by the industry’s most respected professionals. Discover more about some O&P ALMANAC EXCLUSIVE! of these international experts whose work is advancing the 2013 Exhibit Directory industry around the world. and Product Guide Get an advance look at the companies and products from across the globe to be DEPARTMENTS showcased at the O&P World Congress. 4 AOPA Contact Page


How to reach staff

6 08



Reimbursement Page Top 10 reimbursement errors to avoid


Facility Spotlight Capital Prosthetic & Orthotic Center Inc.


At a Glance Statistics and O&P data In the News Research, updates, and company announcements AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more

64 AOPA Membership 00 Applications

66 Jobs

Opportunities for O&P professionals

68 Calendar

Upcoming meetings and events


Ad Index


AOPA Answers Expert answers to your FAQs

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: 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: Cover Photo: John’s Hopkins Applied Physics Lab






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,

Jeff Collins, CPA, Cascade Orthopedic Supply Inc., Chico, CA

Kelly O’Neill, manager of membership and meetings, 571/431-0852,

President Tom Kirk, PhD, Member of Hanger Inc. Board Austin, TX

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, Josephine Rossi, editor, 703/914-9200 x26, Catherine Marinoff, art director, 786/293-1577, Dean Mather, advertising sales representative, 856/768-9360, Stephen Custer, production manager, 571/431-0876, Lia K. Dangelico, contributing writer, 703/914-9200 x24, Christine Umbrell, editorial/production associate, 703/914-9200 x33, Kyle O’Connor, publication intern/ contributing writer, 703/914-9200 x32,

Stephen Custer, communications manager, 571/431-0810, Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, Betty Leppin, Project Manager, 571/431-0876, AOPA Bookstore: 571/431-0865 GOVERNMENT AFFAIRS Devon Bernard, manager of reimbursement services, 571/431-0854,

President-Elect Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Vice President Charles H. Dankmeyer, Jr., CPO, Dankmeyer Inc., Linthicum Heights, MD Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX

Mike Hamontree, Hamontree Associates, Newport Beach, CA Dave McGill, Össur Americas, Foothill Ranch, CA Ronald Manganiello, New England Orthotics & Prosthetics Systems LLC, Branford, CT Eileen Levis, Orthologix, LLC, Trevose, PA

Treasurer James Weber, MBA, Prosthetic & Orthotic Care Inc., St. Louis, MO

Michael Oros, CPO, Scheck and Siress O&P Inc., Oakbrook Terrace, IL

Executive Director/Secretary Thomas F. Fise, JD, AOPA, Alexandria, VA

Kel Bergmann, CPO, SCOPe Orthotics & Prosthetics Inc., San Diego, CA

Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, Reimbursement/Coding: 571/431-0833,

Scott Schneider, Ottobock, Minneapolis, MN

Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA James Campbell, PhD, CO, Becker Orthopedic Appliance Co., Troy, MI

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

Copyright 2013 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.



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3-D Printing and O&P Additive manufacturing, commonly referred to as 3-D printing, is the process of making a 3-D solid object from a digital model by printing small layers of material on top of each other. This process is gaining traction in the O&P community; recent examples include successfully printed and implanted lower jaw and finger prostheses.

2002 Scientists engineer a miniature functional kidney.

Medical Milestones in 3-D Printing:

2006 Objet creates first machine capable of printing in multiple materials.

1999 The first lab-grown organ is implanted in humans.

2009 Organovo uses a 3-D bioprinter to print blood vessels.

1983 Charles Hull invents stereolithography, 3-D printing’s predecessor.


2012 A 3-D printed prosthetic jaw is implanted into an 83-year-old woman.





Source: “Infographic: A Brief History of 3-D Printing,” T. Rowe Price.


$2 billion

Percentage of the 3-D printing market dedicated to prototyping, the largest commercial application of the technology.

Global sales and services related to 3-D printing in 2012.



$3.8 million

Amount of money saved by the U.S. Government from 2004 to 2009 as a result of 3-D printing.


Degrees at which researchers at Washington State University bake their 3-D printed ceramic-plastic scaffold structure that is used to fix bone fractures.


The annual growth rate of the 3-D printing industry.

Sources: “3-D Printer Manufacturing in the US: Market Report,” IBIS Word; “3-D Printing and the Future of Manufacturing,” Consumer Science Corporation; “3D Printer Used to Make Bone-like Material,” Washington State University. 6



2008 First person walks on a 3-D printed prosthesis.

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Diabetes-Related Lower-Limb Amputations On the Decline As a result of improvements in diabetic foot ulcer treatments over the past decade, fewer Americans require lower-limb amputations, according to a study published in Foot & Ankle International. Researchers at the University of Iowa found “dramatic” decreases in the number and severity of lower-limb amputations. While the number of Americans living with diabetes has increased—affecting nearly 26 million people in the United States—amputations have decreased, the researchers found. The researchers studied Medicare claims between 2000 and 2010 for lowerlimb amputation rates and diabetic foot ulcer treatment numbers. They found amputations decreased by 28.8 percent. During that same time period, surgical orthopedic treatments for ulcers rose by 143.3 percent; such procedures include total-contact casting, Achilles tendon release, and calf muscle lengthening. Amputation levels among the Medicare population also have shifted over the past decade. According to the researchers, amputations at the upper- and lower-leg level have declined 47 percent, while amputations at the partial-toe level have increased 24 percent.

Study: AFOs Improve Balance Confidence in Poststroke Hemiplegia Patients Researchers at Northwestern University Prosthetics-Orthotics Center in Chicago and the U.S. Department of Veterans Affairs have found that ankle-foot orthosis (AFO) use improves balance confidence in patients with chronic poststroke hemiplegia. These findings were published in the June 2013 issue of Prosthetics and Orthotics International. AFOs may improve walking speed, stride length, and gait pattern in this population. However, effects on balance—crucial for safe ambulation—had been inconclusive, according to the study. One aspect of balance shown to contribute to functional ability is self-efficacy, defined as the belief in one’s ability to succeed in particular situations. Self-efficacy has been shown to be more strongly associated with activity and participation than with physical performance measures of gait or balance. To investigate whether balance confidence is improved with AFO use, researchers measured 15 patients with poststroke hemiplegia using the Activitiesspecific Balance Confidence (ABC) Scale. They obtained two data sets, one with and one without AFO use. They found that the ABC scores were significantly higher with AFO use. According to the researchers, the results provide evidence for improvements in balance confidence with AFO use, and rehabilitative interventions that improve balance confidence may help restore participation and overall functioning in pathological populations. They conclude that future research should explore the specific mechanisms underlying the improvement in balance confidence as part of evaluating poststroke function.



Heel Cup Treatment Could Help Avoid Diabetes-Related Amputations A trial sponsored by the Nottingham University Hospitals National Health Service (NHS) Trust in the United Kingdom is testing a lightweight fiberglass heel cup designed to protect and promote healing of diabetesrelated heel ulcers, thus reducing the risk of amputation. The heel cup cast is being tested in 30 hospitals. The trial is expected to run for approximately one year and involve more than 500 patients. Funding is being provided by the UK’s Department of Health. Participants are randomly assigned to wear the fiberglass heel cup cast or to continue to receive the standard treatment without a heel cast, and participate in healing assessments for six months. The study will provide information about reduction in pain, decrease in ulcer area, amputations, well-being, costs, and other clinical outcomes.










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Medicare Pushes to Recoup Improperly Paid Claims for Incarcerated Beneficiaries As a result of a January 2013 report published by the Office of Inspector General (OIG), Centers for Medicare and Medicaid Services (CMS) has instructed its contractors to take specific action to attempt to recover improper claim payments that were made on behalf of Medicare beneficiaries who were incarcerated when the services were provided. Medicare regulations do not allow Medicare to pay for services for incarcerated beneficiaries except when the penal authority requires inmates to personally pay for their medical expenses. The OIG report, “Medicare Improperly Paid Providers Millions of Dollars for Incarcerated



Hanger Clinic has announced several practitioner hirings at its patient-care clinics across the country: • Theresa Bonnema, CP, C.Ped, in Iowa City, Iowa • Philip Dunham, BOCO, C.Ped, in Hiram, Georgia • Jonathan Flynn, CPO, in Holland, Michigan • Thomas Gore, CO, in Fairfield, Ohio • Jeffrey Keener, CO, in Jacksonville, Florida • Kelley Kimbrough, CO, in Galveston, Texas • Lynwood Kornegay, CO, in Auburn and Sacramento, California • Amanda Parsons-Twesten, CPO, in Salina, Kansas • Kathryn Penney, CP, in Hollywood, Florida • Colin Provost, BOCO, in Chambersburg, Pennsylvania • Jessica Sadler, CO, in Frisco, Colorado • Karina Shelton, CP, in Salinas/ Santa Cruz, California • Lori Vanderhoof, CPO, in Rockville, Maryland. Ryan Blanck, CPO, of the Center for the Intrepid in San Antonio and Brooke Army Medical Center, received the Meritorious Civilian 10


Beneficiaries Who Received Services During 2009 Through 2011,” identified $33.6 million in improperly paid claims during the two-year review period. OIG recommended that CMS take action to recover payments that should not have been made. While treatment of an incarcerated beneficiary may be a rare event, it is important to understand Medicare regulations and negotiate payment terms directly with the penal authority prior to agreeing to provide the service. Questions regarding this issue may be directed to AOPA staff members Joe McTernan at and Devon Bernard at

Service Award—the second-highest honor granted by the Army to civilian employees—for his innovation and dedication to caring for wounded service members. John Craig, CPO, LPO, FAAOP, owner of AA Prosthetic Services, Brownwood, Texas, has been appointed to the board of directors of Limbs International, a humanitarian nonprofit organization that manufactures and distributes low-cost prostheses. The Amputee Coalition has elected combat wounded war veteran Ron Drach to serve a three-year term on its board of directors. Tamarack Habilitation Technologies has hired Joe Hofmeister as chief operating officer. Freedom Innovations, headquartered in Irvine, California, has named Claudia Gehrmann as its general manager for Europe. The Orthotic & Prosthetic Activities Foundation has awarded the 2013 Dale Yasukawa Memorial Scholarship to Josh Yoder of Oak Harbor, Washington.

IN MEMORIAM Stefan Moser, C.Ped, founder of Swiss Balance in Santa Monica, California, has died at the age of 54. Moser was participating in an off-road motorcycle trip in the Mojave Desert, California, at the time of his death. Moser first earned his certification in prosthetics in Lucerne, Switzerland. He subsequently worked for the International Red Cross in Angola and Lebanon, establishing prosthetic workshops and training local technicians in fitting prosthetic devices for civil war casualties. Moser moved to California in 1983 and founded Swiss Balance in 1989. In 1991, Moser earned his pedorthic certification. He also was a member of the International Society for Prosthetics and Orthotics. Moser is survived by seven brothers and sisters and numerous nieces and nephews.



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Jurisdiction A Releases Prepayment Review Results for Lower-Limb Prostheses NHIC, the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC), has announced that its latest widespread complex medical review of claims for lower-limb prostheses Healthcare Common Procedure Coding System codes billed with a K3 functional level modifier and components/additions provided resulted in a claim denial rate of 69 percent. The review results involved prepayment complex medical review of 145 claims submitted by 105 suppliers for claims processed February 2013 to April 2013. Responses to the Additional Documentation Request were not received for 30 (21 percent) of the claims. For the remaining 115 claims, 36 claims were allowed and 79 were denied. The total denied allowance amount (dollar amount of allowable charges for services determined to be billed in error divided by the total allowance amount of services medically reviewed) resulted in an overall charge denial rate of 62 percent. Based on the results of this prepayment review, DME MAC Jurdistiction A said it will continue its review.



The Association of Amputee Surfers (AmpSurf) will hold its 8th annual Operation Restoration event September 5-8. The Pismo Beach, California, event will offer two adaptive surfing clinics and other rehabilitative activities for wounded war veterans, as well as a charity golf tournament. Seattle-based Cadence Biomedical has received $1 million in grants from the Department of Defense’s Joint Warfighter Medical Research Program. Össur Americas, Foothill Ranch, California, has signed an exclusive agreement with Harrington Management Group (HMG), Canton,



Ohio, a third-party consulting firm that specializes in O&P and durable medical equipment payment issues, to provide reimbursement support for prosthetists who are providing users with Össur’s bionic prostheses. HMG will provide an audit team whose members have prior experience working at the Centers for Medicare & Medicaid Services (CMS) and CMS’ administrative law judge offices. The International Paralympic Company (IPC) has announced that worldwide Paralympic partner Ottobock, Duderstadt, Germany, signed an agreement with the local organizing committee of the 2013 IPC Athletics World Championships to become an official partner of the event.

PnO Data Solutions, Los Angeles, has signed an exclusive agreement with Siliconcoach, Dunedin, New Zealand, a movement analysis software company. The agreement results in O&P-specific video gait analysis tools and research-based gait reports. Racquetball Rehabilitation Clinics, a national program sponsored by The Military Racquetball Federation, recently hosted a clinic at Arizona State University in Phoenix to help wounded soldiers and amputees get back into the game. The event, sponsored by Ability Dynamics, drew many local wounded vets, some of whom played the game using prosthetics.


The reasons for the latest denials include the following: • Lack of medical record documentation: 27 percent of the denied claims were missing the clinical documentation to corroborate the prosthetist’s records and support medical necessity. • Evaluation/assessment documentation: 8 percent of the denied claims were missing the evaluation/assessment documentation for the functional level of item(s) billed (prosthetist assessment). • Clinical documentation did not support the functional level of the lower-limb prosthesis: 31 percent of the denied claims had clinical records that did not justify the functional level of the billed item. • Proof of delivery: 15 percent of the denied claims were missing the proof of delivery. Delivery is missing items delivered, manufacturer name, and model number. The percentages above reflect the fact that a claim could have more than one missing or incomplete item. The following educational materials and links have been provided by NHIC so suppliers can be in compliance with documentation requirements:

Ferrier Coupler Options!

• Local Coverage Determination for Lower Limb Prostheses (L11464) and related Policy Article (A25310): • The DME MAC Jurisdiction A Supplier Manual (Chapter 10 includes information regarding documentation requirements): suppmandownload.shtml. • Dear Physician Letter: medical_review/mr_bulletins/mr_bulletin_current/phy_letter_ artificial_limbs.pdf. • Comprehensive Error Rate Testing (CERT) Errors (Monthly Publications) and CERT Physician Letter: • Results of Widespread Prepayment Complex Review for Lower-Limb Prostheses, posted April 24, 2012; Dec. 28, 2012; and March 6, 2013: medical_review/mr_bulletin_pca.shtml/. • Results of Widespread Prepayment Probe for Lower-Limb Prostheses, posted Nov. 30, 2011: mr_bulletin_pca/113011_llp.pdf. a

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

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

Model A5

Model F5

Model P5

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

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

Model FA5

Model FF5

Model FP5

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

Model T5

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

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

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




Reimbursement Page By Joe McTernan, AOPA government affairs department

Top 10 Reimbursement Errors to Avoid Sound operating procedures and proper employee training can help prevent these common missteps


ne of the most popular sessions at the AOPA National Assembly is the Top Ten Series, a session that addresses the top 10 things that you must know regarding a particular issue. This month’s installment of The Reimbursement Page brings this concept to print. The old saying, “Don’t sweat the small stuff” makes a lot of sense in everyday life, but it no longer applies to O&P reimbursement. As Medicare shines the audit spotlight on O&P providers, small mistakes can lead to big problems. Taking the time to make sure you avoid the 10 common errors discussed below will allow you to focus on the larger reimbursement challenges currently faced by the O&P industry.

