July 2014 Almanac

Page 1

The Magazine for the Orthotics & Prosthetics Profession

j u lY 2014

OTS or Custom-Fit: Know the Difference P.16

This Just In: Prior Authorization No Cure-All for Reimbursement P.18

State Issues Affecting Your Business窶年ow P.30

New Tool for Mobility Outcomes Assessment P.34

WATER Sports www.AOPAnet.org

Get your patients in on the action this summer

E! Q UI Z M Earn


Business CE

Credits P.16 & P.38

Your Connection to Everything O&P

Life in action

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The Magazine for the Orthotics & Prosthetics Profession

JULY 2014 | VOL. 63, No. 7


Departments | COLUMNS



President’s View....................................... 4

Insights from AOPA President Anita Liberman-Lampear, MA

AOPA Contacts............................................6 How to reach staff

Numbers........................................................ 8

At-a-glance statistics and data

Happenings............................................... 10

Research, updates, and industry news

People & Places........................................ 14

Transitions in the profession

22 | No Waves, No Glory Get your patients into the water this summer with these practitioners’ tips for fitting, minimizing component corrosion, and more. By Lia Dangelico

18 | This Just In

P. 16

CE Opportunity to earn up to 2 CE credits by taking the online quiz.


Compliance Corner............................... 38

Pay Attention to the PDAC CE Opportunity to earn up to 2 CE credits by taking the online quiz.


Member Spotlight................................ 40

P. 30

30 | The State of O&P Understanding regulators, legislator, and private insurers’ moves at the state level offers valuable insights for protecting your business and career. By Christine Umbrell

34| Prosthetic Limb Users Survey

Proper billing procedures for orthoses

What this coding verification process means to you

Prior Authorization No Cure-All for Reimbursement Experts say a poorly constructed prior authorization system could further slow review requests and complicate patient care. By Adam Stone

Reimbursement Page.......................... 16

OTS or Custom-Fit?

n n

The Ohio Willow Wood Co. Prosthetic Care Facility of Virginia

AOPA News................................................46

AOPA meetings, announcements, member benefits, and more

P. 34

of Mobility

Researchers review the development and validation of a patient-reported outcome measurement tool. By Susan Spaulding, CPO; Sara Morgan, CPO; and Brian Hafner, PhD

Welcome New Members ................... 51 Marketplace.............................................. 52

Careers......................................................... 53

Professional opportunities

Calendar...................................................... 54

Upcoming meetings and events

Ad Index....................................................... 55 Ask AOPA................................................... 56

Advertise with Us! For advertising information, contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Expert answers to your questions about Medicare and mailings

O&P Almanac / July 2014



Building the Global O&P Presence

Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.


verything has to start somewhere, with something and someone. In 2008, the something was a dream for AOPA to sponsor an O&P World Congress in the western hemisphere. The somewhere was the then Orthopaedie + Reaha- Technik show for orthotics and prosthetics held in Leipzig, Germany, every two years. That someone was one of my predecessors, Brad Ruhl, then president of AOPA. Brad, along with Tom Fise, executive director, and Tina Moran, senior director of meetings and membership, traveled to Leipzig that year to share the idea with the global O&P players of AOPA’s dream in hosting the World Congress. Brad had arranged in advance a series of meetings with the German Association of Orthopaedic Technology, sponsors of the Leipzig event, exhibitors, ISPO, and other groups to begin seeking indications of interest about participation in the event. Another of my predecessors, Tom DiBello, CO, FAAOP, journeyed to the Leipzig show in 2010 to further cement relationships with individual practitioners from around the world and to gauge and encourage their interest. More and more the reality of a World Congress on U. S. soil took shape. Tom and AOPA staff went back in 2012 and continued an intensive effort to enlist specific high-profile, internationally recognized speakers and to recruit the leading lights of global O&P to serve on the World Congress Planning Committee. Of course the smashing result of all of this effort by these two former presidents was the now historic AOPA World Congress held Sept. 18-21, 2013, in Orlando, Florida. Just a few weeks ago, it was my pleasure to attend the OTWorld, as it is now known, to advance our plans for the 2nd AOPA World Congress, Sept. 6-9, 2017, at the Mandalay Bay Hotel and Resort in Las Vegas. Not only will it be a World Congress but it will be AOPA’s Centennial Celebration, and you can bet it will be a big deal! The response from everyone we met in Leipzig this year was enthusiastic and confirms my personal belief that the 2013 World Congress paved the way for bringing the far-flung world of O&P just closer and closer together. From a more personal perspective, it was a tremendous honor to attend OTWorld and talk to our colleagues from other countries—Holland, France, Belgium, Spain, Germany, to mention a few—and, of course, see our American colleagues in action showing their products to folks from around the world. The exhibit space was four times (or more) the size of our shows, however, it was different than what we were used to as well. Products were showcased in enclosed cases or better yet, on the many patients walking around. And of course, I’d be remiss if I didn’t tell you about the great German beer (and wine) served along with local bratwurst and other yummy treats! Leipzig was definitely the epitome of Old World meets New World! In the meantime, don’t forget to mark your calendar to join us in Las Vegas, Sept. 4-7, 2014, for the 98th annual National Assembly, also at the Mandalay Bay. And as long as you’re marking your calendar, 6:30 p.m., Friday, September 5 is the Sixth Annual Wine Auction—you will not want to miss it. Contact Devon Bernard for details on how to donate wine or other treasures to help us raise money for the AOPA Political Action Committee and the continuous advocacy it supports on behalf of O&P. Sincerely, Anita Liberman-Lampear, MA, AOPA President 4

July 2014 | O&P Almanac

Board of Directors Officers

President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI President-Elect Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD Vice President James Campbell, PhD, CO Becker Orthopedic Appliance Co., Troy, MI Immediate Past President Tom Kirk, PhD Member of Hanger Inc. Board, Austin, TX Treasurer James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA Directors Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Alfred E. Kritter Jr., CPO FAAOP Hanger, Inc., Savannah, GA Eileen Levis Orthologix LLC, Trevose, PA Ronald Manganiello New England Orthotics & Prosthetics Systems LLC, Branford, CT Dave McGill Össur Americas, Foothill Ranch, CA Michael Oros, CPO Scheck and Siress O&P Inc., Oakbrook Terrace, IL Scott Schneider Ottobock, Minneapolis, MN Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA


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

The Magazine for the Orthotics & Prosthetics Profession

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

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

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company

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


O&p Almanac

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

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

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

Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com

MEMBERSHIP & Meetings Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Stephen Custer, communications manager, 571/431-0810, scuster@AOPAnet.org Lauren Anderson, manager of membership services, 571/431-0843, landerson@AOPAnet.org Betty Leppin, project manager, 571/431-0876, bleppin@AOPAnet.org

Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/662-5828, cumbrell@contentcommunicators.com Stephen Custer, production manager, 571/431-0810, scuster@AOPAnet.org Lia K. Dangelico, contributing writer, ldangelico@contentcommunicators.com

AOPA Bookstore: 571/431-0865 Government affairs Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Devon Bernard, assistant director of coding reimbursement, programming and education, 571/431-0854, dbernard@AOPAnet.org 6

July 2014 | O&P Almanac

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email almanac@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. Address Changes Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2014 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted. Cover Photo: Arthur Finnieston

Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

Advertise with Us! Reach out to AOPA’s membership and 15,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit http://bit.ly/aopa14media for advertising options!

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Together, we’ll solve it.

The products you need. The service you deserve. There are bigger O&P supply companies out there, sure. But you won’t find one that cares more about its customers than PEL. Just ask the people who know us. Or better yet, get to know us yourself. Learn more at pelsupply.com ©2014 PEL, LLC


Mobility Saves Lives and Money Using Medicare’s own data, report proves what the O&P community has known all along


Commissioned by AOPA and the Amputee Coalition, the recent Dobson DaVanzo study “Retrospective Cohort Study of the Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries” explains how orthotic and prosthetic care is a cost-saver in the long term. Here, we examine exactly what this means for payers, patients, and the more than 3,000 facilities that provide O&P services.


Amount saved by lower-extremity orthosis users in total average Medicare episode payments compared to non-orthosis users.



Amount saved by spinal orthosis users in total average Medicare episode payments compared to non-orthosis users.


Average age range of patients in the study


12 Months

Time period during which lower-extremity prostheses users were found to have increased independence compared to non-prosthesis users.


18 Months


Time period during which lower-extremity orthosis users were found to have better outcomes compared to non-orthosis users.

O&P users were found to have fewer ER admissions: 0.13 fewer for lower-extremity orthosis users, and 0.55 fewer for lower-extremity prosthesis users.

Average Medicare Per-Month-Per-Member Costs

Non-O&P O&P Study Comparison Group Group $1,663


Spinal Orthosis Patients



Lower-Extremity Prosthesis Patients



Lower-Extremity Orthosis Patients


July 2014 | O&P Almanac

“This study finds that patients who received O&P services experience greater independence than patients who do not, with better comparable outcomes and Medicare payments.” —Dobson DaVanzo final report

ALPSTM new Guardian Suction Liner features raised Grip GelTM bands that grip against the socket wall to form a secure interface. The low modulus bands stretch against the socket wall, while the inner wall conforms easily to the residual limb. This ensures there is no restriction of blood flow or stiffening to inhibit donning.

Grip GelTM bands are strategically placed for both transtibial and transfemoral applications.


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Diabetic Denial

One in four Americans who have diabetes do not know it, according to the recently released National Diabetes Statistics Report 2014, published by U.S. Centers for Disease Control and Prevention. Other key findings:

• More than 29 million people in the United States have diabetes. • Another 86 million adults have prediabetes. Learn more at www.cdc.gov/diabetes/pubs/ statsreport14.htm.

Medicaid Influx? You may see an uptick in Medicaid patients now that the Affordable Care Act is in play: An additional 6 million Americans enrolled in Medicaid and related health programs during the six-month period ending April 30, compared to before the six-month ACA signup period began last October. The likelihood of increased Medicaid patients is especially high if you live in a state that adopted the Medicaid expansion.

Number of Medicare Patients 3.3% increase in states that did not adopt Medicaid expansion

Learn more at www.hhs.gov.


July 2014 | O&P Almanac

Lawmakers Decry Audit Pause law, which requires Legislators have put pen to that a provider receive paper to support the O&P a final decision from profession’s opposition an ALJ within 90 days to the Office of Medicare of filing an appeal. Hearing and Appeal’s “OMHA’s decision to (OMHA’s) decision to suspend ALJ referrals suspend for two years Tammy Duckworth constitutes an explicit referrals of non-beneficiary- (D-Illinois) interruption of due initiated appeals to process that is devastating to providers Administrative Law Judges (ALJs). who are the backbone of delivering More than 30 lawmakers responded Medicare services to over 40 million to the request of AOPA Policy Forum beneficiaries,” wrote the lawmakers. attendees to support the industry’s To read the letter in its entirety, or position. Written by Reps. Tammy to watch a video clip of Duckworth Duckworth (D-Illinois) and Todd Rokita questioning CMS Deputy Director (R-Iowa), with signatures from dozens Shantanu Agrawal, MD, on this of additional legislators, the letter point, visit www.aopanet.org. opposes the egregious violation of the


POPS Stays On Top of CR8730 Changes CMS recently notified the Pennsylvania Orthotic and Prosthetic Society (POPS) on the updated status of Medicare requirements for orthotic, prosthetic, and pedorthic providers in licensing states (CR8730). CMS has advised that when the state directs the National Supplier Clearinghouse Medicare administrative contractor (NSC MAC) that the licensure rules are final for suppliers of prosthetics, orthotics, and pedorthics, the NSC MAC will then require the license for any new enrollment, change

of enrollment, or revalidation that includes products requiring the license. The new rules have not yet been introduced for public comment. There will be a 30-day comment period before the rules can be finalized. The NSC MAC is aware of the status of licensure in Pennsylvania and will not require the licensure until confirmed by the state that the license rules are finalized. “We will continue to keep practitioners in Pennsylvania informed as the process continues,” says Eileen Levis, POPS president and AOPA board member.


15.3% increase in states that did adopt Medicaid expansion




Patient Fitness? There’s an App for That Lower-limb amputees can now find rehab and ongoing health support on their iPhones with Ottobock’s Fitness for Amputees app. The free app is designed to assist lower-limb prosthesis users with a self-managed workout regimen. The app was developed by physical and occupational therapists to help leg amputees achieve more mobility and to provide professional support during rehabilitation. The app offers exercises in two areas:

strength and endurance and coordination and balance. Workouts are designed for amputees to use both with and without their prostheses in easy, normal, and difficult intensities. Users can configure the app to match a personal training or therapy plan. Enhanced features include user statistics to track progress and optional alarm reminders, and no special equipment is required. The app is available at the iTunes store.

DEKA Arm Gets the Green Light

PHOTOS: Ottobock, www.darpa.mil, www.3dsystems.com

The Food and Drug Administration (FDA) has approved the 510(K) premarket notification for the DEKA Arm System, a myoelectric prosthetic arm developed by DEKA Integrated Solutions Company and funded primarily through a grant from the Defense Advanced Research Projects Agency. The FDA reviewed the DEKA arm through its de novo classification process, a regulatory pathway for low- to moderate-risk medical devices that are considered to be innovative. This process does not rely on information previously submitted for “predicate” devices as a means to evaluate new products but rather reviews the submitted product as a one-of-a-kind device. The FDA studied data from a Department of Veterans Affairs study of 36 patients who used the DEKA arm to perform several activities of daily living. Ninety percent of the participants reported they were able to perform activities using the DEKA arm system that they were unable to perform with their existing prosthesis.

Scoliosis Brace Goes 3-D

FDA approval of the 510(K) premarket notification clears the way for DEKA to manufacture and market its prosthetic arm to healthcare professionals and consumers.

Testing of a new 3-D printed scoliosis brace designed by 3D Systems has shown positive results. Twenty-two patients at the Children’s Hospital of Oakland tested the device, under the direction of James Policy, MD, of Stanford University, and Robert Jensen, CPO. The brace was shown to have a good ability to correct the scoliosis, and the patients provided positive feedback on its comfort. The process used by 3D Systems to create the device involves a check-socket brace, which is digitized, creating a reference underlay. It is then adjusted for optimal fit. That data is used to 3-D print the brace on a special printer. The final product is flexible and thin, making it easy to hide under a child’s shirt.

O&P Almanac / July 2014





O&P Exempted From Proposed Bundling Legislation

O&P Associate Degree Debuts St. Petersburg College in Florida has begun accepting applications for its new two-year associate in science degree in orthotics and prosthetics technology, a first-of-its-kind degree for orthotic and prosthetic O&P technicians in the Sunshine State. The coursework will be offered at the institution’s J.E. Hanger College of Orthotics and Prosthetics at the Health Education Center. The associate degree expands options for students at the college, which has had a bachelor’s degree program in O&P since 2005. The degree will help prepare graduates to become certified technicians who can fabricate, repair, and maintain quality O&P devices under the direction of certified practitioners. With the addition of the associate degree, St. Petersburg College has become the only U.S. educational institution offer O&P education of all levels and scopes.

