Make a Difference at the 2014 AOPA Policy Forum, April 2-4, in Washington, DC! Page 38
The American Orthotic & Prosthetic Association
THE MAGAZINE FOR THE ORTHOTICS & PROSTHETICS INDUSTRY
Ops How far have you gone to improve patient mobility?
E! QUIZ M Earn
Credits SEE PAGE 18
Dos and Donâ€™ts for Managing Family Members Success Strategies for ALJ Hearings
ALPS Guardian Suction Liner • Raised GripGel bands grip socket wall wall creating secure interface between socket and liner to prevent slippage • Low modulus GripGel bands help ensure no restriction of blood flow • Single piece construction improves durability; no seams • Transtibial rings begin 3 ½” from center of distal end • Transfemoral rings begin 5 ½” from center of distal end • For volume fluctuations use ALPS ENCP skin reliever for continued use of same socket
Aspen Medical Products Horizon™ Lower Spine Bracing • Fully adjustable; comfortably fits 24” to 70” waists • Unique independent upper/lower tightening system for customized pain relief • Effective treatment for low back pain, improves compliance and satisfaction • Tri-Band technology system and integrated vertical stays provide stability and comfort PDAC approved – Codes L0456, L0637, L0631 and L0627 • PDAC approved Codes L0456, L0637, L0631 and L0627
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USING ALPHA LINER LINER?*?
O&P MARCH 2014, VOLUME 63, No. 3
CONTENTS Photo: U.S. Army photo by Meghan Portillo/NCO Journal
Special Ops By Christine Umbrell While most prosthetists and orthotists rely on their creative instincts to fit patients with the best devices, several have taken their innovative impulses to an extreme. The O&P Almanac shares the stories of four practitioners who have created unique components to solve specific problems for patients.
Feature Photo: Snell Prosthetic & Orthotic Laboratory
28 Family Ties
By Adam Stone Hiring strategies can be particularly challenging when family is involved. Here, HR executives and owners of family-owned O&P facilities share tips for hiring relatives, managing nonfamily employees, establishing chain of command, and implementing exit policies in this complicated environment.
Reimbursement Page How to successfully navigate Administrative Law Judge hearings E! QUIZ M Earn
AOPA Contact Page How to reach staff
At a Glance Statistics and O&P data
Credits SEE PAGE 18
Ask the Expert Answers to common proof of delivery and date of delivery questions Facility Spotlight Arizona AFO
Presidentâ€™s Corner Insights from AOPA President Anita LibermanLampear, MA
In the News Research, updates, and company announcements
AOPA Headlines News about AOPA initiatives, meetings, member benefits, and more
48 00 00
AOPA Membership NEW! Applications & Member Milestones
Products and services for O&P
Opportunities for O&P professionals
Upcoming meetings and events
AOPA Answers Expert answers to your FAQs
On the cover: Ryan Blanck, CPO, with patient and IDEO-user Beth Shaver at the 2014 Hanger Education Fair. Photo: Hanger Clinic
O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: 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. Postmaster: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. For advertising information, contact Bob Heiman at 856/673-4000 or email email@example.com.
MARCH 2014 O&P Almanac
President’s IN THE NEWS corner
A New World in O&P You can make a difference.
April 2-3, 2014 Special Extended Program April 3-4
Renaissance Hotel Washington, DC
Registration is open. Register at bit.ly/2014policy. Make your plans now to attend the 2014 AOPA Policy Forum.
Meet your member of Congress and tell them how, through orthotics and prosthetics:
Mobility Saves Lives (and Money)
O&P Almanac MARCH 2014
t seemed like O&P was on cruise control when I joined the AOPA Board in 2007. The issues resonating back then included determining the legality of consignment closets; speaking with one voice; establishing evidencebased care; increasing practitioner research involvement, addressing competitive bidding; and several other issues. They were issues, yes, but not terribly complicated and not life-threatening to our ability to serve patients. So what’s changed? We’re still talking about physician distribution of O&P products, competitive bidding, evidence-based research and care, plus those other topics. The big difference—and it is a big difference—is that serious efforts and serious money are being devoted to move beyond the conversation and into the real world of getting something done. Your AOPA Board met Jan. 13, 2014, and the agenda was accompanied by 372 pages of background materials to help educate all of us on decisions that had to be made. But what is so telling is how much more complicated our business is today than it is seven years ago. Back then, I don’t recall talking about FDA compliance, physician-owned distribution facilities, the Department of Health and Human Services Office of Inspector General changing our lives, AOPA suing CMS, and AOPA challenging the ankle-foot orthoses/knee-ankle-foot orthoses Medical Directors Policy change. Similarly, I don’t recall obtaining federal funding for O&P research, mounting six survival imperatives to ensure we’re around to celebrate AOPA’s 2017 centennial, and, now, looking ahead to the “new normal” in our practices. And that is just the beginning. In the weeks ahead, be sure to take advantage of the monthly audio conferences that bring you up to date and help you stay ahead of the curve on regulations, coding, and so many other important aspects of your business. The Essential Coding and Billing Seminars are being presented four times this year and one already took place in New Orleans. Dates and locations for the other three will be announced soon. Also, be sure to hold the Sept. 4-7, 2014 dates for the AOPA National Assembly at the Mandalay Bay Resort and Casino in Las Vegas. And something really new: Now, you can get two continuing credits by reading the O&P Almanac’s monthly Reimbursement Page column and the quarterly Compliance Corner column and then passing the online quizzes. That’s one more reason why you should be an O&P Almanac loyalist. AOPA is your association and those of us who serve on the Board are a reflection of you and your needs. Let us know how we can help and, by all means, please stay involved. The AOPAVotes website, www.aopavotes.org, is your tool for advocacy. Send a message to your legislators. Make your voice heard. Most importantly, thank you for your support. You are making our progress possible! Sincerely,
Anita Liberman-Lampear, MA President, AOPA PS: Please join me at the April 2-3 Policy Forum and the all new extended “you need to know” programming April 3-4. It’s all too important to miss!
AOPA IN THE Contact NEWS INFORMATION AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org EXECUTIVE OFFICES
MEMBERSHIP & Meetings
BOARD of DIRECTORS
Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org
Tina Moran, CMP, senior director of membership operations and meetings, 571/431-0808, tmoran@AOPAnet.org
Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org
Maynard Carkhuff Freedom Innovations, LLC, Irvine, CA
Kelly Oâ€™Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org
President Anita Liberman-Lampear, MA University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI
O&p Almanac Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, firstname.lastname@example.org Catherine Marinoff, art director, 786/293-1577, email@example.com Bob Heiman, director of sales, 856/673-4000 firstname.lastname@example.org Lia K. Dangelico, managing editor and contributing writer, 703/914-9200 x24, email@example.com Stephen Custer, production manager, 571/431-0810, scuster@AOPAnet.org Christine Umbrell, editorial/production associate and contributing writer, 703/914-9200 x33, firstname.lastname@example.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 AOPA Bookstore: 571/431-0865 Government affairs Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org
President-Elect Charles H. Dankmeyer Jr., CPO Dankmeyer Inc., Linthicum Heights, MD Vice President James Campbell, PhD, CO Becker Orthopedic Appliance Co., Troy, MI Immediate Past President Tom Kirk, PhD Member of Hanger Inc. Board, Austin, TX Treasurer James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA
Devon Bernard, assistant director of coding reimbursement, programming and education, 571/431-0854, dbernard@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com
Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Alfred E. Kritter Jr., CPO FAAOP, Hanger, Inc., Savannah, GA Eileen Levis Orthologix LLC, Trevose, PA Ronald Manganiello New England Orthotics & Prosthetics Systems LLC, Branford, CT Dave McGill Ă–ssur Americas, Foothill Ranch, CA Michael Oros, CPO Scheck and Siress O&P Inc., Oakbrook Terrace, IL Scott Schneider Ottobock, Minneapolis, MN Don Shurr, CPO, PT American Prosthetics & Orthotics Inc., Iowa City, IA
O&P Almanac Publisher Thomas F. Fise, JD Editorial Management Stratton Publishing & Marketing Inc. Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company
Copyright 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 Almanac. The Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.
O&P Almanac MARCH 2014
A STEP-BY-STEP GUIDE TO THE RAC AUDITS. The RAC audits have been tough on everyone in the O&P industry. To help all providers navigate the process, weâ€™ve developed an interactive, step-by-step resource. Why? Because when the industry succeeds, everyone benefits â€“ especially patients.
START HERE at Hanger.com/RAC
AT IN THE A GLANCE NEWS
Family Businesses Remain Strong Across the U.S. Many successful O&P facilities and companies are family-owned, or began that way. Here’s a look at how family businesses are faring across all U.S. industries.
Family-Owned Businesses That Survive Past the First Generation:
Operate into the 2nd generation
Operate into the 3rd generation
Operate into the 4th generation
Source: Joseph Astrachan, PhD, Family Business Review.
Percentage of U.S. family business leaders who say they intend to pass ownership to the next generation.
Percentage of total U.S. employment generated by family businesses.
Percentage of family businesses led by a female CEO or president.
O&P Almanac MARCH 2014
Find out more about family-owned businesses in O&P, including tips for managing family members, in “Family Ties” on page 28.
Number of family businesses in the U.S.
Average lifespan of a family-owned business.
Percentage of family businesses that believe their ethical standards are more stringent than those of competing, nonfamily firms.
Sources: University of Vermont’s “Family Business Facts;” www.familybusinesscenter.com; www.dcfamilybusiness.com; www.familybusinessinstitute.com.
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IN THE NEWS
REAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEWS BREAKING NEW
CMS Announces ‘Pause’ in RAC Activities, Program Refinements In late February, CMS announced that due to the upcoming transition of contractors responsible for performing Recovery Audit Contractor (RAC) duties, providers may see a pause in RAC activities. As the initial RAC contracts are reaching the end of their term, CMS is in the process of reviewing responses to a request for proposals, which will ultimately result in the award of new RAC contracts in the next few months. As part of this process, CMS will be consolidating the RAC contract for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Home Health, and Hospice services into a single RAC contract that will provide all RAC services nationwide for these three benefit categories. Previously, these services were performed by all four RAC contractors under the current contract model. CMS has stated that the reason for the pause in RAC activities is to allow the current RAC contractors to complete any audits already in process before the expiration of their contract. In its release, CMS indicated that the last day a RAC contractor may send an additional documentation request to a provider is Feb. 21, 2014. The last day a RAC may send an overpayment notice to a Medicare Administrative Contractor for purposes of collection is June 1, 2014.
In addition to the announcement regarding the pause in RAC activities during the transition between contractors, CMS also announced several refinements to the RAC
program that it intends to implement with the new contract awards. These changes are outlined in the chart below, which was reproduced from, and can be found on, the CMS website:
Upon notification of an appeal by a provider, the Recovery Auditor is required to stop the discussion period.
Recovery Auditors must wait 30 days to allow for a discussion before sending the claim to the MAC for adjustment. Providers will not have to choose between initiating a discussion and an appeal.
Providers do not receive confir- Recovery Auditors must confirm receipt of a discussion request within three days. mation that their discussion request has been received. Recovery Auditors are paid their contingency fee after recoupment of improper payments, even if the provider chooses to appeal.
Recovery Auditors must wait until the second level of appeal is exhausted before they receive their contingency fee.
Additional documentation request (ADR) limits are based on the entire facility, without regard to the differences in department within the facility.
The CMS is establishing revised ADR limits that will be diversified across different claim types (e.g., inpatient, outpatient).
ADR limits are the same for all providers of similar size and are not adjusted based on a provider’s compliance with Medicare rules.
CMS will require Recovery Auditors to adjust the ADR limits in accordance with a provider’s denial rate. Providers with low denial rates will have lower ADR limits while providers with high denial rates will have higher ADR limits.
Questions regarding this issue may be directed to Joe McTernan at jmcternan@ aopanet.org or Devon Bernard at email@example.com.
3-D Printer Uses Carbon Fiber for Prosthetic Applications The first 3-D printer to use carbon fiber was introduced in January 2014. The MarkOne printer from MarkForged can print with fiberglass, nylon, and plastic filament in addition to carbon fiber. The new product, which debuted at SolidWorks World 2014 in San Diego, allows users to print stronger items since the carbon fiber is 20 times stiffer and five times stronger than the acrylonitrile butadiene styrene, or ABS, the plastic used in other 3-D printers.
O&P Almanac MARCH 2014
One use for the new printer is stronger, lighter, and more practical prosthetic limbs, according to the manufacturer. “We wanted to make it really easy for people to start printing with it, so they can explore prosthetics, custom bones, tools, and fixtures,” says inventor Gregory Mark. The device costs approximately $5,000, and is 23-inches wide, 14-inches tall, and 13-inches deep. Pre-orders for the printer began in February.