Providing Services to Incarcerated Medicare Beneficiaries


Medicare regulations are very clear in respect to coverage of medical services for incarcerated beneficiaries. Except for very limited circumstances, most penal authorities are obligated to pay for inmates’ medical expenses. When this is the case, Medicare does not cover or reimburse for any medical services received during a period of incarceration. This issue has recently received renewed focus due to a report issued by the Department of Health and Human Services Office of Inspector General (OIG) in January of 2013 that reported the improper Medicare payment of more than $33 million for medical services provided to incarcerated beneficiaries during



a two-year period from 2009-2011. A copy of the complete OIG report may be found at reports/region7/71201113.pdf. As a result of the OIG report, the Centers for Medicare & Medicaid Services (CMS) instructed its contractors to attempt to identify previously paid claims for Medicare beneficiaries who were incarcerated. This process commenced in April 2013 and will continue for the foreseeable future. Billing the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for O&P services delivered to incarcerated Medicare beneficiaries is often a costly mistake as it is very difficult to negotiate payment terms with the penal authority after delivery of the service, especially if you do not have an existing contractual relationship with it. The good news is that a little front-end diligence can virtually eliminate the potential for erroneous claim submission. All four of the DME MACs have access to CMS databases that indicate whether a Medicare beneficiary is incarcerated. A simple phone call to the DME MAC customer service line or an online check of the HIPAA Eligibility Transaction System (HETS) should provide you with confirmation of the patient’s incarceration status. More information on using the HETS system is available at http://www. HETSHelp/index.html?redirect=/ hetshelp.

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Reimbursement Page

Regulations-and-Guidance/Guidance/ Manuals/Downloads/pim83c04.pdf. Failure to obtain a properly completed proof of delivery document is reason enough to cause denial of a claim or recoupment of previous payment if the claim is audited at a later date. With a proper understanding of proof of delivery requirements and a well executed delivery process, no claim should be denied as a result of an improper proof of delivery document.

Billing DME MAC for Prosthetic Services Included in SNF PPS Payment


While the majority of prosthetic Healthcare Common Procedure Coding System (HCPCS) codes were exempted from inclusion in the Skilled Nursing Facility Prospective Payment System (SNF PPS) payment rate mandated by the Balanced Budget Act of 1997, there are specific categories of prosthetic procedures that are not exempt and must be billed to the SNF itself. These services include immediate postsurgical prostheses, partial hand and foot prostheses, textiles, supplies, and repairs. In addition, there is one outlier foot code, L5987, that is not included on the exempt code list. CMS publishes an updated file of SNF PPS exempt codes on an annual basis. The bottom line is that if a HCPCS code is on the list, it may be billed to the DME MAC when a patient is a Medicare Part A-covered SNF stay. If a HCPCS code is not on the list, payment terms must be negotiated directly with the SNF. A current copy of the SNF PPS exempt code list can be found at Medicare/Billing/SNFConsolidatedBilling/ 2013Update.html. Click on “file 1” in the downloads section. This will download a .zip file containing a spreadsheet of the current list. It is a common error to assume that all prosthetic codes are exempt from SNF PPS and may be billed directly to the DME MAC. A simple review of the list prior to providing the service will help to avoid unnecessary Medicare claim denials.

Billing Medicare for Spinal Orthoses Delivered Prior to Surgery


While no Medicare regulation says you cannot fit and deliver a spinal orthosis to a Medicare beneficiary prior to the surgery which necessitates its use, there is policy that confirms that the inpatient facility where the surgery is performed remains responsible for payment regardless of when it was



delivered. The limited exception to this scenario is when documentation to support the pre-surgical medical need for the brace—usually for stabilization purposes—is available. If the brace is being fit and delivered early for convenience purposes (e.g. so it is available for application in the surgical suite), however, the hospital remains responsible for payment. If you pre-deliver a spinal orthosis (or any other device) but the medical necessity is not established until the patient is in a Medicare Part A-covered stay, a claim should not be submitted to the DME MAC. This is a common error that often results in initial payment of the claim and subsequent recoupment through audit processes.


Improperly Documenting Proof of Delivery

The DME MACs routinely publish results of their audit findings and without fail, a missing, incomplete, or improper proof of delivery document is always among the top reasons for claim denials. Obtaining proper proof of delivery documentation is one of the few things that O&P providers have complete control of, and taking the time to make sure your process is correct is an easy way to reduce your company’s claim denial rate. Medicare proof of delivery requirements are documented in section 4.26 of chapter 4 of the Medicare Program Integrity Manual, which can be found at


Failing to Sign Progress Notes

Like the proof of delivery document, another common error that is easily avoided is the failure to properly sign and record the date of progress notes. While the requirements do not specify where the date is recorded, it is a requirement that the date of the record is easily understood by a medical reviewer. Therefore, it is always in your best interest to not only sign your records but also to indicate the date. This is not only a requirement for physician notes but also for progress notes of ancillary providers such as orthotists or prosthetists. While Medicare does not allow providers or suppliers to alter any medical record, including the application of a signature at a later date, regulations do allow for the author of the record to sign an attestation statement confirming that an unsigned record was indeed penned by him or her. CMS has published a useful FAQ on signature requirements located at MLN/MLNProducts/downloads/ Signature_Requirements_Fact_Sheet_ ICN905364.pdf.

Believing Bilateral Amputees Are Exempt from Functional Level Requirements


This is a very common misconception among O&P providers. The Medicare Lower Limb Prosthesis Local Coverage Determination


(LCD) includes the following statement: “It is recognized, within the functional classification hierarchy, that bilateral amputees often cannot be strictly bound by functional level classifications.” This statement allows for coverage of components outside the typical functional level restrictions for bilateral amputees but does not, nor was it ever intended to, supersede the requirement that any service a Medicare recipient receives must be medically necessary. While the policy statement may allow coverage for components that exceed the patient’s functional level assessment, it remains the responsibility of both the physician and the prosthetist to document the specific medical reasons why the patient requires the components in question. Reimbursement for claims for bilateral amputees who are fit with components categorized above their current functional level usually requires multiple levels of appeal.


Improperly Using the Two-Day Rule

The two-day rule is a useful tool when used properly. It essentially allows you to deliver a completed orthosis or prosthesis to a Medicare recipient in a Part A-covered hospital stay during the last two days prior to discharge and subsequently bill the DME MAC using the date of discharge as your date of service on the claim. In order for your claim to be processed and paid correctly, however, the patient must be discharged to a location that qualifies as his or her home and there must be no medical need for the patient to use the device during the remainder of the hospital stay. Medicare rules are very clear that the two-day rule should never be used to improperly shift responsibility for paying for medically necessary services from the hospital to the DME MAC. Since its inception, CMS has expressed concern that the two-day rule, if not used properly, can result in an illegal shift of payment

responsibility. Claims billed under the two-day rule are highly susceptible to audit and potential recoupment, so it is extremely important to document that there is no medical need to use the device for any reason during the final two days of the inpatient stay.

Reimbursement Page

applications, prosthetic covers and skins, and prosthetic feet described by L5980. A thorough review of the Lower Limb Prosthesis LCD can result in fewer claim denials when billing for preparatory prostheses.

Providing Medicare Beneficiaries with New Diabetic Shoes and Inserts Every Year


The Medicare Therapeutic Shoe Policy indicates that the benefit is limited to one pair of off-the-shelf shoes or custom shoes and up to three pairs of diabetic inserts every calendar year. The operative term in the previous statement is “limited to.” While patients are eligible for coverage, documentation that supports the medical need for a new pair of shoes and inserts must exist, especially if the patient received a pair of shoes and inserts late in one calendar year and then another pair early in the next calendar year. Anytime you are providing diabetic shoes and inserts to a Medicare recipient and there is a record of him or her receiving a pair in the past, it is imperative that your documentation includes a discussion of the condition of the previous pair of shoes and/or inserts. In addition, if you decide to dispense more than one pair of inserts at the same time the shoes are delivered, you must document that the patient has been instructed to rotate the inserts so that they wear evenly over time. Failure to document this may result in unnecessary claim denials and lengthy appeals.

Providing Components or Features on Preparatory Prostheses Prohibited by Policy


The Medicare Lower Limb Prosthesis LCD contains a list of HCPCS codes that will automatically be denied as not medically necessary when provided with a preparatory prosthesis. This list includes but is not limited to codes that describe acrylic sockets, suction sockets for trans-tibial

Following Useful 10 Not Lifetime Restrictions With the exception of prostheses and prosthetic components, which may be replaced when it is medically necessary, and knee orthoses, which have a useful lifetime of one to three years, all other O&P devices default to a five-year useful lifetime. This means that if you bill Medicare to replace a device that is less than five years old, it will automatically be denied as not medically necessary. Two major exceptions to this are if the replacement is needed due to loss or irreparable damage, or if there is a change in patient condition that warrants a larger or smaller device. If the replacement is required due to one of those two events, there must be documentation to support the need for the replacement. Replacement claims for items covered by the five-year useful lifetime will always be denied as not medically necessary if Medicare records indicate the same device was provided within the past five years. The 10 common mistakes discussed above are just an example of the many issues that often result in unnecessary claim denials. For the most part, they represent errors that are easily avoided through the creation of sound operating procedures and proper training of employees. a Joe McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmcternan@






Frontiers 18




harles Kettering, an American inventor and engineer, once said, “There will always be a frontier where there is an open mind and a willing hand.” Such is the case in orthotics and prosthetics, with a number of clinicians, researchers, and manufacturers making strides in unchartered areas of product development and patient care. As a result, breakthrough innovations in manufacturing and sensory feedback are marking new frontiers in O&P technology. Three-dimensional (3-D) printing, for example, is fast becoming an exciting new option for custom manufacturing of orthoses and prostheses, while testing of sophisticated thought-controlled devices and sensory feedback systems is redefining how patients will control their artificial limbs with ever greater dexterity and ease. Today’s advancements not only elevate the orthotics and prosthetic profession, but also offer patients new opportunities for unprecedented mobility and support. With all of the recent buzz around 3-D printing, it may seem that this technology is brand new. In fact, Charles Hull invented stereolithography in 1983, founding a company, 3-D Systems, in 1986. The technology had a low public profile for many years because it was used primarily to create prototypes of manufactured goods, saving time and money by eliminating the need to handfashion models. Over time, the technology matured and manufacturers began to use 3-D printing to make end products.



Photo: John’s Hopkins Applied Physics Lab

New Uses for Established Technology

Photo: Northeastern University

Photo: Bespoke Innovations

Northeastern’s 3-D printed AFOs.

BeSpoke Innovations’ 3-D printed hand brace. (Also pictured bottom right.)



company started with the hand and wrist because “it is a relatively small part to print compared to a trunk orthosis or a leg, so it comes at a lower cost,” he says.“It’s also a commonly prescribed device for both chronic conditions and trauma.” According to Dugan, the benefits of the 3-D printed brace extend to both the orthotist and the patient. The streamlined process takes only a few days to produce a finished product, and that product conforms perfectly to the patient, allowing for a better fit and increased comfort. “They are stylish,” he says. “Form and function combine to create a good-looking product that patients will want to wear.” And unlike many orthoses that have Velcro straps, foam, and other parts that can be difficult to clean, the high-durability polymer used in 3-D printing can be washed in the dishwasher.

The cutting-edge technology can be a marketing tool for O&P facilities as well. “This is a compelling product that people like to talk about. It can be a walking advertisement for the business,” he says. Researchers at Northeastern University in Boston also are working with 3-D printing and orthotics, but with a twist. “We’re trying to combine different technologies to advance the state of the art in orthotic design,” says Constantinos Mavroidis, PhD, director of the Biomedical Mechatronics Laboratory in the Department of Mechanical and Industrial Engineering. Mavroidis and his team were among the first groups to develop customized orthoses to fit the patient’s anatomy, using 3-D laser scanners, CAD software, and 3-D printers.

Photo: Bespoke Innovations

Today, 3-D printed items range from Invisalign braces and medical implants to jewelry, parts for fighter jets, orthotic and prosthetic components, and more. The process is easy to visualize, explains Steve Dugan, director of marketing for Bespoke Innovations, a San Francisco-based company that began by creating customized 3-D printed coverings, or “fairings,” for prostheses and was acquired by 3-D Systems last year. “We are all familiar with two-dimensional printing, which deposits a layer of ink,” he says. “Instead of ink, a 3-D printer deposits a very thin layer of plastic, and then prints subsequent layers on top until thousands of layers are stacked, each a cross-sectional representation of the object you want to make. The printers are so precise, you can print a hinge into a part, and when you pull it out, the hinge actually works.” Bespoke has developed a new platform for 3-D printing that combines scanning technology—an algorithm that renders the scan into a 3-D image— and the 3-D printer that generates the object. The company’s first product offering to use that platform is a wrist brace, now in initial beta testing with clinicians and patients. Bespoke also is working on orthoses for other parts of the body, but the

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For the past few years, the team has been working on adding sensors to create “smart, patient-specific” devices. Sensors can provide feedback about the mechanical state of an orthosis, says Mavroidis. By measuring various forces acting on the device, clinicians can assess a patient’s progress during rehabilitation as well as predict when an orthosis is wearing out and should be replaced. “These are the measurements we can make right now,” says Mavroidis, “but we may eventually be able to make others, such as measuring temperature and humidity to avoid conditions that would create ulcers, or evaluating certain parameters to help us avoid friction wounds.” In general, sensors cannot be manufactured using 3-D printing, so when a sensor needs to be included in a 3-D printed structure, the question is how to embed it successfully in the material during the printing process, rather than attaching it externally postfabrication. Mavroidis and his former doctoral student Richard Ranky, PhD, have developed their own 3-D printed customized sensors using a conductive material that can be embedded in the 3-D printed structure. They also have developed an anklefoot orthosis equipped with sensors that is ready for preclinical testing in human subjects. The duo is trying to commercialize these technologies through their recent startup, 3-Spark LLC, which was a 2013 finalist in the MassChallenge program for budding entrepreneurs.



Photos: John’s Hopkins Applied Physics Lab

The Modular Prosthetic Limb, developed by scientists at Johns Hopkins’ Applied Physics Lab, has 26 joints and more than 100 sensors.

Ranky and Mavroidis are refining the design process to take advantage of the mechanical properties of 3-D printed materials, which differ considerably from the thermoplastic materials being used today. For example, to make a stiffer orthosis now, “you would use a thicker piece of plastic,” explains Ranky. “With this new technology, it doesn’t have to be thicker. You could use a rib structure or mesh to accomplish the same result.” So, he says, 3-D printed orthoses will be able to produce the same outcomes as thermoplastic devices, but they will accomplish it using differently shaped geometry. “These new geometries are what we are currently investigating.”

Thought-Controlled Prostheses Some of the most exciting news in prosthetics has been the development of brain-controlled devices. Scientists at Johns Hopkins’ Applied Physics Lab (APL) in Laurel, Maryland, have created six prosthetic arms for use in research into thought control and sensory feedback. The process begins with targeted muscle reinnervation, or TMR, says Michael McLoughlin, deputy business area executive for research and exploratory development at APL and the program’s leader. Even when a limb is missing, the brain continues to send signals to it. In TMR, surgeons locate the nerves that

used to go to the amputated hand and move them to healthy muscles in the chest or residual limb. When patients think about moving their arm or hand or fingers, the brain sends electrical signals to those nerves, and surface electrodes in the prosthesis detect them, interpret the patterns, and respond with the appropriate movements. “Patients imagine moving their missing limb, and the Modular Prosthetic Limb learns how to interpret their intentions,” he says. “It’s very intuitive. And it doesn’t take long to train the arm. The patient goes through a set of motions, and the computer learns the patterns in a few minutes.” The APL prosthetic arm has 26 joints, so, it can do nearly everything a natural arm and hand can do, says McLoughlin. TMR involves not only motor nerves, but also those that carry sensory information. That sensory feedback can enable users to detect, for example, whether an object is hard or soft. “The arm has more than 100 sensors, and we are just beginning to learn to use them,” says McLoughlin. “In my long-term vision, the sensors would enable you, with eyes closed, to grasp an object with the right force, to know when it starts to slip from your hand or when it begins to deform from a too-tight grip.” McLoughlin hopes that the arm will be available to the public in about two years. “The barriers are not science or technological development,” he says. “It’s a matter of good design engineering and transition.” A major challenge is that upperextremity amputees represent a small population, making funding problematic. The Defense Advanced Research Projects Agency has supported much of the research in this field so far, and McLoughlin hopes that other funders, such as charitable foundations, may want to help finance future development.