New Facility Accreditation Guide Published


July 2014 | O&P Almanac

Policy Change for Jurisdiction B Jurisdiction B will no longer require providers to reference a manufacturer catalog page number (including MSRP) for established Healthcare Common Procedure Coding System codes with its additional documentation requests (ADRs) as part of its

prepayment review program for lower- and upper-limb prosthetic claims. While the request will remain part of the ADR letter, verbiage has been added to indicate that this information is only required when a miscellaneous code is reported by the provider of service.

Big Holdup for ICD-10 Each of the four Durable Medical Equipment Medicare Administrative Contractors (DME MACs) has released a statement acknowledging the delay in implementation of ICD-10 diagnosis codes as a result of the April 1 passage of the Protecting Access to Medicare Act of 2014. This law delayed implementation of ICD-10 codes from Oct. 1, 2014, until no sooner than Oct. 1, 2015. The DME MACs also announced that an interim final rule establishing the new compliance date of Oct. 1, 2015, will be issued by CMS in the near future.

Photo: www.spcollege.edu/op/,

The American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) has published its Patient Care Facility Accreditation Guide for facility owners seeking accreditation. The publication is available electronically at www. abcop.org and in print by emailing accreditation@abcop.org.

In an initial victory for O&P professionals across the United States, orthotics and prosthetics has been exempted from the proposed bundle in the final version of H.R. 4673, the Bundling and Coordinating Post-Acute-Care Act of 2014. The exemption comes after AOPA and key industry professionals participated in several meetings with key lawmakers and submitted a position paper to other congressional staff. AOPA outlined the reasoning and need for orthotics and prosthetics to be included in the list of exceptions to post-acute-care bundling. These same sentiments were echoed by the O&P Alliance in separate meetings and testimonies before Congress as well. While this is an early victory for AOPA, the O&P Alliance, and the O&P community, it is important to remember that the bill was just introduced and has not been passed by either the Senate or the House. Nothing is finalized until the bill is signed into law.



Auf Wiedersehen, OTWorld! If you weren’t able to hop on a plane and participate in this year’s OTWorld—the renamed International Trade Show and World Congress at the Leipzig Fair and Exhibition Centre—you missed a record-breaking event where professionals from O&P and related industries networked and shared their experiences. OTWorld drew more than 20,400 visitors from 80 countries. “Innovation” was the focus at the trade show, where attendees were met with interdisciplinary approaches and global networks.

This year’s event was the largest in its history, with orthopedic technicians, orthopedic shoemakers, engineers, medical practitioners, and therapists congregating for high-level discussions and professional development sessions. Your absence this year can be corrected in two years—you can start planning now to attend the next OTWorld. Mark your calendar and research fares to Leipzig, Germany, May 3-6, 2016.

PHOTOS: Leipziger Messe GmbH / Uwe Frauendorf, Thinkstock/iStock/ Latsalomao,

Prof. Fritz Uwe Niethard

Bonjour, ISPO!

Europe will set the stage for another important O&P event in 2015—the International Society for Prosthetics and Orthotics (ISPO) World Congress, scheduled for June 22-25, 2015 in the French city of Lyon. The ISPO World Congress offers a unique platform for the international exchange of ideas and experiences between technicians, doctors,

therapists, and engineers involved in treating orthotic and prosthetic patients. Participants benefit from the unique international discussions and the concentration on the individual markets. Interested in contributing to the agenda? The deadline for submitting proposals for symposia and instructional courses is September 15. Download the online form on www.ispo2015.org and email it to congress_scientific@ ispoint.org to submit your proposal.

Stay Stateside for 3-D Printing Workshop Want to learn more about how 3-D printing will impact O&P facilities? Attend a free public workshop hosted by the Food and Drug Administration (FDA) on “Additive Manufacturing of Medical Devices: An Interactive Discussion on the Technical Considerations of 3-D Printing.” Scheduled for October 8-9 in Silver Spring, Maryland, the workshop will provide a forum for the FDA, medical device manufacturers, additive manufacturing companies, and academia to discuss technical challenges and solutions of 3-D printing. FDA is seeking input regarding technical assessments that should be considered for additively manufactured devices to provide a transparent evaluation process for future submissions. To register, visit www.fda.gov, or contact Matthew Di Prima at 301/796-2507, matthew.diprima@ fda.hhs.gov.

O&P Almanac / July 2014


People & Places Professionals TRANSITIONS

BUSINESSES TRANSITIONS CFI Prosthetics-Orthotics, headquartered in Memphis, hosted a First Swing Learn to Golf Clinic on April 26 at Vantage Point Golf Center in Cordova, Tennessee, with OPAF & The First Clinics. Area therapists, practitioners, and golf teaching professionals were schooled in both equipment and techniques for golf instruction for those with physical challenges.

Kate Ross, Give Life Hero Award Winner

Richard Browne Jr., a below-knee amputee and Team Össur sprinter, has been named the first parathlete to simultaneously hold four world records in sprinting: 60 meters (6.99), 100 meters (10.75), 200 meters (21.91), and 4- by 100-meter relay (40.73).

Gerry Helbig has been named president of Curbell Plastics Inc.

Hanger Clinic has teamed up with the nonprofit group The Buried Life to provide a bionic hand to Torri Biddle, a 19-year-old woman born without part of her right arm. Hanger Clinic practitioner Craig Jackman, CPO, provided the prosthetic clinical care. See more at http://youtu.be/QV0bdzQRBD8.

Matthew Okon, CPO, has been named laboratory manager of Scheck & Siress’ Hickory Hills, Illinois, patient-care facility.

Orthotic Holdings Inc., a lower-extremity orthotics manufacturer, has announced the acquisition of PedAlign, a foot orthotics company in San Diego.

Sylvia Mathews Burwell has been confirmed as secretary of the Department of Health and Human Services. Gerry Helbig

Euro International Inc. operating as Streifeneder USA in Tampa, Florida, has become the exclusive U.S. office of Streifeneder ortho.production, headquartered in Emmering, Germany. The company is a supplier to the prosthetics, orthotics, and sports medicine fields.

Kate Ross, a blogger for Ottobock Momentum, has been awarded a Give Life Hero Award by a Minnesota branch of the American Red Cross. Ross, who lost her right leg above the knee in 2009, is being recognized for her commitment to blood and platelet donation. Kate Ross

John Ruzich, CP, has transferred his interest in Scheck & Siress to the remaining seven shareholders at the company. He will continue providing patient care on a part-time basis at Scheck & Siress’s Hickory Hills, Illinois, location.


Boston Arm


Melvin J. Glimcher, MD, a pioneer in the orthopedic and O&P fields, passed away on May 12. Glimcher is credited with creating the Boston Arm, an upper-extremity prosthesis activated by electrical impulses generated in muscles of the residual limb. The engineering principles in the device have been adapted in more modern prostheses.

July 2014 | O&P Almanac

Touch Bionics has announced enhancements to its i-limb ultra revolution. Visit www.touchbionics.com for more information.

Extraordinarily significant findings show Medicare data proves the value of an O&P intervention based on economic criteria.

Get Involved and Spread the Word About The Valuable Benefits of O&P Care

You Know Mobility Saves— But How Do You Spread The News?

Simple! Visit MobilitySaves.org.

Find All the Tools You’ll Need at MoblitySaves.org:

Access the Full Study

Review the White Paper

Share this information with clinicians, practitioners, and insurance providers

Educate others with informative slide shows

Healthy Lives

Follow Mobility Saves on Facebook and Twitter

Watch the News Release

O&P CARE IS COST EFFECTIVE—It is a SAVER, not an expense to insurers! O&P professionals have learned the positive outcomes from the Dobson DaVanzo study, which proves that timely O&P intervention results in fewer co-morbidities and lower healthcare costs for both patients and payers. Share this significant news by using the educational tools provided at MobilitySaves.org. Dobson DaVanzo’s study commissioned by the Amputee Coalition, funded by AOPA and publicly released August 27, 2013, makes the cost effective case for O&P intervention and proves that “Mobility Saves.” O&P professionals knew that intuitively and now Medicare’s own costs and figures prove it irrefutably:

Mobility Saves Lives And Money! Watch Katy Sullivan’s story and more experiences.

Get Involved, Spread the Good Word


reimbursement Page

by JOseph McTERNAN

OTS or Custom-Fit? Orthoses billing advice in an uncertain environment

Editor’s Note—Readers of Credits Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 17 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.



ith the Jan. 1, 2014, implementation of 55 Healthcare Common Procedure Coding System (HCPCS) codes dedicated to off-the-shelf (OTS) orthoses, CMS created a new and uncertain future for providers of orthotic devices regarding proper coding of prefabricated orthoses. A total of 32 codes were either issued as new or had their descriptors changed to describe orthoses that are always considered OTS. Another 23 pairs of existing codes were split into custom-fitted and OTS versions. With these changes comes a whole series of questions regarding how to bill for prefabricated orthoses, and what specifically categorizes an orthosis as being delivered off-the-shelf versus custom-fitted. This month’s Reimbursement Page provides guidance on how to properly bill for these items while remaining compliant with Medicare regulations and policy requirements.

History of OTS Codes

E! Q UI Z M Earn


Business CE

Credits P.18

July 2014 | O&P Almanac

Evolution of OTS Orthosis Codes

The Medicare Modernization Act of 2003 (MMA) established the legislative authority for Medicare competitive bidding of certain Medicare Durable

PHOTOS: AOPA, Thinkstock/Michaeljung


To understand where we are today, we must look back at a brief history of OTS orthoses. The discussion began in February 2012 when CMS published a list of 62 codes that it believed could be considered OTS for purposes of competitive bidding. AOPA thoroughly reviewed the list and provided CMS with almost 500 pages of formal comments—including references to clinical literature—that discussed each of the 62 codes and why AOPA agreed or disagreed with CMS’ proposal that they could be classified as OTS. When CMS released its final list of OTS codes in August 2013, the list had been reduced to 55 codes, 23 of which

represented “split” codes that could be billed either OTS or custom-fitted, depending on the specific clinical needs of the patient. The list was memorialized in the 2014 HCPCS update with the issuance of new/changed codes effective for dates of service on or after Jan. 1, 2014. While the 2014 HCPCS update identified the descriptive difference between OTS and custom-fitted orthoses, significant questions remain regarding what level of clinical care is required to justify the coding of an orthosis as customfitted rather than OTS. In addition, the Medicare fee schedule for the OTS versions of the 23 split codes was left unchanged from the previous fee schedule, creating a situation where, in the current environment, providers receive identical reimbursement whether they provide clinical care in fitting the device or simply hand the device to the patient without any clinical care. This has caused a dilemma for providers who, under increasing demands for documentation, may choose to take the “easy way” and bill all split-code orthoses they deliver using OTS codes, regardless of whether they provided clinical care. While this may seem like a logical choice, it may have long-term consequences if providers are misreporting the services they are providing due to a perceived lesser burden of documentation for OTS orthoses.


Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items. While all prosthetics and custom-fabricated and -fitted orthoses were legislatively exempted from competitive bidding, the exemption did not extend to OTS orthoses. OTS orthoses were not included as product categories subject to competitive bidding in the first and second round of Medicare competitive bidding, but CMS created the list of OTS orthosis codes in anticipation of their inclusion in future rounds of competitive bidding.

Under increasing demands for documentation, [providers] may choose… to bill all split-code orthoses they deliver using OTS codes. While this may seem like a logical choice, it may have long-term consequences if providers are misreporting the services they are providing.


The MMA originally created the definition of OTS orthoses as those that require “minimal self-adjustment” to achieve a proper fit. This definition was significantly expanded through regulation, when the term minimal “selfadjustment” was further defined as that which can be performed by the patient, caregiver, or supplier of the device. After the implementation of the OTS orthosis codes in January 2014, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) further expanded the definition of OTS orthoses when they created policy that included the need for “substantial modification” to bill a device using the custom-fitted version of one of the split codes.

While AOPA believes the progressive expansion of the definition of OTS orthoses exceeds the intent of the statutory definition of minimal selfadjustment and continues to challenge CMS’ authority to further expand the definition of minimal self-adjustment, the policy containing the expanded definition is currently in effect and therefore cannot be disregarded.

Proper Coding Decisions

For the 32 codes that CMS classified as always OTS, the decision on how to properly code products described by these codes has already been made. The only way to code these items is by using a code that is defined as OTS. This does not mean that there is no need for documentation to justify the medical need of the device, as this is required for everything you do. It simply means that there is no choice whether to code the same item using an OTS or custom-fitted HCPCS code. For the 23 split codes, however, a decision must be made regarding the correct way to code a specific device, using either the custom-fitted code or the OTS code. By definition, these code pairs describe identical devices. The decision regarding which code to use is not determined by the device itself, but rather by the level of clinical care required to meet the medical needs of the patient. To use the code that describes the custom-fitted version of the code pair, there must be documentation of the specific modification(s) that were made to the device and why they were medically necessary in order for the device to function properly, according to the recent DME MAC policy announcement. In addition, documentation must indicate that the modifications were performed by an individual with the expertise necessary to perform the modification (e.g., certified orthotist). Failure to maintain this documentation will result in a claim denial for incorrect coding. In addition to making the decision regarding the proper code to describe the service you provide based on the level of clinical service required to

properly fit the patient, you also must consider the role of the Pricing, Data Analysis, and Coding (PDAC) contractor in this process. The PDAC recently announced that it will be contacting manufacturers who have previously submitted products to the PDAC for code verification in an effort to determine if any of those products are designed to always be provided as OTS items. If a manufacturer indicates that this is the case, the PDAC will reclassify that product using the OTS code only. As with all PDAC coding verifications, once a coding verification is issued, it is binding on the supplier community. This means that claims submitted for products that contain codes that are not verified as correct by the PDAC will be denied as incorrect coding. As with all coding decisions, the final responsibility of how you code for your services is yours alone. As the provider of record, you are held liable for proper coding by Medicare and its auditors. While many questions remain, as long as your documentation supports the medical need for clinically based modifications to ensure the proper fit of an orthosis, you should be confident in your claim submission for custom-fitted codes. Jospeh McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmcternan@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit http://bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:


O&P Almanac / July 2014


This Just In

Prior Authorization No Cure-All for Reimbursement Potential CMS initiative could add layers of bureaucracy, compromise patient care By Adam Stone

BONUS! FREE WEBINAR: Participate in the free AOPA Prior Authorization Webinar offered July 8 and July 22 at 1:00 pm. Learn the pros and cons under the pending CMS proposed rule, how the proposal w0uld affect O&P, what prior authorization means for prosthetic patients, and more. Register now at http://bit.ly/PriorAuthAOPA.


he use of prior authoriza-

tion has proven successful in a number of medical practice areas. So if Medicare were to implement the practice in the O&P field, the reimbursement landscape might change for the better? Not likely, say AOPA and its allies. Here’s why. Advocates say prior authorization could finally ease the burden of timeconsuming, expensive, and generally unfair audits. By identifying a procedure in advance as being acceptable under Medicare criteria, prior authorization would, in theory, ensure there would be no doubt down the road as to the appropriateness of either the procedure or the cost. So far, there is little indication that a prior authorization initiative would


July 2014 | O&P Almanac

achieve any of these hoped-for ends for O&P, says Joe McTernan, AOPA director of coding and reimbursement, programming and education. There are simply too many unknown—and perhaps unknowable—factors in the equation. First and foremost, nothing in the CMS proposed rule indicates an affirmative prior authorization decision is a guarantee of Medicare payment. For AOPA to consider any support of a prior authorization initiative, there must be assurance that claims that receive a positive prior authorization decision will be paid, assuming technical requirements (e.g. proper proof of delivery documentation) are met. Equally as important is AOPA’s concern about the impact prior authorization will have on timely access to quality clinical care for Medicare beneficiaries. Patients who require prosthetic care cannot be made to wait for weeks or even months for Medicare to decide whether a particular prosthesis is covered for their clinical needs. Delaying patient care due to administrative issues may have a significant negative impact on the patient’s ability to begin the rehabilitation process. Early rehabilitation is a crucial part of the recovery process and must not be delayed as the result of another step in the Medicare claim processing system.

