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The American Orthotic & Prosthetic Association DECEMBER 2013




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O&P DECEMBER 2013, VOLUME 62, No. 12

CONTENTS Cover Story

16 Total Treatment

By Lia Dangelico The end of the year is a great time for practitioners to plan for expanding skill sets in the months ahead. O&P practitioners who educate themselves on issues relating to pharmacology, skin care, and weight and health management may be able to offer better care and improve their overall practice.


24 Keeping Pace with Office IT

By Christine Umbrell Ensuring a facility’s IT infrastructure is up-to-date should be a priority, even in the midst of the challenging business climate for the O&P profession. Industry experts offer their suggestions for upgrading parts or all of your office technology, and explain why doing so will lead to increased efficiency and decreased long-term expenses.




Reimbursement Page Establish a self-audit process as a preventive measure


Facility Spotlight Center for Orthotic & Prosthetic Care


Ask the Expert Tackling common coding and billing questions


AOPA Contact Page How to reach staff


At a Glance Statistics and O&P data

08 36

In the News Research, updates, and company announcements AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more

44 Marketplace

46 Jobs

Opportunities for O&P professionals

49 Calendar

Upcoming meetings and events

51 AOPA Membership 00 Applications 51

Ad Index


AOPA Answers Expert answers to your FAQs

Products and services for O&P

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.

DECEMBER 2013 O&P Almanac


AOPA IN THE Contact NEWS INFORMATION AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 EXECUTIVE OFFICES



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,

Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA

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

President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI

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, Bob Heiman, director of sales, 856/673-4000 Stephen Custer, production manager, 571/431-0810, Lia K. Dangelico, managing editor and contributing writer, 703/914-9200 x24, Christine Umbrell, editorial/production associate and contributing writer, 703/914-9200 x33,

Stephen Custer, communications manager, 571/431-0810, Lauren Anderson, manager of membership services, 571/4310843, Betty Leppin, project manager, 571/431-0876, AOPA Bookstore: 571/431-0865 Government affairs Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811,

President-Elect Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD Vice President James Campbell, PhD, CO Becker Orthopedic Appliance Co., Troy, MI Immediate Past President Tom Kirk, PhD Member of Hanger Inc. Board, Austin, TX Treasurer James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA

Devon Bernard, assistant director of coding reimbursement, programming and education, 571/431-0854, Reimbursement/Coding: 571/431-0833,

Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Alfred E. Kritter Jr., CPO FAAOP, Hanger, Inc., Savannah, GA Eileen Levis Orthologix LLC, Trevose, PA Ronald Manganiello New England Orthotics & Prosthetics Systems LLC, Branford, CT Dave McGill Ă–ssur Americas, Foothill Ranch, CA Michael Oros, CPO Scheck and Siress O&P Inc., Oakbrook Terrace, IL Scott Schneider Ottobock, Minneapolis, MN Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA

O&P Almanac Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales RH Media LLC 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.


O&P Almanac DECEMBER 2013

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How Does Your O&P Business Compare? The average net sales/billing for an O&P business in 2012 was $4.3 million (median $1.7 million), with prosthetics accounting for 46 percent of gross sales.

O&P Business Net Sales/Billing

Up to $1 million

Over $5 million

Percent of Gross Sales/Billings By Category



3% 6%


Durable Medical Equipment


16% 28%


34% $2 to $5 million

46% Prosthetics


$1 to $2 million


Average net profit margin (net income before taxes as a percentage of sales) of O&P businesses.


Percentage of O&P companies that use outside central fabrication.


Percentage of O&P facilities with more than 20 employees.

Sources: AOPA’s “2013 Compensation & Benefits Report” and “2013 Operating Performance Report.” 6

O&P Almanac DECEMBER 2013



Source: AOPA’s “2013 Operating Performance Report.”

Average length of time an O&P business has been in operation.

$52,065 Average compensation for a certified pedorthist at an O&P facility.


Average compensation for a practitioner assistant/ extender at an O&P facility.

AOPA’s “2013 Operating Performance Report” and “2013 Compensation & Benefits Report” may be purchased in the AOPA Bookstore at

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ALJ Rulings Support Use of Practitioner Records Two recent Administrative Law Judge (ALJ) rulings, one involving a Medicare claim and one involving a state worker’s compensation case, have helped encourage recognition of orthotists and prosthetists as medical providers, allowing their records to be included in the patient’s medical record when determining medical necessity. In an excerpt from the Medicare case, the ALJ stated: “The provider’s (name redacted) documentation is defined by the cited 2009 Noridian prosthesis guidelines as being ‘medical records.’ These guidelines also state that it is recommended that the treating physician’s records be submitted, but they are not required to be submitted.” In an excerpt from the worker’s compensation case, the ALJ stated: “The Administrative Law Judge is of the opinion that (provider name redacted), as a provider of prosthetic

devices, including the artificial limb which is the subject of this medical dispute, is as much a ‘medical provider’ as a pharmacist and even more so.” While these two opinions do not establish required precedent for future rulings, the fact that separate ALJs in very different circumstances recognized the status of O&P providers as medical professionals provides encouragement to continue to fight for and demand the recognition that O&P professionals deserve. Acceptance of documentation by the O&P provider as part of the patient’s medical record represents a significant step in challenging egregious audit activity by Medicare and its contractors. For more information regarding these ALJ decisions and how this information may help you build a strategy to defend your claims, or to share new ALJ information, contact Joe McTernan at

NC State Researchers Study Robotic Ankles for Stroke-Related Impairments Greg Sawicki, assistant professor of biomedical engineering at North Carolina State University, has received a five-year, $750,000 grant from the National Institutes of Health (NIH) to compare different robotic ankle devices to assist people with strokerelated mobility impairments. Sawicki, who directs the Human Physiology of Wearable Robotics Lab, will work with fellow principal investigator Steven Collins, a mechanical engineering professor at Carnegie Mellon University, to develop a way to compare different devices to assist people recovering from stroke. Their project proposes to create a platform


O&P Almanac DECEMBER 2013

that would allow investigators to test various robotic control methods and compare how they affect measurable physiological outcomes. NC State was awarded the grant through President Obama’s National Robotics Initiative, a group of federal agencies to support development of robots that work with or beside humans. NIH funds projects that improve human capabilities or enhance medical treatments. Sawicki received the funding for his project, “Novel Platform for Rapid Exploration of Robotic Ankle Exoskeleton Control Strategies to Augment Healthy Restore Post-Stroke Locomotion.”


Hanger Launches Tool to Help O&P Providers with RAC audits Hanger Inc. announced it has developed an interactive online resource designed to help O&P providers navigate the Recovery Audit Contractor (RAC) audit process. The Hanger RAC Navigation Tool is available free-of-charge to all at “The administrative burden of the RAC audits continues to strain the O&P industry, often shifting valuable time and resources away from what’s most important—patient care and customer service,” says Vinit Asar, president and CEO of Hanger. “As the market leader, it is Hanger’s responsibility to help the industry navigate regulatory and legislative headwinds and elevate O&P in the health-care space. That’s why we’ve created the RAC Navigation Tool and are making it available for use by all in O&P. It is the right thing to do for O&P and all patients in need of orthotic and prosthetic solutions.”   The new RAC Navigation Tool was designed to help clarify and streamline the process of responding to audits. It provides an interactive and clear mapping of the process along with options to review the details and recommended guidelines of each step. The tool also delivers downloadable, standardized documents in one place.


“Unfortunately, for now, the audits are a new normal for the O&P industry,” says Asar. “While the RAC Navigation Tool is designed to ease the administrative burden, we still need to address the heart of the problem. We are actively working with AOPA and other industry leaders to carefully lobby for course corrections to the process and to educate legislators on the O&P patient-care delivery model. We understand the need for legislation that protects against fraud and abuse in our industry, but we need to work with [the Centers for Medicare and Medicaid Services] (CMS) to ensure a proper and effective process is in place.”  AOPA Executive Director Tom Fise added, “We applaud Hanger’s decision to develop a resource for all O&P providers. Being unified in our lobbying and communications with CMS is critical, but so is streamlining our responses to these various audits. The more effective and efficient we can be in our responses, the better it is for our industry and our patients.”

people in the news

Hanger Clinic has announced several hirings: • Wasim Akhtar, CP, has been hired as clinic manager in the Folsom, California, patient-care clinic. • Amy Barrios, CP, has joined the Tulsa, Oklahoma, patient-care clinic. • Anthony Dargan, CPO, has been hired as area clinic manager in the Alexandria, Reston, and Leesburg, Virginia, patient-care clinics. • Brittany Kolesar, CO, has joined the Seattle patient-care clinic. • Patrick Nimphie, CPO, has been hired in the Grand Rapids, Michigan, patient-care clinic area. • Brentt Ramharter, CPO, has been hired as clinic manager in the Albuquerque, New Mexico, patientcare clinic. • David Stollsteimer, CPO, has joined the Bath, New York, patientcare clinic.

• Kim Tablada, CP, has been hired at the Sacramento, California, patientcare clinic. • John Vetter, CPO, has been hired in the Burbank, California, patientcare clinic area. Wendy Beattie, CPO, FAAOP, of Becker Orthopedic, has assumed new responsibilities heading up the O&P training program at Eastern Michigan University. Dan Cox has been named sales manager for Aqualeg Inc. Jennifer Fayter is the new sales manager for Nabtesco Proteor USA, Muskego, Wisconsin. Hugh Gill, chief technical officer of Touch Bionics, headquartered in Livingston, Scotland, has been

inducted into the Scottish Engineering Hall of Fame for his work on the i-limb multiarticulating bionic hand. Sami Madden, a 21-year-old University of Arizona student who was born without fully formed arms or legs, has been elected president of the International Child Amputee Network. Teresa K. Masters, CPO, LPO, has joined Advanced Anatomical Design, LLC Orthotics, Prosthetics, and Pedorthics. Danielle Melton, MD, has been selected as chair of the Amputee Coalition’s Scientific & Medical Advisory Committee. In addition, the Coalition has named two new members to serve three-year terms on the committee: Jacqueline Hebert, MD, and Col. Donald Gajewski, MD.

