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The American Orthotic & Prosthetic Association

JULY 2013




O&P STRONG The industry rises to get Boston Marathon bombing victims back on their feet

Solving Complex Communication Challenges How to Appeal RAC Recoupment Requests

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Knit-Rite Compressogrip® Shrinkers • Full line to cover all your patients • Consistent compression – Every roll quality tested • Original Tubular Compression Prosthetic Shrinker for control and prevention of edema following amputation surgery, and for limb volumetric maintenance • A/K shrinker for transfemoral applications has lower cost than traditional shrinkers, and fewer sizes to fit more patients • Tapered B/K shrinker has additional width at top to accommodate fuller thighs and reduces rolling and bunching

Mike Burns

Purchasing Clerk • Served as Radar Air Traffic Control Supervisor / U.S. Sarah Dippel Marine Corps Customer Service Rep • Started at PEL in 2009 • A customer favorite — ”Always • Degree in Business has a smile in her voice.” Management • Started with PEL in 2005 • Activities include weight lifting • Degree in Medical Assisting, and riding his Harley earned while working at PEL • “I take pride in my job, and • Hobbies are crocheting and treat the company as if I baking owned it myself. I try to • “I make sure all orders always do what is right for the are entered exactly so the Company and the Customer.” customer receives the correct products in a timely manner.”

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Experience the Power of One.

O&P JULY 2013, VOLUME 62, No. 7

CONTENTS Cover Story

18 O&P Strong Photo: United Prosthetics Inc.

By Christine Umbrell The Boston Marathon bombings changed nearly 300 lives forever, and AOPA’s Walk and Run Again Coalition has vowed to provide appropriate treatment for the underinsured victims who became amputees that day. Practitioners share their patients’ stories of healing, and explain how the increased media attention is creating a greater understanding of the O&P industry as a whole.


24 Text Me, Por Favor

By Adam Stone Today’s O&P practitioners face a wide variety of communications challenges, from evolving technologies to language barriers. Experts offer straightforward advice to ensure optimal communication between practices and patients.



AOPA Contact Page How to reach staff


At a Glance Statistics and O&P data

08 28 COLUMN


Reimbursement Page Appealing RAC recoupment requests

40 Marketplace 42 Jobs

Opportunities for O&P professionals

In the News Research, updates, and company announcements

44 Calendar

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


Ad Index


AOPA Answers Expert answers to your FAQs

Upcoming meetings and events

38 AOPA Membership 00 Applications

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

JULY 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,


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

Don DeBolt, chief operating officer, 571/431-0814,

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

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

O&p Almanac

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

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

Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, Betty Leppin, Project Manager, 571/431-0876, AOPA Bookstore: 571/431-0865 Government affairs Devon Bernard, manager of reimbursement services, 571/431-0854,

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

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

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

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

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

Kel Bergmann, CPO, SCOPe Orthotics & Prosthetics Inc., San Diego, CA Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA

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

Scott Schneider, Ottobock, Minneapolis, MN

James Campbell, PhD, CO, Becker Orthopedic Appliance Co., Troy, MI

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

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


O&P Almanac JULY 2013

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The Wounded Warrior Project The Wounded Warrior Project began when several veterans and friends were moved by stories of the first wounded service members returning home from Afghanistan and Iraq. Originally, the program provided care and comfort items to wounded service members. Since then, it has grown into a complete rehabilitative effort to assist them as they recover and transition back to civilian life.

Year(s) in which Wounded Warrior Project alumni sustained injuries*: 2001—



















17.4% 12.1%

2011— 2012—


Source: 2012 Wounded Warrior Project Survey


Year Wounded Warrior Project was founded.


*The total percentage is greater than 100 due to injuries sustained in multiple years.


Number of cities hosting a four-day Soldier Ride event, a program in which soldiers utilize cycling and service to overcome physical, mental, or emotional wounds.

25 and 50

Number of miles on Soldier Ride courses, both of which are lined by cheering locals.

Source: Wounded Warrior Project ( 6

O&P Almanac JULY 2013

Total number of Wounded Warrior Project participants.

$115 million Amount allotted for Wounded Warrior Project programs in FY 2012.


Percentage of alumni who sought sports/recreation opportunities in their local communities.


Rebound Hip provides unique, post-arthroscopy protection for your patients. The Rebound Hip provides gentle controlling forces that facilitate healing while allowing your patients to safely perform daily activities. It is designed to limit flexion, extension and rotation during post-surgical rehabilitation. And, its low-profile, light-weight breathable design makes the Rebound Hip more comfortable to wear resulting in better patient compliance.

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Two-Step Prosthetic Implant Trial To Begin in U.S. U.S. clinical trials on a new way to attach prosthetic legs are set to begin at the George E. Wahlen Department of Veterans Affairs Medical Center in Salt Lake City this summer. The new prosthetic implant is a two-step process. First, an osseointegration surgery is performed in which a titanium rod is implanted into the amputee’s residual bone. The porous titanium material allows skin and bone to grow into the rod, forming a secure bond. Second, a post is inserted about six weeks later, extending out of the skin and connecting to the prosthetic limb. While the procedure has been done in Europe, Australia, and Africa for several years, the procedure has taken longer to get approval in the United States due to the regulatory process. The hospital received a $1 million grant from the U.S. Department of Veterans Affairs (VA) and recently began screening VA patients from all over the country who have lost a leg above the knee for the first 10-patient clinical trial. Researchers hope to have the first surgical implant within the next 12 months.

TSA Eliminates CastScope Screening for Amputees The Transportation Security Administration (TSA) will no longer use CastScope to screen individuals with prosthetic devices. Amputees will now be screened in the same manner as other travelers. The CastScope, which uses imaging technology, had been used in selected airports since 2008 for additional screening of those with casts or with prosthetic devices. Unlike a full-body imaging machine, a CastScope X-rays only the area with a prosthetic device, often resulting in as many as 15 or 20 X-rays of one leg. A 2010 survey of 7,300 amputees across the country by the Amputee Coalition showed that travelers with limb loss feel that they have been subjected to inconsistent, unfair, abusive, and often embarrassing screenings by TSA employees. The Amputee Coalition, the Wounded Warrior Project, and other organizations advocated for the elimination of the use of the CastScope for airport screening due to increased exposure to radiation and the difficulties it created with the screening process. “We are very pleased that TSA listened to the limb loss community and decided to eliminate the use of this technology in screening people wearing prosthetic devices,”


O&P Almanac JULY 2013

says Leslie Pitt Schneider, Amputee Coalition board member. “We have been receiving complaints from amputees who travel through the airports using CastScopes on a regular basis, and we believe this action will help to make the screening process less difficult for amputees and air travel less of a barrier.” TSA continues to recommend that travelers with disabilities and medical conditions visit or contact TSA Cares for information before they fly.

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DARPA Studies Neural-Interface Prostheses The Defense Advanced Research Projects Agency (DARPA) has instituted a number of programs to improve the reliability of prosthetic limbs with direct neural connections. DARPA’s Reliable Neural-Interface Technology (RE-NET) program focuses on the long-term viability of brain interfaces and is developing high-performance, reliable peripheral interfaces. These peripheral interfaces use signals from nerves or muscles to control prostheses and to provide direct sensory feedback.

Artist’s concept of Leaded Implantable Myoelectric Sensors to be used as a novel peripheral-interface technology with targeted muscle re-innervation.


Russell Cannon has been named Northeast regional sales manager of Ability Dynamics. Carrie Davis, of Amputee Empowerment Partners, was presented with the International Margarette Golding Award for Technical Orthopedics, making her the first recipient in the United States.

O&P Almanac JULY 2013

RE-NET’s peripheral interfaces are approaching the level of control demonstrated by cortical interfaces and have better biotic and abiotic performance and reliability, according to DARPA. Implanting peripheral interfaces may be a lower-risk and lessinvasive procedure for amputees than cortical electrodes. Ongoing clinical trials demonstrate the functionality of both interface types. In one trial at the Rehabilitation Institute of Chicago, a veteran who had been injured in Iraq experimented with a type of peripheral interface. Former Army Staff Sgt. Glen Lehman controlled a prosthetic arm after the transfer of multiple nerves to the selected muscle via targeted muscle re-innervation. By rewiring nerves from amputated limbs, new interfaces allow for prosthetic control with existing muscles. In another clinical trial, researchers at Case Western Reserve University used a flat interface nerve electrode to demonstrate direct sensory feedback. By interfacing with residual nerves in a patient’s partial limb, some sense of touch by the fingers was restored. Unlike visual feedback, direct sensory feedback allows patients to move a hand without keeping their eyes on it, which enables simple tasks, like rummaging through a bag for small items. For more information, visit

people in the news

Advanced Arm Dynamics announced the addition of two occupational therapists to its national clinical team: Christopher Bollinger, MOT, OTR, in Philadelphia; and Joby Varghese, MOT, OTR, in Dallas.