CMS Takes First Steps

CMS initiated an educational session about new prior authorization initiatives in mid-June, when it hosted an open forum call on the topic. Suppliers, physicians, practitioners, ambulance suppliers, and other interested parties participated in the call. The forum was intended as a step toward establishing a prior authorization process for certain O&P activities that are “frequently subject to unnecessary utilization,” according to CMS. Such a statement may give an indication of CMS’ intent in writing these new rules: Rather than seeking to ease the burden on practitioners, the statement suggests, prior authorization would be yet another means to limit practitioners’ autonomy. Some positive news came out of the call, McTernan notes. In particular, two different CMS representatives indicated that in cases where prior authorization is granted to a prosthetic claim, that claim would not be subject to future audit. While no official changes have been made, the public comment now gives AOPA some leverage in pressing for such a rule. “This now opens the door for AOPA, as part of our comments, to point out that this was said by CMS representatives, and now we need this in writing,” McTernan says. It’s not a win, but it

Prior Authorization: Be A Player in Shaping Your Future AND Be Careful What You Ask For CMS threw us a curve when they published their proposal on May 28, 2014 seeking to institute prior authorization for Medicare prosthetics. Some O&P folks have said, in essence, ‘any alternative to these god-awful audits has to be an improvement,’ or “involving the patient as his/her own advocate for Medicare approval must be good.” But are we really sure what Medicare prior authorization will require or how it will really affect you or your patients? There is an old saying: “the devil you know is better than the devil you don’t know.” AOPA is urging EVERYONE in O&P to be a player—YOU NEED TO SEND YOUR COMMENTS TO CMS in advance of the July 28 deadline! If you don’t, they’ll do whatever they like and say—“see, very few people bothered to comment, so clearly these folks aren’t concerned about prior authorization and how we do it.” And before you can speak up, you NEED TO STUDY AND UNDERSTAND THE PROPOSAL. What does it really say, what does it NOT say, and what issues are left unclear in Medicare’s proposal? AOPA’s action plan and recommendations to all O&P stakeholders (patient care facilities, manufacturers/suppliers, licensed and/or credentialed O&P practitioners, and your patients) includes: • Offering two FREE educational webinars on July 8 and July 22 at 1 pm ET. O&P insiders—people who you know and trust—will examine Medicare’s proposal and explain its pros and cons for you. Sign-up and reserving your spot at http://bit.ly/PriorAuthAOPA. • Providing a pre-written letter for you to quickly submit comments to CMS via AOPAvotes listing ways that prior authorization needs to be changed to be acceptable to your business (including a guarantee of payment and elimination of RAC audits). All letters through AOPAvotes.org will be hand-delivered to CMS prior to the comment submission deadline. Or submit personalized comments directly using this suggested text. • AOPA is communicating regularly with the Amputee Coalition to trade perspectives on this new process so important to practitioners and patients alike; • The truth is that Medicare cares a lot more about what patients/Medicare beneficiaries think than they care about what providers think. AOPA will be distributing information that practitioners can share with your patients to get them involved. • Informational tools, like “Prior Authorization—What it is & What it isn’t” • AOPA will be submitting its own comments on behalf of you, its members. This is not a substitute for you, assuring that Medicare hears your views, so send CMS your comments in addition to those from AOPA. • AOPA is working with the O&P Alliance and all organizations in the profession to educate and encourage folks to participate.

Participate in one of the upcoming FREE AOPA webinars—July 8 or July 22. Learn the facts and hear the pros and cons of the Medicare proposal. Get more info on how to participate, to be heard, and to send in your comments.

Visit http://bit.ly/PriorAuthAOPA. • For today, recognize that, as CMS has written its proposal on Prior Authorization • A Medicare approved prior authorization would NOT be a guarantee of payment, AND • Medicare Prior Authorization would be in addition to, not in place of RAC and pre-payment audits. The proposal makes no promise to stop or reduce audits, rather it lays another regulatory level on top of audits! This Medicare Prior Authorization proposal, if implemented as written, will dramatically change how you do business. Be a player... Learn about Medicare’s proposal and make sure your voice is heard! For more information, contact 571/431-0876 or scuster@AOPAnet.org. American Orthotic & Prosthetic Association, 330 John Carlyle Street, Suite 200, Alexandria, VA 22314 (571)-431-0876, info@AOPAnet.org, www.AOPANET.ORG

O&P Almanac | July 2014


This Just In

is a small step forward. These statements may only be considered as what they are—individual statements made during a telephone conversation. CMS must be willing to memorialize these statements by adding a section to the final rule that confirms, in writing, that claims that are affirmed through prior authorization will not be subject to future audit.

Process Could Compromise Care

While AOPA is concerned that prior authorization would not ease the audit burden, the O&P community is equally apprehensive that prior authorization could, in practice, significantly slow the process of patient care. As the situation stands in mid June, a new rule would require that contactors make “a reasonable effort” to decide on authorization requests within 10 days. That is a vast and frightening loophole, leaving open the possibility of prolonged decisions that could have a seriously deleterious effect on care. What is a “reasonable effort,” and

who is to determine the yardstick for such an effort? What system will be put in place to deal with cases that exceed the 10-day target? “How in the world can they assure anybody that is going to happen? And what happens if it doesn’t?” McTernan asks. As practitioners know, any delay in the delivery of O&P care can significantly erode a patient’s short- and long-term quality of life. “There are patients who require ambulation as part of their rehab process, who will be exposed to further injury, who will be exposed to higher rates of comorbidity, if decisions are not made in a timely way,” McTernan says. The promise of a “reasonable effort” gives little reassurance to practitioners seeking to halt the domino effort of symptoms that can arise when the delivery of care is stalled by government bureaucracy. “There are many patients who already may be compromised, and if they don’t have the ability to get up and move, the potential for further damage can be huge,” McTernan says. “The last thing you want for a patient

who has circulation impairment is for them to be lying in bed.” For providers, patient care is the foremost concern. At the same time, providers should be wary of any prior authorization rule that cannot offer a promise of timely review. “It obviously has an immediate impact on cash flow,” McTernan says. “If you receive a component from a manufacturer, you typically don’t have the luxury of paying for the component six months from now. Just like in any other business relationship, there are terms, and that manufacturer is expecting payment.” The issue of cash flow is especially sensitive given the current environment surrounding delayed due process through the Medicare appeals process, especially when requesting hearings before an Administrative Law Judge (ALJ). Many O&P practitioners have found themselves virtually pushed out of business simply by having a tremendous portion of their operating monies tied up in the audit process. Any new imposition on cash flow will only exacerbate an already challenging situation.

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July 2014 | O&P Almanac



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This Just In

Cause for Alarm?

While the recent CMS public call helped to clarify some of the nuances of the proposed rule, it did little to alter the fundamentals of prior authorization. In general, the basic premise of prior authorization may prove disadvantageous to the O&P community. Consider just a few of the downsides that could result from a poorly constructed prior authorization scheme: • Unacceptably slow review of requests. A track record for this already exists. For example, a demonstration project for power mobility devices showed significant delays in the processing of prior authorization requests for Medicare beneficiaries with needed services. Prior authorization could result in further delays. • Too many layers in the process. Medicare itself operates on a vast and sometimes unwieldy scale. Under the proposed rule, contractors may add another layer of complexity to the equation, and the contractors who process requests

may not be the same individuals who eventually process claims. The hazards are clear: not just miscommunication, but the real possibility of claims being denied after the fact, even if authorization has been granted in advance.

O&P Community Remains Alert

Even as the debate over prior authorization unfolds, AOPA has been active on the legislative front. AOPA has submitted statements to the House Energy and Commerce Health Subcommittee; the Oversight and Government Reform Subcommittee on Energy Policy, Health Care, and Entitlements; and the Health Subcommittee of the House Ways and Means Committee. In all of these meetings, “AOPA proposed constructive ways to address fraud, waste, and abuse of the Medicare system as alternatives to the current RAC program, which harms honest providers and has created a massive backlog of appeals at the administrative law judge level,” McTernan says.

AOPA pointed to a potentially powerful antifraud measure that has never been implemented: Section 427 of the Medicare, Medicaid, and SCHIP Benefit Improvement and Protection Act of 2000 (BIPA). This requires CMS to make payments only to “qualified providers.” AOPA drove home the points that Medicare should only pay licensed providers (in licensure states), or providers accredited by the major O&P accrediting bodies. On behalf of providers struggling with a challenging audit climate, AOPA once again proposed reasonable reforms of the RAC and prepayment audit systems. By speaking out in public forums at the highest levels of government, AOPA is working to ensure the best possible care for patients, as well as the commercial well-being of O&P providers. Adam Stone is a contributing writer to O&P Almanac. Reach him at adam. stone@newsroom42.com.



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O&P Almanac | July 2014


o N s e v a ORY



Need to Know

Body image, removing the prosthesis, and getting in and out of the water tend to be big concerns for patients. Encourage them with practical solutions, such as using the corner of the pool as a leverage point to get in and out of the water.

Assess the feasibility of waterproofing patients’ current devices. Second devices can be expensive and are not covered by insurance, so be sure to discuss this upfront to help manage expectations.

PHOTOS: Adam Finnieston, CPO, LPO /Sean Reyngoudt

Strike a balance between rust-resistance and function. Carbon fiber, titanium, or stainless steel are commonly used materials and tend to be waterproof.


Fitting problems can be amplified during water sports, so focus on the basics of socket fit, alignment, and the system to prevent the patient from losing his or her limb in the water.

With a suction sockets, use an extended suspension sleeve proximally and for the distal aspect of the sleeve, and employ a strap or tape to seal it to the socket.

July 2014 | O&P Almanac

by Lia Dangelico


Water sports help patients build confidence and enjoy the outdoors. Are you up to the challenge of fitting them this summer?


hen the Beach Boys sang, “Catch a wave and you’re sittin’

on top of the world,” anyone who has ever surfed fully understands what they meant. But it’s not just surfing. There’s just something about being out on the water. Whether it’s floating on a raft in a neighborhood pool or twisting this way and that on a wake board, water brings a mix of calm and power and weightlessness that has mesmerized humans for ages. Those who engage in water sports know everyone should experience them at least once, but for prosthetic users, the idea and all that comes with it can seem daunting—if not impossible. And for practitioners, extra consideration is needed for fitting and working with these amputees. In search of solutions, O&P Almanac spoke to several prosthetists from around the United States who prove every day that it’s not only possible to get patients in the water, it also can be a great tool of empowerment, self-confidence, and fulfillment for everyone involved.

s e v

O&P Almanac / July 2014



Scopin’ the Swell


July 2014 | O&P Almanac

…The Rest Is Details

Staying focused on the patient in front of you is important, say experts. Their fears, unique physical abilities and disabilities, and even personal preferences all play into the challenges you, as a practitioner, will face in helping them get back into the water. For some, even though they want to do the activity, the thought of doing it can invoke anxiety, says Robin Burton, executive director of the Orthotics and Prosthetics Activities Foundation (OPAF). Taking off the prosthesis and getting in and out of the water are big concerns, as is body image. After all, “there isn’t a soul alive who likes putting a bathing suit on and walking out to a pool, and if you’re dealing with mobility issues, that is typically a big ‘to do,’” she says, noting that “once we get them in the water, we’ve got them sold. But it’s a major hurdle to get there.” How can you encourage a reluctant patient? Burton says take a step back and try to swim a lap in their shoes, so to speak. “For many of these individuals, one of their great fears is that they are ‘different,’ and everything they (Continued on page 26)

PHOTOS: Amy Ginsburg, CP, CFom

A California resident and lifelong water sports enthusiast, Amy Ginsburg, CP, CFom, of Hanger Prosthetics, understands the lure of the sea and has helped a number of lower- and upper-extremity prosthetic patients get back in the water. She attributes much of her success to partnering with her colleagues Dave Coe, CPO, and Dan Selleck, CPO, who have guided her and shared what works for them along the way. Ginsburg emphasized that the work is dictated by her patients’ desires, rather than her chasing water sports in particular. “My patients drive me to make things that help them get back to what they want to do,” she says. With the ocean nearby, water sports are typically something her patients did before their amputations and want to get back to, or [it’s] something new they want to try.

Coming up with the right solution for individual patients also means a reality check. “It’s a matter of knowing your patient,” says Ginsburg, “what they’re going to do in the water and what their goals are, in order to talk about componentry and what it takes to get there.” Prosthetists who are new to water sports should consider where their patient will be using the device—in chlorinated pools, fresh water, or ocean salt water. A device that makes sense for standing in the surf may not work for someone looking to catch a wave or two with the device on, considering the current, salt water, and the waves. Similarly, many patients who want to swim in a pool simply remove their everyday devices before getting in the water—they don’t bother with a second device for water activities. While some individuals don’t use their prosthesis in the water for a variety of reasons—notably because they can become a hindrance—others work with prosthetists to create a dedicated “water leg,” that they can use for a variety of high-intensity water sports.


Turning Dreams into Reality OPAF and other nonprofits help O&P patients and others with mobility issues get back into the water Now in its 10th year, First Clinics, provided by the Orthotics and Prosthetics Activities Foundation (OPAF), offer introductory-level adaptive activities to O&P patients, stroke and brain injury victims, and others. With three aquatic programs available, including swimming, kayaking, and scuba diving, each clinic is led by certified instructors who assist patients with getting in and out of the water and learning the basics of the given sport. “We try to give them a taste of adaptive scuba [and other sports],” says Robin Burton, OPAF’s executive director. “We show them what they can expect, but we want them to continue, for this to become a lifelong activity.” Participation is open to ages five and older and is “inclusive,” says Burton. All participants are encouraged to bring a friend, spouse, or family member so that the activities can be experienced by individuals of all ages and ability levels. Being surrounded by others with mobility issues is “not the way life works,” she says, “so we like to have able bodied people there, too. And we want younger participants to see adults involved… We want them to see that life as an adult goes on, and that a full, quality life can be had by all.” OPAF, which will host 30-35 clinics this year, welcomes patient-care facilities to sponsor First Clinics in their area, as a way to bring providers and patients together to learn from one another and build community, not to mention as a great marketing tool for the facility. For more information, go to www.opafonline.org. In addition, several other non-profit organizations are making an impact as well: • AmpSurf works to “help all people with disabilities and their families through adaptive surfing and other outdoor activities.” Its Learn to Surf clinics have helped disabled veterans and others get in the water for more than 11 years. www.ampsurf.org • Disabled Sports USA’s SummerFest programs provide “low-cost adaptive sports opportunities to youth, adults, and wounded warriors with disabilities in more than 30 different sports,” including waterskiing, kayaking, and swimming. www.disabledsportsusa.org/programs/summer • First Descents offers young adult cancer fighters and survivors (including amputees) a free outdoor adventure to “climb, paddle and surf beyond their diagnosis,” reconnect with others, and reclaim their lives. www.firstdescents.org.