Still on the Drawing Board The researchers, scientists, clinicians, and others who seek to improve orthotics and prosthetics take many different approaches. These are some avenues of exploration that may produce important new products in the future.

Cushioning polymer for amputated bone Advanced Amputee Solutions, a Detroit startup founded by Gordon Maniere, CP, is developing a polymer that will be applied to the cut bone during amputation surgery. The goal is to protect the bone and provide a shock-absorbing cushion that will reduce pain and enable the amputee to put weight on the limb.

Socket cooling device Another startup, Leto Solutions in San Antonio, wants to make prostheses more comfortable. Iraq war veteran and amputee Gary Walters suffered from heat buildup in the socket of his prosthetic leg, and, along with fellow engineering and business students at the University of Texas at San Antonio, founded a company to address the problem. Leto Solutions developed a socket cooling system that uses a ceramic plate with battery-powered thermoelectric components that draw the heat from within the socket and eject it outside the device. The system is embedded in the socket and includes an on-off switch.

Extra-sensitive sensors Researchers at the Georgia Institute of Technology have developed sensor arrays that are as sensitive as the human fingertip. The arrays are transparent and flexible, and they emit signals when they are mechanically agitated. This means that the movement of a prosthetic hand or arm could be translated to control the signals, perhaps one day providing amputees with a sense of touch.

Digging Deeper on Sensory Feedback Researchers at Case Western Reserve University in Cleveland are taking a different approach to sensory feedback—one they hope will allow amputees to see their prostheses as natural extensions of themselves, rather than foreign objects. “About 50 percent of people who use myoelectric prostheses abandon them because they can’t feel a connection to the device,” explains lead researcher

Dustin J. Tyler, PhD, associate professor of biomedical engineering at Case Western. “Using the device is also visually intense, because they have to look at an object to know if they are holding it.” Tyler’s work, which has been funded by the Cleveland Veterans Affairs Medical Center, involves electrodes on the median, radial, and ulnar nerves to stimulate and produce sensation. The electrodes are approximately 10 to 15 millimeters across



Photo: Case Western Reserve University

As part of Case Western Reserve University’s research, a test subject attempts to pick up and remove blocks magnetically held on a table without being able to see them or his prosthetic hand. Researchers run the test once without sensation and again with sensation.

and run about 7 millimeters along the length of the nerve, fitting around it like a cuff, which “respects the blood flow and protective membranes of the nerve,” he says. The electrodes include leads that extend externally through the skin, giving researchers access. By using electrical stimulation in novel patterns, scientists have been able to create a full range of sensations in their subjects. “They report things like feeling soft Velcro moving over an area, or feeling someone touch their [missing] hand. One person said it felt like he was feeling his pulse,” says Tyler. “And with sensation, the brain begins to think more like the body has an actual hand. We call it a ‘perceptual hand,’ rather than a ‘phantom hand.’”



Before this procedure, a patient with a very short below-elbow amputation said he could sense his missing fingers just at the level of the amputation. “Since stimulation, he perceives his fingers back to where they were before the amputation, back where his hand would have been. He has a much more realistic perception now,” says Tyler. For some amputees, phantom limb pain can involve the sensation of a tightly clenched hand or arm muscles. While Tyler’s studies are not focused on phantom limb pain, he notes that anecdotally, stimulation has allowed one patient to feel he could move his phantom limbs and reduce or remove that pain entirely.

Tyler hopes to extend his research into lower extremities as well. “If we can give patients a sense of foot strike and toe versus heel, we can help them move more naturally on different terrains,” he says. Tyler’s experimental percutaneous system is not the final product, but he hopes his studies can lead to practical devices within five to 10 years. He is particularly interested in finding partners among prosthetic manufacturers to develop devices that could communicate wirelessly with the implanted electrodes. a Deborah Conn is a contributing writer to O&P Almanac. Reach her at debconn@

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o survive and thrive in these demanding times, O&P practitioners can benefit from a full, in-person update on all that’s happening within their industry. That’s what attendees will receive at the 2013 O&P World Congress, being held September 18-21 at the Gaylord Palms Resort, Orlando, Florida. The Congress promises to be laser-focused on the business of O&P, delivering the finest industryspecific educational sessions that emphasize bottom-line, profitoriented, take-it-home and use-it

programs for U.S. patient-care facility and supplier members. Educational highlights include sessions on FDA compliance, survival imperatives in O&P, and an informative session with Congresswoman Tammy Duckworth (D-Illinois). An Iraq War veteran, Rep. Duckworth served as a U.S. Army helicopter pilot and suffered severe combat wounds, losing both of her legs and damaging her right arm. She was the first female double amputee from the war and has been an ardent supporter of the O&P profession.

Also of special interest, a session on surviving Recovery Audit Contractor audits is part of the educational offerings. Orthotics and prosthetics are no longer flying under the radar of Medicare auditors. The August 2011 release of the Office of Inspector General report on Medicare payments for lower-limb prostheses effectively placed O&P providers in the auditing spotlight, and the resultant delays to cash flow have been devastating. This two-and-a-half hour session will be presented by the most knowledgeable experts in O&P reimbursement, including attorneys with direct Medicare audit litigation experience. In addition to its business-oriented programming, the Congress will take a special look at international themes with its “Whole New World� program, which will present innovative ideas and insights for O&P care from practitioners around the world. To open up new avenues of collaboration and creativity, AOPA has teamed with the U.S. National Member Society of the International Society for Prosthetics and Orthotics (USISPO), the German Association of Orthopaedic Technology/, the Amputee Coalition, the Canadian Association of Prosthetics and Orthotics, Uniting Fronteras, and the Mexico Member Society of ISPO.


More than 200 providers of every type of O&P component, device, product, and service imaginable will be on hand to demonstrate and discuss their work. Plus, World Congress attendees will have the opportunity to navigate a show-floor theater, international pavilions, two lunch-lounge areas, the International Showcase, and poster presentations. As you make plans to attend the Congress, get to know some of the expert speakers slated to appear. Their distinguished work runs the gamut of the field—from practice profitability to O&P innovations in the developing world.

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The World Congress will bring together prosthetists, orthotists, physicians, technicians, scientists, researchers, engineers, programmers, clinicians, pedorthists, fitters, physical therapists, manufacturers, suppliers, patient-care facility owners, managers and executives, and other rehabilitation care givers. This diverse community of professionals focusing on different aspects of orthotics, prosthetics, and pedorthics will provide a unique and powerful environment to advance the field forward.

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Heinz Trebbin, CPO(d), MSc, has worked for 25 years on the formidable task of tackling prosthetic and orthopedic issues in developing countries. Many nations lack training programs; funding is limited; and O&P issues are often not a national priority. In addition, disabled people typically live on the margins of society, although recent efforts by the United Nations are helping to change that. “You see more disabled people in schools, more people integrating into society,” says Trebbin, rehab consultant and managing director of the Germany-based DOI orthoinnovativ GmbH. While the challenges are great, Trebbin has seen some big wins, for instance in El Salvador, where he and others have spent 15 years partnering with local educational institutions, to help build an O&P infrastructure. The number of devices being produced has increased by 3,000 percent in recent years. Fifty practitioners a year are being trained, and students are coming to attend those institutions from throughout Latin America.

A researcher in the VA Bone and Joint Research Lab in the University of Utah’s Department of Orthopedics, Roy D. Bloebaum, PhD, has his eye on osseointegration. He recently won approval from the U.S. Food and Drug Administration for a feasibility study to explore possible uses of osseointegration that can make it possible to craft solutions for patients with complicated socket problems, for example very short residual limbs. Such solutions are already in use in Europe. “It’s an exceptional opportunity, but there is risk involved,” he says. “There is always the chance of infection, for example. But overall we are feeling excellent. We have studied this for six years. We’ve done animal work. We’ve learned from the good and bad in what is going on in Europe. There have been some major mistakes, but also some good things, and we will be incorporating those good things into our research.”



Skin problems of the amputation stump in lower-limb amputees are a common problem, one that practitioners deal with daily. While expert opinions are available, currently a systematic, scientific evaluation of the problem is not. Jan Geertzen, MD, PhD, has been giving the issue of skin problems a thorough examination, as immediate past president of ISPO and head of the Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, located in The Netherlands. Through his research, Geertzen has reviewed the scientific evidence surrounding skin problems, analyzed determinants of those problems, determined which proportion of lower-limb amputees with a skin problem forced to wear their prosthesis less, and worked to determine a point-prevalence of skin problems of the amputation stump in lower-limb amputees. His findings have shed new light on the situation, for example by identifying a series of determinants (smoking, use of antibacterial soap, and washing frequency) that call for further study, as well as new statistics on the prevalence of skin problems of the stump in lower-limb amputees. Jason Highsmith, PhD, DPT, CP, FAAOP, has spent two years comparing prosthetic knees and is ready to unveil his results. A dual licensed physical therapist and prosthetist with a doctoral degree in medical science, Highsmith serves as vice president of the American Academy of Orthotists and Prosthetists and is an assistant professor at the University of South Florida’s School of Physical Therapy & Rehabilitation Sciences in Tampa, Florida. Highsmith has been conducting clinical trials with 20 amputees and five control subjects, looking at the relative merits of the Genium Knee and the C-Leg to determine which most improves quality of life. While the C-Leg is the more established device, Genium boasts a sensor array that allows amputees to climb stairs and walk backwards, according to the manufacturer. To compare the products, Highsmith and his colleagues introduced a number of new research methods: “We’re very pleased with that as a technique going forward,” he says. In addition, “a very high turnout among the subjects suggests they were enthusiastic, which we took to be a good sign.”

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Through her research, Pamala Filippis Lupo, CO, has been asking a fundamental question, one close to the heart of every O&P practitioner: Can we make any money doing this? Director of orthotics and orthotic residency director at Wright & Filippis in Rochester Hills, Michigan, she has worked with a number of colleagues to probe the issue, including Ralph Hooper, CPO, Carolina O&P; Jon Naft, CPO, Geauga O&P; and Michael Oros, CPO, FAAOP, Scheck & Siress. The team has examined four facilities, charting their operations and delivery methods, to find the means to optimum profitability. They looked at the virtues of paper versus online charts, non-revenue producing clinical hours, and the ideal mix of personnel (who provides care and whose time is most profitably spent). They have seen some startling results. For example, the time spent by practitioners early in the day, before patients arrive, has been shown as a lost opportunity, with losses reaching as high as $250,000 a year. “Here was an hour or two in which patients were not being seen, time that was therefore unproductive,” says Filippis Lupo. “We were paying practitioners, but they were bringing nothing in the door.” With four companies sharing data, the researchers have been able to glean a fairly full picture of the revenue situation within the profession. “We are all in this together, and that means we need to share information in order to become better and stronger as a profession,” she says.


“We are all in this together, and that means we need to share information in order to become better and stronger as a profession.” —PAMALA FILIPPIS LUPO, CO



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Bernhard Budaker, Dr.-Ing.



Collab l a n o i

Urs Schneider, MD, PhD

As the largest organization for applied research in Europe, Fraunhofer is sending two of its leading minds to the upcoming Congress: Bernhard Budaker, Dr-Ing., group manager for Motion Control Systems, and Urs Schneider, MD, PhD, head of the Department of Biomechatronic Systems. Fraunhofer’s reach is extensive. Among its 60 institutes, the majority of more than 20,000 staffers are qualified scientists and engineers. Within the Department of Biomechatronic Systems, fields of study include the following: • biomechanics • bionics • electric motor development, design, and testing • human motion analysis • sensor development, especially inertial navigation units • development of a simulation-based workflow environment for orthopedic product development. As part of the Congress’ emphasis on recent developments in Germany, Fraunhofer’s representatives will discuss the ways end users will drive future developments in O&P. Events include a podium discussion between American and German representatives from different associations, including the Amputee Coalition of America and the Federal Amputees Association of Germany. In particular, Budaker and Schneider will present new developments in the field of power drives and sensors. In addition, a presentation on new technology developments in the field of O&P will review the collaboration between American and German research institutes.



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Jon Batzdorff, CPO, FAAOP, will continue the international focus of the Congress as USISPO president and organizer of USISPO Humanitarian Care Track. He also heads up the nonprofit Prosthetika in Santa Rosa, California. “When we look at international activities, there are the developed countries and the developing countries. In the developed countries, there is a lot of research and innovation, which we are going to see at this conference,” he says. “In the developing countries, we will hear a lot about ‘appropriate’ technology: technology that is developed using accessible materials, technology that is economically feasible.” While these appropriate technologies might not mirror their counterparts in the developed world, they are hardly primitive. “This is not old school. These are new technologies, but they are geared toward keeping the costs low,” he says. For an American audience, this look into the international situation is more than merely interesting. In the developing world, for example, U.S. manufacturers and distributors have an opportunity to enter untapped markets. At the same time, the developing world’s ability to make creative use of its resources could help American and European practitioners re-envision their current approaches to patient care. “If you see how people are managing to make low-cost prostheses under limited resources in developing countries, it’s not that hard to see how that applies to your own practice. You can’t make high-end expensive prostheses for everyone,” Batzdorff says. a

Adam Stone is a contributing writer for O&P Almanac. Reach him at adam.stone@


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On the following pages is an advance look at the companies that will be exhibiting at the 2013 O&P World Congress. You’ll find website information and booth numbers for each exhibitor—use this guide and floor plan to organize your visit to the Exhibit Hall. Better yet, check out their websites now and plan ahead!