Artist’s concept of a flat interface nerve electrode.

The Amputee Coalition has elected a combat wounded war veteran, Ron Drach, to serve a three-year term on its board of directors. Kevin Garrison, CP, LP, was honored when he and his Florida facility, Garrison’s Prosthetic Services, received an Honorable Mention Award in the Rehabilitation Case Management category at the fourth annual Case in Point Platinum Awards. Mike Kloos has been named president of VGM Insurance in Waterloo, Iowa.

U.S. Paralympian Blake Leeper, a sprinter and two-time medalist at the 2012 London Paralympic Games, has been inducted into the Boys & Girls Club of America Alumni Hall of Fame. Kevin Young has been hired as a sales representative for Technical Orthopedics.





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CMS Seeks Input for Electronic Documentation Template The Centers for Medicare and Medicaid Services (CMS) is exploring the development of a list of suggested clinical elements for an electronic template that will assist providers with documenting the physician notes that substantiate the need for a lower-limb prosthesis. This template also may facilitate the electronic submission of medical documentation. CMS is planning to host a series of special Open Door Forum (ODF) calls to grant an opportunity for suppliers and physicians to provide template feedback. At the conclusion of the ODF calls, CMS will forward the resulting list of clinical elements to the Electronic Determination of Coverage Workgroup, which focuses on giving practitioners access to payer-approved tools such as templates for documentation and standards-based exchange of information between providers and payers. The first call, held on May 28, was well


BUSINESSES in the news

Ability Dynamics, Tempe, Arizona, sponsored a Racquetball Rehabilitation Clinic at Arizona State University in Phoenix as part of a new program from The Military Racquetball Federation. Active Space Technologies, Coimbra, Portugal, has received a contract within the EUREKA Eurostars Programme to develop a robotic orthopedic orthosis for elbow joints, based on aerospace technology. Advanced Amputee Solutions in Detroit is developing a polymer that can be applied during amputation surgery to cushion the cut bone and seal the bone marrow. Allard USA, Rockaway, New Jersey, has announced the launch of TeamUP, a national team for people with foot drop. TeamUP will compete in marathons as well as biking, running, and golfing events. The Amputee Coalition has announced a peer support affiliation


O&P Almanac JULY 2013

attended by O&P representatives. While AOPA participated in the call and attempted to register comments, the allotted time for the call expired before representatives had the opportunity to do so. AOPA has submitted written comments on the template to CMS and is in the process of developing a suggested alternate template that represents less of a burden to the physician community while ensuring the proper documentation of relevant medical information. AOPA will continue to participate in all ODF calls regarding this subject and encourages its members to participate as well. Visit the “Downloads” section of and click on the “Lower-Limb Prosthesis Suggested Electronic Clinical Template” link to view the document, which describes the data elements that CMS believes would be useful in supporting the documentation requirements for coverage. Comments on the document can be sent to

agreement between the Coalition and TIRR Memorial Hermann Hospital in Houston. The Amputee Prosthetic Clinic hosted the Orthotic & Prosthetic Activities Foundation’s First Dive Intro to Scuba Clinic in Macon, Georgia. The Challenged Athlete Foundation announced it is distributing $2.1 million in grants to 1,132 challenged athletes in 20 countries. The grants will fund adaptive equipment, training and coaching, and competition expenses. Orthocare Innovations has received the Edison Awards’ top award in the Science and Medicine—Assistive Device category, which recognized the company’s Magellan microprocessor foot/ankle system. Össur, Reykjavik, Iceland, has signed an agreement to acquire 100 percent of the shares of O&P provider TeamOlmed, Jönköping, Sweden.

Out on a Limb, a documentary about the science of prosthetics, won the Boston International Film Festival Indie Spec Best Documentary Award. Physiotheraphy Associates has opened a new physical therapy clinic in Chevy Chase, Maryland. Sunshine Prosthetics and Orthotics has opened in Wayne, New Jersey. Swiftwick, a Tennessee-based compression sock manufacturer, has teamed up with Cascade Orthopedic Supply Inc. to provide liner socks. A team of eight undergraduate students at The University of Texas at San Antonio (UTSA) won the Student Technology Venture Competition presented by the UTSA Center for Innovation and Technology Entrepreneurship, in recognition of its prototype thermoelectric cooling system that adds comfort and improves hygiene for prosthetic users.


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AOPA is proud to announce the formation of a new Business Management Certificate program. The AOPAversity O&P Business Management Certificate is a comprehensive certificate program that will offer a series of business


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Reimbursement Page By Devon Bernard

Exercise Your Right to Appeal Make the time to appeal a RAC recoupment request


ith prepayment audits resulting in claim denials and other audits resulting in overpayment requests (a return of monies on a previously paid claim), your right to appeal is becoming more important and more valuable than ever.

Worth Your Time In its Fiscal Year 2011 Report to Congress, the Centers for Medicare and Medicaid Services (CMS) stated that the four Recovery Audit Contractors (RACs) identified a total of 903,372 Medicare claims as overpayments and issued recoupment requests. Out of those 903,372 claims, only 60,717 were appealed. This represents an appeal rate of just more than 6 percent—in other words, more than 93 percent of the overpayments were not contested. This appeal rate benefits the RACs since they are paid on a contingency basis. The RACs are counting on you to not appeal their findings. If you win an appeal, the RACs don’t keep their contingency fee. What is even more interesting is that, of the 60,717 claims that were


O&P Almanac JULY 2013

appealed, 43 percent were eventually overturned in the providers’ favor. This represents a substantial success rate of overturning a RAC recoupment request for those who take the time to go through the appeal process. While the statistics do not provide any O&P-specific information, they do illustrate the value in pursuing the appeal process. Regardless of the “what” (denial/ nonpayment or overpayment request) or “why” (RAC audit, prepayment review, etc.) of an appeal, the process remains basically the same—you will have to navigate through the five official levels of appeals.

Level 1: Redetermination Redetermination is the first level of appeal. After you receive an unfavorable determination on a claim, you have 120 days to file an appeal in writing. Once a request for redetermination is submitted, it will be reviewed by someone other than the person who made the initial determination, but it will be reviewed by the Durable

Medical Equipment Medicare Administrative Contractor (DME MAC) that processed the initial claim. You should receive a response within 45 days, although it may take up to 60 days.

Level 2: Reconsideration If your appeal is unsuccessful at the redetermination stage, the next step is to request reconsideration. At this level, your claim will no longer be reviewed by the DME MAC that originally processed your claim. Instead, it will be reviewed by an outside Qualified Independent Contractor (QIC), which is currently designated as C2C Solutions Inc. All reconsideration requests must be made in writing and within 180 days of receipt of the redetermination decision. This is the last level of appeal where you may submit additional or new documentation supporting your assertion that the claim denial/overpayment request should be overturned; after this level, no new documentation can be submitted unless you can prove or


demonstrate good cause for why the documentation was not submitted during the first two levels of appeal. If the QIC cannot make a decision in the applicable timeframe, within 60 days of receipt of the request, you then have the right to escalate the appeal to the next level and request an administrative law judge (ALJ) hearing.

Level 3: ALJ Hearing Once your appeal is denied at the reconsideration stage—or once you have approval to escalate to this level—the third level of appeal is the ALJ hearing. This is typically the level where most appeals end (and often end in the provider’s favor). The ALJs will perform an independent review of the claim based only upon the information that has been submitted. They are not bound by Medicare rules or policies. Their decision will be based on their interpretation of the laws surrounding the Social Security Act, which is why most appeals are successful at this level. Keep three things in mind when requesting an ALJ hearing: • A request for this type of hearing must be made in writing and within 60 days of the receipt of the reconsideration decision. • You may request that an ALJ hearing be conducted in-person before the judge, by videoconference, or by telephone. • You must meet a minimum amount in controversy (AIC) or a monetary threshold. The AIC for 2013 must be at least $140; you may combine any number of claims to meet this amount. Once you have filed your ALJ hearing request and it is received by the proper ALJ office, you should receive a decision within 90 days—but keep in mind that this 90-day timeframe can be extended. For example, it may be extended if you submitted new information/evidence or if you requested an in-person hearing.

Reimbursement Page

Paying on ‘Demand Letters’ During the Appeal Process If your appeal involves an overpayment request (also called a “demand letter”), the appeal process may be slightly different. The five levels remain in place, but the timeframe for filing an appeal is altered because of the money involved. Typically, when you receive a demand letter, a few options are available to you:




Pay back the overpayment up front and all at once. If you do this, you will not lose your right to appeal, but you will avoid being subject to paying interest on the overpayment amount. The interest begins to accrue on the 30th day after you received the demand letter and is assessed each subsequent 30-day period until the debt (overpayment amount plus the interest) is fully paid off. The interest is not compounded interest, but rather simple interest, and it is only applied to the amount of the original debt unpaid. If Medicare collects any interest from you, it must repay you that amount if you are successful during the appeals process. Request that your claims be offset. If you volunteer to have your claims offset, Medicare will immediately withhold payments from your future claims until the overpayment amount has been paid back in full, plus interest. Do nothing. If you choose to do nothing, by the 41st day after receiving the demand letter Medicare will automatically begin to offset your claims.