Participants in OPAF’s First Dive and First Swim clinics.

O&P Almanac | July 2014



A patient at Arthur Finnieston Prosthetics and Orthotics, Sean Reyngoudt is a competitive kiteboader and wakeboarder and water sports enthusiast. Here, he’s wearing an all-terrain foot with a custom titanium thermoplastic adaptor.


July 2014 | O&P Almanac

must strike a balance between function and anti-corrosion, says Adam Finnieston, CPO, LPO, of Arthur Finnieston Prosthetics & Orthotics. Finnieston helps 10 to 15 patients pursue both recreational and competitive water sports each year. In the past, waterproof prostheses required a compromise—they could get wet but they couldn’t do much else. The challenge, says Finnieston, has been to come up with a highly functional prosthesis that also happens to be waterproof. “Prosthetists have everything available to us everyday to make devices suitable for water sports, including carbon fiber, titanium, or stainless steel—all of which tend to be waterproof.” For many, this is where the passion of the job comes in. With the right resources, prosthetists must get creative to mold a device to each patient’s unique needs. For example, for a below-elbow amputee who wanted to get back to surfing, Ginsburg used the smallest seal-in liner she could find. “With below-elbow, you’re not so much worried about rust; instead,

you’re thinking about extension,” she says. But for below-knee surfers, Ginsburg does have to worry about corrosion and water’s effects on all of the metal parts. For a patient who used a seal-in liner, Ginsburg laminated the entire prosthesis to the foot, carrying the lamination all the way down so no components were exposed. That allowed the patient to wave ski—sitting on top surfboard and maneuvering with a paddle. Faced with such challenges, Finnieston champions the K.I.S.S method—keeping it simple. He uses the Active Socket system—an elevated vacuum socket that inherently is negative pressure without any batteries, parts, and pieces—with competitive athlete and patient Sean Reyngoudt, as well as stand-up paddle boarders, surfers, scuba divers, and others. With water sports, fitting problems

PHOTOS: Adam Finnieston, CPO, LPO/Sean Reyngoudt

(Continued from page 24) do is going to be different,” she says. In reality, practitioners know from experience there’s very little these amputees can’t do, so Burton advises practical solutions for some of the most common challenges. For example, she suggests swimmers use the corner of the pool as a leverage point to get in and out of the water. Prosthetists also need to assess the componentry that is currently being used. Can the device—or should it — be made “waterproof,” or is a second device is needed? Fabrication costs, prosthetic parts, whether the amputee is an upper- or lower-extremity amputee, and the suspension system all factor into the total cost, which typically is comparable to that of a high-end sports leg, according to Ginsburg and several other prosthetists. Given that and the fact that insurance won’t cover it, a second device isn’t a reality for all patients. So be sure to share your recommendations and any costs involved in fabrication up front. This will help manage expectations from the start. But if patients decide to pursue a water-specific device, practitioners


can be amplified because “a lot of the forces required for surfing, wake boarding, and kite surfing are in multiple planes,” he says. So focusing on the basics of socket fit, alignment, and the system being used are key to avoiding disasters—such as a patient losing his or her limb in the water. Though he hates to admit it, Finnieston says this has happened numerous times. When using a suction socket, water sprays are a big concern, where water can shoot up underneath the suspension sleeve and create a loss of suction. Embarrassing or not, it’s a reality for anyone working with this population and to combat it Finnieston’s patients use an extended suspension sleeve proximally and for the distal aspect of the sleeve, they employ a strap or tape to seal it to the socket. This helps keep any water out of the sleeve and keeps the device on securely.

with their devices and see what was working and what wasn’t. For practitioners, these gatherings provide an experience that can’t be had during an office visit. She also saw how much patients learned from one another and helped each other face their fears. “It helped them, especially first timers, to see other amputees and able bodied people doing what they wanted to do and to have someone to help them get into the water and feel safe,” she says. Similarly, OPAF’s First Clinics introduce O&P patients, stroke and brain and spinal injury victims, and others with developmental challenges to a variety of activities. At a recent golf clinic, referral sources offered training for practitioners on how to advise and work with patients to pursue their golf hobbies in the morning and, in the afternoon, patients showed up to work with practitioners, who were able to apply what they had just learned. For Ginsburg, the value of

community connection is framed in a distinct, feel-good memory: when a hip-disarticulation patient was able to get back to surfing by paddling in on her stomach. The woman made her way to the shoreline and then had two others help her get onto her board. “For her, that was just amazing,” say says. “She never thought would be able to do it, and getting to ride a wave on her stomach is something she will never forget.” There’s so much fulfillment in seeing patients succeed, but “knowing that with a prosthesis, there’s a way to challenge yourself or get into things that you wouldn’t think you’d be able to get into,” is incredible says Ginsburg. “There’s always a way to make something to help that person get back on his board or bike… it just comes down to working together to find a solution.” Lia Dangelico is a contributing writer to O&P Almanac. Reach her at ldangelico@contentcommunicators.com.

PHOTOS: Adam Finnieston, CPO, LPO/Sean Reyngoudt; Amy Ginsburg, CP, CFom

First In, Last Out

When facing any number of challenges, there’s strength in numbers, and many patients, practitioners, and the greater community have benefited from coming together, united with a shared goal. For amputee athletes across the country these clinics, partnerships, and community groups have helped them get back in the water and establish life-long friendships. Ginsburg saw this first hand when she started an amputee surf group that brought together surfers in Orange County, California, each month for several years. Developing that sense of community helped everyone involved, as did being able to get in the water with her patients O&P Almanac | July 2014




assembly ’14


Featured Speakers Hugh Herr, PhD, heads the biomechatronics research group at the MIT Media Lab. Andrew Hansen, PhD, is the director of the Minneapolis VA Rehabilitation Engineering Research Program and associate professor at the University of Minnesota.


There is a reason why more people attend the AOPA National Assembly than any other O&P convention in the United States. Maybe

Adrianne Haslet-Davis tells her compelling story of how her life changed after the Boston Marathon Bombing.

it is simply because the National Assembly

Janos Ertl, MD, specializes in adult orthopedic trauma and sports medicine/ arthroscopy.

accommodations, top-notch speakers, fun

has it all: a massive exhibit hall, luxurious networking events, and, of course, extreme

Jason Highsmith, PhD, DPT, CP, FAAOP, is a dual-licensed prosthetist and physical therapist with a PhD in medical science.

education. This year’s show offers five distinct

Urs Schneider, MD, PhD, oversees the Fraunhofer Orthopedics Research Department in Stuttgart.

pedorthists, technicians, and

Troy Watson, MD, is a board-certified orthopedic surgeon specializing in treatment of the foot and ankle. Cordell Atkins, PT, DPT, CWS, CDE, C.Ped, currently serves as the director of the Diabetic Foot Clinic at the TOSH Campus in Salt Lake City. Lori A. Dolan, PhD, is well known for her research in the area of adolescent idiopathic scoliosis. Steven King, PTM, C.Ped, is a podiatrist, pedorthist, and researcher.

Please see the preliminary program for all programming and esteemed speakers.

education tracks for orthotists, prosthetists, business managers.

What’s new this year?  36–38 CE credits.  21 pedorthic scientific credits.  New Exhibit Hall Schedule provides more time in the exhibit hall without sacrificing CE credits. The exhibit hall will not be open the traditional last half-day.  Five dedicated education tracks for orthotists, prosthetists, technicians, pedorthists, and business managers.  13 organized symposia on topics such as scoliosis, impact of research and outcomes, the diabetic foot, generational factors, elevated vacuum, modern technologies, emerging trends in pediatric orthotic management, clinical use of direct measurement, growing an O&P practice in a no-growth environment, cranial remolding treatment, evaluating evidence, and more.  Coordinated four-day Pedorthic Education Program focusing on diabetic treatment and wound care from a multidisciplinary faculty of physicians, wound care experts, and diabetes educators.

Make the Alumni Connection When completing your Assembly registration, be sure to include your graduating school and year so you can be invited to connect with other alumni from your school. (Even if it is the school of hard knocks, connect with your classmates.) •

Connect with your classmates through the mobile app—your school will be set up as a networking group. Proudly wear your school button, which will be provided at registration.

Join your friends at the Welcome Reception, where you will find a table and message board for your school.

 New Las Vegas Location—The Assembly meeting space at the Mandalay Bay has the exhibit hall and meeting space in very close proximity, which will keep attendees engaged. The venue features 29 dining outlets, ranging from Charlie Palmers Steakhouse to a Food Court and everything in between. Many entertainment options are available at the Mandalay Bay and within close proximity—it’s Vegas.

Share pictures, messages, and more through the Facebook event page.

Meet your friends at informal social gatherings on Saturday night.

 So much more!

WHAT PARTICIPANTS SAID about the last meeting

Register today for the 2014 AOPA National Assembly, to be held September 4-7 at the Mandalay Bay Resort in Las Vegas. Don’t gamble with your valuable time, financial resources, or continuing education—attend the show that provides the biggest return on your investment: the AOPA National Assembly.

“The poster session and the quality of the speakers is what really sets AOPA apart.”

 More receptions and networking events, plus a new and improved Thranhardt Golf Classic scheduled the day before Manufacturers’ Workshops.  Alumni Networking Opportunities.

Preview the Preliminary Program: http://www.aopanet.org/wpcontent/uploads/2014/05/NatlAssembly-2014-Prelim-Program.pdf Register Online: https://www.expotracshows.com/ aopa/2014/ General Information: http://www.aopanet.org/ education/2014-assembly/ Hotel Reservations: http://www.aopanet.org/ education/2014-assembly/ attend/#hotel Questions: Visit www.AOPAnet.org or contact AOPA at 571/431-0876 or info@AOPAnet.org

Registration is now open. Visit www.AOPAnet.org for updates and more information. Be sure to follow AOPA on Facebook, Twitter and Linked In for all the latest news about the Assembly and of special interest to the profession.

The State of O&P

Is your neighbor the bellwether for what’s to come? By Christine Umbrell


s an O&P practitioner, it’s a

Need To Know Regulators and legislators pay close attention to how other states are cutting back, and borrow those ideas for their own state’s budget cuts. In several states where capitated benefits, or “per-member-per-month” rates, are on the table, O&P patients might not have enough coverage—even for one device. In Tennessee, private insurer fee cuts take effect this month. The new maximum allowable for O&P items is 75 percent of the Medicare Jurisdiction C fee schedule— essentially a 30 percent cut in reimbursement. Some states view licensure as a tool for amplifying their voice, protecting the public, and defining O&P as a profession and not a trade by separating it out from DME.


July 2014 | O&P Almanac

good bet you are all too aware of the countless federal regulations currently affecting the industry. But when was the last time you took a hard look at the changes facing O&P at the state level? “Any O&P group that hasn’t plugged into the state decision-making process is really behind the eight ball,” says Peter Thomas, JD, general counsel for National Association for the Advancement of Orthotics and Prosthetics and counsel for the O&P Alliance. Unprecedented activity is occurring at the state level as the Affordable Care Act (ACA) takes effect. Many states are aggressively reviewing their Medicaid policies. “In some ways, the ACA federalizes the rules of private insurance, but it also pushes a lot of the insurance and Medicaid decisions down to the states,” says Thomas. In many cases, an increased number of Medicaid enrollees means that states are looking for ways to stem the bleeding caused by higher enrollment costs. Unfortunately, O&P is an easy target. And it’s not just state programs that are rethinking O&P coverage— many private insurers in each state are looking closely at their fee schedules and making cuts that could affect the industry.

FEATURE: The State of O&P

Even if the regulatory activity is relatively quiet in your backyard, keeping an eye on other states is imperative for industry professionals. Regulators and legislators pay close attention to how other states are cutting back, and look to borrow those ideas to implement their own state budget cuts. What’s happening in a neighboring state today could determine your fate tomorrow.

Overcoming Capitation in Alabama

In Alabama, a state that has not opted into the Affordable Care Act, the health-care model has changed to feature five Medicaid regional care organizations (RCOs). Once the RCO model was announced last fall, representatives of the Alabama Prosthetic and Orthotic Association began meeting with Medicaid representatives to determine how O&P would be viewed in the new system. “We were told in March 2014 that O&P would be handled within the RCO system, which means it would be in a capitated system,” says Glenn Crumpton, CPO, of Alabama Artificial Limb & Orthopedic Services Inc., and an active member of the state association. The state hired Scott Williamson, MBA, president of Quality Outcomes, to help maneuver the red tape to ensure O&P did not become a capitated benefit. If it did, that would mean a contracted rate for each individual, or “per-member-per-month” rate, regardless of the number or nature of services provided. In this system, O&P patients might not have enough coverage—even for one device. “Capitated arrangements typically have not fared well for people who need O&P care,” says Thomas. “They may exclude many newer technologies and components that are actually pretty standard.” Alabama successfully argued that the proposed capitated system would catastrophically endanger and potentially disable beneficiaries who have traditionally benefited from appropriate O&P intervention. They also

Licensure: The Industry Debate Continues


o far, about 20 states have enacted licensure laws. Several others are

pushing initiatives to do so. But practitioners in some states remain unconvinced that licensure is the best way to ensure quality O&P care. Licensure can be positive when it’s used as a tool to help recognize qualified providers, and when it has teeth to ensure any unlicensed professionals do not treat patients. But if it’s viewed as just another credential and regulators are not given enforcement powers, then it’s simply not worth it, some argue. In Georgia, James Young Jr., LP, CP, FAAOP, of Amputee Prosthetic Clinic headquartered in Macon, can see both sides of the argument. “As someone in a licensure state, I have mixed emotions about licensure,” says Young. The added costs associated with licensure fees and the associated regulatory burdens can be challenging for business owners. “But I’m an amputee and an O&P patient, too, so I like to know that only individuals who have met a miniJames Young, LP, CP, FAAOP mum benchmark will be treating patients.” Young also adds that licensure can be a challenge for practitioners who want to move across state lines: Established practitioners who were licensed in their home states because of grandfather clauses may not meet licensure requirements in other states because their education level does not meet new requirements. And sometimes this doesn’t seem fair: “A prosthetist who started as an apprentice and worked his way up may be much more competent than a new master’s level practitioner—but he may not be able to get licensed,” explains Young. Practitioners in North Carolina have conflicting opinions about licensure. “We don’t have licensure here, and there’s a 50/50 split about whether we should pursue it,” says Ashlie White, an employee at Beacon P&O in Raleigh and a board member for NAAOP. Some fear the additional regulations would add financial and administrative burdens. Others worry that their current staffing structures would be scrutinized. “You need to have a lot of money for a licensure fight, and you need more than 50 percent of the state to be onboard.” But White notes the many advantages of licensure as well: It increases professionalism, provides a forum for patient complaints, and legitimizes the profession. “Licensure is something states should do, but it should be more uniform,” says Ashlie White Carey Glass, CPO, of Allied O&P in New Jersey, a licensure state. “If we all have the same rules, then we could have reciprocity, and one high standard level of care.”