DECEMBER 2013 O&P Almanac



Research Paves the Way for Touch-Sensitive Prosthetic Limbs colleagues identified patterns of neural activity that occur during natural object manipulation and then successfully induced these patterns through artificial means. The researchers used the data from their experiments to create a set of instructions that can be incorporated into a robotic prosthetic arm to provide sensory feedback to the brain through a neural interface. Bensmaia believes such feedback will bring these devices closer to being tested in human clinical trials. “The algorithms to decipher motor signals have come quite a long way, where you can now control arms with seven degrees of freedom. It’s very sophisticated. But I think there’s a strong argument to be made that they will not be clinically viable until the sensory feedback is incorporated,” says Bensmaia. “When it is, the functionality of these limbs will increase substantially.” Photo:

New research published in the Proceedings of the National Academy of Sciences lays the groundwork for touch-sensitive prosthetic limbs. Researchers at the University of Chicago are investigating devices that could convey real-time sensory information to amputees via a direct interface with the brain. Sliman Bensmaia, PhD, assistant professor in the department of organismal biology and anatomy, is the study’s senior author. According to Bensmaia, “To restore sensory motor function of an arm, you not only have to replace the motor signals that the brain sends to the arm to move it around, but you also have to replace the sensory signals that the arm sends back to the brain.” The research is part of Revolutionizing Prosthetics, a multi-year Defense Advanced Research Projects Agency (DARPA) project that seeks to create a modular upper-limb prosthesis to restore natural motor control and sensation in amputees. The project, which is managed by the Johns Hopkins University Applied Physics Laboratory, has created an interdisciplinary team of experts with funding from DARPA, National Science Foundation, and National Institutes of Health. The research focuses on the sensory aspects of limbs. In a series of experiments with monkeys, Bensmaia and his

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O&P Almanac DECEMBER 2013


Clinical Trial Assesses Nerve Block Device for Amputee Pain Management A clinical study focusing on intractable limb pain management for amputees is set to begin in 2014 and run through 2015. The study will test the Altius System High Frequency Nerve Block technology, developed by Neuros Medical. The device consists of an electrode, powered by a pacemaker-sized generator, placed around a peripheral nerve. Neuros was granted an investigational device exemption by the U.S. Food and Drug Administration in October, clearing


the way for the company to begin the clinical trial. The technology previously was tested in a pilot trial study, which yielded successful results: More than half of the subjects who participated in the pilot were able to stop taking their pain medications. The clinical study will test the Altius technology with 130 patients in 15 U.S. institutions. If successful, Neuros will apply for premarket approval of the technology.

BUSINESS in the news

The Board of Certification/ Accreditation (BOC) has debuted an accreditation program for retail pharmacies. BOC is now accepting applications for Pharmacy Accreditation, for retail pharmacies that meet standards established by the Department of Health and Human Services, Centers for Medicare and Medicaid Services, Drug Enforcement Agency, Food and Drug Administration, and the respective state boards of pharmacy standards. The International Association of Plastics Distribution (IAPD) announced that Nonspec, a startup prosthetic design company from the University of Massachusetts Lowell, won first place in the IAPD Plastics Application Design Competition for a low-cost telescoping prosthetic arm for children that can expand as a child grows. Thirty-four members of OPGA/ POINT are recipients of the 2013 Freedom Award for their compassionate service and dedication to veterans and active-duty soldiers. The award recognizes those who have provided orthotic and prosthetic fitting and/or rehabilitation for soldiers wounded in action: • Active Life Inc. Orthotics, Prosthetics & Compression, Santa Monica, California • Actra Rehabilitation, Oshkosh, Wisconsin

• Adaptec Prosthetics LLC, Littleton, Colorado • Allen Orthotics & Prosthetics, Midland, Texas • American Limb & Orthopedic Co. of Valparaiso, Valparaiso, Indiana • American Orthopedics Inc., Columbus, Ohio • Beacon Prosthetics and Orthotics, Raleigh, North Carolina • Center for Prosthetics & Orthotic Design, Albuquerque, New Mexico • Center for Prosthetics Orthotics Inc., Seattle, Washington • Choice Orthotics & Prosthetics, Knoxville, Tennessee • Clark & Associates Prosthetics and Orthotics, Waterloo, Iowa • Fidelity Orthopedic Inc., Dayton, Ohio • Foot Solutions, Costa Mesa, California • Foot Solutions, Creve Coeur, Missouri • Foot Solutions, Little Rock, Arkansas • Foot Solutions of Fort Worth Inc., Fort Worth, Texas • Georgia Prosthetics Inc., Atlanta, Georgia • Hamilton Prosthetics and Orthotics, Phoenix, Arizona • Henson Orthotic & Prosthetics Enterprises, Stockton, California • JP&O Prosthetic and Orthotic Lab, Jonesboro, Arkansas • Leimkuehler Inc., Cleveland, Ohio

• Limb Lab, Mankato and Rochester, Minnesota • Norpro Orthotics & Prosthetics Inc., West Palm Beach, Florida • Optimus Prosthetics, Dayton, Ohio • Orthocare Orthotics and Prosthetics Inc., Leesburg, Florida • Orthotic Prosthetic Specialists, Munster, Indiana • Preferred Orthotic & Prosthetic Services, Tacoma, Washington • Prevail Prosthetics & Orthotics, Fort Wayne, Indiana • Redstick Orthopedics & Prosthetics, Baton Rouge, Louisiana • Rimrock Prosthetics Inc., Billings, Montana • Strobel & Associates Prosthetics Inc., Plano, Texas • Stubbs Prosthetics & Orthotics, Chattanooga, Tennessee • Valley Institute Prosthetics & Orthotics, Bakersfield, California • Valley Prosthetics and Orthotics Inc., Allentown, Pennsylvania Ottobock has won the 2013 Econ Award for excellence in public relations for its London 2012 “Passion for Paralympics” campaign. Ottobock has announced the debut of its original film Limitless. The film, which features Ottobock employee Leslie Pitt Schneider, premiered at the ReelAbilities Disabilities Film Festival in Minneapolis in November.

DECEMBER 2013 O&P Almanac



Reimbursement Page By Joe McTernan, AOPA government affairs department

The Self Audit Develop and use this tool to prevent costly setbacks for your business


s 2013 comes to a close, it is safe to assume that it has been a very challenging year for orthotic and prosthetic providers. The seemingly endless barrage of Medicare audits—whether they are Recovery Audit Contractor audits, Comprehensive Error Rate Testing audits, or Durable Medical Equipment Medicare Administrative Contractor prepayment and postpayment reviews—has led to tremendous uncertainty for the future of O&P businesses. Many businesses have been pushed to the brink as a result of the cash flow crisis created by these audits; unfortunately, others have been forced to close their doors. While there is no immediate solution that will reduce the frequency or intensity of Medicare audits, there are steps you can take today that may improve your chances of future success when your Medicare claims are audited. One of these steps is to implement an effective self-audit process that can help you identify and correct small deficiencies before they become legitimate threats to the survival of your business.

Consistency is key as you establish the protocols that will determine how, when, and how often self audits will take place. There is no specific process that will work for every O&P practice; your process must be tailored to the size and needs of your individual business. 12

O&P Almanac DECEMBER 2013

A Place to Start When performing self audits, the first thing you must do is create a formal and repeatable process. Consistency is key as you establish the protocols that will determine how, when, and how often self audits will take place. There is no specific process that will work for every O&P practice; your process must be tailored to the size and needs of your individual business. The process should start with the appointment of an individual or group of individuals who will perform the audits. When possible, it is a good idea to spread this responsibility across two or more individuals, as it creates an automatic system of checks and balances. If this is not possible, it is imperative that the individual performing the audits has a comprehensive knowledge of Medicare policy and regulations, as these will be used by professional auditors who may review your claims at a later date. When possible, make sure the individual conducting the self audit has no direct financial interest in payment of the claims they are reviewing. This can be a significant challenge, especially in a small business environment, but a direct financial interest in claim payment can often influence the decisions of the individual performing the audit.

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Reimbursement Page

Once you have established who is responsible for performing the self audit, you must then decide what you will be looking for. Medicare audits are one of the few things that truly represent an “all or nothing” situation. A single mistake is enough to warrant the denial of a procedure code or a complete claim, resulting in lost revenue and potential allegations of fraud and abuse. While no process is perfect, a good place to start is making sure that the items that are always required for Medicare reimbursement are obtained, complete, and compliant. Two things that immediately come to mind are physician orders and proof of delivery documentation. While the need for these items seems obvious on the surface, they are frequently identified as primary reasons for claim denials during a Medicare audit.

Initial and Detailed Written Orders While an initial order is technically not a requirement for claim payment, it is more often than not a vital piece of documentation to support your claim. The initial order can be verbal or written and essentially authorizes you to begin evaluation and treatment of the patient. If the order you receive from the referring physician contains


O&P Almanac DECEMBER 2013

all of the requirements of a detailed written order, an initial order is not necessary. This rarely occurs, so it is important to first understand what must be included with an initial order when performing a self audit. Initial orders, at a minimum, must contain the beneficiary’s name, a description of the item being ordered, the referring physician’s name, and the start date

When possible, make sure the individual conducting the self audit has no direct financial interest in payment of the claims they are reviewing. of the order. Initial orders that do not contain the four specific requirements are considered to be noncompliant and, therefore, are invalid. When performing a self audit, it is important to make sure that the start date listed on the order is on or before the date the evaluation and potential treatment of the patient begins. Treating a Medicare beneficiary

without an order is grounds for immediate denial of the claim. A detailed written order is mandatory for all Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies claims. While it is not required to be on file prior to evaluating and treating a Medicare beneficiary, it must be on file prior to claim submission. Every detailed written order must include the beneficiary’s name; the referring physician’s name; a detailed description of the item or items being billed, including all components that will be billed separately; the date of the order; the start date of the order (if different than the date of the order); and the physician’s signature. The physician’s signature may be applied via “pen and ink” or electronically. Faxed orders are acceptable for documentation purposes but Medicare reserves the right to request the original in cases where there is evidence of tampering. When performing a self audit, you should verify that the detailed written order contains all of the required information.

Proof of Delivery Documentation An incomplete or missing proof of delivery document often results in unnecessary claim denials, regardless of how much other documentation you have in the patient file. Medicare regulations are very specific regarding what must be documented in order to prove that the item for which you billed was actually provided to the patient. The specific regulations regarding proof of delivery may be found in section 4.26 of chapter 4 of Medicare’s “Program Integrity Manual,” which is located at www.cms. gov/Regulations-and-Guidance/Guidance/ Manuals/Downloads/pim83c04.pdf. Failure to review proof of delivery documentation during a self audit and ensure that your policies are fully compliant with Medicare regulations could be a very costly mistake should Medicare choose to audit your claims down the road.


Additional Considerations While physician orders and proof of delivery requirements are crucial parts of any self audit, there are other pieces of required documentation that also must be considered. Medicare expects there to be and relies on documentation within the patient’s medical record to support the medical need for any item or service that you provide. This often requires you to rely on the documentation of other health-care providers, especially physicians, in order to support the medical need for your claim. Performing self audits that include a review of required documentation from sources outside of your organization is a vital part of the process. Documentation should be legible, should discuss the medical

need for the specific item or service that is being ordered, and must be signed and dated by the health-care professional who is writing the information. In cases where the signature of the referral source is not legible, you may need to obtain a signature log that identifies the signature as authentic. While it is challenging to ensure the documentation of others is written in a way that Medicare considers acceptable for supporting

Reimbursement Page

the medical need of the item you are providing, the fact remains that it is a Medicare requirement and, therefore, must be part of the self-audit process. The process of creating and administering a self-audit program is one that must be uniquely tailored to the individual needs of your O&P practice. While this issue’s Reimbursement Page only highlighted a few important components of the process, the nature of your business will dictate additional steps that you should take when creating your own self-audit process. The important thing to remember is that a thorough and effective process today may save you from serious consequences tomorrow. a Joe McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmcternan@

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DECEMBER 2013 O&P Almanac


T tal

Treatment Looking to comprehensive aspects of care to improve quality of life for patients


O&P Almanac DECEMBER 2013

COVER STORY By Lia Dangelico


he end of the year is a time of reflection for many. Practitioners may recall patient milestones, reimbursement challenges, staff and management changes, and other memorable moments. As the New Year looms just weeks away, practitioners should take time now to consider how they can expand their reach of care to improve patient outcomes and deepen skill sets in the months ahead. While there is much to be said for specialties and expertise in health care, practitioners should do more than jump to a referral when faced with a challenge that seems outside the realm of traditional O&P practices. Practitioners who educate themselves on issues relating to pharmacology, skin care, and weight and health management may be able to offer information to patients that will ultimately benefit their O&P care.