However, if you file a redetermination request within 30 days of receiving a demand letter—a much shorter window than the traditional 120 days—you can postpone the recoupment process, but not the assessment of interest. Consequently, as you proceed to the reconsideration level of appeal, you may continue to have the recoupment process postponed, as long as you file the reconsideration request within 60 days of receiving the redetermination decision letter. If you file your redermination request past the 30-day window or your reconsideration request past the 60-day window, and the recoupment process begins, as soon as you file your request the recoupment process will cease. If you proceed to the ALJ hearing level, the ability to stop the recoupment process ends 30 days after your receive the reconsideration decision letter; this means that 30 days after the second level of appeals, Medicare will continue with the recoupment process until the original debt and any subsequent interest has been paid in full.

JULY 2013 O&P Almanac



Reimbursement Page

Collecting Interest on Recouped Money During Appeals Because Medicare can collect interest from providers during the appeals process, providers want to know if they can collect interest from Medicare on the money it recoups from providers during the appeals process—or if Medicare doesn’t pay providers promptly after a successful appeal decision. The answer depends on the situation. If a claim denial is overturned in your favor during the first two levels of appeal (redetermination and reconsideration), you may be able to collect interest on the initial claim amount only. However, the interest can only be collected and will only be paid if the overturned amount is not repaid within 30 days of the final determination. So, if you don’t receive your money (claim payment) within 30 days of a successful redetermination or reconsideration request, you are due interest. As with the interest Medicare collects from providers/suppliers, the interest you collect is a simple interest and not a compounded interest. If you do not pay back an overpayment during the appeal process, the recoupment process will start up again after the reconsideration level of appeal. This means that Medicare will automatically begin to recoup/offset your claims until the original debt and interest is paid off in full. For claims involving recoupments made after the reconsideration level and subsequent higher levels of appeals, Medicare will pay interest on monies recouped during the time that a claim is awaiting a final decision. The interest is only payable on the principal amount recouped, meaning Medicare will only pay you interest


O&P Almanac JULY 2013

If the 90-day timeframe was not extended and the ALJ office did not render a decision, you can request, in writing, that your appeal be escalated to the next level of appeal, or you can wait for the ALJ office to render a decision. Once the ALJ office receives your request to escalate the appeal, it has five days to either render a decision or escalate your appeal to the next level.

Level 4: DAB Review

on the money recouped to satisfy the original debt, and it will not pay interest on the interest it recouped, but it will pay that money back to you. There is a caveat on collecting interest payments from Medicare on money that was recouped during the appeal process. The interest can only be assessed on money that was recouped via “involuntary payments” or offset payments. If you refund Medicare voluntarily (pay the overpayment before recoupment begins), you may not collect interest from Medicare because Medicare didn’t charge or collect interest from you. To learn more about how the interest is calculated and applied, see Chapter 3 of the Medicare Financial Management Manual. To review or learn more about the appeals process, see Chapter 29 of the Medicare Claims Processing Manual. These manuals may be found on the CMS website, www. Guidance/Manuals/Internet-OnlyManuals-IOMs.html.

Next up is the fourth level of appeal—a review by the Departmental Appeals Board (DAB), also known as a Medicare Appeals Council (MAC). A request for a DAB review must be made within 60 days of receipt of the ALJ decision and must be in writing. The DAB will review all of the information on file and must issue a decision within 90 days of receipt of the request for review. The DAB may decide to uphold the decision of the ALJ’s office, determine that the ALJ office should re-review the appeal, or reverse the ALJ office’s decision. As with the ALJs, the DAB can extend the 90-day timeframe; for example, the DAB may have up to 180 days to render a decision if the appeal was escalated from ALJ.

Level 5: Judicial Review The fifth level of appeal is a judicial review. At this level, you will file a civil lawsuit against the Medicare program in federal court. As this is an official court proceeding, you must be represented by an attorney, and an AIC of $1,400 must be met. All requests must be made within 60 days of receiving the DAB’s decision. This is the final level of appeal, and you will ultimately get an answer, one way or another, should you get this far in the process. a Devon Bernard is AOPA’s manager of reimbursement services. Reach him at

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One of the several improvised memorials along Boylston Street in Boston, Massachusetts, for the victims of the Boston Marathon 2013 bombing on April 21, 2013.


O&P Almanac JULY 2013

COVER STORY By Christine Umbrell

Practitioners treating Amputees From the Boston Marathon bombing share their stories of hope


he April 21 Boston Marathon bombing tragedy will be remembered by all as a horrific terrorist event that changed nearly 300 lives forever, but the response by Americans—as well as AOPA and the O&P community—has demonstrated the cooperative and generous spirit of our nation. Though three spectators died—and another 264 were wounded—as a result of two pressure cooker bombs that detonated near the finish line of the marathon, the rapid response in terms of both medical care and monetary donations is evidence of the commitment of many to help the injured recover. For the 16 spectators who became amputees that day, their healing process is still in its initial stages. But with the support of a country, and the use of prosthetic devices, they are learning how to return to their activities of daily living in the hopes they can find their new normal.

Overwhelming demonstrations of support began in the moments right after the bombs went off, as strangers stepped in to administer basic first aid to those spectators most severely wounded. “These patients got life-saving resuscitation and tourniquets immediately, and some patients arrived at Massachusetts General Hospital within 23 minutes of the bombing,” recalls David Crandell, MD, inpatient medical director of the amputee and musculoskeletal programs at Spaulding Rehabilitation Hospital—the medical facility where most of the amputee patients were released once their hospital stays were complete. And strong displays of support have continued throughout the rehabilitation process. “The nation has been great,” says Crandell. “People showed up with an outpouring of donations and support, which has been very meaningful. And many people have volunteered their time.”

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Photo: Marcio Jose Bastos Silva /

A Nation Responds

Monetary donations came pouring in to The One Fund Boston, established immediately after the bombing by Massachusetts Gov. Deval Patrick and Boston Mayor Thomas Menino. More than $60 million has been donated by businesses, foundations, and individuals, with an expected distribution date of June 30. The victims of the Boston bombing (or family members of the deceased) will each receive a percentage of The One Fund. In addition, AOPA’s Walk and Run Again Coalition has vowed to step in to ensure the availability of appropriate patient care as well as artificial limbs and other mobility devices on a compassionate access basis for any uninsured or underinsured Boston Marathon bombing amputees. “I’m going to advocate for them to get the most appropriate componentry to be able to function at the highest level,” says Crandell. He is hoping that the combination of insurance coverage, donations from suppliers and prosthetists, and assistance from AOPA’s Walk and Run Again Coalition will cover most if not all of the costs associated with these patients receiving their initial prostheses. “Then they will be able to use The One Fund money for home modifications, or to pay their rent if they can’t work,” he explains.

amputations that occurred as a result of a terrorist attack. Their injuries are “blast injuries—more akin to a military population,” Crandell notes. “We had a high number of injuries on the same day—though not all of the amputations occurred the same day” because some were completed after physicians had time to evaluate the extent of the injuries. The majority are lower-limb amputations, because the bombs were detonated on the ground. Many of the amputee patients were first seen by prosthetists at the hospitals two to three days after the bombing. “We were brought in to put on FLO-TECH devices and compression bandages, and to evaluate levels,” recalls Greig Martino, CP, vice president, United Prosthetics Inc., Braintree, Massachusetts. At that time, many of the patients’ wounds were still open and getting ready to close. “They brought us in to discuss when patients would be ready for prosthetic usage.” After their hospital stays, patients were transferred to Spaulding, a brand new, state-of-the-art facility,

for rehab and prosthetic evaluations. Except for two or three amputees who were from out of town, Spaulding became home for the amputees. “Patients have been engulfed in PT and OT, and they are learning that their lives have changed—but haven’t ended,” says Martino. Education and visits from amputee and peer educators have helped the patients understand how their lives have been altered—and how they can continue to achieve success, just in a different way.

Treatment After Trauma Treating patients who have lost limbs as a result of a bombing presents a different set of challenges from treating regular “civilian” patients, the majority of whom lose limbs as a result of vascular disease or diabetes. Like soldiers wounded in war zones, many of the Boston amputees have sustained some hearing loss and traumatic brain injuries along with amputations, which may impact their gait. “We need to make sure concussions have not affected equilibrium, and inner ear problems are not affecting stability,” explains Martino.