IN THE NEWS
Left to right: Aaron Holm, founder, Wiggle Your Toes; Jeff Bauman, Boston Marathon bombing survivor; Adam McPherson, Ottobock’s U.S. market manager for microprocessor knees
Ottobock Hosts Boston Marathon Survivor Jeff Bauman, one of the Boston Marathon bombing survivors, visited Ottobock’s fabrication facility and service area in Minneapolis in February. Bauman became a bilateral above-knee amputee after the first bomb exploded at the finish line during the marathon last April. He is the only victim who recalled watching the man later identified as one of the accused attackers, Tamerlan Tsarnaev, set down a backpack moments before the bomb exploded. He worked with the FBI and a sketch artist to produce a drawing of the suspect. During his visit at Ottobock’s facility, Bauman, who is a bilateral Genium user, met with staff and shared his appreciation for his prostheses. He noted that the first time he walked with his Ottobock legs, he was “completely caught off guard by how much I felt like I was walking with my own legs.” Bauman also answered questions about his upcoming memoir, Stronger, to be published in April. “It is always inspiring to see what people like Jeff accomplish,” said Brad Ruhl, president and chief executive officer of Ottobock HealthCare. “To see the activities Jeff takes on with the products we provided makes all of our lives more fulfilling.”
Dennis Aabo Sorensen, a Danish man who lost his left hand in a firework accident 10 years ago, spent one month last year using a prototype of a bionic hand that allowed him to feel lifelike sensations from his “fingers ” as part of an international research project. This is the first time an amputee has had real-time touch sensation from a prosthetic device, according to Silvestro Micera, senior author of the research study and director of the Translational Neural Engineering Laboratory at Ecole polytechnique fédérale de Lausanne in Switzerland. An international team of robotics experts from Italy, Switzerland, and Germany worked together in designing the prosthetic device, which was connected to nerves in Sorensen’s arm during surgery. The research is featured in the article “Restoring Natural Sensory Feedback in Real-Time Bidirectional Hand Prostheses” in the February 2014 issue of Science Translational Medicine. The robotic hand, called Lifehand 2, was attached to Sorensen’s arm via implanted electrodes during an operation, which took place in Rome. Four electrodes were implanted onto nerves in Sorensen’s upper arm. The thin, precise electrodes, which were designed to detect and measure information about touch, were connected to the artificial sensors in the fingers of the prosthesis. Feedback related to touch and pressure of the prosthetic fingers could be sent to the brain via the electrodes. Sorensen spent a month after the surgery undergoing laboratory tests to ensure the electrodes were functioning and fully connected to the bionic hand. The device is still a prototype, so Sorensen had to undergo a second surgery to remove the sensors due to safety restrictions imposed on clinical trials. He recalls the trial as a positive experience: “It was really, really amazing because suddenly my artificial hand and my brain were working together for the first time in many years,” Sorensen said in an interview with NPR. The research team is currently miniaturizing the technology to be useful in home application, but it could be several years before such a device becomes commercially available.
MARCH 2014 O&P Almanac
Photo: Università Campus Bio-Medico di Roma
Photo courtesy of Ottobock
Artificial Hand Prototype Enables Sensory Feedback
IN THE NEWS
Hanger Clinic President and COO Rick Taylor
O&P Learning, Solutions Celebrated at 2014 Hanger Education Fair Hanger Inc. held its 2014 Annual Education Fair and National Meeting February 4-8, in Las Vegas, Nevada. More than 850 clinicians and therapists—both newly hired and those who have been with the company a number of years— convened at the annual event for continuing education on the most advanced orthotic, prosthetic, and rehabilitative solutions in the world. The Annual Hanger Education Fair also presented a number of business, networking, and celebratory events. An expansive exhibit hall featured more than 120 exhibits and 280 exhibitor representatives, including a number of manufacturers who displayed some of their newest componentry. Awards were distributed throughout the week to celebrate the success of employees who excelled at
delivering exceptional care and service in 2013. Reminding employees of Hanger’s mantra of empowering human potential, many patients were in attendance, helping to educate attendees and sharing personal stories of overcoming adversity and thriving with prosthetic, orthotic, and rehabilitative solutions. A special message from some of Hanger’s most precocious young patients shared at the conclusion of the conference is still a topic of conversation and inspiration. Eleven pediatric patients were asked what they want to be when they grow up and what they think the future holds. Their answers were no surprise—they know they can be whatever they want to be. The video can be viewed at http:// youtu.be/UWvUzK-buM4.
OMHA Violates BIPA With 24-Month ALJ Hearing Delay The Office of Medicare Hearings and Appeals (OMHA), the entity in charge of the third level of appeals, has temporarily suspended the processing of any new Administrative Law Judge (ALJ) hearings; this suspension is expected to last two years. The delay is a result of the overwhelming number of appeal requests the ALJs are receiving on a weekly basis and the backlog of appeals they have yet to review and render a verdict. OMHA has indicated that the workload of the ALJs has increased by 184 percent over the past three years, and this increase can be linked to the increased activity of the Recovery Audit Contractors (RACs) and other Medicare audit activity. This increase means that each of the 65 ALJs has at least 4,000 appeals he or she must review in order to eliminate the current backlog of appeals. The wait time for resolution, once a case is assigned to an ALJ, could be 16 months or longer, according to CMS and OMHA. The ALJ level of appeal continues to be O&P practitioners’ best opportunity to be victorious and overturn
O&P Almanac MARCH 2014
unfavorable decisions made by the RACs and other auditors, and this delay undermines and delays the best prospect for relief. The OMHA announcement provides the O&P profession with even more concrete evidence that the current system of overly aggressive auditors is flawed and is putting undue burden on providers. AOPA’s position is that this two-year delay is a clear violation of the rights of due process afforded by the Benefits Improvements and Protection Act, or BIPA, of 2000. In February, AOPA addressed concerns about this announcement and the subsequent revocation of the rights of those who are appealing with a letter to CMS Administrator Marilyn Tavenner. AOPA is requesting that members forward AOPA’s letter to their representatives and urge them to support the right to due process. Visit www.AOPAnet.org to read AOPA’s letter to Tavenner and the OMHA Memo delaying ALJ hearings. Go to http://bit.ly/ALJletter and contact your representative to help restore due process.
IN THE NEWS
people in the news
Curbell Plastics has announced that five employees have received new responsibilities: • Joseph Galbo is operations manager for the West Coast and will lead and manage regional plans. • Brent Feuz is Curbell’s marketing analyst and will oversee benchmarking activities to measure marketing performance. • Candace Resch will continue to serve as senior product specialist, engineering plastics, and will take on national responsibilities for the DuPont Vespel Shapes product line. • Brian Sauers is serving as business manager and will have marketing, budgeting, planning, and training responsibilities in the films and tapes business. • Jeff Wilson is the business development manager, orthotics, prosthetics, and podiatry.
• William Murphy, C.Ped, has joined the Tamarac, Florida, patient-care clinic. • Timothy “Chad” O’Connor has been hired at the Lafayette, Colorado, patient-care clinic. • Jason Sandford, CO, has joined the Morgantown, West Virginia, patientcare clinic. • Peter Springs, CPO, has been hired in the Spokane, Washington, patient-care clinic area. • Mark Webster, CO, has joined the Huntersville, North Carolina, patient-care clinic. The National Association for the Advancement of Orthotics & Prosthetics has elected Rebecca J. Hast to its board of directors. Hast has served as president of Linkia LLC since Rebecca J. Hast November 2005.
Carrie Green has been named marketing manager at the Board of Certification/Accreditation.
Hanger Clinic has announced several hirings: • Alan Dolberry, CPO, has joined the Las Cruces, New Mexico, patientcare clinic. • Jeffrey Fawcett, CO, has joined the Charlotte, North Carolina, patientcare clinic. • David Gross, CP, has joined the Forest Hills, New York, patient-care clinic. • Jeffrey Honma, CPO, has been hired as area clinic manager for the patient-care clinics in Downey and Whittier, California. • Marc Karn, CP, has been hired as clinic manager in the West Palm Beach, Florida, patient-care clinic.
Ottobock has hired Joseph Wujcik as a territory sales representative for technical orthopedics. He will be responsible for the territory that includes New Jersey, eastern New York, Maryland, and Delaware. In addition, Ottobock has announced that Paralympic snowboarder Keith Gabel of Ogden, Utah, has been named the newest Ottobock Ambassador. Gabel will serve as a role model for young athletes and will work with Ottobock to promote the importance of a healthy lifestyle.
LeRoy William Nattress Jr., PhD LeRoy William Nattress Jr., PhD, an assistant clinical professor at Loma Linda University’s School of Public Health, and executive director of the Services Center for Independent Life, passed away in December. Nattress was dedicated to advancing O&P education and was heavily involved in volunteer organizations for people with disabilities. He is a past education director for AOPA and also served as executive director for the American Board for Certification in Orthotics, Prosthetics, and Pedorthics. He served as coordinator of the prosthetics education program and the University of California—Los Angeles. In addition, he was co-founder of the O&P program at Century College in White Bear Lake, Minnesota, and worked with Otto Bock Orthopedic in designing the company’s U.S. endoskeleton system education program.
Jeff Palmer, CPO, is the new branch manager and director of operations at American Prosthetics & Orthotics’ Iowa City Jeff Palmer, CPO patient-care facilities.
Marc Karn, CP
MARCH 2014 O&P Almanac
IN THE NEWS
Jurisdiction D Announces Results of AFO Prepayment Review The Jurisdiction D Durable Medical Equipment Medicare Administrative Contractor has released the results of its prepayment review of ankle-foot orthosis (AFO) claims described by L1960, L1970, and L4360 from September to December 2013. The error rate for both L1960 and L1970 was determined to be 90 percent, and the error rate for L4360 was 86 percent. The primary reasons for denial of L1960 and L1970 included lack of detailed physician documentation of the need for a custom-fabricated device and lack
BUSINESSES in the news
The American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) has become an event sponsor for the Orthotic & Prosthetic Activities Foundation (OPAF)/ McKeever’s First Ride event in Atlanta on April 5. Additionally, ABC has returned as a Silver Level sponsor for OPAF in 2014. The Amputee Coalition is accepting counselor and camper applications for the 2014 Paddy Rossbach Youth Camp. Youth ages 10 to 17 are eligible to attend; counselors must be 19 or older. All costs, including travel, are covered by the Amputee Coalition, but limited space is available. The application deadline is March 14; visit www. amputee-coalition.org. Friends of Disabled Adults and Children, a nonprofit organization providing more than $10 million annually in durable medical equipment and supplies to the disabled community, announced it has formed a partnership with Prosthetic Hope International Inc., an Atlanta-based
O&P Almanac MARCH 2014
nonprofit organization providing rehabilitation care for people who need O&P services. Orthofeet announced a partnership with the American Association of Diabetes Educators to develop a grassroots educational campaign to promote foot health for adults with diabetes. Organizers of the ORTHOPÄDIE + REHA-TECHNIK International Trade Show and World Congress announced that it will now be known as OTWorld. This year’s event will take place May 13–16, 2014, in Leipzig, Germany. Rep. Tim Griffin (R-Arkansas) visited Snell Prosthetic & Orthotic Laboratory’s main office in Little Rock in January. He toured the facility and learned how the company makes O&P devices. Frank Snell, CPO, LPO, FAAOP, the company’s president, showed Griffin some of the latest microprocessorcontrolled prostheses.
Swiftwick, a leading producer of athletic compression socks, has announced a partnership with Southern Prosthetics Supply.
Apple Commercial Features i-Limb Technology A new commercial for Apple was released in February featuring a Touch Bionics i-Limb user and the My i-Limb app. The ad features Touch Bionics patient ambassador Jason Kroger, who wears two i-Limb ultra revolution devices in conjunction with the My i-Limb app, a mobile app available for patients who have upper-limb loss or deficiency. See the video at http://youtu.be/zJahlKPCL9g. A
Photo: Touch Bionics Inc.
of documentation of the coverage criteria for a custom device. For L4360, the primary reason for denial was lack of documentation supporting the basic coverage criteria for an AFO. Based on the results of the prepayment review, Jurisdiction D has indicated that these codes will remain under prepayment review for the immediate future. Questions regarding this issue may be directed to Joe McTernan at firstname.lastname@example.org or Devon Bernard at email@example.com.
Reimbursement Page By Joe McTernan, AOPA government affairs department
ALJ Hearing Success Strategies Critical steps for defending your claim
Editor’s Note: Readers E! QUIZ M of Reimbursement Earn 2 Page are now eligible Business CE Credits to earn two CE credits. SEE PAGE 18 After reading this column, simply scan the QR code or use the link on page 18 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.