DECEMBER 2013 O&P Almanac


How Pharmacology Affects Treatment According to a Centers for Disease Control and Prevention report, nearly half of all Americans use at least one prescription medication each month, and more than 20 percent use three or more. In emergency rooms across the country, three quarters of all visits require drug therapy, with 2.6 billion prescription drugs ordered by emergency facilities every year. It’s safe to assume most O&P patients have been, are, or will be on medication at some point while under your care, says Megan Ehret, PharmD, MS, BCPP, associate professor of pharmacy practice at the University of Connecticut. When it comes to pharmacology, Ehret believes all O&P practitioners should have base-level knowledge of how medications work and how they can interfere with care. All medications have side effects and risks, so if, for example, a patient is on pain medication and his or her device is not fitting properly, practitioners need to be able to determine if the improper fit is being caused by the device, or if there is something else, like nerve damage, that needs to be addressed, she says. Knowing what medications patients are taking helps to avoid wasted time and added frustration, so there are several key questions Ehret recommends practitioners regularly ask patients about


O&P Almanac DECEMBER 2013

“A better understanding of a patient’s medication can lead to an overall better therapeutic outcome, and can lead to a device that fits, looks good, and functions the best way it can.” –Megan Ehret, PharmD, MS, BCPP their medications, including: • What medications—prescriptions or over-the-counter—are you taking now, and what have you taken in the past? • Were there medications that didn’t work for you in the past? If so, what happened? • What herbal remedies/supplements are you taking? Top areas of concern for the O&P population are medications for pain control, diabetes, and water-retentionrelated illnesses, Ehret says. For example, blood thinners and antiplatelet drugs, such as aspirin, can present a bleeding risk for patients with open wounds. Muscle relaxants and other pain medications can cause dizziness and drowsiness, affecting the balance and coordination of patients, as well as the fit of braces and sockets. For patients suffering from high blood pressure and congestive heart failure,

diuretics and other water-retention medications commonly prescribed can lead to dehydration and volume loss, which could affect fitting. Even common herbal supplements, such as St. John’s wort and ginkgo biloba, can interact with drugs and present bleeding risks. Unfortunately, pharmacology is not part of the curriculum in most O&P educational programs, so few practitioners have the necessary background and even fewer know where to go and whom to ask for resources. Ehret recommends web-based clinical reference tools, such as Micromedex and Lexicomp, that explain how the different medications work and identify any adverse side effects. “These tools can help practitioners learn to categorize drugs into easily identifiable groups—diuretics, antidepressants, and more—so they are better aware,” she says. In turn, practitioners can translate these key points to patients to educate them on which medications should not be mixed, as well as notable side effects, and more. Embracing pharmacology in your practice also presents a great opportunity to build a relationship with a local pharmacist, adds Ehret. O&P practices can partner with pharmacists in the area who can give consults, teach staff, and assist with clinics. Even sparking a personal relationship between practitioner and pharmacist can have a profound impact on care. “A better understanding of a patient’s medication can lead to an overall better therapeutic outcome,” says Ehret, “and can lead to a device that fits, looks good, and functions the best way it can.”










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Getting to the Bottom of Skin Issues

Partnering for Better Care One way to expand and improve care is to get involved in a prosthetic clinic, says John Angelico, CP/LP, chairman of Scheck & Siress, whose office participates in clinics at several Illinois hospitals. In addition to prosthetists, the clinics typically involve a physiatrist, physical therapist, and—depending on the setting—nurse, wound care expert, or psychologist, and are held in large hospital settings. “We typically see patients prior to amputation, immediately after, and before and after they get their prosthesis,” says Angelico. “It’s a nice, complete patient-care scenario.” During the clinics, patients are evaluated by practitioners of different specialties to determine if adjustments to prosthetic or overall medical care are needed. Referral requests can be made and patients can easily make appointments on the spot. If you’re interested in starting a clinic, Angelico recommends forming a relationship with a physiatrist or an orthopedic or vascular doctor—it’s important to have a rehabilitation doctor involved—and then floating the idea. Clinics can be held in physical therapy gyms, inpatient or outpatient offices, hospitals, and

Another common problem affecting O&P patients is temporary and chronic skin conditions. Dry skin and eczema occur with many patients in this population. In addition, as many as 40 percent of lower-limb amputees, whose residual skin is exposed to heavy shear and stress due to weight bearing, experience stump oedema, cysts, skin carcinoma, and more, according to research by Jan Geertzen, MD, PhD, professor and head of rehabilitation medicine at the University Medical Center Groningen in The Netherlands, along with colleagues Henk Meulenbelt, Marcel Jonkman, and Pieter Dijkstra. Geertzen presented the findings of this study at the 2013 O&P World Congress in September. The report, “Skin Problems of the Stump in Lower-Limb Amputees,” found that skin problems can impede daily prosthetic use, reduce mobility, and jeopardize vocation.

in other spaces. Angelico and other practitioners also encourage patients to get involved in support groups through local hospitals or health systems, as well as with extracurricular organizations, such as Adaptive Adventures, that promote socialization, peer support, and healthy lifestyles. The Amputee Coalition recently partnered with Johns Hopkins University School of Medicine to launch the “Improving Emotional Well-Being for Persons with Limb Loss Program,” in order to empower prosthetists to provide better mental health support and information to patients. Learn more about their efforts and others in “Beyond the Limb,” in the October 2013 issue of O&P Almanac.

Jan Geertzen, MD, PhD

Practitioners can work to prevent these occurrences by addressing personal hygiene issues and lifestyle choices. According to the report, hygiene, body moisture, hairiness of the skin, and the environment in which the patient lives can determine whether or not skin infections develop; and “ulcerations also can be enhanced by poor nutritional skin status, vascular insufficiency, or localized pressure from a poorly fitting prosthesis.”


O&P Almanac DECEMBER 2013

Researchers found that several factors contributed to the prevalence of skin problems among lower-limb amputees, including washing the stump four or more times a week, use of antibacterial soap, use of a liner, and smoking. Any patient with an abrasion would likely increase his or her level of hygiene to prevent infection, but for amputee patients, that high frequency of washing can make skin on the stump even more vulnerable than it already is. Washing frequently with soap, including antibacterial soap, can lead to dry skin and more serious skin problems.

Hygiene, body moisture, hairiness of the skin, and the environment in which the patient lives can determine whether or not skin infections develop.

Skin problems triggered by liners offer another avenue for prosthetists to work in tandem with patients before consulting a dermatologist. Practitioners should observe the use of liners, and if signs of hyperhidrosis or persistent heat rashes, as well as persistently cold skin, appear, alternative options should be considered. O&P patients should be encouraged not to smoke due to the inherent health hazards, but smoking also can

lead to an “increase of elastosis that leads to a decrease of elasticity of the skin… which may increase the reaction of the skin on mechanical stress, and therefore facilitate the development of skin problems,” according to the report. Geertzen recommends discussing proper hygiene for the residual limb as well as the liner/socket with patients, and suggests patients wash the areas daily without antibacterial or perfumed soap. Specific treatment, of course, depends on the problem. For example, says Geertzen, if a patient is experiencing a yeast or fungal problem, a cream with corticosteroids could be a good option for treatment. Many of the same principles can be applied to orthotic users. According to the American Board for Certification in Orthotics, Prosthetics, & Pedorthics, practitioners should advise patients to regularly clean orthoses with mild soap or a non-toxic cleaner and keep any creams, lotions, or other products away from orthoses. Practitioners also should be able to easily identify potential problems, such as pressure points, skin breakdown, numbness, and contractures. If problems worsen or appear chronic, patients should be referred to a trusted dermatologist.

Facing Weight Management Head On In the scope of full-body treatment, practitioners must acknowledge the implications of weight and lifestyle on the functionality and useable life of orthotic and prosthetic devices. More than 2 in 3 adults in the U.S. are overweight or obese, according to the American Medical Association, leading to heart disease, stroke, osteoarthritis, and other ailments. The Arthritis Foundation suggests that each pound gained puts as much as four pounds of added stress on the hips, knees, and the rest of the body, causing joints to break down. Practitioners should take a proactive approach to help patients develop and maintain healthy lifestyles—saving patients, practitioners, and the greater healthcare community time and money. Experts with the Weight-Control Information Network (WIN), a National Institutes of Diabetes and Digestive and Kidney Diseases service, suggest that talking with patients about weight loss promotes behavioral changes, but few providers have adequate time with patients and lack the proper training on how to talk to patients about this sensitive topic.

DECEMBER 2013 O&P Almanac


When tackling the weight management issue, WIN recommends respectfully asking patients if they are comfortable talking about weight loss, then starting small by discussing possible risk factors for being overweight, and eventually working with patients to establish realistic goals. Starting goals can be simple, such as improving portion control at mealtimes and walking for 10 minutes‚ three times a day. Along with a diet rich in protein, fruits, and vegetables, exercising for 30 minutes a day, at least five times a week, can strengthen muscles, the heart, and the lungs, according to WIN. For patients who are resistant to traditional approaches to physical activity, O&P practitioners can offer other options, including virtual-reality computer-based exercising. This new trend offers an alternative to conventional exercise and offers benefits for the O&P patient population, says Bijan Najafi, PhD, associate professor of surgery and director of the interdisciplinary Consortium on Advanced Motion Performance at the University of Arizona College of Medicine. “Game-based exercise [or

“Game-based exercise [or exergaming] may address some of the shortcomings of traditional exercise and can be personalized based on the patient’s ability.” -Bijan Najafi, PhD

exergaming] may address some of the shortcomings of traditional exercise and can be personalized based on the patient’s ability.” Exergaming also could better assist patients to perceive possible motor errors—for example, inaccurate estimation of foot position during obstacle crossing—in a safe, virtual environment, says

Najafi. Advancements in virtual reality exercises allow patients and practitioners to design personalized exercise routines that are targeted to improve lower-extremity joint perception. “In a recent randomized control trial, we demonstrated that a 30-minute game-based virtual reality exercise, twice per week for four weeks, significantly enhanced balance as well as lower-extremity joint perception in diabetic patients with diminished foot sensation,” Najafi says. “This, in turn, may enhance mobility and assist in effective weight management.” Body-worn sensors, such as Fitbit, other smart watches, and fitness and health tracker mobile apps also encourage patients to be more active. A recent study at Northwestern University found that adults who used a “personal digital assistant” as well as coaching via telephone while trying to lose weight were able to lose nearly 4 kilograms (8.8 pounds) more than the control group, who didn’t use such programs. Researchers concluded that mobile connective technology can “enhance short-term weight loss in combination with an existing system of care.” Overall, patient education remains a key factor in maintaining a healthy lifestyle. A wealth of information is available online, including nutritional guides, weight trackers, recipes, calculators, and more, that can be shared with patients and listed on practice websites for easy access. If patients request a dietician, the Academy of Nutrition and Dietetics provides referrals in all 50 states at As a new year begins, challenge yourself and your clinical team to tackle one or more of these areas to improve patient care in 2014. The outcome may propel your practice, as well as the happiness and well-being of your patients, much further than expected. a Lia Dangelico is a contributing writer to O&P Almanac. Reach her at