The donations of money and prosthetic componentry will be an important factor in the amputees’ healing process, according to Charles Dankmeyer Jr., CPO, AOPA’s vice president and CEO of Dankmeyer Inc. in Linthicum Heights, Maryland. “The first thing trauma amputees ask after limb loss is, ‘Am I ever going to be the same?’” says Dankmeyer. “Then once they hear they can return to a similar life with prosthetics, they worry about the expense of the componentry. It’s a huge burden lifted to have that anxiety of, ‘Can I afford it?’ taken away.” The Boston patients face unique challenges in recovering from


O&P Almanac JULY 2013


Road to Recovery

Spaulding Rehabilitation Hospital, Boston

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Photo: United Prosthetics Inc.

Another consideration in treating these amputees is the condition of the residual limb. With blast injuries, the explosion pushes foreign particles into a large portion of the soft tissue, which can compromise the skin, ligaments, and muscles. The extent of soft-tissue damage can be unclear, often involving the use of creative muscle flaps or skin grafts to get adjacent soft tissue coverage of an amputated limb. Three of the amputee patients have had multiple skin grafts, according to Crandell. “Some of the residual limbs are not uniquely ideal for fitting a prosthesis; they will need ongoing monitoring” and an interdisciplinary approach to treatment. “The prosthetists, physical therapists, and patients and their families are working closely together to coordinate Greig Martino, CP, teaches his Boston Marathon patient to walk on her newly delivered prostheses in both in-patient and outpatient the parallel bars at the Spaulding Rehab Hospital Prosthetics Clinic. rehab, and we’ll be monitoring members wounded in combat—may their skin very closely.” member as she neared the finish line. face psychological challenges, and “hit And for those patients who While the daughter suffered from nearthe wall” once their new reality sets lost one leg but sustained severe fatal shrapnel wounds, including a torn in, says Martino. Ensuring they receive injuries to their other leg, mastering femoral artery, her mother suffered care for post-traumatic stress disorder prosthetic usage will become even amputations on both legs. or other psychological issues will be more important: “Their lower-limb Martino has been working closely just as important as ensuring these amputation is their good leg” since with the mother, who is a transtibial patients’ physical health. their remaining leg will require amputee on the left side and a kneeextensive continuing care and rehab, disarticulation patient on the right says Crandell. side. Martino fit her with initial Healing Together At the beginning of June, most of prostheses that she was able to use in For Crandell and Martino, treating the Boston amputees had been molded combination with a walker, with hopes family members who have been and were being fit for prostheses; a she would be ambulating without injured at the same time has made this few required additional surgeries. At the walker very quickly. “She has a experience unique. Several amputees that time, Martino and his facility were mechanical hydraulic knee and total have relatives or friends who also working with several of the patients. contact sockets on both sides, with sustained injuries during the bombing— “The first six to 12 months are the sleeve suspensions,” says Martino. The so they are recovering together. “I’m most critical, due to the stages of componentry is “pretty basic right treating two brothers who both have residual limb healing, and overall now because we expect significant amputations, and a mother and wound healing,” says Martino. anatomical change as the swelling daughter—the mother has become an The progression to first prosthesis for goes down and the limbs mature,” amputee and the daughter has other these patients also is being impacted he explains. As with other Boston types of injuries,” Crandell explains. by the other injuries many of them amputees, the patient’s sockets may The mother’s sister was running sustained during the bombing. have to be changed two to three times in the marathon for the first time, and In addition to ongoing physical in the first year. Martino expects this the mother and daughter were both challenges, many of the Boston patient to advance to a microprocessor seriously injured as they waited on bombing amputees—like service knee in the future. Boylston Street to support their family

Fortunately, for the Boston amputees, the generous donations mean that most of these patients will have the ability to obtain the componentry they need. For those amputees who must pay out-of-pocket for a percentage of their componentry because it is not fully covered by insurance, it is hoped that the current spotlight on O&P may ultimately benefit them and reduce their burden.

AOPA’s Walk and Run Again Coalition

O&P in the Headlines One byproduct of the events of the past few months has been increased national exposure to amputees and their cause. The intense media attention given to the Boston Marathon bombing victims and the support from AOPA’s Coalition to Walk and Run Again has resulted in a greater understanding of the O&P industry in general. In launching the initiative, AOPA officials said that a number of the Boston bombing amputees will experience the financial nightmare that befalls thousands of Americans facing amputations: often extremely severe limits in health insurance coverage, such as a cap of $1,000 per prostheses or coverage for only one artificial limb over the course of an individual’s lifetime. The care and cost of an initial prosthetic device could total $30,000 or more and often must be replaced every five to seven years. Uninsured and under-insured Boston bombing amputees will be provided substantial assistance to cover the cost of their initial prostheses and related care as a result of the creation of the Coalition by AOPA and its members. “Our goal here as the makers of artificial limbs is to extend compassionate aid to the victims of the Boston terror attacks” says Tom Fise, AOPA’s executive director. “We want to ensure that, in the midst of this horrific tragedy, these individuals are not further traumatized by the harsh and unreasonable limits that are present in all too many health insurance policies today in the United States. As an


O&P Almanac JULY 2013

Eligibility Requirements Here is a closer look at what is required to receive assistance from AOPA’s Coalition to Walk and Run Again: The sole prerequisite for assistance is receipt of a letter from the victim’s physician that indicates that the patient was injured in the Boston Marathon bombing, describes the specific needs of the patient and geographic information, and attests that the patient’s insurance coverage is insufficient to meet the costs of the necessary prosthetic/orthotic care. If the patient already has a certified orthotist/prosthetist, that individual should work with the patient’s physician to develop a prescription and detailed work order that specifies the componentry required. A copy of that prescription should accompany the request for assistance. In that instance, the Coalition will endeavor to secure—without cost to the patient—the specific requested clinical services including the componentry, or as close to the prescription as possible. If the patient does not have a certified orthotist/prosthetist, the Coalition is pleased to identify a person who can render the needed care.

industry, we would not want to see these people victimized twice.” Currently, there are an estimated 1.9 million people living with limb loss in the United States. Annually, the immediate health-care costs for the amputation of a limb—not including prosthetic costs or rehabilitation costs—is estimated to total more than $8.3 billion. A recent study by the U.S. Department of Defense and Department of Veterans Affairs estimated five-year prosthetic costs to be as high as $450,000 for a person with multiple limb amputations, $230,000 for a person with a unilateral lowerlimb amputation, and $117,000 for a person with a unilateral upper-limb

amputation. Studies estimate that lifetime health-care costs for a person with limb loss total more than $500,000. “As the certified prosthetists and orthotists who practice in patientcare facilities and the orthotic and prosthetic manufacturers who develop the technology and create the components for artificial limbs and customized bracing that restore mobility, we are in a unique position to offer needed assistance,” says Dankmeyer. “We want to do what whatever we can to help these fellow Americans as they start this challenging journey.” All of the Boston Marathon bombing amputees have received high-quality

trauma and surgical treatment by first responders and the incomparable clinical personnel residing in Massachusetts hospitals. But it appears that many of the victims, some from Massachusetts and others from diverse locations outside the metro area, may not have health insurance or may not have health insurance plans that will ensure access to the needed limbs and mobility assistive devices. The Coalition is using its national network to secure in-kind assistance to facilitate care for any Boston Marathon bombing amputee’s prosthetic and orthotic needs (excluding physician and hospital costs), with the sole prerequisite for assistance being receipt of a letter from the victim’s physician that indicates that the patient was injured in the Boston Marathon bombing; describes the specific needs of the patient and geographic information; and attests that the patient’s insurance coverage is insufficient to meet the costs of the necessary prosthetic/orthotic care. Amputee Coalition President

Kendra Calhoun “commend(s) all the organizations that have come forward with help and support for the victims and their families. As tragic and violent as the circumstances of these injuries were, the 14 people who lost arms, legs, hands, or feet as a result of the attack represent a fraction of the 500 people who undergo amputations in the United States on any given day. The world becomes a very different place when you lose a limb, but the beautiful thing is that prosthetic devices can help people regain an amazing amount of function—and there should be no reason why every American amputee shouldn’t be fully functional, except that health insurance isn’t willing to pay for it.”