2013 Exhibit Directory BOLD listings indicate the exhibitor is a member with the American Orthotic & Prosthetic Association (AOPA). indicates the exhibitor is a Supplier Plus Partner with AOPA. Exhibitors as of July 10, 2013. ABILITY DYNAMICS LLC...................... 412



AETREX WORLDWIDE INC................. 1413

ACOR ORTHOPAEDIC INC..................... 212

ALGEOS USA LLC.................................. 1533

ACSYS ORTHOPEDIC........................... 501

ALLARD USA INC.............................. 1400

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ADAPTEC PROSTHETICS LLC............... 218



AOPA extends special thanks to our sponsors:

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O&P Showcase International Pavilion & Showcase






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ALPS........................................... 1601

AMERICAN ORTHOPEDIC MANUFACTURING CORP. ...................1827 AMERICAN PROSTHETIC COMPONENTS LLC.............................. 335

ALTERNATIVE PROSTHETIC SERVICES INC................................... 1919

AMFIT INC.................................... 1613 AMPUTEE COALITION OF AMERICA ...1834


ANATOMICAL CONCEPTS INC............ 1731 AON...................................................... 1930 APIS FOOTWEAR CO............................ 915


AQUALEG INC...................................... 300

BIOM............................................. 331 BIOSCULPTOR CORP.......................... 1635 BOARD OF CERTIFICATION/ ACCREDITATION, INT’L (BOC) ............1832


ARTECH LABORATORY INC.................. 509


BIODESIGNS INC................................. 326

ARIZONA AFO INC............................. 1227





ASPEN MEDICAL PRODUCTS............... 413

BOSTON BRACE INTERNATIONAL INC./ DBA NOPCO........................................ 211

ATHLETES WITH DISABILITIES NETWORK ..............................................1739

BOWMAN ENTERPRISE ERVICES INC....................................... 303


THE BREMER GROUP CO................... 1823

THE BARR FOUNDATION ..........................1737

BRIGHTREE LLC............................... 701C


BTS BIOENGINEERING CORP................... 1732


BULLDOG TOOLS INC......................... 1709 CADENCE BIOMEDICAL..................... 1307 CAILOR FLEMING INSURANCE........... 1815



CASCADE ORTHOPEDIC SUPPLY INC...................................... 1511 CENTER FOR ORTHOTIC DESIGN— A FILLAUER CO................................... 431

DAW INDUSTRIES INC......................... 813


DELCAM USA............... 1408 & 1412

FLORIDA BRACE CORP....................... 1705

DR. COMFORT..................................... 400

FLO-TECH® ORTHOTIC & PROSTHETIC SYSTEMS INC................................... 1819

EMOTIS—A FILLAUER COMPANY........ 431 EMR STAT.......................................... 701I ENDOLITE....................................... 919

COLLEGE PARK INDUSTRIES INC......... 601 COMFORT PRODUCTS INC................. 1113 CONFAIRMED GMBH.............................. 1032

COYOTE DESIGN............................... 701D

FOOTCARE SRL..................................... 1332 FOOTMAXX........................................... 1730 FRAUNHOFER IPA..................................... 933 FREEDOM INNOVATIONS LLC.............. 319 FRIDDLE’S ORTHOPEDIC APPLIANCES INC............................. 701H

CENTRI—A FILLAUER CO............... 431 CJ SOCKET TECHNOLOGIES.............. 1026

FILLAUER COMPANIES...... 431 & 543

CYBERTECH MEDICAL....................... 1327

DREW SHOE CORPORATION...................... 606 CASCADE DAFO INC..................... 1631

FABTECH SYSTEMS LLC...................... 513

ESP, LLC................................................... 311


EURO INTERNATIONAL INC.................. 609

GAITRITE-CIR SYSTEMS..................... 301 GAME READY........................................... 633 GRACE PROSTHETIC FABRICATION INC............................. 1709 GUANGZHOU RENFU MEDICAL EQUIPMENT CO., LTD......................... 1333 GUARD INDUSTRIES INC................... 1831 AUGUST 2013 O&P ALMANAC


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HOPE ORTHOPEDIC............................. 600

LEVY & RAPPEL................................ 1825

HOSMER DORRANCE CORP.— A FILLAUER CO................................... 431


IB-ER PROSTHETICS LTD. STI............ 1433 IDEAS................................................. 608 JANCO INC............................................... 206 JMS PLASTIC SUPPLY........................ 226 KINETIC RESEARCH INC./BADER PROSTHETICS & ORTHOTICS............. 1311 KISS TECHNOLOGIES LLC.................. 1214 KJR SRI................................................. 1237 KLM LABS................................................ 313 KNIT-RITE INC.................................. 701A LADON SYSTEMS/LAWTON BRACE & LIMB CO. INC...................................... 328

LIFE-LIKE LABORATORY LLC............... 410 LINKIA, LLC........................................ 604 MD ORTHOPAEDICS.......................... 1326 MED SPEC (ASO)................................ 511 MEDEX INTERNATIONAL INC............... 229 MEDEX INTL (HOLDINGS) LIMITED.... 1926 MEDI USA......................................... 1027 MEDICARE CONTRACTORS.................... 1809 MEXICO MEMBER SOCIETY OF ISPO.... 938

NATIONAL ASSN FOR THE ADVANCEMENT OF O&P (NAAOP) .....1738 NATIONAL COMMISSION ON ORTHOTIC & PROSTHETIC EDUCATION (NCOPE) ....1736 NABTESCO PROTEOR USA...... 630 & 631 NEW STEP ORTHOTIC LAB INC.......... 1805 NORA SYSTEMS, INC........................... 614 NORTH SEA PLASTICS.............................. 642 O&P 1 CENTRAL FABRICATION......... 701K O&P BUSINESS NEWS/SLACK INC....... 732 O&P EDGE/WESTERN MEDIA LLC........ 731 OKM QUIMICA ORTOPEDICA................... 1033 ON-GOING CARE SOLUTIONS................. 701J OP MARKETING................................ 1811 OPIE SOFTWARE/OANDP.COM........... 1701

MJ MARKELL SHOE CO. INC................ 507 MOTION CONTROL INC.— A FILLAUER CO................................... 431 MYRDAL ORTHOPEDIC TECHNOLOGIES................................... 934



OPTEC USA, INC.................................. 901 OPTIMUS PROSTHETICS/O&P SOLUTIONS...................................... 701G ORFIT INDUSTRIES AMERICA.............. 531


ORTHOCARE INNOVATIONS............... 1501 ORTHOFEET...................................... 1801 ORTHOMERICA PRODUCTS INC................. 1213 & 1313 ORTHOTIC & PROSTHETIC ACTIVITIES FOUNDATION -OPAF & THE FIRST CLINICS ............................................1637 ORTHOTIC & PROSTHETIC EQUIPMENT CORPORATION.................................... 829 ORTHOTIC & PROSTHETIC GROUP OF AMERICA (OPGA)........................ 701B ÖSSUR AMERICAS INC...................... 1401

OTS CORP.—A FILLAUER CO........... 431 OTTOBOCK........................................ 1001

PROFESSIONAL TECHNOLOGIES INTERNATIONAL INC. (PRO-TECH)..... 1804 PROSTHETIC DESIGN INC.................... 315 PROTOKINETICS LLC........................... 125 PROVEL INC........................................ 309

SPS.................................................. 1219

QUALITY OUTCOMES......................... 701F

SPYDER TECHNOLOGIES.................. 701E

REBOUND MEDICAL SOLUTIONS, INC................................ 1927 RENIA GMBH. CHEMISCHE FABRIK..... 612 RENEWAL TECHNOLOGIES .............. 701M RESTORATIVE CARE OF AMERICA INC.................................... 1901 ROBOTICOM– FABRICA MACHINALE SRL .....................................1334 RODIN 4D........................................... 208 ROYAL KNIT INC.................................. 928


SPINAL TECHNOLOGY INC.............. 425

ST&G USA CORP.................................. 927 STEEPERUSA...................................... 713 SURESTEP.......................................... 401 TAMARACK HABILITATION TECHNOLOGIES INC............................. 827 TECHMED 3D INC................................ 833 TEKSCAN, INC....................................... 1914 THE PEDORTHIC FOUNDATION................ 1838 THYSSENKRUPP AIN PLASTICS......... 1922



RX TEXTILES INC.............................. 1404

TOP SHELF ORTHOPEDICS................ 1915

SILIPOS INC........................................ 207

TOUCH BIONICS................................ 1010

SOLETECH INC.................................... 913

TOWNSEND DESIGN.......................... 1013 TRS INC. (THERAPEUTIC RECREATION SYSTEMS INC.)................................... 306 AUGUST 2013 O&P ALMANAC


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TRULIFE.............................................. 830

UPS.................................................... 535

VQ ORTHOCARE.................................... 1918

ULTRAFLEX SYSTEMS INC...................... 1813


WBC INDUSTRIES INC....................... 1900

UNIENDO FRONTERAS ........................ 839

WILLOWWOOD.................................. 1419

VISCENT ORTHOPEDIC SOLUTIONS....... 222 VORUM............................................... 325

International O&P Showcase Participants CAMP NO LIMITS/NO LIMITS FOUNDATION.............................................. USA



FOOT FOUNDATION..................................... USA





ICRC SPECIAL FUND FOR THE DISABLED.................................. NICARAGUA



ST. PETERSBURG COLLEGE......................... USA

ISPO RWANDA...................................RWANDA WAITING ON WEBSITE – SENT E-MAIL JONKOPING UNIVERSITY, SCHOOL OF HEALTH SCIENCES, PROSETHICS & ORTHOTICS.........................................SWEDEN LIMBS FOR U............................................. USA MIRACLEFEET............................................ USA ORTHOTIC & PROSTHETIC ACTIVITIES FOUNDATION (OPAF)................................... USA PEDORTHIC FOOTCARE ASSOCIATION......... USA


2013 Product Guide On the following pages, you’ll see a sampling of the products that will be displayed at the 2013 O&P World Congress, Sept. 18-21, 2013. Go to to register.



New ALPS™ Guardian Suction Liner—Features raised GripGel™ bands that grip the socket wall to form a secure interface between the socket and liner to prevent slippage or premature release. Low modulus GripGel™ bands stretch against the socket wall, while the inner wall conforms easily to the residual limb, to ensure there is NO RESTRICTION of blood flow or stiffening to inhibit donning. Key features include full length inversion for ease of donning and high Performance Knitted Fabric Cover. Contact ALPS customer service at 800/574-5426 or email for more information.

The Vista CTO4 is a four post version of Aspen’s award winning Vista CTO. Designed for maximum comfort, support and adjustability, the Vista CTO4 provides therapeutic motion restriction in all three planes of motion. Multiple adjustment points allow the orthotist to quickly fit various anatomies without using tools. The Vista CTO and CTO4 both utilize the new Vista MultiPost™ Cervical Collar for full adjustability of the front and back panel. Supporting the progression of care, the Vista CTO4 can easily be stepped down to the Vista CTO and Vista MultiPost Collar as patient condition improves. Contact Aspen customer service at 800/295-2776 or visit

MT. EMEY 3D SYSTEM Booth 915 Capture 3D data for custom foot orthotics and custom shoes in Custom Molded Insoles with 3D camera no time. Ultra-portable 3D camera, super convenient and easy to use, significant cost PDAC A5513 savings and enhanced Fast Turnaround Tri-Lam turnaround time. Stay in control, Affordable Toll Free 1-888-937-2747 stay ahead, and stay cleaner! Call 888/937-2747 to find out how you can get yours free.

INTRODUCING THE VISTA MULTIPOST! Booth 413 The Vista MultiPost Cervical Collar is Aspen’s newest addition to it’s award winning line of spine care products. The Vista MultiPost Combines the universal sizing, superior motion restriction and skin-friendly Vista® collar front with a newly designed adjustable back panel. This new back panel includes height adjustment technology allowing optimum fit for various anatomies and conditions. Pivoting Occipital Panels self adjust to patient for increased comfort and support. The Vista MultiPost also easily attaches and detaches from the Vista CTO and CTO4, Aspen’s comfortable CTO solutions. The Vista MultiPost is code L0180 approved. Contact Aspen customer service at 800/295-2776 or visit



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DAFO® TAMI2 Booth 1631

APOPPS-TF™ Booth 1819

You asked; we listened. We’re pleased to announce our popular articulated DAFO® Tami2 can now be ordered without a polyethylene inner liner. Available with straight or dorsi-assist Tamarack hinges, the Tami2 without the inner liner is best suited for patients who have a stable, neutral foot position but are in need of lightweight sagittal plane support to control foot drop. Simply choose “no liner” on the updated product order form. Cascade Dafo Inc. is the industry’s leading manufacturer of pediatric lower-extremity orthoses. Custom-fabricated orthoses unmatched in quality, fit, and function—backed with a full (90-day) warranty and exceptional customer support.    Contact Cascade Dafo customer service at 800/848-7332 or visit

Moving beyond traditional prosthetic limitations, the biomechanically-engineered FLO-TECH-TOR-TF™ and Universal Frame Outer SocketTF™ (UFOS-TF™) create new possibilities for first time lower extremity patients. Use the FLO-TECH-TOR-TF™ when ambulatory training is desired. Fitting snugly over this socket, the UFOS-TF™ four-bolt plate permits attachment of a wide range of lower extremity components. The waist belt extension strap provides adjustability ensuring stability during normal weight bearing and ambulation. The FLO-TECH-TOR-TF™, in conjunction with the UFOS-TF™ can be used later as a showering device, or as an alternate prosthesis. Call 800/FLO-TECH or visit

NEW FROM COLLEGE PARK—ENDO COMPONENTS Booth 601 College Park Industries has increased their offerings to include a line of commonly used endoskeletal components. Utilizing knowledge from 25 years of material research and product design, these endo components are carefully engineered for structural integrity and noise abatement. Tested to the highest of quality standards, the components perfectly compliment the performance and outcomes College Park prosthetic feet are known for. For more information, call 800/728-7950, or visit



THE NEW KINTERRA™ FOOT/ANKLE SYSTEM IS EXTRAORDINARILY NORMAL. Booth 319 Kinterra™ combines hydraulics and carbon fiber technology to provide K3 ambulators 12° of motion and an exceptionally normal walking gait—regardless of surface angle or speed. The result is rock solid stability and the confidence for users to choose a new path. Kinterra’s articulating ankle delivers: • Improved stability and safety, especially on slopes and varied terrain • Reduced socket pressures for healthier residual limbs • Enhanced comfort while sitting and squatting • Increased ground contact and a more symmetrical gait. See the Kinterra in action at Kinterra.


THE PLIÉ® 2.0 IS THE WORLD’S MOST RESPONSIVE MPC KNEE. Booth 319 By integrating high-performance processing capabilities and a cutting-edge hydraulic system, the Plié 2.0 is the most responsive MPC knee ever developed. Rapid reaction to changes in gait allow users to stay in stance phase longer, take small steps in confined spaces and change walking speeds more fluidly. The result is a knee that provides increased stability and safety from falls while performing naturally and comfortably. The Plié 2.0 is quickly and easily programmed using a software wizard. And as the first water-resistant microprocessor knee, with a replaceable battery and a line of designer fairings—the Plié 2.0 offers a full range of benefits for both the clinician and end user. Visit

ORTHOMERICA INTRODUCES NEW PDAC CODED CALIFORNIA® CATALINA™ 637 & 631 Booth 1213 & 1313 The California® Catalina™ 637 and 631 both deliver effective compression to the region of pain localizing the patient’s therapy while maintaining comfort for the patient. The Catalina 637 also contains rigid side panels which provide additional lateral support. The Catalina’s unique two-pull closure system makes it easy-to-fit and simple for the patient to don and doff. It limits motion and provides effective compression for the relief of lower back pain, making it ideal throughout rehabilitation treatment. Available in sizes XS to 4XL. For more information, visit Orthomerica at AOPA, contact us at 800/446-6770, or visit



The Freedom DynAdapt™ foot is a slim profile, carbon fiber foot system with a slender, anatomic design for easy fit and finish. Its multiaxial function provides maximum comfort and the uninterrupted strands of carbon fiber in the full length heel provide patients with effortless rollover and a more natural gait. The new EnduraCore™ Technnology composite-laminate delivers up to three times the fatigue life of a standard laminate in a design that also returns more energy. The result is a highly durable product that preserves user energy so they can do more with confidence. Learn more at

Orthomerica’s Fuzion AFO was developed to allow GREATER FIT, FUNCTION and FREEDOM for challenging foot deformations compared to traditional AFOs. The circumferential wrap of the Fuzion firmly and comfortably holds the foot in a more structured biomechanical position instead of trying to seat the foot with two or three straps. The Fuzion’s design and materials ensure greater patient compliance for a variety of challenging clinical indications. Available for both select adult and pediatric patients. For more information, visit Orthomerica at AOPA, contact us at 877/737-8444, or visit Orthomerica’s newly redesigned website