O&P Almanac DECEMBER 2013

Celebrating Changed Lives

Aiden’s future holds endless possibilities And an ABC Practitioner was there

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KEEPING PACE WITH OFFICE IT Choosing and implementing the right technology toolkit for your practice

By Christine Umbrell


hese days, O&P business owners are facing decreasing profit margins and increasing documentation requirements caused by recoupment challenges and multiple audits. Investing the resources to research and implement a new information technology (IT) system—or even upgrade parts of an existing system—can seem daunting. But those facilities that stay current in the IT arena are taking a long-term view of their business strategy, and are preparing now for future success in terms of Medicare requirements, payment security compliance, and overall patient satisfaction. Seeking increased efficiency and adherence to Medicare’s electronic health record (EHR) requirements, many health-care facilities are taking steps to transform their IT infrastructure. But while primary-care physicians, optometrists, and other health-care practitioners are deploying virtualization, streamlining their operations, and centralizing management, some O&P businesses continue to rely on “old-fashioned” paper files and outdated computer systems. Although the EHR mandate does not currently apply to O&P facilities, O&P office managers should consider following the lead of other health-care practices by converting to electronic processes and updating their IT infrastructure.


O&P Almanac DECEMBER 2013

Reluctant O&P business owners may hesitate to invest in IT systems at small facilities due to concerns about new equipment costs and decreased staff productivity during a transition. But forward-thinking O&P managers see the benefits that will come from upgrading IT: increases in quality and efficiency and reductions in overall long-term costs associated with antiquated record-keeping and other out-of-date applications. What’s more, as the government pushes for both EHR and increased patient security via the Health Insurance Portability and Accountability Act (HIPAA), O&P practitioners who implement more streamlined IT systems will stay current with federal recommendations and requirements.

Regular Checkups All O&P businesses should re-evaluate the IT systems in place at their facilities on a regular basis as part of an overall facility business plan, according to Andrew Ullman, BSME, MSM. Ullman is owner, UCO International, headquartered in Wheeling, Illinois, a company that develops, imports, and distributes O&P products, and provides custom fabrication of orthotics. Ullman regularly visits both big and small O&P facilities and is aware of the IT systems different facilities have in place—some of which show room for improvement. Regular environmental scanning of IT infrastructure at O&P facilities remains an important business strategy even in the midst of the reimbursement challenges and audits currently impacting the industry. “Because of Medicare issues, many O&P facilities are in survival mode, so they may not be keeping up as much” as in past years, warns Ullman. For O&P facilities to remain viable in today’s regulatory environment, “re-evaluating every aspect of the business is important,” says Mitchell Dobson, CPO, FAAOP, vice president, compliance, for Hanger Clinic. “IT components are at the forefront of these needs assessments.”

While older systems may appear to be sufficient for day-to-day operational purposes, remember to factor in the “useful life” of current applications or systems, advises Walt Meffert, vice president and chief information officer at Hanger Inc. “Direct and indirect expenses to keep paying for the routine care and feeding of legacy systems can be significant,” he says. “Keep in mind why a computer system is being used,” adds Meffert. “It should help a business schedule, process, and collect from patients.” If your current system does not make those processes more efficient, other options should be considered.

“People tend to buy a [technology] package because it looks cool, then they figure out how to use it… But it should be the other way around: Get the machines to fit the people rather than the people to fit the machines.” —Andrew Ullman

“Your whole facility should be constantly re-evaluated—what’s changing, and what’s new that’s available,” Ullman says. For example, in terms of billing practices, what are the Medicare changes each year, and can your automated billing system accommodate those changes?

Narrowing the Choices Once a facility decides to reassess its IT solutions, there are many options for systems and software. Some facilities have different processes in place for each aspect of their business—one for payroll, one for patient care, and another for accounting. Before purchasing any new IT-related software or hardware, Ullman recommends figuring out how your current processes work—“then fit your technology to those systems. Make sure your technology will be useful.”

DECEMBER 2013 O&P Almanac


New IT Developments for O&P The following technologies are some of the newest developments in IT that could prove useful to O&P facilities, according to Walt Meffert, vice president and chief information officer at Hanger Inc. •

Image intake and sharing systems. These systems are used “to ingest and share outside image studies and reports provisioned by patients and providers,” explains Meffert. Examples include Digital Imaging and Communications in Medicine (DICOM) and non-DICOM images and video from various specialties.

Voice-user interface. Voice recognition on keyboardless devices, such as tablets and smartphones, can help reduce data entry when applied to electronic health record (EHR) user interfaces.

Secure text messaging. Secure texting for health care “leverages the familiar texting experience and employs cryptographic protocols for compliance,” says Meffert.

Medical device connectivity systems. Such systems serve as gateways between instruments or monitors and an EHR record system. “They transfer and translate data between proprietary instrument formats and the input requirements of specific EHR products and versions.”

Patient portals. Clinical patient portals enable a secure online patient-provider relationship and access to clinical and educational information.

Mobile health monitoring. Virtual monitoring takes advantage of IT and telecommunications to monitor the health of patients at home or on the move. “Patients are provided monitoring devices that capture physiological states and then transmit or stage the data for clinical review,” explains Meffert.

Wireless health-care asset management. These applications involve the transmission, storage, and analysis of geospatial location information sent in real time from a small wireless locator device attached to the health-care asset being tracked, says Meffert. “The locator devices communicate via wireless communications protocols, such as radiofrequency identification (RFID), Wifi, ultrasounds, infrared, and ZigBee.”


O&P Almanac DECEMBER 2013

Ullman warns against purchasing products without considering the “big picture” of how they will fit into existing facility processes. “People tend to buy a package because it looks cool, then they figure out how to use it,” he says. “But it should be the other way around: Get the machines to fit the people rather than the people to fit the machines.” Meffert advises researching “an electronic practice management system to help with registration, scheduling, billing, and collections.” While many providers offer such systems, there are variables in terms of on-premises hardware or support. “A business should ensure it picks a provider that is aligned with its business goals, IT support capabilities, and financial capabilities,” he says.

Best Practices for IT The most appropriate new offerings for O&P provide integration, suggests Ullman. “The more integrated the better,” he says. If health-care technologies are properly integrated, the “whole” can be greater than the sum of its parts. While many facilities have multiple IT-related systems in place—billing software, accounting software, a patient recording-keeping system, and a scanner for modeling, for example—newer solutions have come to market that combine these functions so each system can transfer data. There are numerous advantages of a more integrated system: less data re-entry, increased efficiency, and better organization of the various pieces of a patient’s file. Another best practice for O&P IT is using “the Cloud” for backup and storage purposes. “Cloud-based systems enable use of a health-care computer system without physically owning any of the assets,” says Meffert. “Everything is accessed securely through the Internet browser to a remote data center.” Before uploading any data to a Cloud service, however, make sure the provider has signed a HIPAA business associate agreement.


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When comparing all of the relevant products to make a final decision concerning new technology, three components must be given equal attention: the functionality of the software, the consultant or vendor who is installing it for you, and your own hardware and operating system.

Ulllman also recommends considering web-based choices when replacing outdated software. “This reduces a facility’s dependence on its own hardware or network.”While Cloud and online solutions may be useful, Ullman cautions against relying on these solutions for facilities that have frequent or extended outages of Internet access. Still another recent IT trend is leveraging mobile phone and tablet technologies, and integrating these devices into facility systems. “Tablet computing has many uses in health care,” says Meffert. “Depending on the applications used, or one’s ability to use photo or video, the tablet can be quite a useful tool.” Also becoming more common among O&P practices are technologies that enhance communications and interactions with patients. Patients may want to “take advantage of self-service payment, scheduling portals, or text integration with a scheduling system,” suggests Meffert. Implementing such technologies can make a facility more appealing to younger or techsavvy patients. Of course, all of these best practices need to be sufficiently secure to protect patients’ personal health information. Office managers should ensure that any patient information uploaded electronically “is stored in a physically safe location, is using disk encryption, and is protected with user IDs and passwords,” says Meffert. Along these same lines, he warns against


O&P Almanac DECEMBER 2013

transmitting any patient information via email, USB flash drives, or portable hard disks without encrypting it first.

The Role of IT in Clinical Documentation One of the most important pieces of the IT puzzle that should be regularly re-evaluated is clinical documentation software. “Due to some external audit processes, like the [Recovery Audit Contractor] audits, some clinicians have become a bit disenfranchised about the quality and quantity of clinical documentation they need to produce,” explains Dobson. “To capture adequate clinical information to support these efforts, there can be literally hundreds of data points. A good clinical data template interface can be the difference between gathering good information versus the right information.” Thus, in researching IT, facility managers should seek a user interface that allows for clinical evaluation flow “and gives the clinician the

ability to navigate with flexibility to the areas that are specific to the patients,” says Dobson. “The advent of HIPAA-compliant communication pathways allows more real-time and detailed communication.”

The Purchase Decision When comparing all of the relevant products to make a final decision concerning new technology, three components must be given equal attention, says Ullman: the functionality of the software, the consultant or vendor who is installing it for you, and your own hardware and operating system. “These three components work together, so glitches are possible” during implementation, says Ullman. “Most new technologies are not just plug-and-play.” In many cases, hiring a consultant to assist with research and implementation can be useful. Meffert recommends evaluating potential systems in terms of technology capabilities, such as the availability of local support. “A solution

with a large hardware footprint may not be the best decision if a company does not have access to a full-time technology support person,” he explains. When researching new products, Ullman recommends accessing the wealth of reviews and other resources available online. He also suggests going to O&P shows, such as AOPA’s annual National Assembly, to meet providers and get feedback and insight from other practitioners and office managers. In addition, consult colleagues for their opinions: “Go to facilities that are not your competition to see how their technology works,” says Ullman. And ask about the people who helped install their new system. Check references ahead of time to make sure that any consultants you hire can actually do what they promise they can do. “If I were a smaller O&P facility, I would talk to friends at a larger facility,” he adds. Though the larger facilities may have bigger budgets, technology-related pricing tends to decrease over time, so smaller facilities may be able to invest in systems the larger facilities implemented a year or two ago—if those systems are receiving positive reviews.

Once a final product is selected, a collaborative effort between the vendor, staff, and consultant should aim to transition quickly: A slow transition can mean double the work for staff, so moving quickly but thoroughly can realize the most cost savings.