O&P Almanac | July 2014


FEATURE: The State of O&P

Impact of the ACA on Your State The rollout of the Affordable Care Act (ACA) means changes to health-care regulations in every state. Here are three ways it might be affecting your home state, according to Peter Thomas, JD, general counsel for NAAOP and counsel for the O&P Alliance: • Private insurance plans are adapting. Changes to private plans and provider networks— including who is qualified to be included in a network— could affect O&P coverage. • Half of the states are expanding Medicaid programs. In states where Medicaid is expanding, the benefits packages are changing—and O&P coverage could shift. For those states adopting alternative benefit plans, the states may design specific plans for certain populations or beneficiary groups. • Some patients could lose coverage. “We need to monitor and make sure that as the ACA is rolled out, amputees and others with physical disabilities have access to the O&P care they need,” says Thomas.


July 2014 | O&P Almanac

pointed out that since O&P accounts Facing Fee Cuts for less than 0.1 percent of Alabama’s in Tennessee Medicaid appropriation, moving to O&P providers in the a capitated payment system for O&P Volunteer State were blindsided would not save the state much money. when Blue Cross Blue Shield (BCBS) Initially, O&P advocates wanted subtly announced it would impleO&P services to fall outside the RCO ment a rate change effective July 1, system. But when they realized that 2014. The new maximum allowable being within the system would be a for O&P items is 75 percent of the more secure option, they worked to Medicare Jurisdiction C fee schedchange the contract language between ule—essentially a 30 percent cut in the RCO and the reimbursement. state agency to Tennessee providrequire O&P care be ers hope to engage in a covered as if it were dialogue to discuss the fee for service. By reduction rather than collaborating with engage in a full-fledged Medicaid represenfight with the insurtatives to explain ance company, says the importance of Michael Fillauer, CPO/L, non-capped coverpresident of Fillauer age, they were able to LLC in Chattanooga. achieve their goal. “Hopefully we can have Michael Fillauer, CPO/L “RCO contract a conversation without language will be being confrontational,” modified to require the provision of he explains. “We want to define who medically necessary O&P services in we are and have an honest discussion the amount, duration, and scope that to share with them the work of O&P is equivalent to the previous Medicaid providers, to work with them and not fee-for-service population,” explains against them.” Crumpton. “By working within the Quality Outcomes is engaging in system and being proactive, we were this effort to help open doors and start able to get a good outcome.” conversations on the state level. “The “This was an incredibly sucreal story of O&P needs to be commucessful grassroots campaign,” says nicated to officials so they understand Williamson. “We were able to have what these fee reductions mean to conversations with influential people beneficiaries,” says Williamson. who provided invaluable guidance. Fillauer says that Tennessee’s status We’re hoping the changes we have as a licensure state should help get made in Alabama can be modeled in practitioners a seat at the table for other states.” such discussions. “We enacted licenAlabama practitioners are now sure to protect the public and to define working on the next step: meeting ourselves as a profession and not a with Medicaid representatives to trade.” He cites the findings in AOPA’s discuss developing metrics to meaDobson DaVanzo study as supporting sure quality care and define outcome documentation for the discussion. measures. They will be holding an “The study demonstrates that O&P Alabama Medicaid Workshop in midkeeps patients mobile and saves money July to explain the recent changes over the long term.” and elicit support for future statePractitioners from all 50 states centered endeavors. should be paying attention to the They also are keeping a watchful reduction in Tennessee: “If it can eye on Tennessee, where trouble is happen here, it can happen anywhere,” brewing with private insurers. says Fillauer.

FEATURE: The State of O&P

Getting Proactive in North Carolina

Matters of Taxes and Licensure

O&P practitioners in South Carolina practithe Tar Heel State are watching their tioners face a challenge that’s unique neighbors closely, and following how to their state: O&P providers must Alabamans have prevented O&P from pay a 6 percent sales and use tax on falling into a capitated system. Like all orthoses they deliver for patients Alabama, North Carolina did not accept with private insurance. “From what I Medicaid expansion as part of the ACA, understand, we are the only state with but is contemplating changes to the such a tax,” says Maurice Johnson, state health-care system—changes that CO, of Floyd Brace in Charleston. may include a capitated system. Though practitioners in the state “It’s a big concern for us,” explains joined forces to fight the tax several Ashlie White, an employee at Beacon years ago, their efforts fell on deaf P&O in Raleigh and a board member ears. Now, they are “going to the polifor NAAOP. “The law doesn’t see us as ticians to see if we can have discusseparated from DME and we do not sions about this,” says Johnson. have our own line item in the state The next step may be to pursue Medicaid budget. This is something licensure within the state: “Licensure we’d like to change in the future.” could rectify the issue by separating Promoting O&P as patient care that us out from DME,” Johnson says. helps patients return to mobility is Licensure also is an important way to distinguish O&P, being considered in White says: If the state doesn’t pay for Minnesota, where praccare that helps individuals return to titioners involved in the Minnesota mobility, then it will fall on the state to Society of Orthotists, Prosthetists, take care of them. and Pedorthists (MSOPP) put forth a Another problem in the state—and licensure bill that has yet to be passed. across the country—is repeated denial Practitioners are hopeful it could pass of coverage by private insurers of in the next cycle—not only because devices they deem experimental—even they want to protect their patients, but components that are regularly covered also because they want to ensure they by Medicare. “Sometimes it’s common have input into how they are regulated. practice to deny coverTeri Kuffel, Esq., age until a third appeal,” vice president of Arise White explains. “This Orthotics & Prosthetics makes patients wait longer in Blaine, is also on the than they need to for board of directors for care.” MSOPP and serves as The state has a trade the Minnesota state association with a busirepresentative for ness and legislative AOPA. focus, which helps keep Minnesota O&P practitioners apprised of business owners also changes. White is helpshare in a spirit of Scott Williamson , MBA ing to write an Insurance cooperation: “We have Fairness Bill for the state, and has also fewer amputees in Minnesota” than designed an online portal dedicated to in most other states, says Kuffel. “And insurance fairness for people with limb there are fewer O&P providers—so loss and limb difference. “One of the less competition. A highly regulated goals of the site is to get our legislation state health-care system exists to keep introduced,” she says. “This centralall players in check.” ized website is a starting point and That willingness to work together works as a call to action,” she says. has been a lifeline when regulators

have put O&P in the hot seat. Three years ago, a bill was introduced that would have removed O&P care for adults in the Medicare system. MSOPP reached out to the community, and used letter-writing, in-person meetings, phone calls, and assistance from AOPA and the Amputee Coalition to kill the bill. More recently, O&P providers worked within the system to help determine their own fate when changes were imminent to the state health-care system. “We met as a group with our Medicaid administrator to help redefine the prior authorization process. We were a part of the continuing feedback and input” in the process, says Kuffel.

What State Are You In?

You never know what changes may be heading your way—so keep an eye on your state capital, but also be aware of the challenges facing practitioners across the country. Get involved before a challenge arises in your state, advises Williamson. “When we only meet with Medicaid and legislators in a crisis, our message falls on less willing ears.” “If we don’t take the time to do research on what’s happening in our own states, then we won’t see what’s coming,” adds White. “We need to work together, instead of compete with each other, to advocate for the profession. The practitioners who are not owners also need to pay attention because it’s their careers at stake,” says White. Christine Umbrell is a contributing writer for O&P Almanac. Reach her at cumbrell@contentcommunicators.com. O&P Almanac | July 2014


Prosthetic Limb Users

Survey of Mobility Researchers develop self-report instrument for measuring mobility of adults with lower-limb amputation


By Susan Spaulding, CPO; Sara Morgan, CPO; and Brian Hafner, PhD


Enhancing mobility in individuals with lower-limb amputation is a primary goal for prosthetists and other health-care providers. Many important clinical decisions, such as the selection of prosthetic components, are based on predictions and evaluations of a patient’s mobility. Determination of a patient’s mobility status (or potential) often is based on observations made by a managing physician or prosthetist. However, these subjective clinical assessments may limit clinicians’ ability to accurately assess changes in mobility over time, compare mobility across individuals, or clearly communicate mobility outcomes to other providers. Standardized outcome measures (like timed walk tests) can be used to measure and document patient outcomes, but they may be time-consuming to administer and may be limited to tasks or activities that can be completed in a clinic environment. Thus, there is a need for efficient and meaningful outcome measures that can be used to quantify patients’ broad experiences with mobility. Researchers at the University of Washington Center on Outcomes Research in Rehabilitation (UWCORR) have developed the Prosthetic Limb Users Survey of Mobility (PLUS-M) to meet this need. PLUS-M is a patient-reported outcome measure intended to efficiently and effectively measure prosthetic mobility in people with lower-limb amputation. PLUS-M has been rigorously developed to fulfill the needs of a variety of stakeholders, including clinicians, researchers, patients, and payers. This article reviews motivations for developing PLUS-M and provides an overview of efforts undertaken to develop and validate this instrument.

July 2014 | O&P Almanac

Why Develop a Patient-Reported Measure of Mobility?

Patient-reported outcomes (PROs) are instruments intended to measure aspects of health from the patient’s perspective, without interpretation from physicians or other health-care providers.1 PROs are especially useful for measuring patients’ perception of their health outside of the clinic, such as their mobility in their home and community. PROs provide information that is distinct from, and complementary to, physical performance measures (which are designed to assess a patient’s ability to perform activities under direct observation of a clinician or researcher). In addition, outcome measures take valuable clinical time to administer, score, and interpret. With these considerations in mind, the PLUS-M was envisioned to have the following characteristics: • Quick and easy to administer • Simple to score and interpret • Able to be administered by paper, computer, tablet, or phone • Suitable for use in both research and clinical care.

FEATURE: Prosthetic Limb Users Survey of Mobility

PLUS-M Protocol

Work to create and test the PLUS-M item bank began in 2010 under a fiveyear research grant from the National Institutes of Health (NIH). The development efforts described in this article have been guided by existing standards for creating high-quality PROs.2 These standards encourage use of rigorous qualitative and quantitative research techniques to produce measures that are both psychometrically sound and clinically meaningful.

Advisory Panel

An advisory panel of key stakeholders was assembled to guide PLUS-M’s development and validation efforts. Panel members included consumers, researchers, clinical providers, and representatives from prosthetic industry partners and government agencies. These stakeholders met regularly to review the project’s progress and guide future research and dissemination efforts. The first step in developing the PLUS-M was to gather this group to define and discuss mobility while using a prosthesis. This group also reviewed and prioritized items for potential inclusion in the PLUS-M item bank.

Literature Review

Development of the initial PLUS-M item bank, or a collection of survey questions, began with a thorough literature review to find questions that could be used or adapted to measure prosthetic mobility. In total, more than 1,000 questions from 45 different PROs were identified. These questions were analyzed and used to identify general mobility activities (like “walking over uneven terrain”) that could be included in the new survey. PLUS-M questions were then developed around each of the activities identified in the review. In cases where

existing questions could be included, PLUS-M developers requested permission from the original item authors to include them in the list of candidate questions. The developers also created novel questions based on unique or complex mobility activities (like “walking up steep gravel driveway”). Ultimately, more than 120 questions were developed or included from existing surveys.

Focus Groups

Focus groups were assembled to discuss mobility from the perspective of prosthetic limb users. Four focus groups, with a total of 37 adults with lower-limb amputation (between six and 12 participants per group), were conducted across the United States to solicit perspectives of people from different geographic areas and climates. These groups consisted of individuals who had diverse perspectives on mobility with a prosthesis, including people with various amputation levels, etiologies, and prosthetic experience. The focus group sessions were semi-structured, and allowed for informal interviews to be conducted in O&P Almanac | July 2014


FEATURE: Prosthetic Limb Users Survey of Mobility

an interactive, supportive group environment. These group sessions were moderated by clinicians and researchers trained in qualitative methods. Example of a focus group discussion about a mobility challenge: • Moderator: “Are there things that you encounter in your environment that makes walking tough?” • Participant A: “Sidewalks.” • Participant B: “One difficult thing is walking on sidewalks that are angled toward the street at different levels.” Later, transcripts of the groups’ conversations were qualitatively analyzed to identify common themes related to the amputees’ experiences with mobility. Items identified in the existing item review were then reassessed to ensure that they addressed aspects of mobility that were identified as important to prosthetic limb users. Focus group discussions informed development of seven new items that were subsequently evaluated in cognitive interviews.

Cognitive Interviews

Cognitive interviews are one-onone sessions with respondents that explore the cognitive processes used when answering survey questions.3,4 These interviews were used to elicit the perspective of prosthetic limb users in regard to the quality of items selected and written by the development team. This qualitative process was critical in determining whether items were meaningful to patients with lower-limb amputation and if they were understood as intended. Cognitive interviews were conducted by members of the research team who had experience working with people with lower-limb amputations. A total of 156 items (130 items from existing item review and focus groups and 26 new items created through the cognitive interview process) were assessed in 36 cognitive interviews. Following the interviews, items were revised or deleted based on participant feedback. Example of question revised through cognitive interviews: 36

July 2014 | O&P Almanac

• Initial item: “Are you able to walk on a sideways incline (e.g., a sidewalk that slopes toward the street)?” • Revised item: “Are you able to walk on a surface that slants sideways where one side is higher than the other?” Of the 156 items assessed, 80 were accepted as is, 22 were substantially revised, and 54 were removed. In addition, three items were split, resulting in three additional items. The remaining 105 items were then administered to more than 1,000 prosthetic limb users.

Large-Scale Administration

Following the cognitive interviews, the remaining items were co-administered with legacy measures of mobility to more than 1,000 prosthetic limb users in an 18-month national survey. This group of prosthetic limb users will be referred to as the development sample because their responses were used to assess each of the 105 items using quantitative modern measure development methods. In addition, normative data for the PLUS-M is established from the development samples’ responses. The initial development sample consisted of adults with unilateral transtibial or transfemoral amputation as the result of traumatic or dysvascular causes. The responses from the PLUS-M and existing measures of mobility were used to establish evidence of reliability and validity. Psychometric analyses of the remaining 105 survey questions informed further removal of items, resulting in the inclusion of the 44 survey questions in the final PLUS-M item bank.