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NEW—KNIT-RITE 4-WAY STRETCH SHRINKER WITH ROUNDED TOE Booth 701A The new 4-Way Stretch Shrinker offers superior fit qualities, is extremely soft, and is easier to don. Core-spun construction provides a wider range of stretch for a reduced number of sizes to fit more limb variations. • Silicone dot suspension band to help keep shrinker in place. AK available with or without waist belt. • Black version features X-Static to help prevent odor in the garment and provide wicking and thermal properties. • Available in Medium (20-30 mmHg) and Heavy (30-40 mmHg) compression, Transtibial and Transfemoral sizes. For more information, contact Knit-Rite at 800/821-3094 or email

SMARTKNIT® AFO & KAFO SOCKS Booth 701A Completely free of seams, Knit-Rite’s patented AFO and KAFO socks are knit like a cocoon, starting from the toe up. SmartKnit® seamless socks eliminate pressure points and help prevent skin irritations found in other traditional socks. Stretchy Core-Spun and Lycra yarns result in a form-fitting design that “hugs” feet and legs resulting in a seam-free, wrinkle-free sock providing protection and comfort. Moisture-wicking fibers transport moisture away from skin and help control odor in the sock keeping feet and legs cool, dry, and healthy. “No heel” design accommodates varying lengths in AFO and KAFO styles for perfect fit every time. For more information, contact Knit-Rite at 800/821-3094 or email 42


Compressogrip® by Knit-Rite—the original tubular compression prosthetic shrinker, has been widely accepted for more than 30 years! • New extra large transfemoral size accomodates up to 40”/102 cm circumferences. • Compressogrip shrinkers offer lower cost, easier donning, and are easier to stock than traditional shrinkers. • Tapered B/K shrinker option has an additional width at the top to accommodate larger thigh girth and reduces rolling and bunching. • Available in white, beige, or grey X-Static silver fiber. • Every latex-free Compressogrip roll is quality tested for consistent compression. For more information, contact Knit-Rite at 800/821-3094 or email

NEW—EASE BY THERAFIRM™ GRADIENT COMPRESSION HOSIERY Booth 701A The new Ease by Therafirm™ premium opaque gradient compression line complements Knit-Rite’s patented Core-Spun by Therafirm® compression socks—both engineered using ultra stretchy yarns for compression garments that are easier to put on and more comfortable to wear. • A very innovative premium line that is also affordable for patients. • Super soft, breathable material offers superior comfort for all-day wear. • Moisture wicking CoolMax fibers provide dry comfortable coolness.   • Delivers lab-tested true gradient compression to promote better blood flow, prevent mild to moderate swelling, and relieve tired, achy legs and feet. For more information, contact Knit-Rite at 800/821-3094 or email



See-through, thin—but powerful—high denier Lycra material uniquely squeezes prosthesis to the body. Better body integration improves control and proprioception. Patients state, “My leg feels more like a part of me.” The patented Power Belt uniquely provides high acceptance for auxiliary transfemoral suspension due to the greater functional benefit, comfort, and confidence it offers, whether for daily use or more demanding activities. Breathable material is cool and comfortable. Available in multiple styles for individual application. For more information, contact Knit-Rite at 800/821-3094 or email

KNIT-RITE SOFT SOCK® WITH 3-D TOE SHAPE Booth 701A Knit-Rite’s textile experts and prosthetists designed the original Soft Sock® using soft wicking fibers for comfort combined with the perfect amount of Lycra stretch for improved fit—now with Knit-Rite’s hemi-spherically knit distal end it is even better! • The patented 3-D distal shape provides patients superior fit and comfort over the flat “envelope” shape of other prosthetic socks. • Soft Socks are available in original CoolMax®, and with X-Static®—the Silver Fiber®, both exceptional to transport moisture away from skin and inhibit odor in the sock. • New Black and Pink color options also feature our unique “hugger” top, reducing bulk and rolling. • Soft and cuddly to the skin—enhanced by Knit-Rite fleecing equipment process. • Lycra provides stretch and exceptional fitting qualities. • Available with unique knit-in distal hole design which doesn’t add thickness to compromise fit, especially as socks are added! For more information, contact Knit-Rite at 800/821-3094 or email

KNIT-RITE LINER-LINER® PROSTHETIC SOCK WITH X-STATIC® Booth 701A The Liner-Liner is a unique prosthetic sock designed specifically to be worn under a suspension liner next to the skin for skin protection. This Knit-Rite innovation has proven for years to be extremely effective to reduce skin irritations and improve comfort with amputees who wear liners as the primary interface. • The ultra-thin material minimizes compromise to liner’s suction grip on the skin using high stretch yarns to provide excellent fitting qualities. • Moisture-wicking fibers enhance comfort while X-STATIC silver fibers assist in preventing odor in the garment. • Washable interface keeps liner cleaner and thereby helps reduce bacterial accumulation. For more information, contact Knit-Rite at 800/821-3094 or email


Developed by Knit-Rite and introduced to the prosthetic profession in 1980, the protective interface may be used with all types of spinal orthoses and body jackets. Torso-Interface provides cushioning, moisture-wicking, and anti-microbial properties to keep skin dry, protected, and comfortable. Seamless finishing provides improved skin protection and patient comfort and aids in preventing skin breakdown. Outstanding stretch allows the fit to be virtually wrinklefree. Variety of styles available including crew neck, v-neck, strapless, with or without axilla flaps. For more information, contact Knit-Rite at 800/821-3094 or email



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PATENTED KISS SUPERHERO REUSABLE TEST SOCKET PLATE Booth 1214 The unique design of this plate allows for easy casting tape removal, without damage. Damage-free casting tape removal allows this plate to be reused, saving costs. Visit www.kiss-suspension. com or call 410/663-KISS for more information.

THE STEALTH AIR™ Booth 901 The STEALTH AIR™ acts as an immobilizing device for the lower back and its primary function is to reduce pain and provide support and immobilization to the lumbar-sacral spine. Why did we name this brace Stealth Air? Depending on which sized brace the weight ranges from 9.9 oz. to 13.7 oz. making this the lightest brace Optec makes. Made with semi-rigid fabric, its structure is made with four self-molding and flexible plastic stays over which the strapping system operates. The STEALTH AIR™ perfectly adapts to many sizes and body types, thus ensuring maximum support and comfort. What makes this brace so much different than our current Stealth line? Not only the sizing and new breathable fabric but also we have made modifications to the compression system which is tear resistant! Through a new locking technology, operated by means of two crossing bands, the closure system is user friendly and allows a wide range of tension settings. It’s not a gimmick, the strapping system in the back along with the arthritic grips are designed to withstand an incredible amount of force. No longer will you have inventory issues! The STEALTH AIR™ is our most revolutionary back brace and is only three sizes fits all, which means more savings for you! Contact OPTEC USA customer service at 888/982-8181 or visit



NOTHING MEASURES LIKE SMARTMEASURE™ Booth 1401 Össur is proud to introduce SmartMeasure, an app for iPhone® and iPad® designed to measure custom knee braces. SmartMeasure is Össur’s most intuitive, efficient and accurate way to measure for any Össur custom knee brace, so you can spend more time with your patients and less time filling out forms. Download the free SmartMeasure app today! Apple, the Apple logo, iPhone and iPad are trademarks of Apple Inc., registered in the U.S. and other countries. To learn more about SmartMeasure by Össur, stop by AOPA booth 1401 or call 800/233-6263.

GO SLEEVELESS WITH THE UNITY™ SLEEVELESS VACUUM SYSTEM BY ÖSSUR® Booth 1401 Until now, all advanced vacuum systems have required a sleeve to maintain vacuum. The problem is, sleeves are bulky. They bunch behind the knee, restricting range-of-motion. They can also puncture, leading to a loss of vacuum. Enter Unity. Building on established Seal-In® technology, the Unity Sleeveless Vacuum System by Össur is the first advanced vacuum solution to generate 15-22 in Hg of vacuum without a sleeve. Visit AOPA Booth #1401 to learn how to get certified and check out the entire line of Unity-compatible Flex-Foot feet, including low-profile and microprocessor solutions. To learn more about the Unity™ Sleeveless Vacuum System by Össur, stop by AOPA booth 1401 or call 800/233-6263.


A NEW TWIST ON OA BRACING Booth 1401 Unloader One® with Smartdosing™ is a comfortable, lightweight, low-profile OA brace that provides excellent suspension and pain relief. The efficacy of our 3-Point Leverage System has been clinically proven by multiple peer reviewed studies. SmartDosing, powered by Boa® Technology, provides patients with a simplified, single-hand dosing dial for on-the-fly adjustability, helping them better manage their unicompartmental OA knee pain. Fit the Unloader One on any patient that has been prescribed an OA brace. If they are not happy with it for whatever reason, they can return it within 30 days for a full refund. To learn more about the Unloader One® with Smartdosing™ by Össur, stop by AOPA booth 1401 or call 800/233-6263.

PREPREG FROM OTTOBOCK Booth 1001 Give your patients the most advanced KAFO technology combined with the most advanced fabrication! Ottobock’s line of KAFOs is now available in prepreg, creating KAFOs up to 40% lighter than laminated alternatives. Prepreg also creates more consistent fabrication outcomes that avoid unwanted buildups. Ottobock Fabrication Services offers decades of expertise, exceptional customer service, and an unparalleled reputation for quality. Our expert services include water transfer, lamination, and prepreg carbon fiber. You can count on timely turnaround delivering the results you want. Visit or call 800/795-8846.

NEW! WALKON® REACTION AFO FROM OTTOBOCK Booth 1001 Lightweight, low profile, and extremely tough, the WalkOn Reaction is a great solution for patients with dorsiflexion weakness. With an anteriorlyplaced calf cuff and longer strut, the Reaction uses ground reaction forces to help extend the user’s knee. Like other Ottobock WalkOns, the Reaction is fabricated from a prepreg advanced carbon composite and helps users walk more naturally. Fitting is fast and easy, as is donning and doffing. Your patient gets great support, smooth rollover, and comfort all in one. Visit or call 800/328-4058.

STRIDE4 STANCE CONTROL KNEE JOINT FROM PEL Booth 1301 The new Stride4 Stance Control Knee Joint from Becker Orthopedic, featuring a four bar linkage mechanism, allows for better rotation and closer mimicking of anatomical knee motion. It offers three specific modes of operation: stance control, free motion and locked with stance phase flexion, allowing the practitioner to make easy adjustments while in each state. The Stride4 allows the patient to easily switch between locked and stance control modes, which provide the joint with approximately 3 degrees of flexion and shock absorption, when the lock option is engaged. For more information on this new joint, and all Becker knee products, call PEL 800/321-1264, via e-mail, or order online at



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Lower Limb Technology is a division of Spinal Technology Inc. We are a leading central fabricator of upper and lower limb orthotics and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality custom products and prosthetic devices, fast delivery time, as well as unparalleled customer support to our customers. For information, contact 800/253-7868, fax 888/775-0588, email, or visit

SPINAL TECHNOLOGY Booth 425 Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper and lower limb orthotics and prosthetics. Our ABC-certified staff orthotists/prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products, fastest delivery time, including weekends & holidays, as well as unparalleled customer support in the industry. Spinal Technology is the exclusive manufacturer of the Providence Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses. For information, contact 800/253-7868, fax 888/775-0588, email, or visit



BEBIONIC3—ADVANCED MULTIARTICULATING HANDS DESIGNED TO IMPROVE YOUR LIFE Booth 713 bebionic3 is the latest addition to SteeperUSA’s upper limb product portfolio, which includes state-of-the-art myo-electric prosthetic hands and control systems, robust body-powered components and lightweight cosmetic systems. Pioneering technology and innovative design features combine to make bebionic3 the most lifelike, functional, and easy-to-use multiarticulating hand commercially available. bebionic3 offers unrivalled simplicity with 14 easily accessible grip patterns, robust design and materials, smart electronics, individual finger motors, sleek aesthetics, and a natural profile. One-step programming with bebalance software makes clinical assessment and adjustment easier than ever before. Contact SteeperUSA customer service at 201/481-4126 or visit

TAMARACK HABILITATION TECHNOLOGIES LAUNCHES GLIDEWEAR PROSTHETIC LINER PATCH Booth 827 The GlideWear™ Prosthetic Liner Patch is designed to provide immediate relief and long-lasting protection from skin breakdown for lowerlimb amputees due to shearing between the skin and liner or socket. Simply place the GlideWear Prosthetic Liner Patch over the affected area before rolling the liner or socket over the top. Available in 2 sizes: Small (2.5 in. x 4.75 in.) and Large (4.5 in. x 7.5 in.) Contact your preferred O&P supplier to purchase or visit for more information.


PRESSUREGUARDIAN™ DEVELOPED BY TILLGES TECHNOLOGIES LLC Booth 1830 PressureGuardian™ is a compact portable pressure sensor device with a compatible data collecting and storing app. With PressureGuardian, valuable patient data is easy to collect, interpret, store, and transmit. The data collected with PressureGuardian allows you to store pressure load readings, wound photos and detailed patient information for a comprehensive record that can be saved, emailed, or printed for filing. PressureGuardian is setting the new standard for quality diabetic wound care and provides measurement, accuracy, and success for your facility and your patients. To learn more about PressureGuardian and C-Fab needs, visit or call 1855/4TILTEC (484-5832).


The integrated design of the DuraWalk foot’s toe pad, urethane heel, and low-cut foot shell provides multiaxial function for the user. The flexible toe spring allows for a smooth gait cycle while the foot’s multiaxial function delivers stability on uneven terrain. Unique to the foot is a detachable heel which clinicians may change the density of in order to maximize function. The DuraWalk’s construction and performance make it suitable for use in both transtibial and transfemoral applications. The foot has a maximum weight limit of 350 pounds. For more information, please call 800/848-4930 or visit a


POSTER AWARD These awards have been made possible by a special endowment by Becker Orthopedic and WillowWood.

Gain international recognition, $500 Cash and a trip to the 2013 O&P World Congress….Not to mention recognition and a trophy for your affiliated school. Submission Deadline is August 23, 2013.

NEW FOR 2013

Special recognition will be given to the school the student/resident is affiliated with.

To submit your abstract, visit https://

The American Orthotic and Prosthetic Association (AOPA) and its partners invite O&P Students and Residents to present research findings or a particular case study via a poster presentation at the 2013 O&P World Congress to be held September 18-21 in Orlando, FL, USA. The Otto and Lucille Becker Award will be presented for the best orthotic abstract submitted and the Edwin and Kathryn Arbogast Award for the best prosthetic abstract submitted by a qualifying student or resident. The winners will receive a $500 cash award, registration to the show, coach-class airfare to the Congress and three nights hotel. To qualify to present a poster in this category and be eligible for consideration for this award, the main author must be a student (baccalaureate or master level) or a resident at a qualified patient care facility. Abstracts will not be considered for either award if they have been previously presented, published, or are currently submitted with pending decision on acceptance elsewhere.