Training for Long-Term Success Of course, any new technology is only as useful as the people who are operating it. Once the new system is in place, it’s imperative to allot time and money for appropriate staff training. And it’s also important that the staff understands why embracing the new technology will ultimately benefit the O&P facility.

“Some facilities will get expensive equipment but won’t get their staff properly trained. Or, some staff members may resist using the new systems,” cautions Ullman. “Aligning and training staff with a new technical direction is key,” adds Meffert. For example, “a skilled claims administrator can help a practice be more successful in being reimbursed.” “The computer system is just a tool for staff to use,” explains Meffert. “Make sure the team is aligned with the new direction, and is capable of using it.” a Christine Umbrell is a contributing writer to O&P Almanac. Reach her at

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DECEMBER 2013 O&P Almanac



Facility Spotlight By Deborah Conn

Tim Nutgrass, BOCP, with a patient.

Comprehensive Care The Center for Orthotic & Prosthetic Care team with a patient.

A Kentucky-based O&P facility has expanded to offer great care across several states

Facility: Center for Orthotic & Prosthetic Care


Owner: Don Dixon, CPO; Keith Senn; Mike Maddingly, CPO; Tim Nutgrass, BOCP; David Sickles, CPO, C.Ped History: 16 years in business


O&P Almanac DECEMBER 2013

ownership of a number of O&P facilities and established new offices in nearby communities. COPC has 95 employees throughout the business, 42 of whom are clinicians. Among all the offices, prosthetics care accounts for about 55 percent of business and orthotics accounts for 45 percent, with each office providing the full gamut of care. “If there’s something that is being done in O&P, someone in our company is probably doing it somewhere,” says Dixon. “We are pretty comprehensive, which has helped us grow.” The company has two large central fabrication facilities, one in Louisville and one in Research Triangle Park, North Carolina. These serve all COPC patient-care offices, which have their own smaller labs for device modifications and finishing touches.

Photos: Center for Orthotic & Prosthetic Care

Location: Headquarters in Louisville, Kentucky, with 19 offices in Kentucky, Indiana, New York, and North Carolina

n 16 years, the Center for Orthotic & Prosthetic Care (COPC) has expanded from its first facility in Louisville, Kentucky, to encompass 19 offices in four states. In 1997, Don Dixon, CPO, responded to a call by Kosair Children’s Hospital in Louisville to help with financial and operational issues in its O&P department. Dixon assembled a team of professionals—Keith Senn; Mike Maddingly, CPO; and Tim Nutgrass, BOCP—and the group eventually took over ownership and operation of the department, changing its name but remaining in the hospital complex. Other hospitals, including Duke University Medical Center, approached Dixon and his colleagues for similar assistance, and the team, along with David Sickles, CPO, C.Ped, has taken either full or partial


Facility Spotlight

Emphasis on Education

Photos: Center for Orthotic & Prosthetic Care

Education of both staff members and patients is a priority at COPC. Each central fabrication facility also holds a learning center, where employees attend seminars, vendor training sessions, and other educational offerings. Both employees and vendors benefit from the ability to assemble relevant personnel from multiple offices in one place, says Dixon.

Mike Maddingly, CPO, with a patient.

COPC’s Peak Prosthetic Clinics occur several times a year and are targeted to patients, amputee groups, and referral sources. The clinics are free of charge, and amputees can meet with a clinician for a socket fit assessment, gait analysis, and technology review. Attendees can see new products, and vendor reps may be present to demonstrate them and explain how they work. The company’s marketing efforts are centered around patientcare coordinators, who approach prospective new referral sources and maintain a dialogue with existing sources to be sure they are satisfied with COPC’s care. “Our objective is to make sure our referral sources and our patients are happy with what we’re doing and that they get the information and assistance they need,” says Dixon. “We get everyone together to solve any issues that may arise.” One issue that has had a significant impact on COPC, as well as other facilities, is the increase in Recovery Audit Contractor and prepayment audits. “We have done a lot of education through the years on clinical notes and reviewing our internal processes,” says Keith Senn. “But we

An employee working in the central fabrication lab.

still have to fight through the audits. We’re using AOPA’s help along with our own efforts to see if we can’t trim these audits back. A lot of smaller facilities are having trouble; the audits are holding back their cash flow.”

A Loyal Base COPC’s thriving business is the result of its employees, says Dixon. “Most have been with us for a long time, and their experience and loyalty are the cornerstones of our success.” The company offers two programs for its employees. The first, Performance Recognition, gives workers the opportunity to gain mastery and have autonomy in their work. The second, Personal Goals, is in its early stages. The idea is to have individual employees establish as many as seven personal or professional goals and have the company work with staff members to achieve them.

“We create a real team effort,” says Senn. “We’re in the office every day with the employees, and we all have the same common goal. We offer many growth opportunities within the company, so our employees want to stay with us.” COPC looks to a future that includes “smart growth,” according to Senn. “Our goal is not to open so many offices per year. We want to grow as opportunities present themselves.” And throughout that growth, says Dixon, “our real aim is to build the very best company we can—to use our systems, processes, and operations to offer the best patient care possible and help our employees reach their goals.” a

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

DECEMBER 2013 O&P Almanac



Ask the Expert By Joe McTernan, AOPA government affairs department

Tricky Coding and Billing Scenarios

Reviewing the policy on vacuum pumps, test sockets, and more

AOPA’s reimbursement staff fields hundreds of questions each month regarding how to properly code and bill for O&P services. While the questions vary in their complexity and depth, several questions are asked repeatedly by different folks across the country. This month’s Ask the Expert will highlight a few of these common questions.


Is it appropriate to bill L5781 or L5782 when using a vacuum pump to enhance the suspension ability of a suction socket?


The descriptor for L5781 reads as follows: “Addition to lower-limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system.” The descriptor for L5782 is the same with the addition of the term “heavy duty.” While the creation of an elevated vacuum environment often enhances the ability to suspend a prosthesis using suction, L5781 and L5782 describe a separate and unrelated function that addresses volume management and moisture evacuation of the residual limb. As with any code you bill, Medicare requires documentation of the medical need for the function that you are billing. Medicare views the function of suspending the prosthesis through the use of suction as included in the reimbursement for L5647 or L5652, regardless of whether an elevated


O&P Almanac DECEMBER 2013

The best way to achieve appropriate reimbursement is to make sure records and documentation abundantly reflect and support medical need. vacuum is used to enhance suspension. If you are billing for L5781 or L5782 in addition to the suction suspension codes, you and the prescribing physician must be able to document the specific medical need to control the volume of the patient’s residual limb or to eliminate moisture by creating an elevated vacuum environment. The best way to achieve appropriate reimbursement is to make sure records and documentation abundantly reflect and support medical need.


Ask the Expert


Why am I receiving claim denials when I bill for two test sockets for a prosthesis?


Medicare’s Lower-Limb Prosthesis Policy states: “More than two test (diagnostic) sockets (L5618-L5628) for an individual prosthesis are not reasonable and necessary unless there is documentation in the medical record which justifies the need.” This is a valuable statement when challenging Medicare denials for multiple test sockets provided with a single prosthesis. While anything you provide must be supported by documentation of medical necessity, the policy is worded in such a way that it is reasonable to expect that two test sockets are typically part of the fitting process for the prosthesis. As long as your documentation supports the medical need for two test sockets, you should have a valid argument when appealing the claim. However, the wording of the policy also may work against you when using test sockets as part of the fitting process of a replacement socket. The argument can be made that because a replacement socket is still part of the original prosthesis, additional test sockets may not be deemed medically necessary when fabricating a replacement socket. This reasoning should be countered with the additional documentation that supports the need for the replacement socket.


I would like to treat a patient who is not currently ambulatory with an ankle-foot orthosis (AFO) or a knee-ankle-foot orthosis (KAFO). The patient is expected to be ambulatory while wearing the AFO or KAFO. Does this meet Medicare coverage criteria?


The Medicare AFO/KAFO policy differentiates coverage into two basic categories: AFOs/KAFOs used during ambulation and AFOs/ KAFOs not used during ambulation. As


O&P Almanac DECEMBER 2013

long as the patient is ambulatory while wearing the AFO or KAFO, the item is eligible for coverage—assuming all other coverage criteria are met. There is no policy requirement that states the patient must be ambulatory without the AFO or KAFO.

As long as the patient is ambulatory while wearing the AFO or KAFO, the item is eligible for coverage—assuming all other coverage criteria are met.


How do I bill for the replacement of a locking pin that is used as part of a locking suspension system?


The locking pin is considered part of the overall locking mechanism described by L5671, but if there is a need to replace only the pin itself, the most accurate way to bill it is to use a combination of L7510

(minor parts) and L7520 (labor, per 15 minutes). It is important to document the specific need for the replacement of the pin.


I am receiving claim denials for Healthcare Common Procedure Coding System code L5987 when I deliver a prosthesis to a patient in a Medicare Part A-covered Skilled Nursing Facility (SNF) stay. I thought prostheses were exempt from the SNF Prospective Payment System (PPS) rules and could be billed directly to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC).


While the majority of prosthetic codes are exempt from SNF PPS and may be billed to the DME MAC, L5987 is not included in the list of exempt codes and, therefore, remains under the SNF PPS rate. If a prosthetic foot that is coded as L5987 is provided to a patient in a Medicare Part A-covered SNF stay, payment terms for that code must be negotiated directly with the SNF. a Joe McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmcternan@


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Next Steps for O&P AOPA members must work together to survive and thrive in the industry’s ‘new normal’ Peter Thomas, Esq., speaks at the O&P World Congress RAC program in September.


OPA’s leadership issued a letter in October alerting members to an increasingly obvious conclusion about recent events that have caused turmoil in the O&P community. These changes were triggered by the flawed Office of the Inspector General (OIG) report issued in August 2011 that claimed improper payments for lowerlimb prostheses were made because the referring physician hadn’t seen the patient in a reasonable time prior to the service. The “Dear Physician” letter in August of 2011 quickly followed on the heels of the OIG report. Despite the obviously erroneous conclusions that there must be evidence of a patient’s visit with the referring physician to validate medical necessity, CMS and its auditors launched overzealous and unprecedented audit activity that have sent tremors and even death rattles through the O&P community.

Even within the O&P profession, not all providers experience the same audit results. What they failed to recognize was that the referring physician is usually the surgeon who performed the amputation and who seldom has a continuing patient relationship. AOPA’s lawsuit against CMS is among the many responses to its actions, but regardless of how the lawsuit plays out, there is a growing reality that things will not be the same. The O&P community and other providers must acknowledge the “new normal.”


O&P Almanac DECEMBER 2013

CMS will always have audit authority, as it should. It’s a reasonable expectation on the part of taxpayers that there be safeguards on how those dollars are spent, and fraud and waste in the Medicare system has long been in the headlines. Couple the OIG report and subsequent actions with the pressing need for Medicare to squeeze $750 billion out of the system over the next 10 years to pay for the Affordable Care Act and the future is very clear. It will not be business as usual, and we’re not going back to the way things were.