O&P Almanac MARCH 2014
he Office of Medicare Hearings and Appeals (OMHA) recently announced that it was suspending the assignment of new requests for Administrative Law Judge (ALJ) hearings for a minimum of 24 months—a grave concern to AOPA and its members. While AOPA continues to fight for the preservation of its members’ due process rights under the law, the significant delay in assignment of new hearing requests underscores the need to ensure you, as the practitioner, are fully prepared to defend your claim when granted a hearing with an ALJ. This Reimbursement Page will focus on the ALJ process and how best to prepare for a successful outcome. The ALJ hearing is the third level in the formal Medicare appeals process. It follows redetermination, which is performed by the contractor who made the initial determination; and reconsideration, which is performed by a single contractor known as the Qualified Independent Contractor. While redetermination and reconsideration decisions must be based on published policy, the ALJs have significantly more leeway in rendering decisions as they are not strictly bound by policy but rather by the framework of the law. Many claims that have been denied through redetermination and reconsideration are found to be valid and payable by the ALJ because they fall within the Medicare coverage guidelines as described in the Social Security Act.
Preparation Is Key You should begin preparing for a successful ALJ hearing long before the request for or scheduling of the hearing takes place. It should begin during your first encounter with the patient. Anything and everything that occurs from this moment forward may ultimately play a role in determining your success or failure at the ALJ appeal. While it is virtually impossible to understand the impact a decision may have on the outcome of a hearing several years down the road, taking small steps from the beginning to ensure that you have the proper support for your claim may make all the difference when the case is presented to the ALJ. 1. Obtain documentation. The most important thing you can do to prepare for future scrutiny of your claim is to make every effort to secure written documentation from the referring physician that supports the medical need for the orthotic or prosthetic device you are providing. The need for physician documentation is a critical component of the process, and the lack of it is by far the single most common reason why claims are denied, especially at redetermination and reconsideration levels. Obtaining this documentation can be frustrating as it holds you accountable for the actions of others. While there is no sure way to force physicians to document the information that is expected to be in their records, a small bit of
education often goes a long way. If you can provide your referral sources with specific education regarding the Medicare documentation requirements, you often can encourage them to provide you with the proper documentation that will support you through the appeals process, if not help you get your claim paid the first time. 2. Get organized. Another key to proper preparation is organization. The more organized your patient charts are, the less likely it will be for auditor to deny your claim because they could not locate a piece of required documentation. This organization requires coordination between the clinical and administrative staff in your office and can be achieved with proper communication and solid operating procedures. Taking the time to ensure that all of your staff are following consistent protocols regarding clinical and administrative documentation may mean an initial investment in training and education, but will usually pay dividends when you are facing an audit or an appeal. 3. Diligently complete request form. Finally, it is critically important to complete the official CMS Request for Medicare Hearing by an Administrative Law Judge form completely and accurately in order to prevent a delay in the assignment and hearing of your case. A copy of the form may be downloaded from the CMS website at www.cms.gov/Medicare/ CMS-Forms/CMS-Forms/downloads/ cms20034ab.pdf. With current wait times expected to extend beyond two years, an additional delay caused by improper completion of the form can create further strain on your cash flow and, ultimately, your potential for success. While the form is relatively self-explanatory, there are some pointers that will help ensure you are following the correct process and procedures: • It is important to note that, in most cases, the provider is the appellant, not the beneficiary. Since you have
The more concise and organized you are, the better the chance for success will be. If you can provide the judge with a reason to approve your claim, in most cases he or she is more than happy to do so.
accepted financial liability for the claim (unless you have a properly executed Advanced Beneficiary Notice on file), your company is the appellant and should be indicated as such on the form. • The next section contains two checkboxes in which you indicate whether you are requesting an actual hearing or would like the ALJ to make a decision based on the contents of the claim file only. It is always in your best interest to request a hearing, as it provides you with the opportunity to respond to any questions the judge may have regarding the case and gives you the opportunity to tell your side of the story. Declining a hearing will not result in a quicker decision. • The next section contains space for signatures of the appellant and its representative, if one exists. In most cases, you will not be represented by an attorney or other individual, but if you are, you must complete and sign section 1 as the appellant and your chosen representative must complete and sign section 2. • The final section contains a series of questions regarding the claim,
the most confusing of which asks if the beneficiary assigned his or her appeal rights to you as the provider or supplier. The answer to this question is almost always “No.” Since you are the appellant in the majority of these cases, no assignment of appeal rights exists from the beneficiary to the supplier.
What to Expect from the ALJ While you always have the right to request an in-person hearing with an ALJ, travel expenses often make in-person hearings unrealistic. As a result, the majority of ALJ hearings are performed via telephone or video conference. The ALJs are very accustomed to these types of hearings, and requesting an in-person hearing does not typically provide any additional advantage to the provider. It remains your decision, and you may request an in-person hearing if you are more comfortable being in the same room as the ALJ. Regardless of the format of the hearing, it remains a legal proceeding; you will be sworn in and required to attest that your statements represent the truth to the best of your knowledge.
MARCH 2014 O&P Almanac
Taking the time to ensure that all of your staff are following consistent protocols regarding clinical and administrative documentation may mean an initial investment in training and education, but will usually pay dividends when faced with an audit or an appeal.
As previously mentioned, the OMHA has been completely overwhelmed by the increase in ALJ hearing requests as a result of increased Recovery Audit Contractor and other audits. You should, therefore, expect your hearing to be relatively brief and focused primarily on the facts of the case. The ALJs are under tremendous pressure to reduce their docket size and are constantly looking for ways to quickly render equitable rulings. This is where all of your advance preparation comes into play. The more concise and organized you are, the better your chances for success will be. If you can provide the judge with a reason to approve your claim, in most cases he or she is more than happy to do so. While it is important to tell your story, you do not want to waste the judge’s time with anecdotal information that is unrelated to the reason for denial. It is better to focus on the reason for denial and present a strong, factually based argument as to why the claim should not have been denied. Finally, a little respect goes a long way. ALJs remain officers of the court and should be treated with respect and dignity. They should always be addressed as “your honor” unless they instruct you otherwise. It also is important to remember that you are a participant in their courtroom even if you are not physically present. The judge always controls his or her own courtroom, and a sure way to hurt
O&P Almanac MARCH 2014
your chance of a successful outcome is failing to extend the proper respect to the courtroom and the judge. Typically, once you are sworn in, the judge will indicate that he or she has reviewed the case file and ask if there is any relevant information you would like to present. While technically, no new material may be introduced into the claim file after reconsideration, this is your best opportunity to discuss the merits of the case and explain to the judge why you believe the claim should be covered by Medicare. Make sure you speak clearly and concisely and stick to the facts of the case. Since the judge has much more discretion than reviewers at the first two levels of the appeals process, this is a great opportunity to discuss why Medicare should pay for the claim now, as opposed to discussing why it was previously denied. If you present arguments regarding your opinion about earlier appeal decisions, you are simply wasting your time. Remain positive and provide the judge with a reason to approve your claim rather than a reason to deny it. Once you have presented your case, the judge typically will thank you for your testimony, ask any additional questions he or she may have, and then advise you on when you should expect a final ruling. While it is rare that the judge will either rule for or against you in that moment, he or she may give you an indication regarding
the outcome of the case. But do not be discouraged if there is no indication given as every judge is unique. The hearing will then be adjourned and you will receive a written ruling on your case, usually within several weeks. If the judge rules in your favor, instructions will be sent to the Durable Medical Equipment Medicare Administrative Contractor to pay the claim, including any interest that may have accrued on previous recoupment of payments made through the offset of future claims. If the judge does not rule in your favor, you will receive a written explanation as to why the claim remains denied. If you disagree with this ruling, you may continue the appeals process by requesting a review by the Departmental Appeals Board. While the lines to have a case heard before an ALJ continue to deepen, it remains a vital and valuable part of the Medicare appeals process. Failing to exercise your rights as a provider is truly a missed opportunity. a Joe McTernan is AOPA’s director of coding and reimbursement services. Reach him at jmcternan@ aopanet.org.
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Photos: (left, bottom, right) U.S. Army photos by Meghan Portillo/NCO Journal; (middle) courtesy of David Rotter
O&P Almanac MARCH 2014
COVER STORY By CHRISTINE UMBRELL
O&P practitioners share their innovative devices, approaches for atypical patients
The IDEO device, created by Ryan Blanck, CPO, began as a project for one patient in 2009 and, today, has helped relieve pain for hundreds of patients with damaged limbs.
Customization begins with determining the patient’s goals. If O&P doesn’t offer a solution, the practitioner must innovate, keeping in mind functionality and ease of use.
Patients need to understand that not all custom items will be covered by insurance. To ensure reimbursement, all devices should fall within the L-code system.
s an orthotist or prosthetist, there’s a good chance you chose your career because of the unique opportunity this profession provides for you to be hands-on and creative while helping other people. The day-to-day duties of the average practitioner afford you the opportunity to work with patients and decide what devices will help improve their quality of life. But it’s those “special” patients—the atypical ones with truly unique requests—who bring out the most innovation from O&P professionals. Take, for example, Ryan Blanck, CPO. His well-documented invention of the Intrepid Dynamic Exoskeletal Orthosis (IDEO) has alleviated pain for hundreds of military personnel who have damaged limbs as a result of war injuries. Blanck did not set out to change the standard of care in military O&P when he designed the energy-storing device that is often described as a hybrid between an orthosis and a prosthesis. Instead, he was simply working as a practitioner at the Center for the Intrepid (CFI) at Brooke Army
Medical Center in San Antonio, Texas, when he encountered a single patient with a need. The patient had suffered a gunshot wound that caused significant nerve damage, making movement very difficult. He asked Blanck if there was any device that would support his damaged leg and improve his ability to walk and run. “This started as a fun thing to do for a patient, and grew from there,” explains Blanck. He created the first IDEO, which features a fitted cuff and footplate connected by vertical struts. The device stores and then releases energy; the released energy takes the pressure off of the affected parts of the injured leg, relieving pain and enabling movement. Blanck’s first IDEO patient was thrilled to walk pain-free for the first time since his injury, and also was able to run, jump, and sprint. After he built the first IDEO, Blanck and the CFI team began fitting other limb salvage patients with the device. Each IDEO is customdesigned to the patient to focus on the region where the pain is occurring.
Opposite page: Left, bottom, right: Patients and technicians work with the IDEO device. Middle: A patient wears a custom golf prosthesis created by David Rotter.
MARCH 2014 O&P Almanac
children, with a job to return to. If I can help give a person a little hope to return to what he wants to do, then I’ve done my job.”
Turning Wishes Into Reality
Photo: Hanger Clinic
David Rotter, CPO, LPO, C.Ped, also has had the opportunity to design one-of-a-kind componentry for his patients. “I have insatiable ‘tinker-itis,’” admits Rotter, who is clinical director of prosthetics for Scheck and Siress in Chicago.
Photo: U.S. Army, Meghan Portillo, NCO Journal
Blanck with patient and IDEO-user Beth Shaver at the 2014 Hanger Education Fair.
Blanck adjusts Sgt. Tim Crusing’s IDEO.
O&P Almanac MARCH 2014
Since that first patient, nearly 600 veterans and military personnel have been fit with IDEOs. Significantly, half of the IDEO patients at CFI have been able to return to active duty, and many have avoided amputation because of the device. Last September, Blanck left CFI to join the Hanger Clinic team at the Tacoma patient-care facility in Washington. His IDEO technology is now available to the civilian population, and Blanck serves as the national IDEO program director. Nonmilitary patients are being fit with the IDEO, and Blanck and the Hanger team are conducting research to validate the device’s success, which supplements the research conducted at CFI on the device. As Blanck sets out to expand the Hanger IDEO program and treats a new demographic of O&P patients, he recalls the simple reason he was inspired to become an inventor: “It’s the person tied to the device,” he says. “It’s the person, with a life, with
“It’s the person tied to the device. It’s the person, with a life, with children, with a job to return to. If I can help give a person a little hope to return to what he wants to do, then I’ve done my job.” —Ryan Blanck, CPO One of Rotter’s recent cases involved designing a custom golf prosthesis for a patient in his 60s who had become a quadra-amputee as a result of septic shock. Though he had lost both legs below the knee, one arm below the elbow, and part of the other hand, the patient—a passionate golfer before his illness—came to Rotter requesting a “meaningful golf swing.” That seemingly simple request triggered the inventor in Rotter. “First, you’re presented with a challenge. You look at what’s commercially available, and if that won’t work, the creative process begins,” says Rotter. The first step is to define the patient’s goal—in this case, to play golf. Then you determine how you can achieve that goal with O&P. “You ask, how does a proper golf swing work? And how can I create something that he can use, but also be able to don and doff himself?” explains Rotter.