For further information, contact Tina Moran at 571/431-0808 or Visit our website at AUGUST 2013 O&P ALMANAC



Facility Spotlight By Deborah Conn

Service Minded How a 31-year-old facility still has what it takes to exceed expectations





fter graduating from New York University’s School of Orthotics and Prosthetics, David Kozersky, CPO, LPO, trained in Schenectady and then Columbus, Ohio, where he has remained. He launched Capital Prosthetic & Orthotic Center in May 1982, and today presides over six facilities in two states. Capital P&O has 26 employees, including seven practitioners, four fitters, and five technicians. According to Kozersky, a number of staff members have been with the company for many years, some as long as 30. “As I have grown and brought people on board, they have stayed. We don’t do non-competes; people stay because they want to,” he says. The facility’s corporate office in Columbus houses the majority of the staff in a 7,000-square-foot facility that includes three patient-care rooms and areas for administration, fabrication, and storage. A gait room features elevated walkways for patients, “so I don’t have to bend over anymore,” says Kozersky. He estimates that the practice sees approximately 10 orthotics patients for each prosthetics case, although in dollar value the two are about equal. Practitioners treat patients of all ages, from children to the elderly, says Kozerksy, “and we have a nice reputation for spine work. We now get the area’s most difficult patients.” Kozersky has invented a new type of back brace, which uses a patented CAM system that slides from side to side, allowing for better fit. “If you


Dave Riegle, CO, LO, fits a patient in the gait room at Capital Prosthetic & Orthotic Center.

have larger hips, the bottom section slides out,” he explains. “If you have someone like a weight lifter with a V-shaped chest, the top slides out. If someone gains or loses weight, the brace can slide out or in uniformly.” The orthosis uses a compound closure system that incorporates two pulleys, minimizing the effort required to secure the brace on the torso. This multi-brace lumbar sacral orthosis is still in beta testing, but a soft lumbar sacral orthosis (LSO) is commercially available. Kozersky has contracted with Core Products International in Wisconsin to offer worldwide distribution of his products. “There will be more

inventions,” he says. “I have so much fun working on this.” His latest project is a very lightweight thoracic LSO. “I reduced the standard weight by 40 percent, but the manufacturing time has increased a bit. It’s still a work in progress.” Capital P&O has a marketing professional on staff and uses both radio ads and billboards to publicize its services. Clinicians have personal meetings with physicians both to explain what Capital P&O does and to educate doctors about how to comply with recent Medicare changes when writing O&P prescriptions. “We want to make the physicians’ lives as easy as possible,” says Korzersky. “We’d like

Facility Spotlight

to be the go-to company when they have any questions about O&P.” Kozersky wants Capital P&O to be the go-to company for patients as well. The facility uses its website to promote its services and educate patients. On its Patient Resource Center webpage, Capital P&O includes a range of information, including descriptions of new technology and lists of helpful websites that deal with orthotics and prosthetics. The website also features descriptions of health conditions such as diabetes, scoliosis, plagiocephaly, and vascular diseases, offering explanations of the risks, implications, and available treatments for each. An O&P glossary of terms is provided and includes the gamut of anatomical terms, health conditions, and devices and professional and legislative designations. Capital P&O’s website also includes a brief guide to Medicare coverage, explaining how the process works and enlightening patients about what portion of their care they should be prepared to pay. Patients can download and print the documents they’ll need before an appointment, giving them time to fill out paperwork in advance. A separate website devoted to Kozerky’s back orthoses describes each device and promotes Capital P&O. Whether patients use the Internet or prefer to get their information directly from the facility, Kozersky is committed to providing the highest level of service. “I like to think we are like the character Lumière in Beauty and the Beast,” he says. “‘Be our guest, be our guest, put our service to the test.’ When you call our office, a human picks up the phone, someone with a sympathetic tone of voice that says, ‘We can help.’” a Deborah Conn is a contributing writer for O&P Almanac. Reach her at debconn@





Mid-Year Roundup An in-depth look at the issues receiving priority attention by AOPA and its partners


eldom has so much befallen the O&P community in such a short time. AOPA members with longer memories may recall a similar chaotic period with such devastating consequences, but those with only two or three decades of experience will be hard pressed to find anything comparable to the current challenging environment. To put it in perspective, what seemed like another somewhat innocuous Department of Health and Human Services (HHS) Office of Inspector General (OIG) report took a potshot at increased Medicare reimbursements for lower-limb prostheses. The report inferred something must be amiss (think fraud and abuse) because reimbursement dollars increased by 30-plus percent while the number of amputees dropped by 2.7 percent during that same time period (2005-2009). Here’s what that OIG report did not mention: Contributing significantly to those higher costs were advanced and costly prostheses necessary to meet the needs of wounded warrior amputees returning from Iraq and Afghanistan and long-delayed Centers for Medicare & Medicaid Services (CMS) fee schedule increases. Responding to the OIG report, the CMS Medical Directors issued the now infamous “Dear Physician” letter in August of 2011, which was a game changer. When all was said and done, the change incentivized CMS audit contractors to engage in bounty hunting to pick off high dollar prosthetic claims. In many instances, reimbursements for services performed even before the “Dear Physician” letter



policy change were clawed back because of alleged faulty paperwork, usually citing alleged insufficient medical necessity due to the lack of detail in physicians’ notes. Previously, however, similar prosthetists’ notes were often considered sufficient to establish medical necessity. One thing can hardly be in doubt: If someone has lost a limb, he or she almost always benefits from a prosthesis. O&P providers with years of experience have had to close their doors because their coffers were emptied by the audit contractors, which meant they couldn’t pay their employees or their suppliers. What’s more frustrating is the number of denied or clawed-back claim reimbursements that worked their way through the appeals system, all the way to the administrative law judge (ALJ), where a large number of those denials were overturned. Because the ALJs are overwhelmed by the volume of appeals, it’s a long, long waiting game if you have a claim in the system—often many months for the process to bring closure. Most of the O&P community knows that as a last resort—and only after exhausting every other avenue of relief—AOPA’s response was to file a lawsuit against CMS. The complaint cites CMS’s failure to follow the rules when making a policy change required by both the Medicare law and the Administrative Procedure Act. Government agencies must publish proposed rules or rule changes and allow stakeholders an opportunity for public comment.


a grandmother volunteer coordinator leisure walker jazz lover craft enthusiast avid bowler I am in control. I AM COLLEGE PARK.





Of course, the devastating Recovery Audit Contractor, Comprehensive Error Rate Testing, and prepayment audits have been the big pocketbook issues affecting patient care, but there has been a litany of other, but still important, issues that have demanded serious attention and resources. Growing concern over the increase in physician-owned distributorships— Medicare-enrolled physicians and physician groups that provide custom orthotics and prosthetics under arrangements with other enrolled suppliers—prompted the O&P Alliance to write HHS Inspector General Daniel R. Levinson. As reported in the July issue of O&P Almanac, the May 23, 2013, Alliance letter noted that, unlike a physician referral to a qualified O&P provider, the self-referral raises a specter of overutilization, potentially suspect medical judgment, unfair competition, and increased costs to the Medicare program and its beneficiaries. The profitability of those arrangements is presented at medical meetings, and, recently, there has been an upsurge of entities marketing turnkey O&P laboratory services, most notably in the area of vascular surgery. The Alliance letter also pointed out the similarities between the concerns raised in the March 2013 Fraud Alert with respect to primarily



implantable devices and the growing incidence of O&P physician-owned services and recommended that the same OIG attention be focused on those arrangements.

Looking Ahead In response to a request by the National Commission on Orthotic and Prosthetic Education, AOPA developed a strategy and retained experts to expand and increase the number of programs dedicated to providing a master’s degree level education in orthotics and prosthetics, in keeping with the new requirements adopted by the certifying entities. The Wounded Warrior Workforce Enhancement Act (S. 522) was introduced March 11, 2013, by Sen. Richard Durbin (D-Illinois) and co-sponsored by Sens. Richard Blumenthal (D-Connecticut), Saxby Chambliss (R-Georgia), and Tom Harkin (D-Iowa). The bill would award grants ranging from $1 million to $1.5 million to institutions with existing O&P programs or institutions seeking to create new programs, with a total of $15 million available through 2016. Another $5 million is available to an eligible institution to create a Center in Excellence for Orthotic and Prosthetic Education to improve the outcomes for veterans, members of the Armed Forces, and civilians by conducting evidence-based research on the best knowledge, skills,

and preparation needed to adequately prepare clinicians to provide effective, high-quality O&P care. Sen. Durbin also introduced the Wounded Warrior Research Enhancement Act (S. 521), which provides $30 million in fiscal 2014 to advance O&P clinical care for members of the Armed Forces, veterans, and civilians who have undergone amputation, traumatic brain injury, or other serious injury as a result of combat or military experience. The research would examine steps to prevent amputation, at what point O&P intervention is most effective, which interventions are most effective, which patients benefit most from different types of treatments, which O&P services best facilitate the return of members of the Armed Forces to active duty, and the effect of the aging process on the use of prosthetics. AOPA is continuing to push for reintroduction of the O&P Medicare Improvements Act in the 113th (H.R. 1958/S. 2125 in the 112th) Congress that would deal with fraud and abuse issues by requiring CMS to enforce the Benefits Improvement and Protection Act of 2000, Section 427 (BIPA 427), limiting reimbursement to qualified or licensed providers that offers savings of $250 million over five years. The reintroduction of the Insurance Fairness Act (S. 773/H.R. 4175 in the 112th Congress) also is being pursued. This legislation requires insurers who offer O&P coverage to offer the same benefits as other surgical and medical coverage without caps or other limits. No mandate is involved, just fairness when insurers offer an O&P benefit. In the meantime, AOPA continues to track regulatory and enforcement developments at HHS, the Food and Drug Administration, the Internal Revenue Service, and all of the other agencies of government that touch the daily lives of members and patients. These and other issues will continue to receive priority attention by AOPA and its Alliance partners. Stay tuned for more progress reports. a

STAND UP for your

PROFESSION! It was said that Caesar fiddled while Rome burned. Our profession is on fire and at threat of being diminished to a state that will make it impossible for us to accomplish our mission. The stakes are high and the risks of our ability to provide quality care are becoming more and more difficult. Yet, we still have those who say it is not my business or I can not make a difference. What will it take to get those who stand on the sideline involved so they will help those who carry the ball? Will it require that... A

our service be constantly backed up with physician notes?

A we face our business doors being closed? A

we be questioned about whether or not our service is essential?


we be faced with encroachment from other professions?


we spend more time doing the paperwork required to provide a service than the time it takes to do the service?


we receive reimbursement that is so poor it becomes more and more difficult to keep the doors open?


individuals change professions due to the complexity of operating in our present environment?

I could go on but it would do no good. We all know what the problem is and yes, we know what the answer is. You need to say I am mad as hell and I am not going to take this anymore. How you can have a voice is thru the AOPA Political Action Committee.

Being at the AOPA Wine Tasting and Auction Fundraiser shows your support for AOPA government relations efforts. Therefore, we ask that you help in these Healthcare battles by BIDDING HIGH AND BIDDING OFTEN!!!

Our PAC is fighting all those problems listed above and many more. The only problem is that it is too small and does not have enough funds to do the job we need done. I once made the statement “you donate to your church, your school and to other charities, but you do nothing to insure that you can continue to support those causes”. By that I mean, donate to your PAC to insure that your profession and livelihood will be represented and protected. But to insure these rights, it costs money to educate our legislatures and representatives. If our elected officials do not understand who we are and what we do, then that is our fault. It is the responsibility of everyone who is associated with this industry to stand up and be counted by their numbers and funds. Liberty is not cheap and the right to practice your profession is not either. All of us must stand up and be counted with our time, talents and funds. You can no longer stand by and watch our profession go up in flames. Please do this for yourself, your family,and your future. If you have not signed a PAC authorization form - DO IT NOW. The law says you must agree to be solicited for a contribution. If you have signed an authorization form, then you know what to do next! But Please DO IT NOW. Rick Fleetwood, PAC Chair

This year’s event will be on Thursday, Sept. 19, during the 2013 O&P World Congress in Orlando. For more information, contact Devon Bernard at



AOPA Contests CMS’ Motion to Dismiss Lawsuit


motion to dismiss the lawsuit AOPA filed in May to seek relief from unfair and unauthorized actions of the Centers for Medicare and Medicaid Services (CMS) was filed on July 19 by the U.S. Department of Justice (DOJ), which represents the federal government. As reported in the June issue of the O&P Almanac, AOPA filed suit in reference primarily to the actions of CMS’s Recovery Audit Contractor (RAC) auditors and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) relating to physician documentation requirements. AOPA’s suit challenges the absence of appropriate due process in violation of the federal Administrative Procedure Act and the Medicare statute around Medicare’s decision in August 2011 to change the standard for demonstrating medical necessity, as evidenced in the new physician documentation requirements and related audits of claims for services both before and after August 2011. The lawsuit alleges Medicare violated several federal rules and statutes in the way it implemented these changes, violations which AOPA has asserted render the changed standard illegal, and therefore contends that amounts clawed back via audits by Medicare RAC and other auditors relying on that changed standard also are invalid. On July 19th, DOJ responded with its motion to dismiss, maintaining that the Federal District Court does not have the jurisdiction to hear and decide this lawsuit. DOJ/Medicare also maintained that AOPA had not “exhausted all of its administrative remedies” within the Medicare system itself, and for other reasons had failed to meet the requirements imposed on anyone who wants to sue Medicare.



Hope for a Fair Remedy Although the Medicare statute makes it difficult for aggrieved parties to sue the Medicare program due to restrictions limiting judicial review of Medicare program decisions, AOPA’s attorneys carefully studied all of the rules before filing the lawsuit. The attorneys maintain AOPA has a solid basis to bring this matter to trial in the federal courts. At presstime, AOPA’s attorneys were in the process of filing AOPA’s rationale in a submission to the Federal District Court, contesting the DOJ/Medicare motion to dismiss.

Retroactive Audits Cancelled There has been at least one positive outcome possibly attributable to the filing of AOPA’s lawsuit. One of the major claims in AOPA’s lawsuit is that the CMS audit contractors inappropriately applied the new standard articulated in the August 2011 Dear Physician Letter retroactively to claims in 2009 or 2010. In July, some AOPA members, at least initially confined to Jurisdiction A, notified AOPA stating that they had received notice cancelling recent audits on claims with a date of service prior to August 2011. Members reported that audit contractors explained these cancellations by saying they had received a notification from CMS instructing those cancellations. CMS has said nothing to explain this action, and in fact, senior CMS officials have said there has been no known communication from CMS to RAC auditors (or DME MACs, or others) instructing the auditors to rescind

or cancel any or all prosthetic audits with service dates prior to the August 2011 Dear Physician Letter. If reports by practitioners of audit cancellations for this reason were true, it could be interpreted to constitute a recognition by cries of an important change in the standard via the August 2011 Dear Physician letter and that it is unfair and inappropriate to apply that new standard retroactively, according to AOPA President Tom Kirk, PhD. So far, the cancellation of retroactive audits has not resulted in any change in the lawsuit itself. It is possible that the cancellations are simply a case of the government deciding to change its policy so it can report in court that it has limited pursuit of retroactive claims. Despite the retroactive cancellations, there is no indication that CMS/Medicare will return the dollar amounts its auditors already have collected retroactively. However, it is encouraging that at least one CMS auditor appears to have instructed its audit contractors to cancel existing claims under review for prosthetic O&P services where the service date is prior to August 2011, and presumably not to initiate new prosthetic O&P claims for that retroactive period. AOPA stands firm in the position on behalf of prosthetists and patients stated in its lawsuit, and the organization is hopeful that the Federal District Court will ultimately rule in AOPA’s favor on the government’s pending motion to dismiss, and at full trial.