The ‘New Normal’ As AOPA’s October “New Normal” letter to members observed, “Even within the O&P profession, not all providers experience the same audit results. The differentiator is the ability of the O&P supplier to furnish proper claim documentation. Another fallacy is that we presume all O&P suppliers are as professional as we ourselves are. We are therefore impacted by all the noise from those practices (perhaps certified and accredited) who have demonstrated an inability or unwillingness to develop the types of documentation and claim submission safeguards others may have had in place for years.” The letter went on to say, “Because of the volume of claims that Medicare contractors process, it is not possible to screen every single claim to the level of detail that we see during an audit; most claims are paid so long as they can pass through the automatic screens that CMS has in place. Historically, this relatively low level of claim screening or oversight has caused some suppliers (and some of our peers) to develop a laissez-faire (or worse) attitude toward claim submission and documentation. At the same

AOPA HEADLINES time that the bar for claim documentation has been raised, the quality of submitted claims and supporting documentation has suffered. Thus, Medicare has increased its success rates in recouping payments. “With claim error rates regularly above 70 percent, auditors and claim reviewers have no reason not to expand into the lower-activity claims. We may see more and more activity move into the final level of Medicare appeals: the Administrative Law Judge (ALJ). Many of the prosthetic claims denied in late 2011 and 2012 are just now finding their way to the judges for a final hearing. This trend will likely continue, even though the anecdotal evidence suggested an extraordinarily high prosthetic appeal win rate of greater than 80 percent. Preparing your claims to be appealed all the way to the ALJ level takes patience and perseverance, but this is a necessary persistence to stay in business.” AOPA recently learned CMS has been telling members that taking a claims appeal all the way to the ALJ may take as long as 28 months—an insufferable delay with dramatic consequences for cash flow at both the patient-care and supplier levels. While AOPA’s lawsuit against CMS may provide some relief from the past misdirected and overzealous audits, the future certainly holds serious and continuing challenges that will require O&P providers to adapt in order to survive. And it all comes down to proper documentation in this new world of O&P care—a reality that was underscored at the AOPA World Congress in Orlando in September, where two of the programs devoted to Recovery Audit Contractor (RAC) audits and documentation attracted standingroom-only audiences. AOPA’s phone rings off the hook year-round with questions about RAC audit issues. It was clear at the World Congress that there was concern on the part of practitioners and owners that a new learning curve was needed and that there may indeed be a new normal.

Joe McTernan, director of coding and reimbursement services for AOPA, speaks at the O&P World Congress in September.

A Sort-Of Silver Lining If there can be a silver lining in this situation, AOPA’s October letter to members may have captured it: “Going forward, ‘caution’ is the watchword. The more we push, the more likely we will have a wholesale revision of the present processes. The present state is the ‘new normal’ of claims validation and cannot just go away. It is also performing a very important function of editing out the unqualified prosthetic suppliers, who may presently be in the system. The qualified supplier with good document controls will survive the transient pain of this initial process into the ‘new normal,’ which will continue to serve as a barrier to entry for the unqualified.” The letter closed with this observation and warning, “Beware that requests for a prior approval process or CMS-mandated forms would be a huge step backwards. Most importantly, these proposals would immediately demote us from clinical professionals to Durable Medical Equipment vendors in the eyes of all payers.” There are two other important actions you can take in this effort to survive. First, enlist the support of your senator and representative for The Medicare O&P Improvement Act (HR 3112). When enacted into law, it will help weed out unqualified providers and help curb fraud and abuse, saving $250,000,000 over five years. Every member of the O&P

community should contact his or her senator and representative, urge their support of this bipartisan bill introduced by Rep. Glenn Thompson (R-Pennsylvania) and Rep. Mike Thompson (D-California), and ask them to join the list of co-sponsors, who include (as of Oct. 31, 2013): Representatives Tammy Duckworth (D-Illinois), Tim Griffin (R-Arkansas), Brett Guthrie (R-Kentucky), Peter King (R-New York), Peter Roskam (R-Illinois), Tom Latham (R-Iowa), C.A. Dutch Ruppersberger (D-Maryland), and Aaron Schock (R-Illinois). Second, we must be a united O&P community, and you can help make that happen by ensuring that every O&P provider in your community is an AOPA member. This struggle is the biggest ever faced by the O&P industry. AOPA and its members alone are funding this very expensive lawsuit as well as pursuing multiple other efforts every day to help bring order out of this chaos. This is a time when we must unite. AOPA has put its own financial future on the line. Please note that the relief sought in the lawsuit is only on behalf of AOPA members. We ask that you urge any suppliers or patient-care companies you know are not members to join. Ask them to visit the AOPA home page,, and click on the “JOIN AOPA NOW” link in the middle of the page. We need everyone in O&P to join AOPA and help us all fight this battle together. a

DECEMBER 2013 O&P Almanac



Calling All Prosthetists & Referring Physicians Two surveys have been created to poll prosthetists and physicians nationwide to gather feedback on the documentation requirements from the Centers for Medicare & Medicaid Services (CMS) for Medicare covered lowerextremity amputees. Both surveys, which are easily accessed through the website, were created to gather information that will be summarized and reported to CMS to demonstrate how the current documentation requirements are misguided, are not working effectively, and need to be changed. This effort is being led by Pete Seaman, CP, in Newark, Delaware. As a prosthetist, you are encouraged to do two things: 1. Visit and complete the short prosthetist survey. 2. Forward the link to the physician survey ( to as many of your referring physicians as possible so their much-needed input may be included.

across the country continue to have difficulty obtaining truly beneficial notes from their patients’ attending physicians regarding their prostheses. Hopefully, the surveys will bear out information to support a proposal that CMS’s Recovery Audit Contractor audits be immediately suspended until a standardized and objective functional level determination process is created, accepted, and communicated to all involved parties. AOPA member Jeff Erenstone is trying a new method on fighting the RAC problems, a petition effort on www. If you are interested in looking at Jeff’s petition and possibly signing it, go to medicare-its-time-to-start-following-the-law. Please consider participating in the survey and asking your referring physicians to do the same. For more information, contact Pete Seaman at

The intent of these surveys is to demonstrate that, since 1995, when CMS created the five K-level functional descriptions, CMS has failed to provide a standardized and objective process by which physicians and/or prosthetists can accurately determine a lower-extremity amputee’s potential functional level. Furthermore, CMS’s “Dear Physician” letter of August 2011 did not help the situation as prosthetists

Prosthetist Survey: Physician Survey:

O&P PAC Update 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

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*: • Gaurav Mishra • Thomas Watson, CP

*Due to publishing deadlines this list was created on Nov. 15, 2013, and includes only donations received between Oct. 3, 2013, and Nov. 15, 2013. Any donations received on or made after Nov. 15, 2013, will be published in the next issue of O&P Almanac. The complete 2013 list of O&P PAC donors and supporters will be published in the January 2014 issue. 38

O&P Almanac DECEMBER 2013

Simple As :



2. Visit or Call 410-663-KISS (5477) Š 2011, U.S. Patent, Patent Pending Worldwide KISS is a registered trademark


Medicare Audit Frustrations and Losses: No Comprehensive Solution, But Some Incremental Steps AOPA understands the frustration that O&P practices face when receiving insufficient or nonexistent physician documentation supporting the medical need for the services the physician prescribes. It can be frustrating when physicians are unwilling to provide adequate documentation, often attributed to a lack of reimbursement for doing so. There are, however, a few incremental steps orthotists and prosthetists can consider to reduce, at least modestly, their potential financial loss exposure. One of these steps may be achieved through the careful, occasional, and proper execution of an Advanced Beneficiary Notice (ABN). An ABN is a document that Medicare providers may use to notify a beneficiary, prior to delivering a service or item, that the provider believes Medicare may deem as not medically necessary. To be considered valid, the ABN must specifically list the exact reason(s) why the provider believes the service or item may be considered not medically necessary. In addition, The ABN must be signed and dated by the patient. Finally, ABNs cannot be used routinely; they must state the specific reason why, for that particular patient, the provider believes Medicare may deem a service as not medically necessary. It is not acceptable to ask a patient to sign an ABN because the physician documentation might not be sufficient. If, however, after requesting physician documentation, the provider believes there is a reasonable risk that Medicare might consider this documentation insufficient to support the medical need for the item or service, the patient may be asked to sign an ABN due to potential lack of sufficient physician documentation. A properly executed ABN serves two purposes. First, it shifts the financial liability for the item or service from the

provider to the Medicare beneficiary. Medicare regulations place financial liability for claims denied due to medical necessity on the provider, unless the Medicare beneficiary has been notified, in writing, of the potential denial and had the opportunity to make an informed decision regarding provision of the service. The properly executed ABN serves as documentation of this notification, and the patient’s signature serves as proof of their informed decision. While the provider may choose to appeal the denied claim through the regular channels, the ultimate financial liability for payment of the claim now resides with the Medicare beneficiary. The ABN also may serve to encourage the Medicare beneficiary to become more aware of a potential cost that could rest with that patient, making the patient a more informed and better advocate for his/her own care. Without an ABN, the patient has “no dog in the fight” since he or she cannot be held financially liable for the service should Medicare deem it not medically necessary. Patients are much more likely to be willing to fight for reimbursement when they have a vested interest in the payment of a claim. For more information on how to reduce your financial exposure from Medicare audits, consider attending an AOPA Coding and Billing Seminar. Visit

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.


O&P Almanac DECEMBER 2013

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 an annual subscription of the O&P Almanac at AOPA’s Online Bookstore,


Save the Dates: 2014 AOPA Audio Conferences Announced Mark your calendar now for the audio conferences in 2014. AOPA has confirmed the dates and topics for its 2014 series of audio conferences. Educate yourself and your staff during one-hour sessions in the comfort of your office on the second Wednesday of each month at 1:00 p.m. EDT. This series provides an outstanding opportunity for you and your staff to stay abreast of the latest hot topics in O&P, as well as gain clarification and ask questions.

Buy the Series and Get Two FREE! Visit the AOPA website, buy the series, and get two audio conferences free. AOPA members pay $990 to participate in all 12 sessions (nonmembers pay $1,990). If you purchase the entire year’s worth of conferences, all conferences from the months prior to your purchase of the set will be sent to you in the form of an MP3. Individual seminars are priced at just $99 per line for members ($199 for nonmembers).

Register online at Questions? Contact Betty Leppin at or 571/431-0876.

2014 Topics • January 8: New Year, New Opportunity: Are You Billing for All That You Can? • February 12: Billing for Diabetic and Orthopedic Shoes, Mastectomy Services, and Surgical Dressings • March 12: The ABCs of Audits: What to Expect and How to Respond  • April 9: How To Use Advanced Beneficiary Notices (ABNs) Effectively • May 14: Modifiers: How and When to Use Them • June 11: The Self-Audit: A Useful Tool • July 9: The OIG:  Who Are They and Why Are They Important? • August 13: AFO/KAFO Policy: Understanding the Rules • September 10: Urban Legends in O&P: What To Believe • October 8: Medicare Enrollment, Revalidation, and Participation • November 12: Gifts: Showing Appreciation Without Violating the Law • December 10: New Codes and Changes for 2015

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.