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Photos: Alan Dolecki
Rotter’s patient using his custom golfing prosthesis.
To solve this particular problem, Rotter took a molding of a golf handle. Then he went to one of his favorite spots for inspiration—Home Depot. There, he wandered the aisles until he found part of the solution: caster wheels. “I took a caster from a wheel that goes on a swivel chair and used it on the patient’s below-elbow side to work as a universal joint.” The process took some trial-anderror, but the final product enables the patient to play golf, a win-win for prosthetist and patient: “When someone’s passionate about something, it’s great when you can give it back to them,” says Rotter.
Rotter has used that same creative process to design a number of one-ofa-kind devices, such as a prosthetic jaw for the late Roger Ebert, the movie critic who suffered from cancers of the thyroid and salivary gland.
Photo courtesy of Robert Kuenzi
Never Taking ‘No’ for an Answer
Kuenzi (left) poses with his patient Eduard Lychik.
O&P Almanac MARCH 2014
Robert Kuenzi, MS, CP, is another example of a prosthetist who has risen to the challenge of helping patients realize their dreams. In 2012 Kuenzi, who works at CFI and was a co-worker of Blanck, encountered a military patient named Eduard Lychik who wanted to run again. The problem? He was a hip disarticulation patient, having lost his entire left leg after being hit with a recoilless rifle in Afghanistan. To Kuenzi’s knowledge, no one with Lychik’s type of amputation had ever been able to run with a prosthesis. “Fitting him to be able to walk was very straight-up, but for a hip disarticulation patient, getting to run had not really been done successfully,” Kuenzi recalls. And not only did Lychik want to run; he wanted to run trails, participate in marathons, and compete in extreme events such as Tough Mudders, which required crawling through mud and getting wet. Eight months after Lychik mastered his walking prosthesis, he started pressing Kuenzi to make him a device suitable for running. “My first inclination was to put him off,” recalls
Kuenzi. “But he was very persuasive, so I started to think of ways to make it work.” Kuenzi considered the desired end result and surveyed the available componentry. For the most part, he was able to use commercially available devices to achieve the final goal. The device had to be strong enough to take the impact of running for several hours, but also have a comfortable interface with the body. And since the prosthesis would get wet, electronic options were automatically ruled out. Kuenzi came up with four different configurations of prostheses that might work, and developed parameters to use when Lychik tested the various conditions at the CFI’s Gait Lab. Through trial-and-error, and using the Gait Lab data and Lychik’s personal feedback, one design stood out.
“First, you’re presented with a challenge. You look at what’s commercially available, and if that won’t work, the creative process begins.” —David Rotter, CPO, LPO, C.Ped The result is a simple prosthesis with no moving joints, according to Kuenzi—“a pylon attached to a socket and a running foot.” The device features a Flex-Run foot for shock-absorbing and springback, and incorporates a shock absorber in the upper part of the leg, which allows torsion. Urethane gel cushions the support area on the bottom of the socket, to help absorb shear and impact. In addition, Kuenzi added an old-fashioned shoulder harness with a strap to help suspend the prosthesis, which is adjustable so Lychik can move it to re-distribute his weight during long runs.
success was his strong work ethic in rehab.” Kuenzi also believes the device he fashioned for Lychik could be useful to bone cancer patients, who often end up as hip-disarticulation amputees and are generally teenagers or young adults with strong remaining bodies. Photo courtesy of the U.S. Air Force, 59th Medical Wing
Since receiving his prosthesis, Lychik has competed in the Austin Marathon and a Tough Mudder, and has traveled to several national parks to hike tough trails. Kuenzi attributes some of Lychik’s success to his nevergive-up attitude. “He was an extreme case,” Kuenzi says. “The key to his
Where Innovation Is the Norm: O&P in Canada Canadian orthotist Cheryl Lewis, CO(c), says O&P professionals in her country are forced to be innovators. In Canada, O&P treatment qualifies as home care, which is provided by each province to all citizens. As an orthotist practicing within Ontario, “I have to provide everything on-site and in-house; I have to be involved in everything,” Lewis explains. The government provides a fee scale and reimburses practitioners for each device, minus a 25 percent co-pay.
Lychick poses wearing his custom prosthesis created by Kuenzi.
This requirement inevitably fosters creativity. In one striking example of a truly creative solution,
Roadblocks to the Creative Process
Lewis was faced with a diabetic patient, a farmer who had ignored an infection and ended up with pseudarthrosis. Eventually, he lost integrity in the ankle. “The medial malleolus and distal part of the tibia had been eaten away by osteomyelitis secondary to diabetic neuropathy, the foot shifted medially and then would invert 90 degrees (freely) when he would bear weight,” recalls Lewis. She looked for a solution to immobilize the foot and load up the calf muscle. “I couldn’t just put him in a brace; I had to add a large triangular wedge to keep his foot from folding up,” says Lewis. “On top of it, his heel was 6-inches wide, so I had to split a shoe longitudinally, fit it into a football shape, and use resin to lock the shoe into place again.” She put his whole foot into a leather lacer. “The black foam wedge was molded first on the cast and then the horsehide was wrapped around it, making a solid cylinder. Then the plastic reinforcement was molded/trimmed/glued, and the russet was molded over everything.” Lewis added eyelets and lace hooks to make it easy for the patient to don. The result? The pseudarthrosis began to heal had not been a surgical candidate before Lewis’ treatment, a doctor has now agreed to put a rod in the patient’s leg to stabilize his joint. Photos of the fabrication and fitting of Lewis’ device for a diabetic patient with pseudarthrosis. 26
O&P Almanac MARCH 2014
Photos courtesy of Cheryl Lewis
and his distal joints tightened up. And whereas he
Managing patient expectations is one of the most challenging aspects of creating a one-of-a-kind device, according to Rotter, Blanck, and Kuenzi. “Patients need to understand they have to have patience, and understand that some things may not work,” explains Rotter. What’s more, it’s important that patients understand that some parts may not be billable to insurance. For that reason, practitioners try to ensure their devices fall within the L-code system. And in many cases, a code will apply. For example, there is an L-code for a recreational device, which applies to the golf prosthesis Rotter designed, and there is a code for protective covers. However, there are times when a specific device cannot be built appropriately within the L-code parameters. “Sometimes innovation gets ahead of the pay source,” explains Blanck. It takes both commitment and patience to persevere and continue to innovate before new devices are recognized within the national payment system. a Christine Umbrell is a contributing writer to O&P Almanac. Reach her at email@example.com.
By Adam Stone
Family The right way to hire, fire, and maintain a fair balance in family businesses
O&P Almanac MARCH 2014
Family hires should read and sign a disclosure up front that clearly spells out all duties, policies, and procedures so they understand what’s expected of them.
Set ground rules for “talking shop” outside the office to avoid every family gathering turning into a chance to replay workday events.
If you have to fire someone, follow your procedures to the letter and take every appropriate measure the law will require.
s a third-generation O&P practitioner, Will Graybeal, CPO, understands what it means to hire family. He spent seven years working for his uncle in another practice before his dad hired him into Bristol Orthotics & Prosthetics in Bristol, Tennessee. He says that’s the way it should be done. “I have two boys that are probably eight to 10 years away from looking for a job. They might work here when they are teenagers, but I am not sure I would want them to do that,” he says. “I would rather have them go somewhere else first, see how someone else does it, and learn it a little differently.” That’s one way to do it, but it’s not the only way. In an industry rich in family-owned practices, hiring relatives can be a tricky business. Family members may have different expectations than “ordinary” employees. The boss may not know how to set the stage for the next generation to succeed. Business strategists and O&P practitioners alike say it takes a deft hand to make a family hire that both helps the business and keeps the family intact.
founded in 1948 by Robert’s father Paul, he also hoped to minimize the potential for sibling conflict. To this end, he hired his offspring into different positions. Son Jim, with his master’s degree, has handled the business end of the practice for over two years; son Greg, a certified orthotist and prosthetist, came aboard eight years ago in a clinical role. Robert’s wife Rosie manages the front office.
“Make [all new hires] aware of all policies and procedures, including the disciplinary process. Then anytime their behaviors fall outside those expectations,
John Lund, Blend Images, Getty Images
you have to start the
Give a Fair Shot At Arkansas-based Snell Prosthetic & Orthotic Laboratory, Clint Snell, CPO, decided early on that the best way to bring his kids on board would be to give them all an equal shot. Founded in 1911 by Clint’s grandfather R.D. “Pop” Snell, the facility has already been passed to Clint’s father Jim Snell, who in turn passed it on to his son. Clint was determined to see the family tradition continue, but he wanted to do it in a way that gave all three of his kids a fair bite at the apple. “I had all the kids helping out some during their teen years. I exposed them to the family business and tried to make it a positive exposure,” he says.
As things shook out, two of the younger Snells opted to follow other paths. “In the end, they just didn’t have much interest in the business,” he says. Son Christopher joined the 30-person practice in 2007, having already expressed an interest while in college. Snell’s thinking: If everyone got equal exposure, no one would be jealous at the outcomes.
Spread Out the Talent For Robert Leimkuehler of Ohio-based Leimkuehler Inc., hiring family has been an exercise in thoughtful human resources (HR) strategy. While he hoped his sons would join the family enterprise,
disciplinary process.” —Nathan R. Mitchell
“If you have one family member who has been there a while and then another family member comes, is there going to be an issue? Maybe there could be some jealousy to that,” Leimkuehler says. “In our case, since one son is doing the business end and the other is doing the patient care, there isn’t that overlap.” Leimkuehler says he is satisfied that his hiring strategy has played out so well. Equally important: He’s glad to have brought on his sons early in their careers. “I am trying to take on the role of teaching them all the things I think they need to learn before I decide to retire,” he says. “That can be a very long process.”
Potential Peril Even with such sound tactics in play, there’s a lot that can go wrong when hiring family. Relatives outside
MARCH 2014 O&P Almanac
Photo: Snell Prosthetic & Orthotic Laboratory
the business may resent not getting what they perceive to be “their share.” Siblings may quarrel over duties, responsibilities, or the division of income. Other employees may feel that family members are brought on unfairly, perhaps hired at a higher level than someone who has been working up the ladder. Family members may come on board with mistaken notions as to their role: No one tells them they must abide by the same rules as other employees. Many of these problems can be avoided if appropriate measures are taken at the time of hiring.
“When you are hiring for any position, it is a question of what is your whole philosophy of care and service. If you hire someone from your family, he or she needs to fit in with what you need as an organization. It should have nothing to do with being a family member.” —Arlene Vernon Management consultant Debra Benton recommends getting an outsider’s input before hiring family. As the business owner, you might ask your CPA to conduct an informal interview, or bring in a professional from an outside recruiting firm to assess the fit. That objective stance can help ensure you aren’t clouded by family bias. It also is crucial to make sure the son or daughter understands the rules of the road up front. Too often a practitioner will take it for granted that
O&P Almanac MARCH 2014
Left to right: Clint Snell, CPO; Gene Arant, CO, (prior to his retirement after 50 years with the company); and Christopher Snell of Snell Prosthetic & Orthotic Laboratory.
family members simply understand how the business works, yet those same family members may have a very different version of what is expected of them, and what they deserve. A disclosure up front—which the new hire ought to read and sign—will spell out duties, policies, and procedures, just as it would for any other employee. The guiding principle behind this document: money. It may sound crass to some, but this is business after all, and everyone involved should be thinking about what’s best for the business. This can get messy in a family enterprise, where priorities such as loyalty and birthright may cloud the issue. That’s why it is doubly important that everyone understands and agrees up front that this is a commercial enterprise and must be treated as such. “The biggest mistake people make in a family business is to decide that ‘this is my brother’s wife’s cousin,’ and then commit themselves based on that,” says Arlene Vernon, business strategist and president of HRx Inc. in Minneapolis.
“When you are hiring for any position, it is a question of what is your whole philosophy of care and service. If you hire someone from your family, he or she needs to fit in with what you need as an organization. It should have nothing to do with being a family member,” Vernon says.
Setting the Stage Even supposing family members all have their priorities straight, another hurdle remains. Rank and file employees who may be loyal to the boss and devoted to the practice still may have reservations about a perceived favorite stepping in. In order for family hiring to go smoothly, those concerns must be thoroughly allayed. For Snell, this meant asking son Christopher to prove his stripes before taking his place on the team. “I started with him doing technical work, doing odd jobs around the office when he was in high school,” Snell says. “By doing that, he made an obvious positive contribution to the company.”