Current and Future Directions

Longitudinal Testing: Currently, more than 200 patients with lower-limb amputation are involved in a national, longitudinal validation study to investigate the psychometric properties (reliability, validity, sensitivity, and responsiveness) of the PLUS-M outcome measure. Patients are assessed during five time points over a one-year period. Thirty-nine clinics

and 79 prosthetists are administering the PLUS-M, other existing PROs, and two performance measures (AMP and TUG) to patients before and after delivery of a new prosthesis or replacement socket. Similar outcome data will be compared to evaluate PLUS-M’s validity or its effectiveness in measuring mobility. The fitting of a new prosthesis or replacement socket event was selected, as this is a point when a change in mobility may be observed. Prosthetists and patients are asked to rate the change in mobility after delivery of the new socket. This perception of change in mobility will be correlated with the change in the PLUS-M score to identify the degree of responsiveness. In other words, how many points must the PLUS-M score change to be considered clinically relevant? Secondary Analyses: Development and validation of PLUS-M has included collection of data from more than 1,300 prosthetic limb users. This represents one of the largest prospective studies of health outcomes in persons with lower-limb amputation to-date. To maximize the usefulness of this data, PLUS-M developers asked each study participant to complete multiple standardized outcome measures, including those designed to measure outcomes such as pain, fatigue, and concerns with cognitive function. This rich data set is now being studied by the PLUS-M developers to provide additional insight to clinicians and researchers regarding the health and quality of life of people with lowerlimb amputation. Future Research: Although originally developed for people with unilateral lower-limb amputation, efforts are underway to expand application of PLUS-M to other limb loss populations. PLUS-M is currently undergoing testing among bilateral, lower-limb prosthetic users. Developers are assessing performance of PLUS-M with these participants and plan to release a bilateral version of the PLUS-M instrument later this year. PLUS-M researchers also have

FEATURE: Prosthetic Limb Users Survey of Mobility

received funding from the Orthotics and Prosthetics Research and Education Foundation to compare paper and computerized versions of PLUS-M (and other PROs). This research will allow the developers to determine if PLUS-M can be administered equally well using both paper and computer forms. Results of this research are expected to facilitate integration of PLUS-M into practice management software and electronic medical record systems. Lastly, developers are pursuing funding to translate PLUS-M into Spanish. These efforts collectively aim to improve PLUS-M’s clinical usability and convenience.


PLUS-M is a new patient-report outcome measure of prosthetic mobility that has been developed for clinicians and researchers using contemporary instrument development standards. PLUS-M instruments and user’s guides are freely available from the PLUS-M website, www.plus-m.org. The short forms are easy to use, take little clinical time to administer and score, and are easy to interpret. Our ongoing development efforts are intended to enhance the clinical usefulness of this measure and may provide additional insight to clinicians and researchers about outcomes affecting the health and quality of life in people with lower-limb amputation. It is our hope that the routine use of PLUS-M will provide clinicians and researchers with the means to accurately assess mobility, aid clinical decision-making, justify prosthetic care decisions, and document the effectiveness of provided services. Susan Spaulding, CPO, is a teaching associate in the Division of Prosthetics and Orthotics at the University of Washington. Sara Morgan, CPO, is a prosthetist/orthotist and a doctoral candidate in Rehabilitation Science at the University of Washington. Brian Hafner, PhD, is an associate professor in the Division of Prosthetics and Orthotics at the University of Washington.

PLUS-M: Getting Started What does the PLUS-M measure?

PLUS-M instruments measure prosthesis users’ mobility, defined as the ability to move intentionally and independently from one place to another. Individual PLUS-M questions assess respondents’ perceived ability to carry out specific activities that require use of both lower limbs. PLUS-M questions cover movements that range from basic ambulation, like walking a short distance indoors, to complex activities, like hiking for long distances over uneven ground. PLUS-M response options reflect the degree of difficulty with which respondents report they can carry out these activities.

Who can take the PLUS-M?

The PLUS-M is optimized for adult, English-speaking, unilateral, lower-limb prosthesis users who have acquired amputations. Work is underway to assess PLUS-M for use in people with bilateral amputation. Additionally, future efforts will involve translations into languages other than English.

Can I use the PLUS-M in my clinic?

Yes, PLUS-M short forms are free for non-commercial use. Examples of non-commercial use include administration of paper surveys in clinical practices for the purposes of monitoring patients or administration in research for the purposes of assessing study participants.

How do I administer the PLUS-M?

PLUS-M is a self-report measure, which means that the patient answers the survey items directly. The PLUS-M instrument can be administered electronically, on paper, or verbally.

How do I interpret my patient’s PLUS-M score? The PLUS-M score is a T-score. T-scores tell you how much your patient’s mobility deviates from the average mobility score of prosthetic limb users. The average mobility score for prosthetic limb users falls around the average T-score of 50, the mean mobility score of the development sample. In addition, T-scores may be compared to those reported by subgroups defined by level of amputation, etiology of amputation, gender, and age. For more information, visit www.plus-m.org.


1. U.S. Food and Drug Administration. “Guidance for industry: Patient-reported outcome measures: Use in medical product development to support labeling claims: Draft guidance.” Health Qual Life Outcomes. 2006. 4(79). 2. “Patient-Reported Outcome Measurement Information System (PROMIS).” Instrument Development and Psychometric Evaluation Scientific Standards. 2012. 3. PROMIS Validity Standards Committee on behalf of the PROMIS Network of Investigators. (2012). PROMIS Instrument Development and Psychometric Evaluation Scientific Standards. [Internet] (unpublished document). Available at http://www.nihpromis.org/Documents/PROMIS_Standards_050212.pdf 4. Collins D. “Pretesting survey instruments: An overview of cognitive methods. Quality of Life Research: An International.” J Qual Life Asp. 2003. 12:229-238. O&P Almanac | July 2014



by JOseph McTERNAN

Pay Attention to the PDAC Access the PDAC website often to check for coding verification

Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 39 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.



Compliance with PDAC coding verifications is extremely important to your business, as failure to do so may place Medicare claim payment at risk. E! Q UI Z M Earn


Business CE

Credits P.39

July 2014 | O&P Almanac

What Is the PDAC?

The PDAC is one of many contractors used by CMS to administer the Medicare program. While contractors such as the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) process Medicare claims for payment purposes, the PDAC has a specific role that is unrelated to the payment of actual claims. The PDAC provides three primary functions: the pricing of Healthcare Common Procedure Coding System (HCPCS) codes without Medicare allowables; data analysis, used to identify utilization patterns of HCPCS codes; and coding verification, used to establish coding guidance for specific products. This last function is performed either on a voluntary basis (when a manufacturer or other interested party requests the review of a specific product by the PDAC) or as a policy requirement for payment of certain categories of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items. Whether the code verification is submitted on a voluntary basis or as a requirement of policy, once a product has been reviewed by the PDAC and assigned a coding verification, the PDAC decision is binding for Medicare purposes.

Any claims submitted to Medicare for that product must be coded according to the PDAC coding verification.

Why Is the PDAC Important?

Compliance with PDAC coding verifications is extremely important to your business, as failure to do so may place Medicare claim payment at risk. Medicare claims for devices that are coded in conflict with a PDAC coding verification will be denied as incorrect coding. If they are inadvertently paid, they are exposed to post-payment audit and overpayment determinations. It is important to be familiar with the process of checking the PDAC website for coding verification to prevent incorrect coding of devices for which a coding verification has been published.



The Pricing, Data Analysis, and Coding contractor, or PDAC, is a specialized Medicare contractor that does not process claims but plays a very important role in correct coding of O&P services delivered to Medicare patients. Properly understanding the role of the PDAC is crucial to maintaining full compliance with Medicare rules and regulations. This month’s Compliance Corner will focus on the PDAC, what its coding verification process means to providers, and how to remain compliant when coding devices that have been reviewed by the PDAC.


Using the PDAC Website

To access the PDAC website, visit www.dmepdac.com. Once on the site, click on the term, “Search DMECS for codes and fees.” This will take you to a series of searchable fields. To determine if a coding verification exists for a specific product, use the section labeled, “Search DMEPOS product classification list.” This section allows you to search by manufacturer/ distributor, HCPCS code, product name, or product model number. You may enter information in any or all of these fields to narrow your search, but be careful not to miss a coding verification by being overly specific. If you know the name of the product you are looking to verify, this is usually a good starting point.

described by L1906, knee orthoses described by L1845, power assist features of prosthetic feet described by L5969, prefabricated diabetic inserts described by A5512, and custom-fabricated diabetic inserts (A5513) that are fabricated anywhere other than the laboratory of the supplier that delivers them. If you provide a product described by one of these codes and the PDAC has not published a coding verification for the product, your claim will be denied as incorrect coding. In addition to policy-mandated coding verification, manufacturers may voluntarily request a coding verification for a product. This is accomplished through an application process that requires significant information regarding the product and its use. Once a voluntary request for coding verification has been received and the PDAC publishes its decision, the coding verification becomes binding on the provider community for Medicare claims. It is important to maintain efficient communication with manufacturer partners to determine if specific products have been reviewed and verified by the PDAC.

PDAC Advisory Articles

If you do not get any results this way, try searching by manufacturer. This will typically lead to a larger list of returns but may capture a product that was missed due to misspelled or incorrect product names. If a product has had its coding verified by PDAC, Medicare providers are bound by that verification. Regardless of whether you agree with the verification, Medicare rules require that you code the device according to the PDAC verification.

What Products Require PDAC Coding Verification?

Several categories of O&P devices require PDAC coding verification as part of the Medicare medical policy governing coverage. These include virtually all spinal orthoses, ankle-foot orthoses

The PDAC occasionally issues advisory articles that provide specific clarification regarding coding in certain scenarios. Like coding verification, these advisories, once published, become binding for purposes of Medicare claim submission and could lead to future denials for incorrect coding. PDAC advisory articles are located in the “Articles/Publications” section of the PDAC website. Click on the subtitle, “Advisory articles.” This will take you to a chronological listing of advisory articles. While not all of these advisory articles relate to O&P services, it is important to review the articles on a regular basis to maintain full compliance with Medicare rules. Recent advisory article subjects include the correct coding of powered L-coded items, guidance regarding proper coding of microprocessor knee components, proper coding of articulating digits and prosthetic hands, and proper coding of ankle-foot orthoses.

PDAC advisory articles carry the same weight as published coding verifications, and providers are expected to be aware of and compliant with anything published by the PDAC.

Respecting the PDAC

The PDAC plays an important role in the Medicare program. While it plays no active role in the adjudication and payment of Medicare claims, compliance with published information from the PDAC is crucial to the success of your business. Your company’s compliance team should monitor the PDAC website on a regular basis, and communicate to your clinical and administrative staff any new information generated through advisory articles as well as the coding verification process. Failure to do so may result in serious compliance issues now and down the road. As O&P providers continue to address the compliance challenges of the current Medicare environment, maintaining compliance with PDAC decisions remains an important part of an effective compliance program. Joseph McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmcternan@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit http://bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:


O&P Almanac / July 2014



Prosthetic Care Facility of Virginia


Destination: Prosthetics Prosthetic Care Facility of Virginia offers intensive one-on-one treatment for patients miles from home


hen John Hattingh, CP, LP, CPO(SA), sold his


July 2014 | O&P Almanac

FACILITY: Prosthetic Care Facility of Virginia Location: Leesburg, Virginia Owner: John Hattingh, CP, LP, CPO(SA) History: 1 year

white-water kayaking, dances, and sets out on a new adventure nearly every week. After working with Phipps, John “realized he still had it,” says Michele, and the two decided to establish a different sort of facility. Prosthetic Care Facility of Virginia sees one patient per week. About 65 percent of patients are from out of state, and the company promotes “destination prosthetics” for those who are unable to find the care they want closer to home. The majority of their patients heard of the facility through word of mouth. “Many of these patients have not had success working with other prosthetists,” says Hattingh. “They think that life as an amputee has to be uncomfortable. I don’t believe that. And it doesn’t really matter what device you put on the patient—if the socket doesn’t fit, it doesn’t work.” A recent patient, a 71-yearold woman with an above-knee amputation, had never been able to walk on her prosthetic leg. Hattingh realized a traditional

socket would not work. “He used a socket so old-fashioned that most prosthetists today wouldn’t even recognize it,” recounts Michele. “But it did the trick, and she is walking farther and farther every day.” The company is housed in a medical building, and because Hattingh did his own office renovation, their overhead is quite low. The facility includes a 2,000-square-foot gait lab, and Hattingh does all fabrication in-house. Michele serves as chief financial officer and handles coordination and administration. The only additional staff member is a receptionist. A physical therapist is on call. Because patients stay for a full week, Hattingh can assess them on a daily basis. He allows them to try a number of different devices, although he finds that when the socket fit is comfortable, patients frequently prefer lower-cost feet and knees over highly complex components. The unusual, personal nature of their business is appealing to both Hattinghs, who develop close relationships with their patients— many of whom stay in their guest room. The facility has treated 49 patients in the last year, a far cry from the 1,000 patients Hattingh would have seen during a typical year in Seattle. Still, they are planning to expand. But just enough to accommodate hiring a technician—who happens to be their son. Deborah Conn is a contributing writer to the O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Prosthetic Care Facility of Virginia

Seattle facility to Hanger in 2009, he and his wife, Michele, thought they were finished with running an O&P business. Hattingh had worked at the Northwest Prosthetic and Orthotic Clinic for 25 years, seeing thousands of patients, and he was ready for a change. “It was our intention to retire,” explains Michele. “But the economy had different ideas.” The two headed to South Africa, where they maintained a second home, and John did pro bono work there and some humanitarian projects in North Africa. When they heard a grandchild was on the way back in the United States, they decided to return stateside and explore setting up a new O&P facility. John Hattingh had an idea that he’d like to work small and selectively, concentrating only on prosthetics and seeking out the most difficult cases. The two settled in Leesburg, Virginia, near Dulles Airport. “I decided to try one case, to see if my heart was still in it,” says Hattingh. He and Michele set up Prosthetic Care Facility of Virginia one year ago, just after his noncompete expired, and they started looking for the first patient, preferably an uninsured unilateral amputee. Their Facebook notice came to the attention of Lacey Phipps, a young woman born with club feet who chose to undergo a bilateral amputation because she wanted so badly to be physically active. Hattingh worked with her intensively, and today Phipps competes in triathlons, goes

John Hattingh, , CP, LP, CPO(SA)


The Ohio Willow Wood Co.


Carved From a Strong Foundation After 107 years in business, WillowWood continues to be an innovative product developer


illowWood was founded more than a


July 2014 | O&P Almanac

Ohio Willow Wood Facility in 2007.