DECEMBER 2013 O&P Almanac



What’s on the Horizon? New Codes for 2014— Join the Audio Conference December 11 HIPAA requires all payers to use Healthcare Common Procedure Coding System (HCPCS) Codes. The end of the year marks the beginning of new codes and modifier changes that will take effect Jan. 1, 2014. Do you have a plan in place? Ensuring your practice is sound may prevent unnecessary audits down the road. To prepare for the new year, join AOPA December 11 for an AOPAversity Mastering Medicare Audio Conference that will focus on new codes and medical policy changes for 2014. Find out why coding correctly in 2014 will be an important part of your business operation. The following topics will be discussed: • New HCPCS codes effective Jan. 1, 2014 • Verbiage changes to existing codes and how they may affect your business • Which codes will no longer be used as of Jan. 1, 2014 • Other changes to the HCPCS system • AOPA’s interpretation of why the changes took place.

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 Steve Custer at or 571/431-0876 with registration questions.

New in the AOPA Bookstore: ‘2013 Operating Performance Report’ & ‘2013 Compensation & Benefits Report’ Are you curious about how your business compares to others? These updated surveys will help you see the big picture. AOPA’s “2013 Operating Performance Report” provides a comprehensive financial profile of the O&P industry including balance sheet, income statement, and payer information organized by total revenue size, community size, and profitability. The data was submitted by more than 130 patient-care companies representing 1,050 full-time facilities and 68 part-time facilities. This report provides financial performance results as well as general industry statistics. Except where noted, all information pertains to fiscal year 2012 operations. AOPA’s “2013 Compensation & Benefits Report”


O&P Almanac DECEMBER 2013

represents the most complete, accurate, and up-to-date compensation information for the O&P industry. This report is designed to allow industry members to easily compare their compensation levels and benefits policies with those of similar facilities. The report is divided into two major sections: average salaries and ranges of key employee positions, and benefits offered, including holiday and vacation policies. Both reports may be purchased in the AOPA Bookstore at


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.

Coding Questions Answered 24/7 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.


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

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 advertising, call Bob Heiman, Advertising Sales Representative at 856/673-4000 or email DECEMBER 2013 O&P Almanac



New College Park Shelltread College Park is known for high-quality and durable foot shells. Now your highest impact patients can increase that durability, and everyone can enjoy walking barefoot safely. The College Park Shelltread is made from abrasion-resistant styrenebutadiene rubber with a cross hatch design for enhanced non-skid. Easy to install and affordable, they are available in neutral and black for every size and type of College Park foot shell. For more information, call 800/728-7950 or visit www.

KISS® WrapStrap-R®

Go sleeveless with the Unity™ Sleeveless Vacuum System by Össur® Until now, all advanced vacuum systems have required a sleeve to maintain vacuum. The problem is, sleeves are bulky. They bunch behind the knee, restricting rangeof-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 inHg of vacuum without a sleeve. Visit to get certified and check out the entire line of Unity-compatible Flex-Foot feet, including low-profile and microprocessor solutions.

PEL Offers the K2 FOOT from Fillauer Now available in brown, the Wrapstrap-R by KISS is residue-free and offers removable linkage. This product prevents: • Sleeve doffing inversion • Sleeve doffing dislodging • Under sleeve air leakage This product provides: • Reliable and strong support • Low profile, full adjustability • Tapeless, removable linkage. Wrapstrap-R by KISS available: • CMP24/G: Single brown • CMP24/H: 10-pack brown. For more information, call 410/663-KISS (5477) or visit U.S. Patent 8,182,546, and Patent-Pending Worldwide.


O&P Almanac DECEMBER 2013

Engineered from the ground up for the functional level 2 patient. Other K2 designs are typically stiffer SACH feet or softer K3 designs. The Fillauer K2 Foot is a new design specifically for the functional level 2 patient. • Unique flexible keel/multi-axis design • Flexible, impact-reducing design • Roll-Over Shape (ROS) designed for a natural gait • Compliant dynamics for comfort and stability • Positive lock foot shell interface for stability • Simple, maintenance-free design • Foot comes assembled in foot shell for an easy “out-ofthe-box” fit. For more information, contact PEL at 800/321-1264 or email Customers can order online at a

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


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

- Northeast - Mid-Atlantic - Southeast - North Central

Southeast Be Your Own Boss Southeast Florida • Has the thought of Medicare audits and prepayment reviews stopped you from starting your own O&P practice? • Is the required documentation for authorizations getting you down? • Have startup costs prevented you from going out on your own?

- 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

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O&P Almanac DECEMBER 2013

An established O&P company is looking for candidate(s) for an opportunity with unlimited potential and minimal expense. The position requires certification in orthotics and/or prosthetics and established or be eligible for Florida licensure. Practice has implemented OPIE Software for all the documentation. In addition, you will have the use of a 4,000-square-foot facility to manufacture and provide care to your patients.

O&P Ad 1113 O&P Almanac 330 John Carlyle St., Ste. 200 Alexandria, VA 22314 Fax: 571/431-0899

Pacific Certified Prosthetist and Certified Prosthetist Orthotist East San Francisco Bay Area and Central Valley, California Competitive western United States O&P business seeking certified prosthetists and certified prosthetist/orthotists in the East San Francisco Bay Area and in the Central Valley of California. We have openings in Walnut Creek, Pleasanton, and Fresno. We are looking for seasoned practitioners with experience in practice management, clinical expertise in outpatient and inpatient settings, and a willingness to work within a dynamic team. Unlimited business opportunities are available in the expanding local markets. Competitive salary, benefits, and bonus plan. Interested parties please email inquiries and resume to:



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Think UNM Hospitals. Orthotist/Prosthetist-Certified

Orthotist (Req# 12048165) Requires 3 years of related experience and certification as an Orthotist from the American Board for Certification in Orthotics and Prosthetics. As the region’s only Academic Medical Center, UNM Hospitals continues to be a leader in medical and academic excellence. It’s a level of distinction made possible by the ability of our diverse and richly experienced organization to collaboratively solve challenges and innovate healthcare solutions. It’s what makes us uniquely positioned to continuously raise the level of care we offer, and why we’ve been recognized by Diversity Inc. as a Top 10 Hospital System for 2013. So join us and add your unique perspectives and ideas to our distinction. For more information about UNM Hospitals and our benefits, visit

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:

Visit UNMHospitals

Search by position number MC130328 1000 North Oak Avenue, Marshfield, WI 54449 Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individuals with disabilities and veterans are encouraged to apply.

O & P ALMANAC MAGAZINE “The most gratifying piece of what I do 12/01/2013 every day is to get up early in the 1276765-PAPC63606 morning, get to the office and know that UNMHOS we are going to make a difference.” 3.5” x 4.5” - Kevin Carroll, MS, CP, FAAOP Madelene Kane v.1 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. Join Hanger Clinic and make a difference today. To view available positions and apply online visit: or scan the QR code. 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.


Walnut Creek, CA Jackson, MI Florissant, MO

Albuquerque, NM Burr Ridge, IL Columbus, OH Covington, LA Dayton, OH Englewood, CO Enid, OK Fairfield, CA Grand Rapids, MI Las Cruces, NM EOE Layton, UT

Macon, GA Naples, FL Panama City, FL Portland, ME Santa Rosa, CA Syracuse, NY Tamarac, FL Thomasville, GA Springfield, IL Columbia, MO

Richland, WA Wichita, KS Hammond, IN Bridgeport, WV Carmichael, CA Evansville, IN

Johnston, IA Lincoln, NE Modesto, CA Torrance, CA Somersworth, NH

Hattiesburg, MS Kansas City, MO Phoenix, AZ

San Francisco, CA Jackson, MS Waterville, ME




DECEMBER 2013 O&P Almanac



North Central

North Central



Traverse City/Petoskey/Cadillac, Michigan Opportunity to work and play in beautiful Northwest Lower Michigan. Michigan offers all of life’s pleasures such as boating, fishing, golfing, and skiing, all close to home! Active Brace and Limb is seeking a motivated, organized, and experienced practitioner to add to its professional staff. To discuss our competitive salary and benefit package, or visit an Active Brace and Limb facility, please contact or email your confidential resume to:

Michigan Wright & Filippis, a leader in the rehabilitative health-care field, currently has four open positions for dedicated and compassionate clinicians. There are two positions for certified orthotists with pediatric experience and helmet experience (or wanting to develop these skills) in the Saginaw and Madison Heights areas. The third position is for a CO/ CPO/C.Ped in Kalamazoo, Michigan. The fourth position is a C.Ped in the Bad Axe/Cass City area. Individuals striving to excel professionally and clinically, while being supported by outstanding clinical and operational teams, please apply. Competitive benefits package. To learn more about a career with Wright & Filippis, visit our website:

Scott Phone: 231/932-8702 Email:

CPO and CO Springfield, Missouri CoxHealth in Springfield, Missouri, has immediate openings for a CPO and CO in their NEWLY OPENED integrated, hospital-based clinic. Work with a multidisciplinary team providing evidence-based services to adults and children throughout the continuum of care. Candidates must be selfstarters, eager to grow business, with solid fabrication skills who desire professional growth. SIGN ON BONUS AND RELOCATION EXPENSES AVAILABLE! Nestled in the Ozark Mountains and surrounded by natural beauty, Springfield is beloved by outdoor enthusiasts. Freshwater lakes make the area a fisherman’s paradise. Springfield is also home to the Springfield Cardinals, a double-A affiliate of the St. Louis Cardinals. Located in Southwest Missouri, Springfield is a short distance from several major metropolitan areas including St. Louis, Kansas City, and Tulsa. Come see why a significant number of CoxHealth employees have spent their entire careers working here! • Must have a minimum of a bachelor’s degree and be ABC or BOC certified • Undergraduate degree in orthotics/prosthetics, allied health field, engineering, kinesiology, biology, or biomechanics preferred. Prefer management experience and five to seven years’ clinical experience. • EOE

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

South Shore experience will provideand South Coast, Massachusetts business owners, managers and practitioners an opportunity to Immediate opening for a CPO with at least five years of experience fresh insights, new tools and proven techniques experience. We are looking for a self-motivated practias a pathway for developing better business practices, while marketing and people skills. We have two tioner with good creating ongoing returns for your company. and time would be split between the two offices. locations, Send resumes to: ■ REFRESH YOUR KNOWLEDGE

Email: Fax: 508/587-7330




Earn Your Certificate in


Through a joint partnership between AOPA and the University of The O&P Business Virginia School of Continuing and Professional Studies Management Certificate Program addresses skills that are fundamental to the success of an O&P business.

to get started: AOPA How PRESENTS THE NEW Business Management Certificate Program 1.