Boston 2014 and Beyond With media reports of optimistic amputees hoping to run in next year’s Boston Marathon, how realistic are such plans? “These are all pretty active people and in pretty good physical condition,” says Martino. “If these individuals

SEPTEMBER 18-21, 2013

were able to run a marathon before, then they might be able to run one again,” says Martino. “But it may take a little time.” And those who do start running over the next nine months should anticipate setbacks. “Able-bodied marathon runners end up with blisters and wounds covering their feet—body parts that are meant to be weightbearing,” says Martino. New amputees will likely get wounds and blisters on their residual limbs—body parts not designed to bear weight. As the patients adapt to walking with prostheses and adjust to life beyond rehab, they will learn their capabilities. And members of the O&P industry will be right by their side, helping them achieve their goals. “We won’t be done until everybody’s home, back to work or school,” says Crandell. “We’re trying to help these patients find their joy through their pain.” a Christine Umbrell is editorial/production associate for O&P Almanac. Reach her at

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JULY 2013 O&P Almanac


By Adam Stone


r o v a rF


Changing patient communication preferences call for a review of your practice’s policies


O&P Almanac JULY 2013


or Mark Feathers, CP, of Feathers Prosthetic Services in Emporia, Kansas, medical office communications begins with, well, communications. “I can start talking, and I just can’t assume that everyone understands me. So, I need to let [patients] know: If they don’t understand me, they have to speak up; they have to ask me to slow down and explain it in more detail,” Feathers says. “I tell them, I am not a mind reader, I am not psychic. If you are having a problem, you’ve got to let me know.” Simple misunderstandings can cloud a practitioner’s ability to connect with a patient. But that is just the beginning. From missed appointments to office policy to follow-up care, O&P providers must contend with a range of possible communications glitches. With careful planning, thoughtful procedures, and a healthy dose of technology, it’s possible to establish a consistent flow of information that is solid enough to ensure your practice runs smoothly and patients get all their needs met.

Facing Hurdles It’s no surprise that O&P offices sometimes run into communications gaps, considering all the factors working against them. For starters, there aren’t enough hands on deck. Lean staffing can mean too few people to make too make necessary calls to patients. When staff spends time making those calls, they are unable to be fully attentive to patients in the office waiting for appointments or information. “There is definitely a labor factor in most practices. You do have limited time and limited resources in a small practice,” says Valora Gurganious, a senior management consultant with health-care consulting firm DoctorsManagement and a former practice manager in an orthopedic practice. Changing preferences in communication methods also prove to be a sticking point. Every day it gets harder for staff making appointment reminder calls to connect with live individuals. “It probably will continue to be more and more challenging to talk to a human patient on the end of the line,” Gurganious says. “It’s a generational thing: Nobody takes calls. Many people don’t even take calls from family members. They just text.”

More than 22 million people speak English less than “very well,” according to the American Medical Association, and more than 34 million people were born in another country. Government regulations may also be short-circuiting the lines, says Linda D’Spain, a health-care consultant with the Practice Management Institute. Under the Health Insurance Portability and Accountability Act guidelines, D’Spain notes that “we do have to protect patient privacy at all times.” Unless a practice has a special consent form on file, that can pose obstacles. “We know cell phones are not always 100-percent private; we know that leaving messages may not be private.”

Se Habla Espanol

Language barriers may be more than just an inconvenience for some providers. More than 22 million people speak English less than “very well,” according to the American

Medical Association, and more than 34 million people were born in another country. For a practitioner not versed in foreign tongues, it can be a challenge to provide even basic information about medical procedures or self-care at home. Abstract topics such as office policy can present even greater difficulties. Providers who take part in Minnesota Health Care Programs, for example, are required by the state to provide spoken language interpreter services to all patients with limited English proficiency, whether or not the patient is a recipient of services within the program. The obligation to close the language gap often may fall to the provider. Providers also may be compelled to help with language under the federal Civil Rights Act, says Michael J. Sacopulos, founder and president of Medical Risk Institute, a Terre Haute, Indiana, consultancy. He notes that health-care providers who receive federal financial funds are mandated by law to take adequate steps to ensure those who can’t speak English are provided with the necessary tools to communicate clearly with practitioners. That includes medical offices receiving Medicaid or Medicare. While it is possible patients may never demand such services, if they do the provider likely will be responsible for providing a translator or other accommodation.

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“...You need to have staff members who are fluent in the language that is used by the majority of your patient mix. That is just the cost of doing business.” —Linda D’Spain

That can set a high bar, says Feathers. “I wish I knew how to speak Spanish, but I don’t. Even when you come into a situation where the patient doesn’t speak English and they have someone there translating for them, things can get lost in translation. You’ve got to watch [the patient]; you watch for body language, expressions, and things like that.” Solutions are available, albeit clunky ones. For example, the online Google translator provides less-than-perfect renderings and its medical vocabulary may be limited. You could hire a translator, but that gets expensive. Some insurance companies require a translator with a certified medical vocabulary—an even pricier proposition. One solution that some have found helpful can be woven into hiring practices. A provider can get to know the local community, identify the predominant ethnicity, and make that language a requirement within a job description. “We have so many nationalities now in our country that there is an overall language barrier,” says D’Spain. “So, you need to have staff members who are fluent in the language that is used by the majority of your patient mix. That is just the cost of doing business.” At the very least, a practitioner can ask the non-English speaking patient to bring along a bilingual family member or friend. None of these are perfect solutions, but they do present helpful workarounds for those faced


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with a language barrier they cannot easily overcome.

Routine Matters For most office communications, it’s the routine tasks that weigh most heavily. For example, appointment reminder calls are of special importance with O&P because patients are apt to make frequent visits for fittings and adjustments. The nature of ongoing care for patients also requires open lines of communication. Consequently, experts recommend establishing policies about how best to communicate with patients. Such policies may include permissions for the office to call certain numbers and leave messages, or it may include the need to inform patients of the financial consequence that comes with a missed appointment. (This can be substantial: A typical missed appointment can cost a practice $200

to $400, Gurganious says.) Equally important is the tone your policy sets: It must be respectful of the patient. “Sometimes it sounds like the practice is talking down to a patient, or the letter will be in all caps, and it looks like you are being yelled at. It has to be respectfully written,” D’Spain says. The task will be to set the correct tone while also keeping the language easy to understand. A good litmus test is to hand your policy to a friend or someone outside the practice and see how he or she reacts to it. Once you have a clearly written statement, it’s vital that you provide it to patients at their first appointment— and that they acknowledge your policy in writing. Next, create a solid routine for fulfilling your obligations to the patient. Nowadays, that requires more advanced technology. “[Phone calls] hardly ever reach the patients; most of the time, [office staff] get a voice mail. And very often, the practice does not hear back from that patient to make sure they actually got that message,” says Hugo Diaz, chief marketing officer of Vital Interaction, a provider of interactive patient communications systems. “[The practice will] still get no-shows: People forget about the message; people didn’t listen to their voicemail; maybe the practice had the wrong number. You don’t know. All you know is that you have a no-show.”

Texting is the most effective fix to this problem, according to Diaz. He points to research by the Pew Research Center that shows some 79 percent of cell phone owners say they use text messaging on their cells, and the vast majority read text massages within an hour of receiving them. Like similar automated messaging software, Diaz’s product sends out appointment reminders, notifications when parts arrive at the practice, reminders when it’s time to schedule a regular appointment, and emergency notifications. Dozens of automated services on the market also can help with the language barriers, by allowing users to program in the most common phrases in multiple languages. To find the right one, Diaz recommends trying a software-as-a-service model. This increasingly popular licensing model allows users to test-drive software for a monthly fee, rather than buying the full package. The software typically resides in the cloud (i.e., the software is

Once you have a clearly written statement, it’s vital that you provide it to patients at their first appointment—and that they acknowledge your policy in writing. run from a remote location and clients have access to it via the Internet), so there are no complicated installations or updates. Still, technology can take you only so far, say practitioners. In the world of O&P communications, what matters most is still the one-on-one connection between patient and caregiver. “A lot of the time, it is all so overwhelming at first. [Patients] don’t quite get it all. When they go home, they forget,” says Bill Leimkuehler, CPO, of Leimkuehler Orthotic Prosthetic Center in Cleveland.

“I’ve given someone a half-hour explanation, and I tell them, ‘If you guys aren’t sure, check that sheet.’ That’s what it is all about,” he says. “You can have all the other technology in the world, but that stuff doesn’t do anything if you are standing there face-to-face and they still don’t get it. It’s still up to you to make sure they understand.” a

Adam Stone is a contributing writer to O&P Almanac. Reach him at adam.

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JULY 2013 O&P Almanac





A Vexing Issue The O&P Alliance asks OIG to treat physician-owned O&P labs as they do physician-owned distributorships


hysician-owned distributorships (PODs), where O&P services are provided in a physician’s office through various arrangements, have long been the subject of conversation in the O&P community. To address the issue, the O&P Alliance submitted a thoughtful analysis in a May 23, 2013, letter to Daniel Levinson, inspector general of the Department of Health and Human Services, suggesting a course of action that would ensure that both the “Medicare program and beneficiary interest continue to be served, that access to quality orthotic and prosthetic care is maintained, and to mitigate the potential for fraudulent and abuse activities.”

OIG’s Stance on PODs The Office of Inspector General (OIG) issued a Special Fraud Alert on March 23, 2013, addressing PODs—physicianowned entities that derive revenue from selling or arranging the sale of implantable medical devices ordered by their physician-owners for use in procedures the physician-owners perform on their own patients at hospitals or ambulatory surgical centers. This alert


O&P Almanac JULY 2013

acknowledged that while the focus was on implantable devices, “the same principles would apply when evaluating arrangements involving other types of physician-owned entities.” In its May 23 letter, the O&P Alliance noted prior OIG references to this problem by observing the following: “Through previously published guidance, the OIG has made it clear that an opportunity for a referring physician to earn a profit, including through an investment in an entity for which the physician generates business (e.g., through referrals to the business), could constitute illegal remuneration under the antikickback statute.”