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Photo: Leimkuehler Inc.
It also helps to set the hiring in a positive light for existing employees. A new generation may represent continuity in a practice where a senior member is nearing retirement age, for example, in which case the new hire may come as a relief. “For the rest of the staff, they can see this as a continuation of the business,” says Leimkuehler. “By bringing family on board it is implied that someone close will be taking on these responsibilities. They know the business isn’t going to be sold to some outside entity.”
Keeping Work at Work Everyone brings work home to some degree. You do a little paperwork, decompress with the spouse. But with a family hire it can be difficult to put a stop to the shop talk. Left unchecked, every family gathering becomes an occasion to replay the events of the day or lay out business plans. Put a stop to this kind of trouble before it even begins—talk it through at the time of hiring. Will there be no shop talk outside the office? Some agree to limit conversation only to pressing matters, while some establish a safe word: When someone says “Enough,” the topic needs to change.
Left to right: Robert Leimkuehler, CPO/L, owner Leimkuehler Inc; Rosie Leimkuehler, vice president; Jim Leimkuehler, business manager; Greg Leimkuehler, CPO/L.
Others find a middle ground. They may agree, for instance, that a little business at the communal dinner table is acceptable, assuming others are included. If you must discuss the practice, be sure to give spouses and others some insight into what is being discussed and why it is important.
Cutting Them Loose No matter how deftly a hiring is managed, there may come a time when a son or daughter, cousin or nephew, has to be let go. It’s one of the
Laying the Groundwork For practitioners looking to hire family members, the smartest thing to do is be clear about the ground rules. Here are three tips to help you stay on track from the U.S. Small Business Administration:
Develop and communicate a clear business plan and mission. This gets everyone on the same page. Establish a clear chain of command and lines of authority for decision making. If a family member does not have a role to play in the decision making hierarchy, make sure he or she is aware of this and give that individual structure in his or her role in the business.
Communicate clearly and often with family and non-family members. Not only does this help avoid confusion, it also gives you a holistic view across your business and nips any emotion or potential “blame-games” in the bud.
O&P Almanac MARCH 2014
hardest aspects of family HR: how to fire a relative without destroying the family dynamic? To ease the possible pain, lay out the rules up front. “Make [all new hires] aware of all policies and procedures, including the disciplinary process. Then anytime their behaviors fall outside those expectations, you have to start the disciplinary process,” says Nathan R. Mitchell, founder of the leadership development company Clutch Consulting in Tulsa, Oklahoma. If you have to fire someone, make sure you have your legal ducks in a row. Follow your procedures to the letter and take every appropriate measure the law will require. Worse than a family firing: a family lawsuit for unjust termination. Finally, be prepared to draw the line with members of the extended clan. If you fire someone’s son or sibling, there is a fair chance you will be peppered with questions and possibly criticisms. When it happens, just say “no.” First of all, that information is confidential between you and the employee. Further, there’s a fair chance you will be breaching someone’s legal right to privacy by discussing such matters outside the workplace. a Adam Stone is a contributing writer to O&P Almanac. Reach him at adam. firstname.lastname@example.org.
Ask the Expert By Devon Bernard, AOPA government affairs department
Delivery Concerns Answers to some of the most common questions regarding proof of delivery requirements
AOPA’s reimbursement staff fields hundreds of questions each month regarding how to properly code and bill for O&P services. While the questions vary in their complexity and depth, several questions are asked repeatedly by different folks across the country. This month’s Ask the Expert will highlight a few of these common questions.
Can someone else besides the patient sign the proof of delivery form/slip?
Yes. A designee or someone acting on behalf of the patient may sign the proof of delivery. This designee may be a relative, a power of attorney, or even a floor nurse on duty at a facility. The only person who may not act as a designee for a patient is anyone who may have a vested financial interest in the delivery of the item, for example, you or anyone on your staff. If someone else besides the patient is going to sign the proof of delivery, it is a good idea to document who signed on behalf of the patient, what his or her relationship to the patient is, and why the patient was unable to sign. You also will want to make sure that the designee’s name is clearly listed on the proof of delivery.
What information should be included on the proof of delivery?
There are five or six key parts of a proof of delivery slip/ form, depending on whether you are
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delivering the item to the patient in person or if you are delivering the item via a delivery service, such as UPS, FedEx, US Mail, and others. If you are delivering the item directly to the patient, your proof of delivery form/slip must contain (at a minimum): • patient’s name • delivery address • description of the item(s) (name, model number, or a narrative description) being delivered, including quantities • date the item(s) were delivered • patient’s signature and date they signed. If you are delivering the item using a delivery/shipping service, your proof of delivery documentation must contain (at a minimum): • patient’s name • delivery address • delivery/shipping services’ tracking number, or other reference number. • description of the item(s) (name, model number, or a narrative description) being delivered, including quantities • delivery date/date of service • evidence of delivery.
What is your date of service when you are using a delivery service?
The delivery address on the proof of delivery should match the address of where the item was actually delivered.
That date of service is not the date the patient receives the item or the date the patient signs for the item or the date the shipping/delivery service delivers the item to the patient. Your date of service will be the date that you mail the item(s) to the patient. When the item is delivered to the patient you would use the record of the delivery from the shipping/delivery company as your evidence of delivery to meet the requirements addressed above.
Does the patient have to physically date the proof of delivery form or is an electronic date sufficient?
According to Medicare guidelines, an electronic signature is sufficient. So, if the patient signed and dated the proof of delivery digitally or electronically then the
Ask the Expert
criterion has been met and the proof of delivery should be considered valid.
What address should be listed as the delivery address on our delivery slip/form?
The delivery address should not automatically be the patient’s home address—even if that is the place of service—or your office’s address. The delivery address on the proof of delivery should match the address of where the item was actually delivered. So, if you delivered the item in your office, then the delivery address will be your office address. If you delivered the item to a patient in a physician’s office or facility (hospital,
skilled nursing facility, etc.), then your delivery address should be the address of the physician’s office or the address of the facility. If you have any more questions about proof of delivery slips/forms, you may contact AOPA, or review chapters 4 and 5 of the Medicare Program Integrity Manual, which can be found at www.cms.gov/Manuals/IOM/list.asp. a
Devon Bernard is assistant director of coding reimbursement, programming, and education for AOPA. Reach him at dbernard@ AOPAnet.org.
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Visit AOPA at www.AOPAnet.org.
Manufacturers: Get your products in front of AOPA members! Contact Joe McTernan at jmcternan@AOPAnet.org or 571/431-0811.
MARCH 2014 O&P Almanac
Facility Spotlight By Deborah Conn
Support for All
Arizona AFO Vice President Don Pierson, CO, C.Ped, (left) with Lab Manager George Garcia.
T Facility: Arizona AFO Inc. Location: Mesa, Arizona Owner: Orthotic Holdings Inc. History: 10 years in business
O&P Almanac MARCH 2014
rue to a common American origin story (see Amazon, Disney, Mattel), Arizona AFO Inc., got its start in a garage. This one, in Mesa, Arizona, belonged to certified pedorthist Ernesto Castro, who developed an ankle-foot orthosis (AFO) for posterior tibial tendon dysfunction and patented it under the name Arizona AFO. By 2003, Arizona AFO had 12 full-time employees and moved into more professional quarters. Castro also owned a retail shoe store and brought in Don Pierson, CO, C.Ped, to run the AFO business. Today, the company occupies a 30,000-square-foot facility that is ABC-accredited and employs 60 full-time employees. Two years ago, Castro sold the business to Orthotics Holdings Inc.
Photo: Arizona AFO
Arizona AFO has made a name for itself with well-known product lines and support services Pierson continues as vice president of Arizona AFO, leading a team of three ABC-certified orthotic technicians and another certified pedorthist. He is a believer in continuing education, and the company actively encourages other technicians to seek certification. “We believe it’s important for them to have it,” he says. The Arizona AFO, a plastic AFO covered with leather, is “clinically proven to be 90 percent effective at treating [posterior tibial tendon dysfunction] (PTTD),” says Pierson. While it is by far the company’s most popular device, Arizona AFO also produces a full line of plastic AFOs. Among its newer products is the Moore Balance Brace (MBB). The MBB can be an effective treatment for patients who have an increased fall risk due to a variety of pathologies. Most practitioners prescribe the MBB bilaterally and their patients report that it fits comfortably into a wide range of footwear. Coupled with strength training and fall-prevention programs, the MBB helps patients maintain balance and stability during walking. To further support a fall prevention program, Arizona AFO provides a free “Balance Management Suite” that includes marketing materials, samples of its devices, assessment forms, and published research references. The ScanCast 3D system, which creates three-dimensional color images of the plantar surface of a patient’s foot, is available to all Arizona AFO customers. The system uses two cameras and lasers that
The ScanCast 3D system, which creates three-dimensional color images of the plantar surface of a patient’s foot, is available to all Arizona AFO customers. create clear images of the heel and the margins of the foot and allows practitioners to annotate the images to indicate the locations of pads, cut-outs, and other modifications. “The scanner transmits the images to our facility, where we can fabricate any type of accommodative or functional foot orthosis,” explains Pierson. A health-care practitioner may lease or purchase the system, or, with sufficient business, may use it at no charge. Pierson and George Garcia, a certified technician, are available to offer technical advice over the phone. “With today’s smart phones, a practitioner can shoot a short video of a patient and send it to me and we can talk about which device might work best.” Over the years, Arizona AFO has invested in its computer-aided design and manufacturing capabilities, using four Vorum carving machines, Canfit orthotics design software, and four technicians to digitally modify casts. “By eliminating a lot of hand modifying, we are able to produce a higher volume of devices with greater accuracy,” says Pierson.
“The vast majority of our products have assigned L-codes,” he says, and Arizona AFO has assigned Pricing, Data Analysis and Coding contractors to assist with securing new Medicare reimbursement codes. “We want to provide support to practitioners who may be struggling with reimbursement.” Arizona AFO markets its products through advertising in trade publications and appearances at all major trade shows. It has four regional sales representatives and offers educational webinars and online and in-person workshops. “Things are going very well,” he says. “The company has grown every year. We put practitioners and their patients first, and we work hard to maintain quality and turnaround time.” a
As a practitioner, Pierson is well aware of the importance of reimbursement to O&P facilities.
Deborah Conn is a contributing writer to O&P Almanac. Reach her at debconn@ cox.net.
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MARCH 2014 O&P Almanac
AOPA WORKING FOR YOU
Mark Your Calendars for the
2014 AOPA Policy Forum New programming brings even more value to this powerful advocacy event
hen you travel to Washington, D.C., April 2-4, for the 2014 AOPA Policy Forum, you will not only be briefed on all the issues facing you and the O&P community but you also will be given new tools to make a difference and send a message to the legislators that you, your employees, and your patients elected to represent you. You will receive special training via a mock Congressional visit to help make your advocacy efforts more effective. You also will have opportunities to
The Policy Forum offers a big payback for AOPA members because educating the legislative branch about O&P increases awareness that can lead to more positive legislative and regulatory outcomes. attend extended “how to” special programs covering the most pressing business issues, research, FDA rules, new payment codes, and policies on OTS orthotics; as well as how you can better understand and cope with the Affordable Care Act (ACA), audit challenges, the appeals process, and a primer about suing the Medicare program. You will learn how money 38
O&P Almanac MARCH 2014
makes its way out of Washington for research, education, and other programs that can benefit O&P and your business. The 2014 AOPA Policy Forum’s main event kicks off on April 2 at 11 a.m., with a meeting with state representatives, followed by extensive advocacy updates on the pressing issues, capped off by a networking reception and dinner that evening. The traditional second day Hill visit final preparation breakfast includes the mock Congressional visit training,
Left to right: Rep. Henry Waxman (D-California), Maynard Carkhuff, Kel Bergmann, and Tom Kirk, PhD
followed by your appointments on the Hill. That evening, from 5-8 p.m., a new program offers a session on the O&P research and education funding mysteries of Washington that will affect you, your patients, and your reimbursements—followed by segments on future impacts of acutecare organizations, diagnosis-related groups, post-acute care bundling, and
AOPA WORKING FOR YOU
Left to right: Mike Hamontree, former Senator Bob Dole (R-Kansas), and Brad Ruhl.