O&P Management: Complete theBusiness online sign up form: unique leadership learning certificate-in-op-business-management/ experience will provide


Select and complete four required core modules practitioners an opportunity to and four elective modules within three years.

business owners, managers and


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.

experience fresh insights, new tools and proven techniques

The O&P Business Management Certificate is a comprehensive A NEW granting AOPAversity OPPORTUNITY! certificate program that offers Another addition to the valuable education, products and a series ofoffered business and manageservices by AOPA that you need to succeed. ment seminars to provide business owners, managers and practitioners of O&P patient care facilities, O&P education programs that universities manufacturers and distributors an offer in conjunction with their MBA opportunity to explore crucial business Earn Your Certifiprograms. cate inThe Certificate Program challenges—from finance, sales courses will be offered at the AOPA and marketing to business operaAssembly, online at AOPA’s website tions, reimbursement policies and between AOPA Through a joint partnership the Universityseminars of andandtargeted throughout Virginia School of Continuing and Professional Studies management. The improved Business the country (such as the Mastering Management Certificate Program will Medicare: Essential Coding and Billing How to get started: be similar to non-degree continuing Techniques Seminar). as a pathway for developing

better business practices, while creating ongoing returns for your company.


Please contact:





Fred Lerche, Administrative Director of OP Rehab Services Phone: 417/269-9898 Email: 48

O&P Almanac DECEMBER 2013


Complete the online sign up form:


Complete a Module specific quiz for each program.

4. Participants that successfully complete the For 2.more information, visit program will be awarded a certificate of 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.

completion, in addition to being recognized at the AOPA National Assembly and the O&P Almanac.


■ 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 For more information, visit or email ■ On-site Training Motion Control Inc. On-site Training Course is focused on the expedited fitting of your first patient. Course Length: 3 days, CEUs: 19.5 hours (estimated). Recommended for prosthetists with a patient ready to be fit immediately. For more information, call 801/326-3434, email info@, or visit


2013 ■ December 10-12 WillowWood: OMEGA® Training. Mt. Sterling, OH. Covers the all-new OMEGA software and shape capture using the OMEGA Scanner 3D. Shape creation, shape modification, and software customization discussed. Extensive hands-on practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: 19.25 ABC/19.25 BOC. Visit

PROMOTE Events in the O&P Almanac

CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to for content deadlines. Words

Member Rate

Nonmember Rate

25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$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

■ DECEMBER 13-14 ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg College Caruth Health Education Center, St. Petersburg, FL. The application deadline for this exam was Sept. 1, 2013. Contact 703/836-7114, email, or visit certification.

2014 ■ JANUARY 1 ABC: Application Deadline for Certification Exams. Applications must be received by Jan. 1, 2014, for individuals seeking to take the March 2014 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians. Contact 703/8367114, email certification@abcop. org, or visit certification. ■ January 3-4 ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg College Caruth Health Education Center, St. Petersburg, FL. The application deadline for this exam was Sept. 1, 2013. Contact 703/836-7114, email, or visit ■ January 8 AOPAversity Audio Conference–New Year, New Opportunity: Are You Billing for All That You Can? Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email

■ January 10 WillowWood: LimbLogic® Technicians, via WebEx, 3:00 PM ET. Learn the essential elements for elevated vacuum socket fabrication. Learn unit operation features and diagnostics that keep the LimbLogic system optimal for patient use. 2014 Credits: TBD. Visit ■ January 13-18 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was Nov. 1, 2013. Contact 703/836-7114, email, 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 ■ January 28-30 WillowWood: OMEGA® Training. Mt. Sterling, OH. Covers the all-new OMEGA software and shape capture using the OMEGA Scanner 3D. Shape creation, shape modification, and software customization discussed. Extensive hands-on practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. 2014 Credits: TBD. Visit

DECEMBER 2013 O&P Almanac



FEBRUARY 6 WillowWood: LimbLogic® Practitioners. Mt. Sterling, OH. Course focuses on all the clinical aspects of LimbLogic from operation to appropriate usage. Work with patient models & complete a fully operational LimbLogic socket to an initial dynamic fitting stage. 2014 Credits: TBD. Registration deadline is Jan. 16, 2014. Contact 877/665-5443. Visit ■

■ FEBRUARY 10-11 AOPA: Essential Coding & Billing Seminar. Royal Sonesta. New Orleans. To register, contact Betty Leppin at 571/431-0876 or bleppin@

■ FEBRUARY 12 AOPAversity Audio Conference–Billing for Diabetic and Orthopedic Shoes, Mastectomy Services, and Surgical Dressings. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email

■ FEBRUARY 19 WillowWood: Intro to OMEGA®, via WebEx, 3:00 PM ET. Potential CAD users have opportunity to investigate the new OMEGA software and find out how the system benefits a growing O&P practice. 2014 Credits: TBD. Visit www. ■ FEBRUARY 26-MARCH 1 40th Academy Annual Meeting & Scientific Symposium. Chicago. Hyatt Regency Chicago. For more information, contact Diane Ragusa at 202/380-3663 x208, or



■ MARCH 12 AOPAversity Audio Conference–The ABCs of Audits: What to Expect and How to Respond. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email

APRIL 3-4 Rehabilitation Institute of Chicago: Advanced Pediatric Gait Analysis. Chicago. Must have taken an Elaine Owen course as prereq. 15.00 ABC credits. Contact Melissa Kolski at 312/238-7731 or visit ■

■ APRIL 7-8 AOPA: Essential Coding & Billing Seminar. Bally’s Hotel & Casino. Las Vegas. To register, contact Betty Leppin at 571/431-0876 or bleppin@

■ APRIL 9 AOPAversity Audio Conference–How To Use Advanced Beneficiary Notices (ABNs) Effectively. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email

■ MAY 14 AOPAversity Audio Conference–Modifiers: How and When to Use Them. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email

MAY 15-17 PA Academy Spring Conference. New location: Hilton Hotel PittsburghMeadow Lands. Contact Beth or Joe at 814/455-5383 or email ■

■ JUNE 11 AOPAversity Audio Conference–The Self-Audit: A Useful Tool. Register online at For more information, contact Betty Leppin at 571/431-0876 or email

■ JULY 9 AOPAversity Audio Conference–The OIG: Who Are They and Why Are They Important? Register online at For more information, contact Betty Leppin at 571/431-0876 or email

■ AUGUST 13 AOPAversity Audio Conference–AFO/KAFO Policy: Understanding the Rules. Register online at http:// For more information, contact Betty Leppin at 571/431-0876 or email

■ SEPTEMBER 4-7 97th AOPA National Assembly. Las Vegas. Mandalay Bay Resort & Casino. For more information, contact AOPA Headquarters at 571/431-0876 or info@

■ SEPTEMBER 10 AOPAversity Audio Conference–Urban Legends in O&P: What To Believe. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email

■ OCTOBER 8 AOPAversity Audio Conference–Medicare Enrollment, Revalidation, and Participation. Register online at For more information, contact Betty Leppin at 571/431-0876 or email

■ NOVEMBER 12 AOPAversity Audio Conference–Gifts: Showing Appreciation Without Violating the Law. Register online at aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email

■ DECEMBER 10 AOPAversity Audio Conference–New Codes and Changes for 2015. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email

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

AOPA Applications

CarePoint Medical

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 statelicensed 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:

4860 Cox Road Glen Allen, VA 23060 804/747-8900 Fax: 804/592-4818 Category: Patient-Care Member Dai Barth

Home Care Orthotics & Prosthetics 917 Dolly Parton Parkway Sevierville, TN 37862 865/774-9959 Fax: 865/774-9953 Category: Patient-Care Member Misty Brackins

Level 1: equal to or less than $1 million

Horizon Prosthetic Laboratories LLC

Level 2: $1 million to $1,999,999

8033 SW Cirrus Drive, Ste. 21F Beaverton, OR 97008 503/626-3163 Fax: 503/626-6224 Category: Patient-Care Member Liz Powell, CPB a

Level 3: $2 million to $4,999,999 Level 4: more than $5 million.







13, 27


Orthotics, Prosthetics & Pedorthics



College Park Industries Inc.



DAW Industries



Dr. Comfort

5, C3




Hersco Ortho Labs



KISS Technologies LLC

33, 39


and Review Guide


Össur® Americas Inc.






PEL Supply



American Board for Certification in

Orthotic and Prosthetic Study

DECEMBER 2013 O&P Almanac


AOPA Answers

Closing Out the Calendar Year Answers to your questions regarding holiday gift giving and Medicare participation status changes


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


I want to thank some of my regular patients for their loyalty and support over the years. Can I send them a holiday gift to thank them?


The Office of Inspector General (OIG) published a Special Fraud Alert in August 2002 that addressed the practice of Medicare beneficiary inducement. In the alert, OIG reiterated that the provision of any remuneration that the provider believes will encourage the beneficiary to choose them over another provider is illegal. The term remuneration includes the waiver of copayments and/or deductibles as well as the offering of anything for free or at a cost less than fair market value. There is a general exception to the rule that allows for gifts of minimal value, as long as they are offered without conditions. Minimal value is defined as noncash items of $10 or less per episode and $50 or less on an aggregate basis per Medicare beneficiary, per calendar year. In short, you may offer a Medicare beneficiary a small token of your appreciation for his or her business, but it cannot be cash, and cannot exceed a value of $10 per gift and $50 per year. Also, the gift must be given without any condition, especially one that involves requiring the patient to continue to choose your facility as his or her provider.


O&P Almanac DECEMBER 2013


How do I change my participation status with Medicare?


Your participation status or agreement with Medicare is valid for one year and can be changed only during the open enrollment period. Any changes you make will not take effect until the start of the next calendar year. The Medicare open enrollment period is typically mid-November to the end of December. If you want to change your status from a participating provider to a nonparticipating provider, you can do so during the open enrollment period by sending a letter to the National Supplier Clearinghouse (NSC) indicating that you no longer wish to be a participating provider. The letter must be sent before the end of the year (December 31) and must be signed by a recognized, authorized official of your company. If you want to change your status from a nonparticipating provider to a participating provider, you may do so during the open enrollment period by completing a Medicare participating provider agreement, CMS Form 460, and submitting it to NSC before the end of the year (December 31).


Can we have some of our locations/ facilities be participating providers and some of our locations/facilities be nonparticipating providers?


The answer depends on how many Tax IDs you have. The decision to be a participating provider or nonparticipating provider is tied to the Tax ID of a company and not to its locations or facilities. Thus, if you have multiple locations under one Tax ID, you may not have some locations be participating and some locations be nonparticipating providers. a

Healthier, happier feet start with the most comfortable shoes. More providers choose Dr. Comfort than any other brand–because more patients prefer our shoes. Dr. Comfort shoes come in a variety of beautiful styles–all offering the most comfortable fit for your patients’ feet and the most comfortable fit for their lifestyle. Best of all, we ensure shoes are in stock when you order them and we stand behind all our products with our exclusive 6-month 100% Satisfaction Guarantee. Isn’t it time you discovered the service behind Dr. Comfort shoes?

American Podiatric Medical Association Seal of Acceptance

If you’d like to learn more about becoming an approved Dr. Comfort provider, please call us today. | 800.992.3580 visit to learn more Dr. Comfort® is proud to support the Stop Diabetes® movement.

© 2013 Dr. Comfort All Rights Reserved

A STEP-BY-STEP GUIDE TO THE RAC AUDITS. The RAC audits have been tough on everyone in the O&P industry. To help all providers navigate the process, we’ve developed an interactive, step-by-step resource. Why? Because when the industry succeeds, everyone benefits – especially patients.


December 2013 Almanac  

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

December 2013 Almanac  

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