O&P Litigation Fund Draws Impressive Response More than 330 companies and individuals have generously responded to help fund the AOPA lawsuit against the Centers for Medicare & Medicaid Services (CMS). To date, nearly 15 percent of AOPA member companies have contributed $95,000, with contributions ranging in size from $100 to $3,000. Members recognize the arduous path AOPA has followed since the August 2011 Health and Human Services Office of Inspector General Report inferring fraud in lower-limb prosthetics. AOPA and O&P Alliance meetings with top CMS officials, including three meetings with Administrator Marilyn Tavenner, have not yielded any resolution. The audits have only accelerated, becoming more widespread and harmful to patients and members. Many members are finding themselves in financial straits due to Recovery Audit Contractor and prepayment audits; however, AOPA urges all members to consider contributing to this fund. Those who donate will become charter members of the Heritage Club and receive ongoing recognition for helping preserve the future of O&P. Contributors will have their company names displayed on a large  plaque at future annual

events and will have identifying ribbons attached to their name badges at the 2013 World Congress and future National Assemblies. These visible reminders will identify those in the O&P community who have stepped up to ensure their own survival in the years to come. The O&P world is changing, and this lawsuit may be only the first in a series of legal actions that offer a pathway for survival. Contributions will be used only for two purposes: litigation and necessary research in the unlikely event that there are funds remaining after the litigation. Donations can be made online at forms/support-the-op-profession/. To review the complaint filed by AOPA, visit

Don’t Get Stuck With the Bill: Medicare Inpatient Billing– Join the Audio Conference August 14 Are you talking to the correct representatives from the inpatient facility? Join AOPA August 14 for an AOPAversity Mastering Medicare Audio Conference that will focus on Medicare inpatient billing for your O&P practice. Gain an important edge by learning useful strategies to determine who is responsible for your bill. An AOPA expert will address the following issues: • Proper use of the “Two-Day Rule” • Skilled nursing facility prosthetic exemptions • Part A rules and hospice • Statutorily noncovered services • Billing responsibility.



AOPA members pay just $99 to participate ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at or 571/431-0854 with content questions. Register online at Contact Betty Leppin at or 571/431-0876 with registration questions.


Read Between the Lines: The Medicare Lower-Limb Prosthetic Policy— Join the Audio Conference September 11 Are you making the right adjustments and repairs? Join AOPA on September 11 for an AOPAversity Mastering Medicare Audio Conference that will cover the details of the Medicare Lower-Limb Prosthesis Local Coverage Determination and Policy Article. The audio conference will help you gain a better understanding of what is covered and when. The following topics will be covered: • Prosthetic functional levels • Coverage of initial, preparatory, and definitive prostheses • Skilled nursing facility prospective payment system exemptions

• Adjustments and repairs • Replacements • Useful lifetime restrictions. AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@ or 571/431-0854 with content questions. Register online at Contact Betty Leppin at or 571/431-0876 with registration questions.

Mastering Medicare: AOPA’s Advanced Coding & Billing Techniques Mirage Hotel & Casino October 22-23, 2013, Las Vegas Join your colleagues October 22-23 at the Mirage Hotel & Casino in Las Vegas for AOPA’s “Mastering Medicare: Advanced Coding & Billing Techniques” seminar. AOPA experts will provide up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Designed for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage.

Register online for the “Mastering Medicare: Advanced Coding & Billing Techniques” seminar in Las Vegas at http:// Questions? Contact Devon Bernard at dbernard@aopanet. org or 571/431-0854.




Log On to AOPAversity Online Meeting Place for Free Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you. For a limited time, AOPA members can learn and earn for FREE at the new AOPAversity Online Meeting Place: Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn continuing education credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis.

AOPA also offers two sets of webcasts: • Mastering Medicare: Coding & Billing Basics. These courses are designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare. • Practice Management: Getting Started Series. These courses are designed for those establishing a new O&P practice. Register online by visiting

Welcome to AOPA Jobs AOPA’s Online Career Center gives you access to a very specialized niche. The Online Career Center is an easyto-use, targeted resource that connects O&P companies and industry affiliates with highly qualified professionals. The online job board is designed to help connect our members with new employment opportunities. • Job Seekers: Post your resume online today, or access the newest jobs available to professionals seeking employment. Whether you’re actively or passively seeking work, your online resume is your ticket to great job offers. • Employers: Reach the most qualified candidates by posting your job opening on our Online Career Center. Check out our resumes and only pay for the ones that interest you. • Recruiters: Create and manage your online recruiting account. Post jobs 58


Coding Questions Answered 24/7

to our site and browse candidates interested in your positions. The AOPA Online Career Center is your one-stop resource for career information. Create an account and learn about opportunities as a job seeker, an employer, or a recruiter. Get started at In addition, take advantage of O&P Almanac’s Jobs section to post or browse an employment opportunity, and advertise to AOPA’s 2,000+ member organizations! Regardless of your staffing needs or budget, we have an option that is right for you. For more advertising opportunities, please contact Dean Mather, advertising sales representative, at 856/768-9360 or

AOPA members can take advantage of a “click-of-the-mouse” solution available at AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways––by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at or 571/431-0854 with content questions.


Join us!

Why you should plan to attend: • Research and development expenditures in the United States are more than $95 billion, making the United States the leader in medical innovation and creating the ideal location for a unique gathering of high visibility and importance. • Superior Clinical Education featuring the best speakers from around the world. Hear from physicians, researchers, and top-notch practitioners. • Practical learning and live demonstrations.

SE PTEM BE R 1 8 - 2 1 , 2 01 3 Orlando, Florida, USA Gaylord Palms Resort & Convention Center

Don’t miss the opportunity to participate in an expanded National Assembly in 2013 as AOPA and partners from around the world work to create an O&P World Congress experience for practitioners in the Western Hemisphere and around the world.

• Preparation for the massive changes that U.S. healthcare reform is sure to bring, and its influence on global health policy. • Networking with an elite and influential group of professionals. • Largest display of exhibits in the United States for the orthotic, prosthetic, and pedorthic profession • Ideal U.S. location chosen for travel ease and popularity.

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

For more information, contact us at or visit



Are You Still HIPAA Compliant? Stay Protected in the Wake of the Omnibus Final Rule


n Jan. 17, 2013, the federal government released the long-awaited HITECH Act Omnibus Final Rule, clarifying the HIPAA compliance obligations of health-care providers, health plans, and their business associates. The HITECH Act significantly expanded the reach of HIPAA by imposing additional obligations upon covered entities, including orthotics and prosthetics suppliers; by requiring the reporting of data breaches; by rendering business associates directly liable for violations of HIPAA; and, by substantially increasing available civil and criminal penalties under the law. The HITECH Act also changed the enforcement climate. Recent investigations by the Office for Civil Rights (OCR) signal a dramatic shift in the government’s approach to enforcement, from a reactive approach focused on education to a proactive approach in which covered entities and business associates of all sizes are expected to achieve and sustain compliance. In addition, the OCR has implemented a new audit program, through which the HIPAA compliance status of selected covered entities and business associates will be evaluated. Please join us for an interactive, practical discussion on key aspects of HIPAA compliance. In this one-hour program, we will address:



• The compliance obligations of covered entities, business associates, and downstream subcontractors; • The impact of the Omnibus Final Rule upon compliance; • The new OCR audit program and what to expect from an enforcement perspective; • How to determine whether an unauthorized use or disclosure of PHI rises to the level of a breach, including a review of how the breach standard has changed; and • An overview of compliance with the Security Rule, including the importance of securing portable electronic media.

Speakers • Kimberly J. Kannensohn, Partner, McGuireWoods LLP • Amanda L. Enyeart, Associate, McGuireWoods LLP

Who Should Attend Managers, compliance officers, medical records supervisors, risk managers, and information technology personnel within your organization will benefit from this presentation regarding how to achieve and sustain compliance under HIPAA and the HITECH Act.

How to Register This program is free for all AOPA members. Visit forms/2013-hipaa-the-hitech-final-rulewebinar/ to register. The email address entered into registration is where participant materials and dial-in information will be sent. Questions? Please contact Betty Leppin at 571/431-0876 or bleppin@


About the Congress

Participate in the Second Annual AOPA OPTA Technical Fabrication Contest Don’t miss out on a fun and exciting opportunity to compete with your colleagues in the 2nd Annual AOPA OPTA Technical Fabrication Contest. Enter the contest to fabricate a partial foot prosthesis. Your device may be selected as a cash prize winner in one of three categories: Student, Technician, and Practitioner. Contestants may determine the final shape and cosmetic finishing, and may choose amputation level; contestants must include a short description specifying the issues addressed in the design of the device. A $25 entry fee with online registration is required.

There will be a winner and runner-up in each category; these individuals will be awarded cash prizes and certificate/trophy recognition. Additionally, special recognition in the form of a trophy and press release announcement will be awarded to the school representing the winning students. In addition, one entry will be recognized as the Attendees’ Choice Award. Register today at techfab2013. Contact Steve Custer for registration/administrative questions at or 571/4310810. Contact Scott Wimberley for

The 2013 O&P World Congress already is the most talked about event for 2013—the premier destination for the worldwide O&P community. Register today to participate in an expanded National Assembly as AOPA and partners from around the world work to create an O&P World Congress experience for orthotic, prosthetic, and pedorthic professionals in the Western Hemisphere and around the world. Learn more or register for the congress atSPONSORED BY Gain ABC, OPTA, OTTOBOCK,


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device/technical assistance questions at or 425/349-9557. more or The contest Learn is sponsored byregister ABC, for the congre or contac OPTA, OttoBock, Cascade-USA, and Steve Custer at scuster@AOPAnet.or AOPA.

or 571/431-0810.

O&P Almanac Magazine— Don’t Miss an Issue! If you aren’t receiving and reading AOPA’s official magazine every month, you don’t know what you’re missing. The O&P Almanac is the most respected source for industry insight and association news in the O&P industry. Featured topics include emerging technologies, coding and reimbursement education, premier meetings, people and businesses in the news, and industry modernization.

As a member of AOPA, or a credentialed practitioner with ABC or BOC, you receive a print copy of the O&P Almanac monthly. Your print issue features all of the latest O&P news, regular departments, and special features on hot topics. A digital version of each issue also is available on AOPA’s website at under “Publications.” If you are not a member of AOPA, or a credentialed practitioner with ABC or BOC, you may purchase a year subscription of the O&P Almanac at AOPA’s Online Bookstore,




Follow AOPA on Facebook and Twitter Follow AOPA on Facebook and Twitter to keep on top of latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities. Like us on Facebook at: www.facebook. com/AmericanOandP with your personal account and your organization’s account! Follow us on twitter: @americanoandp, and we’ll follow you, too! Contact Steve Custer at or 571/4310835 with social media and content questions.

Top 5 Reasons To Follow AOPA: • Be the first to find out about training opportunities, jobs, and news from the field. • Build relationships with others working in the O&P field. •

Stay in touch with the latest research, legislative issues, guides, blogs, and articles—all of the hot topics in the community.

• Hear from thought leaders and experts. • Take advantage of special social media follower discounts, perks, and giveaways. a

O&P PAC Update The O&P PAC would like to acknowledge and thank the following AOPA members for their recent contributions to and support of the O&P PAC*: • • • • • • • • • •



Robert Arbogast J. Martin Carlson, CPO Ted Drygas, CPO Rick Fleetwood, MPA Tim Lacy, CP Brad Mattear, CPA, CFo Steve McNamee, CP, BOCO, FAAOP Brad Ruhl Lisa Schoonmaker, CPO, FAAOP Claudia Zacharias, MBA

The O&P PAC advocates for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@ *Due to publishing deadlines this list was created on July 1, 2013, and includes only donations received between March 21, 2013, and July 1, 2013. Any donations received on or made after July 1, 2013, will be published in an upcoming issue of O&P Almanac.

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

O&P Business Management: This unique leadership learning experience will provide business owners, managers and practitioners an opportunity to experience fresh insights, new tools and proven techniques as a pathway for developing better business practices, while creating ongoing returns for your company. ■ REFRESH YOUR KNOWLEDGE ■ DEVELOP BETTER BUSINESS PRACTICES ■ ADVANCE YOUR CAREER ■ CREATE ONGOING RETURNS FOR YOUR COMPANY

Earn Your Certificate in


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

How to get started: 1.

Complete the online sign up form:


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

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


Complete a Module specific quiz for each program.


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


Welcome new members! The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume: Level 1: equal to or less than $1 million Level 2: $1 million to $1,999,999 Level 3: $2 million to $4,999,999 Level 4: more than $5 million.

American Prosthetic & Orthotic Care LLC 223 26th Street Huntington, WV 25703 304/521-4988 Fax: 304/521-4896 Category: Patient-Care Member Shamshad Ahmed, CPO

Arkansas Prosthetics & Pedorthics 119 W. Carpenter Street Benton, AR 72015 501/860-6910 Fax: 501/860-7587 Category: Patient-Care Member Jessica Mungle



Barnhart Prosthetic & Orthotic Services Inc. 1881 2nd Street, Ste. 101 Springfield, OR 97477 541/485-5929 Fax: 541/485-3955 Category: Patient-Care Member Sally Hedrick

Bonafide Management Systems 241 Lombard Street Thousand Oaks, CA 91360 805/908-2333 Fax: 805/777-7661 Category: Supplier Member Caroline Williams

FW Toenges & Sons Inc. 2415 Hobson Road Fort Wayne, IN 46805 260/484-4742 Fax: 260/482-2966 Category: Patient-Care Member Lisa Long

IDEAS Avenue de Villefranche, #80 Rixensart, B-1330 Belgium +011/322-686-0440 Category: Supplier Member Stephane Huberty, MD

Jenco Medical/dba Utah Prosthetics & Orthotics 356 E. 600 S. St. George, UT 84770 435/688-9338 Fax: 435/673-3747 Category: Patient-Care Member Tricia Topping

Precision Orthotics & Prosthetics Inc. 2550 Beverly Blvd., Ste. 201 Los Angeles, CA 90057 213/388-5847 Category: Patient-Care Member Nancy Bernal

Prosthetic Management Group LLC 5184 Caldwell Mill Road, Ste. 204-183 Birmingham, AL 35244 205/531-1047 Category: Patient-Care Member Randy Lindsey

Renewal Technologies 10446 N. 74th Street, Ste. 120 Scottsdale, AZ 85258 480/588-7887 Category: Supplier Affiliate Member Parent: Orthotic & Prosthetic Group of America (OPGA), Waterloo, IA

Stratus Orthopedic Supply Inc. 3021 Lorna Road, Ste. 302 Birmingham, AL 35216 205/822-2400 Fax: 205/822-5710 Category: Patient-Care Member John Quillen

Sunshine Prosthetics and Orthotics 1700 Route 23 N., Ste. 180 Wayne, NJ 07470 973/696-8100 Fax: 973/696-8101 Category: Patient-Care Member Brooke Artesi, CPO, LPO, CMF a


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

Mid-Atlantic CPO Richmond, Virginia

- 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 scuster@, 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

& Prosthetic





American Orthotic

mediakit Rates


O&P Since

1, 2013 effective Jan.

Call Dean Mather, advertising sales representative, at 856/768-9360 or email DMATHER@MRVICA.COM.





Looking for Job Opportunities in Richmond, Virginia? The McGuire VA Medical Center in Richmond, Virginia, is currently seeking applications for an orthotist/ prosthetist in our Prosthetic Treatment Center. The VA Medical Center in Richmond, Virginia, is accepting applications for a certified prosthetist/orthotist. The CPO will perform orthotic/prosthetic functions and provide appropriate orthotic and/or prosthetic devices and treatment. The primary purpose of this position is to provide high-level technical skill fabrication of orthotic and/or prosthetic devices to Prosthetic Treatment Center and Traumatic Center patients. Salary is commensurate with experience and education. An excellent federal government employee benefit package is offered that includes health, life, and long-term care insurance, and the Federal Employee Retirement System. Generous vacation and sick leave starts to accrue on the first full pay period. If you are interested in finding out more about the position and how to apply, visit us at:


CO Norfolk/Virginia Beach and Newport News, Virginia Certified orthotist for southeast Virginia. We are a well-established prosthetic and orthotic company in Norfolk/Virginia Beach and Newport News areas of Virginia. We are seeking an individual with a minimum of three years of experience who is self-motivated. This individual must be able to service our local hospitals and nursing homes, as well as in-office patients. We offer a competitive benefits and salary package. Send resume to:

Coastal Prosthetics & Orthotics Fax: 757/892-5303 Email:


Member Benefits Live and work, where you can play.