FACILITY: The Ohio Willow Wood Co. Location: Mount Sterling, Ohio Owner: Ryan Arbogast History: 107 years

system, called LimbLogic, in 2007. WillowWood also offers a CAD/CAM software system called OMEGA that enables prosthetists to capture digital patient measurements for prosthetic and orthotic devices. Users can send the data to a central fabrication facility or, with additional OMEGA hardware, fabricate lower-limb prostheses and orthoses in-house. In early 2000, Robert Arbogast added two prosthetic clinicians to his staff. “He wanted to get better feedback for the engineers who were developing products,” explains Ryan. “It was hard to tap our customer base since they were busy serving patients, so we opened our own clinical facility for product testing and evaluation.” Through its clinic, WillowWood works with a patient base of about 100 amputees to test new devices. “We are able to develop products more quickly and be more confident when we come to market that they will solve the intended problem and that users will have the best possible experience,” says Ryan. An onsite fabrication facility primarily serves clinic patients but takes in outside business as well. While WillowWood’s sole focus today is the O&P industry, the company owes its longevity in part to a willingness to branch out during challenging times. During the Great Depression,

Deborah Conn is a contributing writer to the O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTO: The Ohio Willow Wood Co.

century ago by William E. Arbogast, a bilateral amputee who got his start by carving prostheses out of willow wood. Today, William’s great-grandson Ryan Arbogast runs the company, which manufactures a range of lower-extremity prostheses, components, and liners. Arbogast assumed his role in 2010 when his father, Robert Arbogast, retired at 65. “We manufacture 95 percent of everything we sell in-house,” Ryan says. The company has 180 employees, with about 170 on site in Mount Sterling, Ohio. Its international network of distributors, first established about 20 years ago, has brought the company’s products to a worldwide audience. Perhaps the company’s best-known product is the Alpha Liner, the first fabric-covered gel interface system in the industry, introduced in 1996. Appropriately enough, it echoes one of the company’s first products, the Sterling Stump Sock, a woolen socket liner that was released in 1921. Other products include the high-performance Pathfinder Foot, which was originally designed for military use. Its design connects a toe spring, footplate, and pneumatic heel spring in a triangular configuration that, says Ryan, “offers optimal flexibility, stability, and comfort.” The company’s 1984 Carbon Copy II Foot was the first energystoring foot with a lifelike cosmetic cover, and WillowWood was the first to introduce a remotecontrolled vacuum suspension

WillowWood manufactured polo mallets and balls. During World War II, it made parts for PT Boats and B-17 bombers. And Ryan doesn’t rule out future forays outside of the industry. The company recently partnered with Outlast to develop a new liner that can absorb and store body heat. The SmartTemp Liner helps delay the onset of sweat in the residual limb and releases stored heat as the body cools, creating more stable skin temperatures throughout the day. The technology has great applications within the O&P industry, says Ryan, but it also is being used in clothing and bedding. “We even had a request to use it for a horse saddle pad,” he says. These ventures into other fields are interesting, but the ultimate goal is to stay focused on advancing care for orthotics and prosthetic s patients. “I want to direct any gains we make in other fields back to research and development in O&P,” says Ryan. Innovation is a priority for WillowWood. “Our size allows us to move very quickly and be fast to market relative to some large companies,” says Ryan. “Our goal is to continue to try to level the playing field for amputees. We try to look for the big problems and solve them. I have my whole career ahead of me, and we’re going to be aggressive in attacking those issues.”

REGISTRATION IS NOW OPEN. Visit www.AOPAnet.org for updates and additional information.



assembly ’14

The premier meeting for orthotic, prosthetic, and pedorthic professionals

Sept. 4–7, 2014 Mandalay Bay, Las Vegas


Exhibits. Education. Networking. CE Credits. The AOPA National Assembly is already the most talked about event for 2014—It is the premier destination for the world-wide orthotic, prosthetic and pedorthic community. Register today to participate in the National Assembly.

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

Mastering Medicare:



Webinar Education The brand new and improved team-building & money-saving, educational experience!



AFO/KAFO Policy: Understanding the Rules*



Urban Legends in O&P: What to Believe*

Obtaining Medicare reimbursement for AFOs and KAFOs can sometimes be a challenging and often frustrating experience. Join AOPA for an AOPAversity Mastering Medicare Audio Conference that will focus on the nuances of AFO/ KAFO LCD and Policy Article and help you to better understand the rules. Attendees will learn:

Rumors run as rampant in O&P as any other industry. Just because you hear the same things from different people does not always mean they are true. AOPA will attempt to dispel some of the bigger myths surrounding O&P billing. Some of the topics discussed will include:

; What documentation must exist in order to use the KX modifier on your claim ; What are the coverage rules for AFOs with ambulatory vs. non-ambulatory patient ; How to bill for repairs to AFOs and KAFOs ; When is it okay to use a custom fabricated AFO/KAFO ; Basic review of the major component of a Medicare medical policy

; Billing for diabetic shoes involving amputees; ; Financial liability on non-assigned claims; ; Proper use of the KX modifier; ; Prostheses and Power Wheelchairs; ; Billing for unlisted procedure codes



AOPAversity Webinar Series



Medicare Enrollment, Revalidation, and Participation*

Will focus and cover the basics of Medicare Enrollment Procedures and topics for discussion will include: ; Reviewing new Medicare Enrollment Standards ; Reviewing the Medicare Enrollment Application ; PECOS vs. the 855S Form ; Difference between a participating Medicare provider and a non-participating Medicare provider ; When you must revalidate and reenroll your Medicare number ; When/How you may change your participation status


During these monthly one-hour sessions, AOPA experts provide the most up-to-date information. Perfect for the entire staff—one fee per conference, for all staff at your company location. Complete the accompanying quiz to earn 1.5 CE credit for each conference.




Wednesday of each month!

Gifts: Showing Appreciation without Violating the Law*


Medicare has very specific rules about what you can and cannot do .What is and is not considered a kickback and how to acknowledge referral sources without getting into trouble. Also a general discussion of other types of activity that can be interpreted as a kickback. ; When gifts to referral sources are acceptable ; When gifts to patience are acceptable ; Federal Anti-Kickback regulation prohibitions ; Doing something nice vs. doing something illegal


New Codes and Changes for 2015*

A discussion of any new codes and modifiers for 2015, including information on how the codes are created and how the DMEPOS fees are established. The call will also cover any new changes in medical policies. ; Learn about new HCPCS codes effective January 1, 2015. ; Discuss verbiage changes to existing codes and how they may affect your business. ; Find out which codes will no longer be used as of January 1, 2015. ; Discover other changes to the HCPCS system. ; Find out AOPA’s interpretation of why the changes took place.



AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. For content questions, contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854. Register online at http://bit.ly/aopa2014audio. For registration questions, contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876. EARN CREDITs


Register online at http://bit.ly/aopa2014audio.



Never a Dull Moment Round up of the latest legislative and regulatory activity reveals some encouraging news in the fight for O&P


o Fast-Forward in Litigation. AOPA

In our quest to deliver maximum return on investment to you the reader and AOPA member, each issue O&P Almanac will summarize recent actions AOPA has undertaken in making a difference in solving problems or meeting challenges faced by the O&P community and deliver a greater ROI on the AOPA investment for all of O&P.

July 2014 | O&P Almanac

Testimony, Fast and Furious. There was hardly

a break between the April 30 hearings held by the House Ways and Means Health Subcommittee on Combating Waste, Fraud and Abuse in the Medicare system and two hearings, both on May 20. At the first hearing, held by the Health Subcommittee, AOPA submitted a statement on short stays and unintended consequences of RAC audits and the massive backlog of Medicare appeals. The second hearing was held by the House Oversight and Government Reform Subcommittee on Energy Policy, Health Care and Entitlements. Both events were followed by a May 21 House Energy and Commerce Health Subcommittee hearing, which again focused on RAC audits and other issues. AOPA

statements in all four forums carried a common thread of criticism of the overly aggressive RAC audits, their consequents on small businesses, and disruptions in timely patient care. In the statements submitted, AOPA proposed constructive ways to address fraud, waste, and abuse of the Medicare system, as alternatives to the current RAC program, which harms honest providers and has created a massive backlog of appeals at the administrative law judge (ALJ) level. AOPA pointed out that a potentially powerful anti-fraud measure has never been implemented: section 427 of the Medicare, Medicaid and SCHIP Benefit Improvement and Protection Act of 2000 (BIPA), which requires CMS to only make payments to “qualified providers.”

PHOTO: Committee on Energy and Commerce


members continue to patiently await a ruling on the government’s motion to dismiss the AOPA lawsuit against CMS due to CMS failure to follow the rules in making policy changes that ultimately led to the rise of devastating recovery audit contractor (RAC) audits. This is a classic example of the wheels of justice moving slowly. The lone bright spot was a recent ruling by the U.S. District Court in Allina Health Services vs. Kathleen Sebelius where a government motion to dismiss was overruled and the case proceeded. The Allina case similarly attacked the absence of proper notice and comment when the Department of Health and Human Services published a proposed rule and provided notice and comment opportunities, but then issued a final rule that bore scant resemblance to the original proposal. The court held that agency promulgation of “a rule by another name evading altogether the notice and comment requirements” constitutes the “most egregious” type of violation of the Administrative Procedure Act. AOPA’s law firm, Winston and Strawn, promptly filed a notice of supplemental authority with the presiding judge in AOPA’s lawsuit, calling attention to the higher court’s decision. In short, all is not lost just yet.


To fight fraud on the front end, AOPA advocated for HR 3112, the Medicare Orthotic and Prosthetic Improvement Act, which, among other provisions, would ensure that Medicare only pays licensed providers (in licensure states) or providers accredited by the major O&P accrediting bodies. AOPA emphasized that imposing surety bond requirements, eliminating the exception to Stark self-referral rules, and implementing prior authorization would not penalize fraudulent providers and ease the burden on legitimate providers. AOPA proposed reasonable reforms of the RAC and prepayment audit systems: establish the prosthetist/ orthotist’s notes as part of the medical record; establish the prosthetist/ orthotist as a provider of care to distinguish from durable medical equipment (DME) suppliers; and establish financial penalties for RAC audits that are overturned on appeal. AOPA also included four other specific suggestions to mitigate the appeals backlog and protect honest O&P providers. CMS Actions Also Demanding.

Following the rules—at least so far— CMS proposed on May 28 a regulation on prior authorization and invited public comment until July 28. The proposal identified 89 lower-limb prosthetic codes that would be subject to submitting a “request for prior authorization.” The CMS proposal carefully avoids using the word “approval,” and instead uses the term “affirmation,” which only confirms the services are covered but is not a

promise or a guarantee of payment. The actual payment decision will be based on the claim submitted after delivery of the device. Even with an “affirmation” from CMS on the request for prior authorization, a claim could still be denied for other specific reasons. AOPA’s comments were initially prepared by a subcommittee of the Board of Directors and then reviewed at the June 23 board meeting before final submission. AOPA is urging all members to also comment individually on the proposal. AOPA’s comments were made available to all members in late

June, offering ample time for members to draw upon AOPA comments in submitting their individual comments. The official AOPA position is opposition to the prior authorization proposal as an unnecessary step that offers no sure pathway for avoiding claim denials or receiving final payment or a lessened threat of a RAC audit. Perhaps the only plus might be that a non-affirmation of a prior authorization request would enable the provider to offer the patient an informed choice on whether to receive the device and accept financial responsibility for payment by signing an Advanced Beneficiary Notice (ABN). Medicare


only allows providers to request an ABN from a patient when there is reason to believe that the claim will be denied as not medically necessary. More OTS Challenges. New wrinkles continue to appear in the long-running saga over what is and what isn’t an off-the-shelf (OTS) orthotic. The latest development is a query of suppliers of those devices or components that CMS deems are OTS because they can be supplied with or without clinical care. For now, the two separate codes for the same device yield the same reimbursement. That, of course, will certainly change with OTS devices at a lower reimbursement than custom-fit. AOPA has disputed the list of exploded codes that CMS claims can be supplied with or without clinical care. AOPA believes the statutory definition is clear: Only those devices that can be utilized with “minimal self adjustment” by the patient are OTS. CMS has expanded that definition to include adjustment by a patient’s caregiver to the more recent iteration of “substantial modification.” If a device can be delivered without substantial modification, then it qualifies as OTS according to CMS— but not according to the view AOPA and the O&P Alliance have advanced in letters and personal visits with CMS officials. The looming issue is if CMS’ definition is expanded beyond “minimal self adjustment” and devices are then included in the next or future rounds of competitive bidding, patient care will suffer. As they say, stay tuned! O&P Almanac / July 2014




AOPA’s 2014 Coding Products Are Available in the Bookstore 2014 Illustrated Guide

This easy-to-use reference manual provides an illustrated guide to the coding system in use for orthotics, prosthetics, and shoes, including HCPCS codes, official Medicare descriptors, and illustrations.

Let’s Make a Movie! Submit Your Videos for AOPA’s Public Relations Campaign


ast year, many of AOPA’s supplier members and exhibitors generously shared video footage to help create the World Congress Opening Ceremony. This year, AOPA is creating a public relations campaign to promote the costeffectiveness study funded by AOPA and commissioned by The Amputee Coalition (www.aopanet.org/wp-content/ uploads/2014/04/January-2014-ED-Letter.pdf). The study proves that orthotics and prosthetics saves lives and money. Specifically, AOPA is seeking examples of patient care in action; how orthotics and prosthetics help people achieve independence; and/or video clips showing people doing things that they would not be able to do without an O&P device. If you have a video clip for AOPA to include in the campaign, please send the video or video link to Tina Moran at tmoran@aopanet.org.

2014 Coding Pro

The Coding Pro is O&P’s comprehensive guide to Medicare codes, reimbursement, and medical policies. This is the single-source reference for all of your coding needs! The Coding Pro CD-ROM provides updated Medicare fee schedules for all 50 states and allows you to customize and import other fee schedules used by your office. Illustrations of the codes allow you to quickly sort codes. And writing prescriptions just got easier with the prescription writing tool. Network Version for use on multiple office terminals.

2014 Quick Coder

Stop searching through numerous pages to find a code! AOPA’s redesigned Quick Coder provides a speedy reference to the HCPCS orthotic, shoe, and prosthetic codes and modifiers. These laminated cards are durable, long-lasting, and convenient to store.

2014 Coding Suite

Save $50 when you purchase the newly updated Coding Suite, which includes all of the coding products discussed above: 2014 Illustrated Guide, 2014 Coding Pro (SingleUser CD Software), and the 2014 Quick Coder.

Go to the AOPA Bookstore and order your Coding Products today, visit http://bit.ly/BookStoreAOPA. 48

July 2014 | O&P Almanac


Earn CE Credits by Reading the O&P Almanac!

E! Q UI Z M Earn


Business CE

Credits P.17 & 39

Education Programs for 21st Century Entrepreneurs—

Because of the highly educational content of the O&P Almanac’s Reimbursement Page and Compliance Corner columns, O&P Almanac readers can now earn two business continuing education (CE) credits each time you read the content and pass the accompanying quizzes. It’s easy, and it’s free. Simply read the Reimbursement Page column (appearing in each issue) and Compliance Corner column (appearing quarterly), take the quizzes, and score a grade of at least 80 percent. AOPA will automatically transmit the information to the certifying boards on a quarterly basis. Find the digital edition of O&P Almanac at: • http://www.aopanet.org/publications/digital-edition/ Find the archive at: • http://issuu.com/americanoandp Access previous monthly quizzes at: • http://bit.ly/OPalmanacQuiz The June 2014 quiz is located at: • https://aopa.wufoo.com/forms/ op-almanac-june-2014-reimbursement-page/ Be sure to read the Reimbursement Page and Compliance Corner article in this issue and take the July 2014 quiz. Take advantage of the opportunity to earn up to four CE credits today! Take the quiz by scanning the QR code or visit http://bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

Survive and Thrive: Bottom-Line, Profit-Oriented O&P Business Programs


f you missed the 2013 O&P World Congress, don’t let this opportunity to participate in these important programs pass you by:

• Everything You Need to Know to Survive RAC and Prepayment Audits in a Desperate Environment • Competitive Bidding: Devastation to Orthotic Patient Care, Or Just a Passing Storm? • Food and Drug Administration Compliance for Patient-Care Facilities, Manufacturers, and Distributors • Your Mock Audit: Are You Ready for the Auditor to Examine Your Claims Record? You and your staff can now have a private viewing of business saving strategies and earn continuing education credits at the same time. Learn more about each session by visiting http://bit.ly/CreditCEpromo. AOPA members just $59 per session B O NUS BUY 3 ($99 per session for nonmembers), and the GET ONE FREE price covers your entire staff. Take advantage of a special offer to buy three, get one free. Review the videos as many times as you like. Register at http://bit.ly/aopabusiness. For more information, contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876.