CMS’s Center for Innovation. There also will be a primer about suing the Medicare program. The bottom line-oriented third day program, on April 4 from 8:30 a.m. to 1 p.m., will provide members with the latest tools on how to avoid problems with FDA compliance, coding, audits, plus coping with the appeals process. This segment will include the pitfalls and possible catch-22 of using those separate codes for the 23 orthotic device codes CMS has exploded into custom fit and off-the-shelf. Most importantly, you will learn how to avoid being a witness against yourself if you fail to use the new codes properly. The Policy Forum offers a big payback for AOPA members because educating the legislative branch about O&P increases awareness that can lead to more positive legislative and regulatory outcomes. The pressing need for more understanding on the part of Congress about the devastating Recovery Audit Contractor (RAC) audits; the painful, protracted appeals process; and the unlawful actions of CMS should be reason enough to attend. But today’s world runs on how much we can do on the same dime. In this case, for another night’s stay in Washington, D.C., you can reap additional knowledge that will further prepare you and your business to cope with today’s—and tomorrow’s— perilous landscape for O&P and other health-care providers. Several of O&P’s recent legislative successes may not have happened 40
O&P Almanac MARCH 2014
AOPA’s Tom Fise presenting an award to Rep. Glenn Thompson (R-Pennsylvania).
One of the best ways you can help your bottom line in 2014 is to book your reservations today to join us at the 2014 AOPA Policy Forum. without the boots-on-the-ground advocacy of AOPA members at the Policy Forum. Most recent was the inclusion of O&P research funding language from AOPA’s Wounded Warrior Research Enhancement Act (S 521), introduced by Sen. Dick Durbin (D-Illinois) and then incorporated by him into the Defense Appropriations bill, which was signed into law by President Obama on Jan. 17, 2013. That was followed within days by news that Durbin also had been successful in including language from the Wounded Warrior Workforce Education Act (S 522), another $10 million in funding in the Senate version of the VA Appropriations bill for expanding and creating O&P masters degree-level education opportunities. These successes follow
Rep. Tammy Duckworth (D-Illinois) speaking at the 2013 Policy Forum.
AOPA’s victory last year in securing an exemption from the ACA’s 2.3 percent excise tax that applied to most O&P medical devices—saving providers, suppliers, and patients more than $100 million per year. But we still have so much work to do. You need to continue the drumbeat on how the RAC audits are causing havoc for you and your patients; how CMS may be breaking the law in how it is classifying certain orthotic devices (seemingly in preparation for including them in competitive bidding); and how important it is for Congress to pass the Medicare O&P Improvement Act (HR 3112) to curb fraud and abuse, the Insurance Fairness for Amputees Act (HR 3020), and the Insured and Amputee Veterans Bill of Rights (HR 3408). Congress needs to know that it may be two years or more before an Administrative Law Judge can schedule your appeal hearing, despite the fact that the law requires a 90-day window for final determination. Congress needs to know something is terribly wrong at CMS and how it is hurting amputees and limbimpaired patients. One of the best ways you can help your bottom line in 2014 is to book your reservations today to join us at the 2014 AOPA Policy Forum and the extended, big-bang-for-yourbuck business/clinical education programming, April 2-4, at the Renaissance Hotel in Washington, D.C., just minutes away from Capitol Hill and all the wonders of your nation’s capital. a
Get the AOPAversity Advantage!
Distance Learning Opportunities Through AOPA
O&P ALMANAC Because of the highly PER MODULE educational content of the O&P Almanac’s Reimbursement Page and Compliance Corner, O&P Almanac readers can now earn two business continuing education (CE) credits each time they read these articles and pass the accompanying quiz. EARN CREDITS
IT’S EASY AND IT’S FREE!
Read and learn from O&P Almanac’s monthly reimbursement column and quarterly compliance corner—you will now not only gain knowledge, but also can earn CE credits by taking a short quiz and receiving a passing grade of 80 percent or higher. AOPA will automatically transmit the information to the certifying boards on a quarterly basis. The print version of the O&P Almanac is delivered to all AOPA members, ABC certified practitioners, BOC certified practitioners as well as subscribers. Additionally the electronic version of O&P Almanac is available online at www.aopanet.org/publications/digital-edition/. Learn more at: www.aopanet.org/publications/op-almanac-magazine/
VIDEO LEARNING LIBRARY EARN UP TO
Series 2> Practice Management: O&P Administration Services contains three modules, including topics such as Establishing an O&P Practice, Acquiring an existing O&P Practice, and Enrolling in Medicare and Medicaid.
During these one-hour sesPER CONFERENCE sions, AOPA experts provide the most up-todate information on a specific topic. Perfect for the entire staff—one fee per conference, for all staff at your company location ($99 Member/$199 Non-Member). A great teambuilding, money-saving, educational experience! Sign up for the entire series and get two conferences FREE. Entire Series ($990 Members/$1,990 Non-Members). The fee is per location and there is no limit on the number of staff you can assemble in one location.
AOPA’s video learning library PER VIDEO offers many different types of high-level education—clinical, business, motivational, and more. Many of the videos have been approved for CE credits. After viewing the educational video in its entirety, complete and submit the quiz continuing education (CE) credits. AOPA will automatically transmit the information to the certifying boards on a quarterly basis for those with passing grades of 80 percent or higher. Those not passing the quiz will be notified.
Learn more at: www.aopanet.org/education/ webcasts/
Learn more at: www.aopanet.org/education/ audio-conferences/
Peruse the complete library at: www.aopanetonline.org/education
1.5 CE PER MODULE
AOPA offers two webcast series:
Series 1> Mastering Medicare: Coding & Billing Basics and Principles contains nine modules is a recommended prerequisite to the Advanced Coding and Billing Techniques Seminar.
AOPAversity is your one-stop resource for quality O&P education, developed explicitly for orthotic, prosthetic and pedorthic professionals. Most education has been approved for continuing education (CE) Credits. Learn on your terms with one of our opportunities listed above! Earn CE credits accepted by certifying boards:
Visit www.AOPAnetonline.org/education today!
Action Needed: Senate To Vote on O&P Master’s Expansion Resources AOPA is pleased that S 1852, a comprehensive veterans’ bill, may be scheduled for debate. The bill would authorize the Veterans Administration to provide $10 million to create new accredited master’s degree programs in O&P or to expand existing O&P programs. With substantial numbers of experienced clinicians eligible for retirement, we must expand the pipeline of graduates with the master’s degrees that are now required for entry-level clinical positions. It is vital that senators understand the importance of this section before they vote on the bill, and that representatives agree to these provisions in subsequent House/Senate negotiations. Ask your members of Congress to support expansion of advanced education in O&P. Go to http://bit.ly/OPmastereducation and send a letter to Congress to support S 1852.
AOPA’s 2014 Coding Products Are Available in the Bookstore Pre-Order Your 2014 Coding Products 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.
2014 Coding Pro The Coding Pro is O&P’s comprehensive guide to Medicare codes, reimbursement, and medical policies. This is the singlesource 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.
O&P Almanac MARCH 2014
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, longlasting, 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 (Single-User CD Software), and the 2014 Quick Coder.
Go to the AOPA Bookstore and order your Coding Products today; visit http://bit.ly/BookStoreAOPA.
O&P Almanac Magazine—
Read the O&P Almanac and Earn CE Credits!
Don’t Miss an Issue!
E! QUIZ M
Because of the highly educational content of the O&P Almanac’s Reimbursement Page and Compliance Corner columns, O&P Earn Almanac readers can now earn two business Business CE continuing education (CE) credits each time Credits you read the content and pass the accompaEasy & free! nying 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 www.aopanet.org/publications/digital-edition/. Find the archive at http://issuu.com/americanoandp. The January 2014 quizzes are located at: https://aopa.wufoo.com/forms/op-almanac-jan-2014-reimbusement-page/ and https://aopa.wufoo.com/forms/op-almanac-jan-2014-compliance-corner/. The February 2014 quiz is located at: https://aopa.wufoo.com/forms/ op-almanac-feb-2014-reimbursement-page/. And be sure to read the Reimbursement Page article in this issue and take the March 2014 quiz by scanning the QR code on the right, located at https://aopa.wufoo. com/forms/op-almanac-mar-2014-reimbursement-page/.
If you aren’t receiving and reading AOPA’s official magazine every month, you don’t know what you’re missing. The O&P Almanac is the most respected source for industry insight and association news in the O&P industry. Featured topics include emerging technologies, coding and reimbursement education, premier meetings, people and businesses in the news, and industry modernization. As a member of AOPA, or a credentialed practitioner with ABC or BOC, you receive a print copy of the O&P Almanac monthly. Your print issue features all of the latest O&P news, regular departments, and special features on hot topics. A digital version of each issue also is available on AOPA’s website at www.aopanet.org under “Publications.” If you are not a member of AOPA, or a credentialed practitioner with ABC or BOC, you may purchase an annual subscription of the O&P Almanac at AOPA’s Online Bookstore, www.aopanetonline.org/store.
New Business Education Programs for 21st Century Entrepreneurs:
Survive and Thrive—Bottom-line, profit-oriented business programs for O&P If 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 CE credits at the same time. Learn more about each session by visiting www.aopanet.org/Need%20CE%20Credits%20 Promo.pdf. AOPA members just $59 per session ($99 per session for nonmembers), and the 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. Contact Betty Leppin at bleppin@AOPAnet. org or 571/431-0876 with any questions.
MARCH 2014 O&P Almanac
Register Today: 2014 AOPA Audio Conferences Available Mark your calendar now for the audio conferences in 2014. AOPA has confirmed the dates and topics for its 2014 series of audio conferences. Educate yourself and your staff during one-hour sessions in the comfort of your office on the second Wednesday of each month at 1:00 p.m. EDT. This series provides an outstanding opportunity for you and your staff to stay abreast of the latest hot topics in O&P, as well as gain clarification and ask questions.
Buy the Series and Get Two FREE! Visit the AOPA website, buy the series, and get two audio conferences free. AOPA members pay $990 to participate in all 12 sessions (nonmembers pay $1,990). If you purchase the entire year’s worth of conferences, all conferences from the months prior to your purchase of the set will be sent to you in the form of an MP3. Individual seminars are priced at just $99 per line for members ($199 for nonmembers).
Register online at http://bit.ly/aopa2014audio. Questions? Contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876.
2014 Topics • March 12: The ABCs of Audits: What to Expect and How to Respond • April 9: How To Use Advanced Beneficiary Notices (ABNs) Effectively • May 14: Modifiers: How and When to Use Them • June 11: The Self-Audit: A Useful Tool • July 9: The OIG: Who Are They and Why Are They Important? • August 13: AFO/KAFO Policy: Understanding the Rules • September 10: Urban Legends in O&P: What To Believe • October 8: Medicare Enrollment, Revalidation, and Participation • November 12: Gifts: Showing Appreciation Without Violating the Law • December 10: New Codes and Changes for 2015
The ABC’s of Audits: What To Expect and How To Respond Join the Audio Conference March 12 Join AOPA on March 12 for an AOPAversity Mastering Medicare Audio Conference that will focus on meeting new Medicare supplier standards and why it’s an important part of your business operation. An AOPA expert will address the following issues during the audio conference. Audits have arrived and they are here to stay. An auditor’s job is to seek out questionable Medicare payments made in the past and recoup as much money for the Medicare program as they can. But where did they come from? How do they work? To answer these questions and many more, including how to prepare for an audit, attend the audio conference. • Learn who is auditing your claims and why • How do audits work
O&P Almanac MARCH 2014
• What restrictions do the auditors have • How to identify potential problems • How to handle an audit (documentation, timely responses, etc.) The cost of participating is always just $99 for AOPA members ($199 for nonmembers) and any number of employees may listen on a given line. Listeners can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Register online at http://bit.ly/aopa2014audio. Contact Betty Leppin at bleppin@ AOPAnet.org or 571/431-0876 with registration questions.
How to Use Advanced Beneficiary Notices (ABNs) Effectively Join the Audio Conference April 9 The Advanced Beneficiary Notice (ABN) is a useful tool when used properly. Used incorrectly, it can result in unnecessary financial liability to providers. Join AOPA April 9, 2014, for an AOPAversity Mastering Medicare Audio Conference that will focus on how to use ABNs successfully, and why it’s an important part of your business operation. The following topics will be covered: • When an ABN is required and when it is not • Properly executing an ABN • Routine use of ABNs, why it is not allowed • Modifiers to use when obtaining an ABN • Communicating effectively with patients regarding ABNs • Common ABN pitfalls
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. Contact Devon Bernard at dbernard@ AOPAnet.org or 571/431-0854 with content questions. Register online at http://bit.ly/aopa2014audio. Contact Betty Leppin at bleppin@AOPAnet.org or 571/431-0876 with registration questions.