Experience the Benefits of AOPA Membership

Challenging RAC and CERT audit policies implemented this past year by overly aggressive CMS contractors is AOPA’s number one priority. All options are on the table to eliminate these burdensome and patient harming practices. Your Voice in Washington. AOPA’s staff and the lobbying team of former CMS Administrator, Tom Scully of the Alston & Bird law firm and Nick Littlefield, former chief of staff for Sen. Ted Kennedy and now a partner in the Foley Hoag law firm bring years of healthcare knowledge and experience to the issues of O&P. AOPA’s efforts help assure equitable reimbursement policies in these uncertain financial times to ensure quality patient care.


Experience the Benefits of AOPA Membership

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

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

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

Membership in AOPA is one of the

best investments that you can make • Expert Reimbursement and Coding Guidance. AOPA’s reimbursement specialists provide coding advice and keep you up-to-date on the latest Medicare quality standards, billing rules and regulations. Answer all of your questions related to O&P coding, reimbursement and compliance—via telephone or email. Members have unlimited access to AOPA staff experts.

in the future of your company.

Making Your Voice Stronger. The O&P Political Action Committee supports candidates who understand the unique contribution the O&P community makes to restoring lives E hope. E GUID and VALU MEMBER rg





efits Member Ben AMER ICAN




s of AOPA Me

the Benefit

ic Association

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n Orthotic services; audit of the America regulation and RAC and CERT year The mission Challenging business in laws, of the O&P ented this past to e treatment g skills; and policies implem ve CMS contracfor favorabl and marketin management by overly aggressi priority. ion. s improve their number one the associat to help member tors is AOPA’s to elimiindustry and on the table nding of the All options are ss and understa ome and patient raise awarene nate these burdens s. Research. harming practice eness • Cost Effectivg climate of health AOPA’s t. in Washington. The changin driven • Your Voice lobbying team of former • Making Your Voice Connec to a patient Forum moving the is Policy care more staff and Scully of ton AOPA’s Annual is demanding strator, Tom process and leaders to Washingand to CMS Admini and Nick e of cost effective s brings O&P Bird law firm and more evidenc level briefing for the Alston & outcomes. AOPA chief of staff to receive high story personally to ness to measure series of Littlefield, formery and now a partner deliver the O&P Congress. the first in a has funded s of Sen. Ted Kenned law firm bring that will measure their member Hoag research projects ness of timely O&P and in the Foley Coding re knowledge rsement and the cost effective the same years of healthca issues of O&P. • Expert Reimbu patients with reimbursement the treatment of did not experience to equitable Guidance. AOPA’s coding advice patients who help assure diagnoses as cost effecAOPA’s efforts in these the More specialists provide t. on te policies up-to-da receive treatmen projects will be reimbursement l times to ensure s, and keep you e quality standard tiveness research simply too expenuncertain financia latest Medicar regulations. Answer are care. and necessary and al O&P businesses quality patient billing rules s related to te r. sive for individu all of your question sement and Voice Stronge AOPA can aggrega tee reimbur to undertake. • Making Your to conduct email. Action Commit O&P coding, s of the field telephone or The O&P Politicaltes who understand the resource to compliance—via . unlimited access supports candida tion the O&P this vital research Members have the unique contributo restoring lives AOPA staff experts. makes community and hope.


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

Orthotist/Prosthetist-Certified Evaluate, design, fabricate and fit devices for patients that have a limb or segment of a limb missing due to congenital or traumatic reasons, or with disabling conditions of the extremities and spine. Must be a graduate of Orthotic or Orthotic/Prosthetic Practitioner Program. BA/BS preferred. Formal training must include basic design principles and fitting skills in lower and upper extremity prosthesis and orthoses. Thorough knowledge of anatomy, kinesiology, developmental philosophy, mechanics and biomechanics. ABC Certification in Orthotics or Orthotics/ Prosthetics. A minimum 3 years of experience as a CO or CPO preferred. Experience in Pediatric Orthotics would be helpful.

Apply online at: Search by position number MC130328 1000 North Oak Avenue, Marshfield, WI 54449

Join today!

Tina Mann

Clinic Manager

Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

“Six doctors came walking in my room, surrounded my bed and they told me I would not get up again.” Today Tina Mann walks, hikes, rock climbs, bikes and lives life fully thanks to Hanger Clinic. She was so inspired by her experience that she became an orthotic resident with Hanger Clinic. Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all available through a career at Hanger Clinic.

View our current positions and apply online at: or scan the QR code.

Hanger was recently named one of Forbes Best Small Companies in America.

Hanger, Inc. is committed to providing equal employment to all qualified individuals. All conditions of employment are administered without discrimination due to race, color, religion, national origin, sex, age, disability, veteran status, citizenship, or any other basis prohibited by federal, state or local law. Residency Program Info, contact: Robert S Lin, MEd, CPO, FAAOP Director of Residency Training and Academic Programs, Hanger Clinic, Ph. 860.667.5304; Fax 860.666.5386.

Available Positions: Clinic Manager Morgantown, WV Herndon, VA

Seattle, WA Portland, OR

Seattle, WA Bellevue, WA Burbank, CA Englewood , CO Valdosta, GA Dayton, OH Columbus, OH Wilmington, NC

Thomasville, GA Tamarac, FL Annapolis, MD Buffalo, NY Johnson City, NY Redding, CA Stockton, CA

Wichita, KS Louisville, KY Hammond, IN Evansville, IN Cary, NC

Beaufort, SC Richland, WA Grand Junction, CO Panama City, FL

Prosthetist / Orthotist



Jackson, MS Hattiesburg, MS

Williamsport, PA




YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiplechoice and clinical-simulation exams. Apply now at http:// For more information, visit www. or email cert@


AUGUST 8 WillowWood: LimbLogic® Practitioners. Mt. Sterling, OH. Course focuses all the clinical aspects of LimbLogic from operation to appropriate usage. Work with patient models and complete a fully operational LimbLogic socket to an initial dynamic fitting stage. Credits: 7.0 ABC/7.0 BOC. Registration deadline was July 18, 2013. Contact 877/665-5443 or visit ■

AUGUST 9 WillowWood: LimbLogic® Technicians. Mt. Sterling, OH. The course focuses on elevated vacuum socket fabrication. Includes basic operation and hands-on fabrication of LimbLogic adapters. Work with patient models and fabricate a LimbLogic socket. Credits: 8.5 ■



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................$5.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of 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 68


ABC/8.75 BOC. Registration deadline was July 18, 2013. Contact 877/665-5443 or visit AUGUST 14 AOPAversity Audio Conference–Don’t Get Stuck With the Bill: Medicare Inpatient Billing. For more information, contact Stephen Custer at 571/431-0876 or ■

AUGUST 15-17 Annual Scoliosis Symposium With the Addition of Lower-Limb Orthotics Management. Hosted by Spinal Technology Inc., Boston. Course will cover measurement techniques and brace options for lower-limb orthotics, fulltime scoliosis bracing protocol for adolescent idiopathic scoliosis, and the Providence Nocturnal Scoliosis System, with hands-on demonstrations in each segment. Presenters include Tufts Medical Center orthopedic surgeons, a Tufts neurosurgeon, and ABCcertified practitioners. Eligible practitioners can earn 16.25 ABC credits for attending the full presentation. For more information, contact Nancy Francis at 508/775-0990 x8374, or email nancy_f@spinaltech. com. ■

AUGUST 20-22 WillowWood: OMEGA® Training. Mt. Sterling, OH. Covers basic and advanced software tool use and shape capture by scanning. ‘By Measurement’ shape creation and custom liners discussed. Includes extensive handson practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: 19.25 ABC/19.25 BOC. Visit ■

SEPTEMBER 1 ABC: Application Deadline for Certification and Clinical Patient Management (CPM) Exams. Applications must be received by Sept. 1, 2013, for individuals seeking to take the November 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians or December/ January CPM exams for orthotists and prosthetists. Contact 703/836-7114, email, or visit ■

SEPTEMBER 3 WillowWood: Intro to OMEGA®, via WebEx, 1:30 PM ET. Potential CAD users have opportunity to investigate OMEGA and find out how the system benefits a growing O&P practice. Credits: 2.5 ABC/2.5 BOC. Visit ■

SEPTEMBER 5 WillowWood: Alpha DESIGN® Liners, via WebEx, 1:30 PM ET. This webinar is the customization of Alpha Liners when off-theshelf options do not suffice. Session educates attendees on how to use OMEGA software individually or in conjunction with WillowWood staff for creating a custom Alpha® Liner. Credits: 2.5 ABC/2.5 BOC. Visit www. ■ SEPTEMBER 11 AOPAversity Audio Conference–Read Between the Lines: The Medicare Lower-Limb Prosthetic Policy. For more information, contact Stephen Custer at 571/431-0876 or scuster@ ■


SEPTEMBER 16-21 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was July 1, 2013. Contact 703/8367114, email info@abcop. org, or visit certification. ■

SEPTEMBER 18-21 O&P World Congress. Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or ■

OCTOBER 3-5 The Virginia Orthotic & Prosthetic Association, 2013 Annual Meeting and Scientific Sessions. Hyatt Fairfax at Fair Lakes, Fairfax, VA. Online registration and hotel reservations were available beginning May 18, 2013. Calling for papers for the orthotics, prosthetics, and technical tracks as well as for the Compliance Clinic. Abstract submission deadline was June 15. Email abstracts to ■

OCTOBER 9 AOPAversity Audio Conference—What’s the Word: A Health-Care Reform Update and What You Can Expect. For more information, contact Stephen Custer at 571/431-0876 or

OCTOBER 18-20 National Pedorthic Services—Educational Course: Pedorthic Extremes: Managing Difficult and Challenging Feet. Milwaukee. For more information, contact Brian Dalton at 414/438-6662, email, or visit

OCTOBER 12 POMAC (Prosthetic and Orthotic Management Associates Corporation) Continuing Education Seminar, Co-Sponsored with PEL Supply Co. New York. LaGuardia Airport Marriott. Contact Drew Shreter at 800/946-9170 or visit www.

OCTOBER 22-23 AOPA: Essential Coding & Billing Seminar. Mirage Hotel & Casino. Las Vegas. To register, contact Stephen Custer at 571/431-0876 or

SEPTEMBER 22 Footcentric. Durham, NC. Learn gait analysis and evidence-based treatments including orthotic modifications and taping for athletic injuries of the foot and ankle while supporting a good cause. 8 CEUs. Register at ■

OCTOBER 1 ABC: Practitioner Residency Completion Deadline for November and December/ January Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email, or visit www. ■




NOVEMBER 1 ABC: Application Deadline for Certification Exams. Applications must be received by Nov. 1, 2013 for individuals seeking to take the January 2014 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians. Contact 703/8367114;; www. ■

NOVEMBER 6-8 The New Jersey Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. Bally’s Hotel and Casino. Atlantic City. For more information, visit membership/chapters/new_ jersey/. ■

NOVEMBER 11-16 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams is Sept. 1, 2013. Contact 703/836-7114, email info@, or visit www.abcop. org/certification. ■

NOVEMBER 13 AOPAversity Audio Conference—Advocacy: A Potent Weapon for Change. For more information, contact Stephen Custer at 571/4310876 or ■



DECEMBER 11 AOPAversity Audio Conference–What’s on the Horizon: New Codes for 2014. For more information, contact Stephen Custer at 571/431-0876 or scuster@


DECEMBER 12-14 Rehabilitation Institute of Chicago—Pediatric Gait Analysis: Segmental Kinematic Approach to Orthotic Management. Chicago. Featuring Elaine Owen. 21.50 ABC Credits. Contact Melissa Kolski at 312/238-7731 or visit ■

JANUARY 26-29 U.S. Member Society of ISPO: Pac Rim 2014: Learning Beyond Our Horizons—A Biennial Symposium on Prosthetics, Orthotics, & Rehabilitation. Wiakoloa Beach Marriott Resort and Spa on the Big Island of Hawaii. Learn about progressive treatment options and innovations and hear from recognized physical rehabilitation professionals while enjoying attractions on the Big Island. Contact Dianne Farabi at 614/659-0197 for more information. Submit abstracts at pacrim14. ■

AUGUST 6-9 CAPO Conference. World Trade & Convention Centre. Halifax, Nova Scotia. Marriott Halifax Harbourfront. Visit ■

www.prostheticsandorthotics. ca/ for more information.

SEPTEMBER 3-6 97th AOPA National Assembly. Las Vegas. Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@ ■

2015 OCTOBER 7-10 98th AOPA National Assembly. San Antonio. Henry B. Gonzales Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or ■

2016 SEPTEMBER 15-18 99th AOPA National Assembly. Orlando. Gaylord Palms Resort. For more information, contact AOPA Headquarters at 571/431-0876 or a ■






Allard USA Inc.






Orthotics, Prosthetics & Pedorthics



College Park Industries Inc.



DAW Industries



Dr. Comfort

5, C3


Ferrier Coupler Inc.



Hersco Ortho Labs



KISS Technologies LLC



Motion Control



Orthomerica Products



and Review Guide


Össur Americas Inc.






PEL Supply



Spinal Technology Inc.






American Board for Certification in

Orthotic and Prosthetic Study ®


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

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

This exclusive service is available only for AOPA members.

Contact Lauren Anderson at 571/431-0843 or

Log on to and start today. Not an AOPA member? GET CONNECTED

Visit AOPA at

MANUFACTURERS: Get your products in front of AOPA members! Contact Joe McTernan at or 571/431-0811.




Billing Odds and Ends Answers to your questions regarding inpatient billing, Medicare documentation, and the GL modifier


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


If a doctor orders an orthosis or prosthesis during an inpatient stay and I provide it, can the facility refuse to pay me?


Unfortunately, yes. Since a facility is responsible for providing all medically necessary care during a Medicare Part A-covered stay, it may choose the vendor that provides such care. If a physician provides you with an order and you provide the item without authorization from the facility, the facility may not be obligated to pay you. This is not a Medicare issue per se; it is more of a contractual issue. While legal precedents may exist in some states that would require the facility to pay for the service, generally the hospital has the right to decide whom it selects as its vendors and business partners.




If we are nonparticipating providers with Medicare and we are not accepting assignment on a claim, do we still have to obtain all of the required documentation before we can submit a claim for payment?


Yes, you are still required to adhere to all Medicare policies and procedures; this includes ensuring you have the proper documentation to support medical necessity. The choices of being a participating or nonparticipating provider and accepting or not accepting assignment only relate to how you bill the patient and how much you may collect from the patient.

Q. A.

When would I use the GL modifier?

The GL modifier is used when you are providing an upgraded item to a Medicare beneficiary, but you are choosing not to bill Medicare or the patient for the upgrade. When using the GL modifier, your claim must include only the charge and the code for the nonupgraded item along with the GL modifier. In the subsequent narrative field of your claim, you must provide a description of the item actually provided to the patient, the upgraded item, and why the item is an upgrade. a

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A program designed to help optimize your materials costs • Unique portfolio of quality products • The best value across product categories • Opportunity to qualify for additional rebates With the challenges facing O&P care providers, it’s becoming more difficult to provide high quality patient care, while managing a business. The SPS Rewards Program ensures you are getting the best value for the products you need to run your business.

To learn more and register for the SPS Rewards Program, contact your SPS Sales Manager or come by the SPS booth at AOPA World Congress.

August 2013 Almanac  

American Orthotic & Prosthetic Association (AOPA) - August 2013 Issue - O&P Almanac

August 2013 Almanac  

American Orthotic & Prosthetic Association (AOPA) - August 2013 Issue - O&P Almanac