O&P Almanac / July 2014



Log On for Free at the AOPAversity Online Meeting Place

Coding Questions Answered 24/7 AOPA members can take advantage of a “click-ofthe-mouse” solution available at LCodeSearch.com. AOPA supplier members provide coding information about specific products. You can search for appropriate products three ways—by L code, by manufacturer, or by category. It’s the 21st century way to get quick answers to many of your coding questions. Access the coding website today by visiting www.LCodeSearch.com. AOPA’s expert staff continues to be available for all coding and reimbursement questions. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions.

Welcome to AOPA Jobs AOPA’s Online Career Center gives

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 AOPAversity Online Meeting Place: www.AOPAnetonline.org/education. Take advantage of the free introductory offer to learn about a variety of clinical and business topics by viewing educational videos from the prior year’s National Assembly. Earn continuing education credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis. AOPA also offers two sets of webcasts: Mastering Medicare 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 http://bit.ly/WebcastsAOPA.


July 2014 | O&P Almanac

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.

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 http://jobs.aopanet.org. In addition, take advantage of O&P Almanac’s Jobs section to post or browse an employment opportunity, and advertise to AOPA’s 2,000+ member organizations! Regardless of your staffing needs or budget, we have an option that is right for you. For advertising, call Bob Heiman, Advertising Sales Representative at 856/673-4000 or email bob.rhmedia@comcast.net.



he officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an www.AOPAnet.org 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.

Choice O&P 314 Erin Drive Knoxville, TN 37919 865/588-4256 Fax: 865/246-0080 Category: Patient-Care Member William Kitchens, CO, LO

Mobility Solutions Prosthetics and Orthotics 4474 Cummings Place N. Keizer, OR 97303 971/340-8485 Category: Patient-Care Member Shannon Levin, CPO

Martin Bionics Innovations P.O. Box 2391 Oklahoma City, OK 73101 405/850-2391 Category: Educational Research Member Jay Martin, CP, LP, FAAOP

North Texas Regional Orthotics & Prosthetics 105 S. Grand Avenue Waxahachie, TX 75165 972/923-2285 Fax: 972/923-1994 Category: Patient-Care Member Amy Jones

Is Your Facility Celebrating a Special Milestone This Year?

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



he O&P PAC advocates for legislative or

political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form contact Devon Bernard at dbernard@AOPAnet.org. We would also like to thank those individuals who have donated directly to a candidate’s fundraiser or to an O&P PAC-sponsored event, as they, too, are valuable supporters in achieving the legislative goals of AOPA and the O&P PAC*. • Jim Cahill, CPO • Glenn Crumpton, CPO • Eileen Levis • Gordon Stevens, CPO *Due to publishing deadlines, this list was created on June 1, 2014, and includes only donations and contributions made or received between April 21, 2014, and June 1, 2014. Any donations or contributions made or received after June 1, 2014, will be published in an upcoming issue of O&P Almanac.

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

Rick Fleetwood, MPA Frank Snell, CPO, FAAOP

Claudia Zacharias, MBA, CAE

O&P Almanac / July 2014



Feature your product or service in Marketplace. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit http://bit.ly/aopa14media for advertising options.

DAW Industries Inc. San Diego, CA 800/252-2828 info@daw-usa.com www.daw-usa.com

ePAD: The Electronic Precision Alignment Device The ePAD shows precisely where the point of origin of the ground reaction force (GRF) vector is located in sagittal and coronal planes. The vertical line produced by the self-leveling laser provides a usable representation of the direction of the GRF vector, leading to valuable weight positioning and posturing information. New Sure Stance Knee by DAW This ultra-light, true variable cadence, multi-axis knee is the world’s first 4-bar stance control knee. The positive lock of the stance control activates up to 35 degrees of flexion. The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K-3 patients.

Trautman Expansion Arbors From Fillauer Fillauer’s new Trautman Expansion Arbors are designed to prevent the sanding cone from flying away. When the expansion arbor spins, it expands and applies pressure to the inside of the sanding sleeve—holding the sleeve on the arbor. If you have ever had to pick up your sanding cone off the floor mid-use because it flew off or had to keep readjusting the cone because it was migrating, then you will find the Trautman Expansion Arbor a must for your lab. Features and benefits: • Provides a smoother grinding surface for straighter lines and higher quality finish • Eliminates grinding chatter that hard grinding surfaces gives • Available in three sizes and as a kit of three • Available in 1/2-13, 5/8-11, and M16 threads to fit most O&P machinery For more information, contact Fillauer at 800/251-6398 or visit www.fillauer.com.


July 2014 | O&P Almanac

Compact Double Action Ankle Joint From PEL Intended for both small adults and pediatric patients, the Compact Double Action Ankle Joint from Becker Orthopedic is comprised of a precontoured stainless steel upright and stirrup, which reduce fabrication time and provide a lightweight and low-profile enhancement to the clinical application. Designed specifically for use with thermoplastics, the Compact Double Action Ankle Joint includes pins in the anterior panels and springs in the posterior panels, which afford the patient a normal gait while providing control in the sagittal plane and increased mediolateral stability of the knee and hip. Contact PEL at 800/321-1264 or www.pelsupply.com.

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

ial Specngs! 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!



Opportunities for O&P Professionals Job location key: - Northeast - Mid-Atlantic

O&P Almanac Careers Rates Color Ad Special 1/4 Page ad 1/2 Page ad

Member $482 $634

Nonmember $678 $830

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

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

- Southeast - North Central - Inter-Mountain - Pacific

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

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

Member Nonmember $80 $140

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

Discover new ways to connect with O&P professionals. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit http://bit.ly/aopa14media for advertising options.

“The most gratifying piece of what I do

every day is to get up early in the morning, get to the office and know that we are going to make a difference.� - Kevin Carroll, MS, CP, FAAOP

Competitive salaries/benefits, continuing education, leading edge technologies, management opportunities and even paid leaves to assist in humanitarian causes, all available through a career at Hanger Clinic. Join Hanger Clinic and make a difference today.


Corvallis, OR Zanesville, OH


Auburn, CA Evansville, IN Havertown, PA Johnston, IA Kansas City, KS La Mesa, CA Olivette, MO

Orange, CA Salisbury, MD Valdosta, GA Wethersfield, CT Cincinnati, OH Somersworth, NH Wichita, KS


Overland Park, KS

Riverside, CA

Albuquerque, NM Brunswick, GA Carson City, NV Columbus, OH Dayton, OH Denver, CO Englewood, CO Lansing, MI Las Vegas, NV

Macon, GA Montrose, CO Oklahoma City, OK San Jose, CA Santa Rosa, CA Tallmadge, OH Thomasville, GA Tulsa, OK Springfield, IL


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

O&P Almanac | July 2014




August 1-2

July 7-12

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and orthotic and prosthetic technicians in 250 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

July 9

AOPA: The OIG—Who Are They and Audio Conference Why Are They Important? Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

July 25-26

ABC: Orthotic Clinical Patient Management (CPM) Exam. St. Petersburg College Caruth Health Education Center, St. Petersburg, FL.Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

August 1

ABC: Practitioner Residency Completion Deadline for the September 2014 Exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

Year-Round Testing BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiple-choice and clinical-simulation exams. Apply now at http://my.bocusa.org. For more information, visit www.bocusa.org or email cert@bocusa.org.


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


July 2014 | O&P Almanac

ABC: Prosthetic Clinical Patient Management (CPM) Exam. St. Petersburg College Caruth Health Education Center, St. Petersburg, FL.Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

August 13

AOPA: AFO/KAFO Policy— Understanding the Rules. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Audio Conference

August 14-15

Spinal Technology Scoliosis Orthotic Symposium— Scoliosis Management, Spinal Trauma Management, and Lower-Limb Orthotics Management. Spinal Technology Inc. hosts our annual Scoliosis Symposium in Boston. Course will cover full-time scoliosis bracing protocol for adolescent idiopathic scoliosis; the Providence Nocturnal Scoliosis System; measurement techniques and brace options for lower-limb orthotics; with hands-on demonstrations in each segment. Presenters include Tufts Medical Center orthopedic surgeons, a Tufts neurosurgeon, and ABC-certified practitioners. Eligible practitioners can earn 16.25 ABC credits for attending the full presentation. Contact Nancy Francis at nancy_f@spinaltech.com or call 508/775-0990 x8374.

September 4-7

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

Online Training

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

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


BONUS! Listings will be placed free of charge on the “Attend O&P Events” section of www.AOPAnet.org.

Words/Rate: Member Nonmember Color Ad Special: Member Nonmember 25 or less $40 $50 1/4 page Ad $482 $678 26-50 $50 $60 1/2 page Ad $634 $830 51+ $2.25/word $5.00/word

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

CALENDAR September 10

AOPA: Urban Legends in O&P: Audio Conference What To Believe. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

November 5-7

New Jersey Chapter AAOP Educational Seminar. NEW LOCATION: Revel Atlantic City Resort Casino, NJ. For more information, visit www.njaaop.com or email director@njaaop.com.

November 6-7 September 13-14

The Foot and Ankle: From Athletic to Decrepit. Durham, NC. Study pathology-based treatments, orthotics, shoe modifications, and taping while supporting a good cause. 16 credits. Register at www.FootCentriconline.com.

September 27-28

The Foot and Ankle: From Athletic to Decrepit. Asheville, NC. Study pathology based treatments, orthotics, shoe modifications, and taping while supporting a good cause. 16 credits. Register at www.FootCentriconline.com.

November 8-9

The Foot and Ankle: From Athletic to Decrepit. Durham, NC. Study pathology-based treatments, orthotics, shoe modifications and taping while supporting a good cause. 16 credits. Register at www.FootCentriconline.com.

November 12

AOPA: Gifts—Showing Appreciation Without Violating the Law. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Audio Conference

October 8

AOPA: Medicare Enrollment, Revalidation, and Participation. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Audio Conference

Bio-Mechanical Composites, Inc.

COPA 2014 Northern California Educational Event. Hilton Garden Inn. Emeryville, CA. For more information, visit www.regonline.com/builder/site/?eventid=1567170.

October 10

Fall 2014: Learning and Leisure—“Dynamic Response Orthotic System” Certification Course. Join us at the LaGuardia Airport Marriott in New York the day prior to the POMAC meeting. Workshop fulfills requirement for Phase I toward certification as a “Dynamic Response Systems Specialist.” 7.75 CEUs. For registration information, visit www. phatbraces.com. For more information, call 515/554-6132.

October 16-18

Virginia Orthotic & Prosthetic Association. Glen Allen, VA. Wyndham Virginia Crossings Resort & Conference Center. For more information, visit www.vopaweb.com or email vopainfo@gmail.com.

November 15

Midwest Chapter AAOP—One-Day Fall Symposium. Hickory Hills, IL. For more information, visit www.mwcaaop. org/meetings-events.html or email mwcaaop@gmail.com.

December 10

AOPA: New Codes and Changes for 2015. Register online at http:// bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.

Audio Conference

2015 OCTOBER 7-10

98th AOPA National Assembly. San Antonio. Henry B. Gonzales Convention Center. For more information, contact AOPA Headquarters at 571/431-0876 or info@AOPAnet.org.

ADVERTISERS INDEX Company ALPS South LLC Amfit, Inc. Cailor Fleming Insurance DAW Industries Dr. Comfort Fillauer Hersco Ottobock PEL

Page Phone 9 41 C3 1 5 C2 2 C4 7


800-574-5426 www.easyliner.com 800-356-3668 www.amfit.com 800-796-8495 www.cailorfleming.com 800-252-2828 www.daw-usa.com 877-713-5175 www.drcomfort.com 800-251-6398 www.fillauer.com 800-301-8275 www.hersco.com 800-328-4058 www.professionals.ottobockus.com 800-321-1264 www.pelsupply.com

O&P Almanac / July 2014



Constant Contact Answers to your questions regarding mailings and address information

AOPA receives hundreds Q of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

Given the Medicare guidelines for contacting patients, can I ever call or mail postcards to my patients?

What address should I use on my delivery slip or proof of delivery: my office address or the patient’s home address?

Most of Medicare’s prohibitions on contacting your patients are outlined in Supplier Standard 11. Prohibited contact applies only to contact via telephone, meaning any other form of contact—including mailing postcards—is permitted at any time.

The address you should use depends on where you actually delivered the item. The delivery address that appears on the delivery slip must match the physical address of where the items/services were provided. For example, if the items were delivered in your office, the delivery address should be your office address. If you delivered the items at the patient’s home, the delivery address should be the patient’s home. If you delivered the items in a physician’s office, the delivery address should be the physician’s office.

Q/ A/

3 This standard does not eliminate your ability to contact patients via telephone. You may still contact patients by phone if one of the following criteria has been met: • The patient has given you written permission to contact him or her concerning the furnishing of a Medicare-covered item. • You are contacting the patient to coordinate delivery of a Medicare-covered item. • You provided a Medicarecovered item to the patient within the past 15 months. The intent of this standard is to eliminate unsolicited calls to the patient in order to drum up potential sales; it is not designed to block your ability to treat your patient. 56

July 2014 | O&P Almanac

Q/ A/

When filling out the advanced beneficiary notice (ABN) form, what information must be included in Section A or the Notifier section?


The intent of Section A is to indicate who provided the ABN to the patient and to provide the patient with a means of following up with any questions he or she may have about the ABN form. At a minimum, you must include your company’s name (to show who provided the ABN) and your company’s address and telephone number (so the patient may contact you, either in writing or by phone, if he or she has any questions). You may also include a fax number or email, but these are not required.


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

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

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

An Endorsed Member of AOPA



Responsive. Powerful. Dynamic. The DynamicArm elbow prosthesis

The incredibly responsive DynamicArm elbow gives your patients the power and speed to get things done! The powerful electric motor and VarioDrive clutch go from zero to full flexion in half a second, and provide quick, precise positioning. Now with a high lifting force of up to 13 lbs and a more natural appearance, the DynamicArm is a great way to lift your patient to the next level. Attend the workshop qualification course at Academy. If you’d like more information—or to have your patient trial the DynamicArm—please contact your sales rep at 800 328 4058. www.professionals.ottobockus.com