Physician-Owned O&P Labs The O&P Alliance letter observed that PODs addressed in the Special Fraud Alert closely resemble the relationship of physician-owned O&P laboratories, and urged “the OIG to apply the same principles when considering the legality of physicianowned O&P laboratories under the anti-kickback statutes.”



custom O&P services provided under the IOAS exception; and contractual joint ventures formed for the provision of custom O&P care should be included within the OIG’s FY 2014 Work Plan.”

Spirit of Cooperation

According to the letter, “with the exception of certain prefabricated off-the-shelf orthoses or supply items,” the PODs “open the door to overutilization, potentially suspect medical judgment, unfair competition, and increased costs to the Medicare program and its beneficiaries.” The letter pointed out that the financial advantages of self-referring physician-owned O&P laboratories are being presented at many medical business meetings, and there has been a noticeable increase in the “number of entities marketing turnkey O&P laboratory services based on the profitability of these arrangements.” The letter concluded with these recommendations: • “The suspicions with which the OIG views PODs should be applied equally to physician ownership of O&P laboratories. Insufficient attention has been paid to physician relationships with O&P practices, which are essentially the equivalent of PODs. We encourage OIG to apply the same principles when considering the legality of physician-owned O&P laboratories under the anti-kickback statutes. • “The billing of custom-made or beyond basic custom-fit O&P devices under the in-office ancillary


O&P Almanac JULY 2013

services (IOAS) exemption should not be allowed. The IOAS exception, when applied to custom prosthetics and orthotics, does not serve any ancillary care advantage and simply serves as a mechanism to maximize physician profits. There are no corresponding benefits to patients. Allowing payment for custom O&P devices under the IOAS exception could lead to overutilization and self-referral abuses, and does not contribute to patient access to appropriate care. • “The OIG’s enforcement activities should be increased in relation to often-abusive contractual joint venture arrangements wherein a referring physician realizes the profits gained by referring his or her patients to an O&P laboratory in which he or she has ownership interest, with little or professional or clinical oversight. • “The requirement for all suppliers of O&P care, including physicians and physician practices, that a thirdparty referral source must prescribe and support the medical necessity for custom O&P devices provided to Medicare beneficiaries should be continued. • “Further analysis and observation of physician-owned O&P laboratories;

The six-page letter was signed by the chief elected officer of each of the five Alliance members—AOPA; the American Academy of Orthotists and Prosthetists; the American Board for Certification in Orthotics, Prosthetics, and Pedorthics; the Board of Certification/Accreditation, International; and the National Association for the Advancement of Orthotics and Prosthetics. This joint letter again fulfilled one of the main goals of a group of O&P leaders meeting nearly seven years ago by speaking with one unified voice on behalf of the O&P community.

As more and more provisions of the Affordable Care Act come into play and as more unique business models emerge for the provision of all kinds of health care, the need for careful scrutiny of the opportunities for business models such as PODs will only increase. To read the entire O&P Alliance letter to Daniel Levinson, go to www., click on the Legislative and Regulatory pull-down menu, and click on Regulatory News. a

STAND UP for your

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

our service be constantly backed up with physician notes?

A we face our business doors being closed? A

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


we be faced with encroachment from other professions?


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


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


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

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

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

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

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


Social Media and Your O&P Practice: 4 Steps to Great Yelp Reviews

Yelp is a website on which anyone can post a review about any local business. It can be a daunting site for business owners. The first time you visit your Yelp page (it is likely someone has already reviewed your business), keep an open mind and be prepared to address any seemingly unfair reviews in an unbiased manner. There are several ways you can promote your business on Yelp or similar websites to ensure you are represented in the best light. 1. Search to see if your business is on the site; if not, set up your page. Yelp is very user-friendly; you simply provide basic contact information along with a few fantastic pictures of your business. Don’t overlook the photos! They are an easy way to show how much you care for your patients and your facility. If you already have a page, make sure you claim it and follow the guidance above to make sure it highlights your business. 2. Identify people who already have Yelp profiles to review your business for you. It is common practice among the business community to seed your profile with some reviews from folks you trust. To make sure those reviews aren’t hidden by Yelp’s algorithm, have those people review a few other businesses as well. People with only one review on the site may have their reviews hidden from view.


O&P Almanac JULY 2013

3. Tell your patients, co-workers, and family about the page, and post on all of your social channels that you have a Yelp page and would appreciate reviews. Some businesses will offer discounts, promotional materials, and other offers if a customer posts a review. Pick a method that makes sense for your business. 4. Handle negative reviews with care. Unfortunately, someone will post a negative review from time to time. Your business has the chance to showcase its strengths by addressing the review directly. If you aren’t sure what to post, consider how you would handle the situation if it occurred in person or via phone. You would likely apologize for the bad experience and attempt to find a positive solution. Yelp works in a similar fashion. Make sure you ask the reviewer to get in touch with you so you can address the situation. Resolving the issue in a prompt manner is an excellent way to get the same reviewer to post a positive follow-up review. Highlighting your business’ excellent customer service and your desire to improve daily is how you will continue to drive business through this social tool. 

UPS Savings Program AOPA Members now save up to 30% on UPS Next Day Air® & International shipping! Sign up today at! Take advantage of special savings on UPS shipping offered to you as an AOPA Member. Through our extensive network, UPS offers you access to solutions that help you meet the special shipping and handling needs, putting your products to market faster.  AOPA members enjoy discounts for all shipping needs and a host of shipping technologies. Members save: • Up to 30% off UPS Next Day Air® • Up to 30% off International Export/Import • Up to 23% off UPS 2nd Day Air®

ial c e p S gs! n savi

All this with the peace of mind that comes from using the carrier that delivers outstanding reliability, greater speed, more service, and innovative technology. UPS guarantees delivery of more packages around the world than anyone, and delivers more packages overnight on time in the US than any other carrier. Simple shipping! Special savings! It’s that easy!


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

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

Mastering Medicare: AOPA’s Advanced Coding & Billing Techniques Mirage Hotel & Casino October 22-23, 2013, Las Vegas Join your colleagues October 22-23 at the Mirage Hotel & Casino in Las Vegas for AOPA’s “Mastering Medicare: Advanced Coding & Billing Techniques” seminar. AOPA experts will provide t up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Designed for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage.

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

JULY 2013 O&P Almanac



Students and Residents: Submit Abstracts by August 9 Gain international recognition for you and your school at the 2013 O&P World Congress! AOPA invites O&P students and residents to present research findings or a case study via a poster presentation at the 2013 O&P World Congress to be held September 18-21 in Orlando. The Otto and Lucille Becker Award will be presented for the best orthotic abstract submitted, and the Edwin and Kathryn Arbogast Award will be presented for the best prosthetic abstract submitted by a qualifying student or resident. The winners will receive a $500 cash award, registration to the show, economy airfare to the Congress, and three nights in a hotel. To qualify to present a poster and be eligible for awards consideration, the main author must be a student

(baccalaureate or master level) or a resident at a qualified patient-care facility. Abstracts will not be considered for either award if they have been previously presented or published, or are currently submitted and pending acceptance elsewhere. These awards have been made possible by a special endowment from Becker Orthopedic and WillowWood. Special recognition will be given to the school with which the student/resident is affiliated. The submission deadline is Aug. 9, 2013. To submit your abstract, visit forms/2013-aopa-studentresident-poster-submissions/. For further information, contact Tina Moran at 571/4310808 or

Welcome to AOPA Jobs AOPA’s Online Career Center gives you access to a very specialized niche. The Online Career Center is an easy-to-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.


O&P Almanac JULY 2013

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


About the Congress

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

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

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


inte compete from arou


a combin device fo

Register to

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

or 571/431-0810.

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

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

JULY 2013 O&P Almanac



Networking for the Future: Building Relationships With Your Referrals— Join the Audio Conference July 10 The value of the relationship should never be underestimated. Networking and marketing your business are vital to its success. Join AOPA on July 10 at 1 p.m. EST for an AOPAversity Mastering Medicare Audio Conference that will focus on maintaining referral source relationships for your O&P practice. Learn strategies and techniques to attain that all-important edge in the competitive world of O&P. An AOPA expert will address the following topics: • • • •

Networking and marketing your O&P practice Reaching out to the right people Techniques that result in out-of-the-box thinking Building and maintaining relationships with referral sources • The importance of brand recognition in O&P.

AOPA members pay just $99 to participate ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon

Bernard at or 571/431-0854 with content questions. Register online at Contact Steve Custer at or 571/431-0876 with registration questions.

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 Steffanie Housman at or 571/431-0835 with social media and content questions.