Mastering Medicare: AOPA’s Advanced Coding & Billing Techniques Bally’s Las Vegas Hotel & Casino April 7-8, 2014 • Las Vegas, NV Join your colleagues April 7-8 at Bally’s Las Vegas Hotel & Casino for AOPA’s Mastering Medicare: Advanced Coding & Billing Techniques seminar. AOPA experts will provide up-to-date information to help O&P practitioners and office billing staff learn how to code complex devices, including repairs and adjustments, through interactive discussions and much more. Meant for both practitioners and office staff, this advanced two-day event will feature breakout sessions for these two groups to ensure concentration on material appropriate to each group. Basic material that was contained in AOPA’s previous Coding & Billing seminars has been converted into nine one-hour webcasts. Register for the webcasts on AOPA’s homepage. Register online for the Mastering Medicare: Advanced Coding & Billing Techniques seminar in Las Vegas at http://bit.ly/aopa2014lasvegas. Questions? Contact Devon Bernard at email@example.com or 571/431-0854.
MARCH 2014 O&P Almanac
Become a Presenter at the 2014 AOPA National Assembly in Las Vegas! AOPA invites you to become a presenter at the 2014 AOPA National Assembly, to be held September 4-7 at the Mandalay Bay Resort in Las Vegas. Your clinical submissions, based on sound research and strong empirical data, will set the stage for a broad curriculum of highly valued business, technical, and scientific offerings. All interested presenters must submit an abstract of their proposed scientific paper or description of their proposed business or technical paper using an electronic submission form. To submit a free paper abstract, use the electronic submission form found at https://aopa.wufoo.com/ forms/2014-call-for-free-papers/. To organize a scientific symposium, use the electronic submission form found at https://aopa.wufoo.com/ forms/2014-call-for-symposia/.
The Review Committee will grade each submission based on the following criteria: • Relevance, level of interest in topic • Quality of scientific content • Quality of clinical content Important Dates Monday, March 10 Deadline for abstract and symposia submissions Tuesday, April 10
Notice of acceptance or rejection
Friday, August 1 Electronic version of handouts due Thursday, Sept 4
AOPA National Assembly begins
Contact AOPA Headquarters with questions, 571/4310876 or tmoran@AOPAnet.org, or visit www.AOPAnet.org.
Sept. 4–7, 2014
Mandalay Bay Resort and Casino
The premier meeting for orthotic, prosthetic, and pedorthic professionals
Las Vegas, Nevada
Experience the energy—attend the country’s oldest and largest meeting for the orthotics, prosthetics, and pedorthic profession.
Energize your staff—ask about group discounts and space for your company to hold their own corporate meeting in conjunction with the Assembly.
The 2014 National Assembly education program will feature a learning program tailored specifically to meet your needs with programs to teach you the latest technology, best business practices, premier patient care through case studies, symposia, instructional courses, manufacturers workshops, panel discussions, live demonstrations, and fun networking events.
There is a reason why more O&P professionals attend the National Assembly than any other national meeting.
Visit www.AOPAnet.org for information and updates.
CLINICAL | BUSINESS | TECHNOLOGY
Products. Services. Networking.
Earn Choice CE Credits! 46
O&P Almanac MARCH 2014
The organizing committee is now accepting free paper abstracts and proposals for Symposia.
Log On to AOPAversity Online Meeting Place for Free Education does not get any more convenient than this. Busy professionals need options––and web-based learning offers sound benefits, including 24/7 access to materials, savings on travel expenses, and reduced fees. Learn at your own pace—where and when it is convenient for you. For a limited time, AOPA members can learn and earn for FREE at the new AOPAversity Online Meeting Place: 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 CE credits by completing the accompanying quiz in the CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis.
Follow AOPA on Facebook and Twitter Follow AOPA on Facebook and Twitter to keep on top of latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities. • Like us on Facebook at: www.facebook.com/AmericanOandP with your personal account and your organization’s account! • Follow us on twitter at: @americanoandp, and we’ll follow you, too! Contact Steve Custer at scuster@ AOPAnet.org or 571/431-0835 with social media and content questions.
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/AOPAwebcasts.
If You’re Paying More Than 1.9%, You’re Paying Too Much AOPA has partnered with Bank of America Merchant Services to offer credit card processing rates as low as 1.9 percent to AOPA members. Many members are paying more than 2.5 percent, and if you’re handling $500,000 a year in credit card transactions, the 0.6 percent savings is like getting a 200 percent return on your membership dues investment. To enroll, contact 888/317-5402 or email firstname.lastname@example.org. AOPA encourages members to request an audit of a recent processing statement to identify the savings they would enjoy.
Coding Questions Answered 24/7 AOPA members can take advantage of a “click-of-the-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.
24/7 MARCH 2014 O&P Almanac
Welcome new members! The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the companyâ€™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 AOPAâ€™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.
Advanced Prosthetic Research Inc.
7700 San Jacinto Place, Ste. 300 Plano, TX 75024 469/241-1477 Category: Patient-Care Member Lisa Williams-Guichet Advanced Prosthetic Research Inc. (APR) is an energetic custom prosthetics facility that opened in 2013. APR provides cutting-edge technology with a personal touch, fabricating all prostheses at its in-house lab, and performing house calls in the Plano, Texas, community. Jan-Morgan Gainer, the owner, got his start selling O&P products and then decided to train as a prosthetist to be able to personally help patients achieve ambulation.
208 Lee Street, Ste. 104 Tumwater, WA 98501 360/269-7115 Category: Suppler, Level 1 Member Dulcey Lamotte Naked Prosthetics manufactures the cutting edge Bio-Mechanical Prosthetic Finger (BPF), made of FDA-approved medical grade nylon. The owner and inventor Colin McDuff, a Navy veteran, created the first prototype of the BPF out of bicycle parts in his garage after losing his finger in an accident. He was granted a patent on his first application, and Naked Prosthetics was born in 2012. Naked Prosthetics individually customizes the BPF to get patients back to an active lifestyle, with a design that is simple, elegant, and fully functional.
Advanced Prosthetics Inc. P.O. Box 351979 Los Angeles, CA 90035 310/621-9950 Category: Patient-Care Member Majid Ashrafy
Booden Orthopedic & Prosthetic Center Inc. 5511 Princess Anne Roak, Ste. 101 Virginia Beach, VA 23462 757/490-8100 Category: Affiliate Member Parent Company: Booden Orthopedic & Prosthetic Center Inc., Norfolk, VA Kevin Booden
O&P Almanac MARCH 2014
Orthotic & Prosthetic Center of Boston LLC 801 Main Street, Unit 8 Concord, MA 01742 978/371-1684 Category: Affiliate Member Parent Company: Orthotic & Prosthetic Center of Cape Cod & the Islands LLC, West Yarmouth, MA Nicholas Grigorieff, CPO
Orthotic & Prosthetic Center of Boston LLC 130 Rumford Avenue, Ste. 106 Newton, MA 02466 617/916-1650 Category: Affiliate Member Parent Company: Orthotic & Prosthetic Center of Cape Cod & the Islands LLC, West Yarmouth, MA Patrick George, CPO
Orthotic & Prosthetic Center of Cape Cod and the Islands LLC 124 Long Pond Road, Unit 9 Plymouth, MA 02360 774/773-9739 Category: Affiliate Member Parent Company: Orthotic & Prosthetic Center of Cape Cod & the Islands LLC, West Yarmouth, MA
Tillges Certified Orthotic Prosthetic Inc. 817 Portland Avenue S. Minneapolis, MN 55404 612/341-3660 Category: Affiliate Membership Parent Company: Tillges Certified Orthotic Prosthetic Inc., Maplewood, MN Debra Merritt, CFo a
You can make a difference. AOPA 2014
POLICY FORUM APRIL 2-3, 2014
Special Extended Program April 3-4
April is Limb Loss Awareness Month
TENTATIVE SCHEDULE WEDNESDAY April 2 11:45 AM
O&P PAC Fundraiser (optional event)
Policy Forum General Sessions
Stay an extra day to participate in post-forum education modules and earn 7.5 CE Credits.
THURSDAY April 3 5:00 – 8:00 PM
Extended Education (Module 1) with Dinner
The Horriﬁc RACs Era for Prosthetics, Where Are We, and Where/When (If Ever) Might It End?
Emerging RAC Fairness Legislation
A Closer Look at How Washington WILL Impact Your Business
Appeals to the ALJs
Understanding Congressional Appropriations
Future Impacts: ACOs, DRGs, Post Acute Care Bundling & CMS’s Ofﬁce of Innovation
Research and Education-Appropriations, VA, DoD— Where Are We Now?
Let’s Sue ‘Em: A Primer About Suing the Medicare Program
Competitive Bidding—Off the Shelf (OTS), New HCPCS Codes—How Does It All Make Sense?
Post Acute Care Bundling—Risk of O&P Being “One of the Many”
Medicare O&P Improvements Act, H.R. 3112—curbing fraud and abuse
Appropriations, Funding for Research & Education, S. 521/S. 522
4:45 PM 6:30 PM
FRIDAY April 4 8:30 AM – 1:00 PM Extended Education (Module II) with Breakfast and Lunch 8:00 AM
8:30 AM – 1 PM
Coding and Reimbursement Segment
O&P PAC Fundraiser (optional event)
Steps You Can Take to Avoid Audits
Reception and Dinner (included)
New Off the Shelf Orthotic Codes—Avoid Becoming a Witness Against Yourself
THURSDAY April 3 Breakfast and General Session
Review of Talking Points
Mock Congressional Visit
8:30 AM – 3PM
What better way to support the profession than to participate in the annual Policy Forum, April 2-3 at the Renaissance Hotel in Washington, DC, with extended educational programs offered April 3-4.
Taking Your Claims All the Way to the ALJ
FDA: Has O&P Awakened a Sleeping Giant?
Registration and complete details are available at: http://www.aopanet.org/legislative-regulatory/ 2014-policy-forum/
Support your profession! For more information about AOPA and the AOPA 2014 Policy Forum visit www.AOPAnet.org.
Registration is open. Register at bit.ly/2014policy. Make your plans now to attend the 2014 AOPA Policy Forum.
Meet your member of Congress and tell them how, through orthotics and prosthetics:
Mobility Saves Lives (and Money)
AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION 330 JOHN CARLYLE STREET SUITE 200 ALEXANDRIA, VA 22314
Congratulations to AOPA members The O&P Almanac celebrates the important milestones being celebrated by established AOPA Members in 2014.
35-Year Anniversary: Skyland Prosthetics & Orthotics Inc.
30-Year Anniversary: Prosthetic Laboratories Inc.
Headquarters: Fletcher, North Carolina Employees: 14 Owners: Pippa Dolen, CMF, and Shaun Dolen, CP
Headquarters: Rochester, Minnesota Locations: 9 facilities throughout Minnesota and Wisconsin Employees: 90 Owners: Steve Amundson, CP, and Mike Gozola, CP
Facility History Prosthetic Laboratories of Rochester Inc. was founded in 1984 by practitioners Steve Amundson, CP, and Mike Gozola, CP, with one additional Steve Admundson, CP Mike Gozola, CP employee. Over the past three decades, the company has grown to nine facilities, and has served more than 100,000 patients. Areas of patient care include comprehensive O&P care as well as services for patients with mastectomy, lymphedema, and pedorthic needs. The facility also is in involved in ongoing case studies and presentations with physician partners and providers.
What Makes This Facility Successful
What Makes This Facility Successful
According to the founders, they rely on the simple philosophy that high-quality work, service, and relationships impact people positively. Prosthetic Laboratories values a team approach with multiple specialists collaborating in the best interest of the patient.
How the Facility Will Thrive in the Future
O&P Almanac MARCH 2014
Skyland has been able to prosper over the years by being “determined to survive many setbacks,” including Bruce’s death and the unexpected loss of a leased facility space in 2007, according to Pippa Dolen. She also points to the remarkable “help and expertise we have been able to garner together in the group we call family”—their staff.
How the Facility Will Thrive in the Future Shaun Dolen, CP, is a skilled and creative practitioner who believes in “whatever it takes to make it right.” Continuing education on the newest technologies is a priority at the facility, as is client satisfaction for all patients. a
Is Your Facility Celebrating a Special Milestone This Year? Photos: www.plor.net
Prosthetic Laboratories’ services and product strategy is based on quality and industry knowledge that create custom solutions for patient care. The owners cite their stability in the marketplace and the depth and strength of skill of the entire team as keys to their ongoing success. The organization fosters a climate focused on exceptional customer care while cultivating an internal infrastructure of support and growth for all employees, including residency and fellowship programs.
Skyland Prosthetics & Orthotics Inc. was established in 1979 by Bruce Dolen, CP, and his wife Pippa as the only employees. The original facility was housed in a 1,500-square-foot nondescript building. Their son Shaun joined the business and became a certified prosthetist, taking on a leadership role when Bruce Dolen died suddenly in 1995. Over the years, the facility has grown from specializing in prosthetics to offering orthotics and postmastectomy services, and the current facility now houses 6,000 square feet.