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

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

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


O&P Almanac JULY 2013


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 CE credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis.

AOPA also offers two sets of webcasts: Mastering Medicare and Practice Management. • 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


Business Optimization Analysis Tool (BOAT) AOPA’s largest and most successful members use the BOAT. The BOAT will help you:



Provide access to the new AOPA Patient Satisfaction Survey (required by certifying bodies).

Participate in the annual Operating Performance and Compensation survey (OPC) —which provides you with a personal benchmark comparison study.

You will have access to your own secure and confidential account on the BOAT which will contain your company’s reported data and is specifically tailored to help O&P

OPC data you submit will automatically populate your BOAT site providing valuable historical information

This Amazing Profit Booster is FREE for AOPA Members.


understand your competi-

Examine the

financial fitness of your business

business owners manage their business for greater profit and quality patient care. If you do not already have a BOAT account, contact AOPA’s BOAT partner, Michael Becher, Industry Insights, 614/389-2100 x 114 or mbecher@, to enroll today.

Help you identify and

your finances

tion, market conditions and referral sources

And much more!

JULY 2013 O&P Almanac


AOPA Applications

Aqualeg Inc.

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

ABC Orthotics & Prosthetics Mobile LLC 805 Downtowner Loop W. Mobile, AL 36551 251/316-3160 Fax: 251/316-3950 Category: Patient-Care Member Pamela Hembree

Altru Health System 1300 S. Columbia Road Grand Forks, ND 58201 701/780-2424 Fax: 701/780-2441 Category: Patient-Care Member Paul Edman, CP, COA


O&P Almanac JULY 2013

Rebound Medical Solutions Inc.

452 Lakeshore Parkway, Ste. 100 Rock Hill, SC 29730 803/324-8900 Fax: 855/716-5163 Category: Supplier Member Michael Burton

1011 Cass Street, Ste. 112 Monterey, CA 93940 831/375-2300 Fax: 831/375-2400 Category: Patient-Care Member Steve Kulifaj

First Step Prosthetics LLC

Rodin 4D

1406 E. Broadway, Ste. A Gallatin, TN 37066 615/461-8557 Category: Affiliate Member Parent Company: First Step Prosthetics LLC, Bowling Green, KY

Gulf Coast Orthotics & Prosthetics 824 Creighton Road Pensacola, FL 32504 850/477-4880 Fax: 850/477-4766 Category: Patient-Care Member Steven Gavin, CPO, LPO

Lake Prosthetics and Research LLC 350 Westpark Way, Ste. 108 Euless, TX 76040 817/358-1500 Fax: 682/224-8430 Category: Patient-Care Member Mary Lake

Lehotay Prosthetics LLC 624 Central Avenue Charleston, WV 25302 304/344-0036 Fax: 304/344-5025 Category: Patient-Care Member Adam Lehotay, CP

L.I.C. Prosthetics and Orthotics 321 E. Center Street Anaheim, CA 92805 714/563-0056 Fax: 714/563-0056 Category: Patient-Care Member Frederick Randjbar

Palliser Orthotic & Prosthetic Clinic Ltd. 1036 7th Street SW Medicine Hat, Alberta T1A 8V7 Canada 403/528-8003 Fax: 403/528-8002 Category: International Member Greg Smith

27 Allee Charles Darwin Pessac, 33600 France +003 305 5647 Category: Supplier Affiliate Member Parent Company: Boston Brace International Inc./dba NOPCO, Avon, MA

TLC Unlimbited 4/147-151 Belmont Avenue Belmont, WA 6104 Australia +618 9277 2988 Category: International Member Rachel Hills

Valley Orthotic Specialists Inc. P.O. Box 718 Mount Jackson, VA 22842 540/477-9132 Fax: 540/477-9150 Category: Patient-Care Member Sarah Lane

Valley Orthotic Specialists Inc. 136 Linden Drive, Ste. 102 Winchester, VA 22601 540/477-9132 Fax: 540/477-9150 Category: Affiliate Member Parent Company: Valley Orthotic Specialists Inc., Mount Jackson, VA

Virginia Surgical Mobility Center 6035 Staples Mill Road Richmond, VA 23228 804/622-0347 Fax: 804/622-0349 Category: Patient-Care Member Linda Angel

Wright Brace & Limb Inc. 565 Progress Street, Ste. B West Branch, MI 48661 989/343-0300 Fax: 989/343-9771 Category: Patient-Care Member Cheryl Wright a

PreStrideTM Stance Control Assessment Orthosis Now available with GX-Assist The PreStride™ allows practitioners to make an informed decision regarding the suitability of Becker Stance Control Technology prior to manufacturing a definitive orthosis.

accommodates individuals with significant weakness of hip musculature with use of a pneumatic spring to assist in knee extension during the swing phase of gait. The GX-Assist can be easily attached or detached from the lateral side of the orthosis as necessary.

The PreStride is a modular and fully adjustable stance control assessment tool that uses a cabling system to automatically unlock the orthotic knee joints at the end of stance phase. It may be fitted, in a controlled clinical setting, to most adults who are between 5’2” and 6’2” in height.

Becker Orthopedic offers the largest selection of stance control componentry available. Call us today to learn more about the PreStride and how we can assist you in making stance control a part of your practice.

Now available with

Intended as an assessment tool for the FullStride™ and SafetyStride™ stance control systems, the PreStride now also comes equipped with the GX-Assist. The GX-Assist

Model 9007 with GX-Assist

Rev 5/13 ©2013 Becker Orthopedic Appliance Co., All rights reserved

(800) 521-2192 (248) 588–7480

Stride Family of Stance Control


Endurance Hydraulic 160 Knee from PEL Available with free shipping through the exclusive PEL H.A.S.* program, the Hosmer Endurance Hydraulic Knee System is a shorter 160-mm unit rated to 300 lbs. The Endurance knee has three modes of operation: automatic stance lock/swing control, flexion lock, and swing phase only. Other features include: • 130 degrees total knee flexion • Integrated proximal stability adjustment and knee covering • Durable, low maintenance • Choice of four proximal attachments • Compact build height of mere 8 3/8 in., 31 oz. • Kit includes Endurance knee unit, mounting kit, knee frame with proximal adjustment screw, and knee cap For more information on the Endurance knee and other innovative products from Hosmer or other Fillauer Companies, call 800/321-1264, fax 800/222-6176, or email PEL at *Higher Activity Shipping program offers best-selling knees and feet with free shipping. Call PEL or look at for details.

Try it! The NEW 3S80 Fitness Knee from Ottobock Have your patients experience the 3S80 Fitness Prosthesis—ask for a trial kit, which includes the 3S80 knee, a variety of adapters, and a series of 1E90 feet. The 3S80 Fitness Prosthesis makes it possible for your above-knee patients to get up and moving again, increasing strength and mobility and enhancing overall health. Contact your sales representative to schedule a trial fitting. If you know which products your patients need, simply call our customer service at 800/328-4058, or visit www.ottobockus. com/FitnessKnee.


O&P Almanac JULY 2013

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

Vari-Flex® XC Rotate™ by Össur®. Go anywhere. Do anything. Increasingly, many amputees desire a prosthetic foot that can keep up with their busy lifestyle. Whether they’re at the office or the gym, they want the convenience of using a single foot throughout the day. By combining smooth rollover and dynamics with vertical and rotational shock absorption, Vari-Flex XC Rotate offers the flexibility that these active individuals require to pursue a life without limitations. To learn more about Vari-Flex XC Rotate by Össur, call 800/233-6263 or visit today.

Patented KISS® Superhero™ Reusable Test Socket Plate The unique design of this plate allows for easy casting tape removal, without damage. Damage-free casting tape removal allows this plate to be reused, saving costs. Visit www.kiss-suspension. com or call 410/663-KISS for more information. a


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

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

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

Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate! $80 $140



DISCOVER more AOPA advertising opportunities.


& Prosthetic

mediakit Rates


O&P Since

1, 2013 effective Jan.

Call Dean Mather, advertising sales representative, at 856/768-9360 or email




O&P Almanac JULY 2013

O&P Faculty Pittsburgh The University of Pittsburgh has two open faculty positions in the Masters of Science Program in Prosthetics and Orthotics (MSPO). Academic rank and tenure status will be dependent upon the experience and credentials of successful applications. ABC certification and PhD in related area of orthotics and/or prosthetics is desired. Minimum of three years of teaching, clinical, or research experience preferred. Evidence of, or potential for, productivity in scholarly activity as shown through publications, grants, and presentations. Involvement in professional O&P organizations desirable. Successful candidates will be responsible for teaching and research in our MSPO program, including program and curriculum development, evaluation, mentoring, and clinical education. We are particularly interested in expanding our research and development activities. Extensive facilities and other resources for research are already in place and available. As part of the University of Pittsburgh, the School of Health and Rehabilitation Science is an affirmative-action institution and welcomes applications from minorities, handicapped, and other categories of underrepresented people. To apply, send CV to:

$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.

American Orthotic


Rory A. Cooper, PhD, Chair Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences University of Pittsburgh 5044 Forbes Tower Senott and Atwood Streets Pittsburgh, PA 15260


Member Benefits Live and work, where you can play.

Experience the Benefits of AOPA Membership

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


Experience the Benefits of AOPA Membership

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

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

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

Membership in AOPA is one of the

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

in the future of your company.

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





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


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

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

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

Join today!

Tina Mann

Clinic Manager

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

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

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

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

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

Available Positions: Clinic Manager Morgantown, WV Seattle, WA

Valdosta, GA Herndon, VA

Dayton, OH Wilmington, NC Thomasville, GA Tamarac, FL Panama City, FL Bethlehem, PA Bridgeport WV Annapolis, MD

Buffalo, NY Johnson City, NY Redding, CA Seattle, WA Bellevue, WA Burbank, CA Englewood

Wichita, KS Louisville, KY Hammond, IN Grand Rapids, MI Beaufort, SC

Pensacola, FL Richland, WA Phoenix, AZ Cary, NC Grand Junction, CO

Jackson, MS Hattiesburg, MS

Williamsport, PA

Prosthetist / Orthotist



JULY 2013 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. Candidates can apply and test when ready, receiving their results instantly for the multiple-choice and clinicalsimulation exams. Apply now at For more information, visit www. or email cert@ ■ 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 fitted immediately. For more information, call 801/326-3434, email info@, or visit www.


2013 ■ JULY 8-13 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was May 1, 2013. Contact 703/836-7114, email, or visit www. ■ JULY 9 WillowWood: Intro to OMEGA®, via WebEx, 1:30 PM ET. Potential CAD users have opportunity to investigate OMEGA and find out how the system benefits a growing O&P practice. Credits: 2.5 ABC/2.5 BOC.

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 44

O&P Almanac JULY 2013

■ JULY 10 AOPAversity Audio Conference—Networking for the Future: Building Relationships With Your Referrals. For more information, contact Stephen Custer at 571/431-0876 or

JULY 12 WillowWood: LimbLogic® Technicians, via WebEx, 1:30 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. Credits: 2.5 ABC/2.5 BOC. Visit ■

JULY 16-18 WillowWood: OMEGA® Training. Mt. Sterling, OH. Covers basic and advanced software tool use and shape capture by scanning. ‘By Measurement’ shape creation and custom liners discussed. Includes extensive handson practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: 19.25 ABC/19.25 BOC. Visit ■

■ JULY 26-27 ABC: Orthotic Clinical Patient Management (CPM) Exam. Georgia Institute of Technology, Atlanta. The application deadline for this exam was May 1, 2013. Contact 703/836-7114, email, or visit

■ AUGUST 1-2 Amputee Conference: Interprofessional Engagement for the LE Amputee. Pre-Conference Reception and Community Amputee Event: Aug. 1, 5-8 PM. Continuing Education Conference: Aug. 2, 8 AM-4:30 PM. For more information, visit or email ■ AUGUST 1 ABC: Practitioner Residency Completion Deadline for September Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email, or visit ■ AUGUST 2-3 ABC: Prosthetic Clinical Patient Management (CPM) Exam. Georgia Institute of Technology, Atlanta. The application deadline for this exam was May 1, 2013. Contact 703/836-7114, email, or visit ■ AUGUST 5-9 Homewood Suites University City. Philadelphia. Applied Technology Institute (ATi) Orthotic Fitter School, independent comprehensive course to prepare for certification exam. Approved entry-level school by NCOPE, ABC, and BOC; and for continuing education by BOC. Course descriptions and registration available online at For more information, contact Lois Meier at 888/265-6077 or email


■ AUGUST 8 WillowWood: LimbLogic® Practitioners. Mt. Sterling, OH. Course focuses on all the clinical aspects of LimbLogic, from operation to appropriate usage. Work with patient models and complete a fully operational LimbLogic socket to an initial dynamic fitting stage. Credits: 7.0 ABC/7.0 BOC. Registration deadline is July 18, 2013. Contact 877/665-5443 or visit ■ AUGUST 9 WillowWood: LimbLogic® Technicians. Mt. Sterling, OH. The course focuses on elevated vacuum socket fabrication. Includes basic operation and hands-on fabrication of LimbLogic adapters. Work with patient models and fabricate a LimbLogic socket. Credits: 8.5 ABC/8.75 BOC. Registration deadline is July 18, 2013. Contact 877/665-5443 or visit

ABC credits for attending the full presentation. For more information, contact Nancy Francis at 508/775-0990 x8374, or email nancy_f@spinaltech. com. ■ AUGUST 22-23 Using Closed Cell Foams: Understanding, Techniques, Hands-on. Nora Systems Inc., Salem, NH. Approved CEUs: 4 ABC/4 BOC continuing education credits. The course, hotel, airport transportation, and meals are provided. Contact Jon Fogg at 770/8809786 or email Jonathan.Fogg@

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

■ SEPTEMBER 11 AOPAversity Audio Conference—Read Between the Lines: The Medicare Lower-Limb Prosthetic Policy. For more information, contact Stephen Custer at 571/431-0876 or scuster@

■ SEPTEMBER 13-15 National Pedorthic Services—Educational Course: A Hands-on Approach to Footwear Modifications. Milwaukee. For more information, contact Brian Dalton at 414/438-6662, email, or visit

■ AUGUST 14 AOPAversity Audio Conference—Don’t Get Stuck With the Bill: Medicare Inpatient Billing. For more information, contact Stephen Custer at 571/4310876 or

■ AUGUST 15-17 Annual Scoliosis Symposium With the Addition of Lower-Limb Orthotics Management. Hosted by Spinal Technology, Inc. Boston. Course will cover measurement techniques and brace options for lower-limb orthotics, fulltime scoliosis bracing protocol for adolescent idiopathic scoliosis, and the Providence Nocturnal Scoliosis System, with hands-on demonstrations in each segment. Presenters include Tufts Medical Center orthopedic surgeons, a Tufts neurosurgeon, and ABCcertified practitioners. Eligible practitioners can earn 16.25

JULY 2013 O&P Almanac



■ SEPTEMBER 16-21 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was July 1, 2013. Contact 703/8367114, email, or visit certification. ■ SEPTEMBER 18-21 O&P World Congress. Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/4310876 or

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

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

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

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

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

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

24/7 Expert Coding Advice 24/7 •

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

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

This exclusive service is available only for AOPA members.

Contact Lauren Anderson at 571/431-0843 or

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

Visit AOPA at

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


O&P Almanac JULY 2013


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

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

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

the Big Island. Contact Dianne Farabi at 614/659-0197 for more information. Submit abstracts at pacrim14. ■ AUGUST 6-9 CAPO Conference. World Trade & Convention Centre. Halifax, Nova Scotia. Marriott Halifax Harbourfront. Visit

www.prostheticsandorthotics. ca/ for more information.


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

■ 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

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

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

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JULY 2013 O&P Almanac


AOPA Answers

Bilateral Billing Answers to your questions regarding bilateral componentry


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


Is it true that a bilateral amputee can have any prosthetic componentry he or she wants and is not subject to a functional level assessment and the K-levels?


The Medicare Lower Limb Prosthetic Policy states the following: “It is recognized, within the functional classification hierarchy, that bilateral amputees often cannot be strictly bound by functional level classifications.” While this statement recognizes that there may be individual circumstances in which a bilateral amputee may have a clinical need for componentry that exceeds his or her functional level assessment, it does not mean that bilateral amputees have no limits on the type of prostheses for which Medicare will pay. Bilateral amputees must undergo a functional level assessment and be assigned a functional level (K-level modifier); in most cases, they will only qualify for prosthetic components within their functional level classification. If there is a specific clinical need for prosthetic components that exceed the patient’s functional level classification, the need must be welldocumented and supported by information in the patient’s medical record.


O&P Almanac JULY 2013

Q. A.

How many claims may RACs audit?

The Centers for Medicare and Medicaid Services has modified the number of Additional Documentation Requests (ADRs) that a Recovery Audit Contractor (RAC) may make for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers. The number of ADRs a RAC may make per 45 days is limited to 10 percent of all claims submitted under a single Tax ID for the previous calendar year, divided by eight. However, for suppliers that are classified by the following taxonomy codes, there is a limit of no more than 10 ADR requests per 45 days: • 51—Medical Supply Company with Orthotist • 52—Medical Supply Company with Prosthetist • 53—Medical Supply Company with Orthotist-Prosthetist • 55—Individual Certified Orthotist • 56—Individual Certified Prosthetist • 57—Individual Certified Prosthetist-Orthotist. Therefore, if you are classified as any of the above, the maximum amount of claims that could be audited by the RACs in a 45-day span is 10. a

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July 2013 Almanac  

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