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 email@example.com.
MEMBER VALUE GUIDE www.AOPAnet.org/join
AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)
Member Beneﬁts Coyote Composite available from PEL Coyote Composite is an ideal replacement for braided carbon fiber in prosthetic and orthotic laminations. It’s made from basalt (volcanic rock)—tougher and more flexible than carbon for more comfort when used in prosthetic sockets or orthotic braces. The inert nature of basalt has less inhalant risk and results in less skin irritation.
The mission of the American Orthotic and Prosthetic Association is to work for favorable treatment of the O&P business in laws, regulation and services; to help members improve their management and marketing skills; and to raise awareness and understanding of the industry and the association.
Expert Reimbursement and
Cost-Effectiveness Research. The
changing of health is Coding Guidance. AOPA’s Membership inreim-AOPA is climate one ofcarethe moving to a patient driven process bursement specialists provide
Your Survival Advocacy in Washington. AOPA’s staff and the lobbying team bring years of healthcare knowledge and experience to the issues of O&P. AOPA’s efforts help assure equitable reimbursement policies in these uncertain ﬁnancial times to ensure quality patient care.
coding advice and keep you up-to-date on the latest Medicare quality standards, RAC and other audits, billing rules and regulations. Answers to all of your questions related to O&P coding, reimbursement and compliance—via telephone or email. Members have unlimited access to AOPA staff experts.
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Making Your Voice Connect. AOPA’s Annual Policy Forum brings O&P leaders to Washington to receive high level brieﬁngs and to E E GUIDdeliver the O&P story personally to VALU BER MEM rg/join their members of Congress. www.AOPAnet.o
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LCodeSearch.com, AOPA’s online coding resource, provides members with a one-stop, up-to-the minute coding reference available 24/7, from anywhere you connect to the Internet.
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For more information, call PEL 800/321-1264 or order online at www.pelsupply.com. a
of AOPA Me
funded a major study by health care ﬁrm Dobson-DaVanzo proving
cost-effectiveness of timely O&P in the future of your company. treatment of patients with the same
Challenging RAC and CERT audit policies implemented by overly aggressive CMS contractors is AOPA’s number one priority. We have ﬁled litigation against CMS seeking relief from the unfair and unauthorized actions of CMS, its RAC auditors, and DME MACs relating to physician documentation requirements, and the change in policy resulting from the “Dear Physician” letter.
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n Orthotic services; audit of the America regulation and RAC and CERT The mission Challenging business in laws, ented by overly of the O&P to e treatment policies implem contractors is g skills; and for favorabl and marketin CMS aggressive management one priority. ion. s improve their the associat AOPA’s number to help member industry and litigation against unfair nding of the We have ﬁled relief from the CMS, ss and understa of CMS seeking raise awarene rized actions MACs and unautho The , and DME ss Research. is ectivene its RAC auditors n documenta• Cost-Eff of health care t and relating to physiciaand the change changing climate driven process ents, Reimbursemen reimto a patient tion requirem • Expert the “Dear more AOPA’s moving e. and from ing more Coding Guidanc ts provide in policy resulting s to and is demand cost-effectivenes bursement specialis Physician” letter. evidence of and keep you s. AOPA has coding advice the latest Medicare measure outcome Advocacy in study by health up-to-date on s, RAC and other • Your Survival funded a major -DaVanzo proving ons. team Dobson Washington. quality standard regulati rm ﬁ lobbying and O&P the care rules and s of timely AOPA’s staff healthcare knowlaudits, billing of your questions the same cost-effectivenes of all sepatients with bring years Answers to ce to the issues did treatment of coding, reimbur patients who can assure edge and experien related to O&P nce—via telephone diagnoses as efforts help t. AOPA of O&P. AOPA’s sement policies ment and complia s have unlimited not receive treatmen s of the ﬁeld to resource equitable reimbur or email. Member aggregate the vital research that n ﬁnancial times staff experts. in these uncertai access to AOPA to conduct this cannot conduct. patient care. rms ensure quality AOPA’s online s individual ﬁ earch.com, • LCodeS Connect. , provides member Your Voice coding resource, up-to-the minute • Making Policy Forum ton Annual one-stop a 24/7, AOPA’s with e available leaders to Washing (Continued) and to brings O&P coding referenc you connect to the level brieﬁngs re to receive high story personally to from anywhe deliver the O&Pof Congress. Internet. s their member
MIS SIO N
• Safer with less itch than carbon • Tougher than fiberglass • Extremely durable • Lightweight strength and rigidity • Easy to use for rigid or flexible lay ups • Use with traditional or flexible resins • Cost effective
Experience the Benefits of AOPA Membership
Experience the Beneﬁts of AOPA Membership
diagnoses as patients who did not receive treatment. AOPA can aggregate the resources of the ﬁeld to conduct this vital research that individual ﬁrms cannot conduct.
2014 AOPA Annual Membership enrollment(Continued) is now open. Call 571/431-0876 to request an application form, or visit www.AOPAnet.org.
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®
al i c e Sp s! ng 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!
MARCH 2014 O&P Almanac
Find your region on the map to locate jobs in your area.
- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific
Classified rates Classified advertising rates are calculated by counting complete words. (Telephone and fax numbers, email, and Web addresses are counted as single words.) AOPA member companies receive the member rate. Member Nonmember Words Rate Rate 50 or fewer words $140 $280 51-75 words $190 $380 76-120 words $260 $520 121 words or more $2.25 per word $5.00 per word Specials: 1/4 page, color 1/2 page, color
$482 $678 $634 $830
Advertisements and payments need to be received approximately one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated at any point on the O&P Job Board online at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Ads may be faxed to 571/431-0899 or emailed to scuster@ AOPAnet.org, along with a VISA or MasterCard number, the name on the card, and the expiration date. Typed advertisements and checks in U.S. currency made out to AOPA can be mailed to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. Responses to O&P box numbers are forwarded free of charge. Company logos are placed free of charge. Job board rates Visit the only online job Member Nonmember board in the industry at Rate Rate jobs.AOPAnet.org! $80 $140
Be served a bigger
slice of the pie!
dollar of of the 3.5 billion AOPA Find your slice begin with an O&P business— opportunity today! advertising
American Orthotic Promoting O&P
Jan. 1, 2014
DISCOVER more AOPA advertising opportunities. Call Bob Heiman, Advertising Sales Representative at 856/673-4000 or email firstname.lastname@example.org
MediA AOPA 2014
O&P Almanac MARCH 2014
North Central CPO or Board-Eligible CPO Traverse City, Michigan We are seeking a motivated CPO or board-eligible CPO for our Traverse City location. Teter O&P is a privately owned company with 20 locations in Michigan. We offer a competitive salary, good benefits, and paid continuing education. If quality of life is important, you won’t be disappointed with us or a beautiful area to live in. Please send resume to:
Todd Stone, CPO 1225 W. Front Street Traverse City, MI 49684 Fax: 877/218-1947 Email: email@example.com
Job Opportunity CPO/BOCPO At Center for Orthotic & Prosthetic Care (COPC) our staff of orthotic and prosthetic professionals is committed to our mission of providing the highest level of patient care possible. COPC is a private partnership that enjoys the privilege and challenge of serving in leading and renowned medical centers in Kentucky, Indiana, North Carolina, and New York. Due to an opening at a new patient-care facility in Paducah, Kentucky, we are seeking a CPO, or Kentucky-licensed BOCPO, with a minimum of five years’ clinical experience. Because we have experienced rapid growth at our patient-care facilities in the Binghamton, New York, area, we are seeking a CPO/BOCPO with a minimum of two years’ experience. Candidates must possess excellent communication, organizational, and interpersonal skills, and the demonstrated ability to provide the highest quality patient care. These positions offer a competitive salary, relocation assistance, and excellent benefits including medical, dental, disability, 401K, certification and licensure fees, and continuing education expenses. If you meet these requirements and have an interest, please submit your resume, in confidence, to:
For the Paducah, Kentucky, position, via fax at 502/451-5354 or via email to firstname.lastname@example.org. For the Binghamton, New York, position, via email to email@example.com.
“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. 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.
AVAILABLE POSITIONS CLINIC MANAGER Jackson, MI Florissant, MO Ardmore, OK
Modesto, CA Reno, NV
Albuquerque, NM Burr Ridge, IL Covington, LA Dayton, OH Enid, OK Grand Rapids, MI Gurnee, IL Macon, GA Mayfield Heights, OH Portland, ME San Antonio, TX
San Francisco, CA Santa Rosa, CA St. Louis, MO Stratford, CT Thomasville, GA Tulsa, OK Tyler, TX Westlake, OH Columbia, MO La Jolla, CA Brunswick, GA
Evansville, IN Johnston, IA Kansas City, KS La Mesa, CA Modesto, CA St. Louis, MO Stockton, CA
Cincinnati, OH Naples, FL Somersworth, NH Springfield, IL Wichita, KS Hammond, IN
Hattiesburg, MS Kalamazoo, MI
Waterville, ME Jackson, MS
Earn Your Certificate in O&P Business Management For more information on the program, please visit bit.ly/BizCertProgram.
How to get started:
O&P BUSINESS MANAGEMENT: This unique leadership learning experience will provide business owners, managers and practitioners an opportunity to experience fresh insights, new tools and proven techniques as a pathway for developing better business practices, while creating ongoing returns for your company.
Complete the online sign up form: https://aopa.wufoo.com/forms/earn-acertificate-in-op-business-management/
Select and complete four required core modules and four elective modules within three years.
■ REFRESH YOUR KNOWLEDGE
Complete a Module specific quiz for each program.
■ ADVANCE YOUR CAREER
Participants that successfully complete the program will be awarded a certificate of completion, in addition to being recognized at the AOPA National Assembly and the O&P Almanac.
■ DEVELOP BETTER BUSINESS PRACTICES
■ CREATE ONGOING RETURNS FOR YOUR COMPANY
An AOPAversity OPPORTUNITY! Another addition to the valuable education, products and services offered by AOPA that you need to succeed.
MARCH 2014 O&P Almanac
■ YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations. Candidates can apply and test when ready, receiving their results instantly for the multiplechoice and clinical-simulation exams. Apply now at http://my.bocusa.org. For more information, visit www.bocusa.org or email firstname.lastname@example.org.
www.bocusa.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.
2014 ■ March 8-9 ABC: Orthotic Clinical Patient Management (CPM) Exam. Dallas. University of Texas Southwestern Medical Center. Contact 703/836-7114, email email@example.com, or visit www.abcop.org/certification. ■ MARCH 11-15 American Academy of Orthopaedic Surgeons Annual Meeting 2014. New Orleans. Morial Convention Center. AAOS designates this live activity for a maximum of 35 AMA PRA Category 1 Credits. Visit www.aaos.org for more information. ■ MARCH 12 AOPAversity Audio Conference–The ABCs of Audits: What to Expect and How to Respond. Register online at http://bit. ly/aopa2014audio. For more
PROMOTE Events in the O&P Almanac
CALENDAR RATES Telephone and fax numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Words
25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$5.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of www.AOPAnet.org. 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. For information on continuing education credits, contact the sponsor. Questions? Email scuster@AOPAnet.org. 54
O&P Almanac MARCH 2014
information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ March 14-15 ABC: Prosthetic Clinical Patient Management (CPM) Exam. Dallas. University of Texas Southwestern Medical Center. Contact 703/836-7114, email firstname.lastname@example.org, or visit www.abcop.org/certification. ■ MARCH 16-18 2014 Essentially Women Conference & Tradeshow. Reno, Nevada. Grand Sierra Resort. Seminars are presented by industry experts and nationally recognized speakers. Visit www.essentiallywomen. com for more information.
March 17-22 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 email@example.com, or visit www.abcop.org/certification. ■
April 1 ABC: Practitioner Residency Completion Deadline for May 2014 Exams. Contact 703/8367114, email certification@abcop. org, or visit www.abcop.org/ certification. ■
■ APRIL 2-4 AOPA 2014 Policy Forum. Washington, DC. Renaissance Hotel. April is Limb Loss Awareness Month— what better way to support the profession than to participate in the Annual Policy Forum with extended education on April 3-4. To register or for more information, visit www. AOPAnet.org. Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.
■ April 3-4 Rehabilitation Institute of Chicago: Advanced Pediatric Gait Analysis. Chicago. Must have taken an Elaine Owen course as prereq. 15.00 ABC credits. Contact Melissa Kolski at 312/238-7731 or visit www.ric.org/education. ■ APRIL 3-5 Georgia Society of Orthotists & Prosthetists 2014 Annual Meeting. Atlanta. Wyndham Atlanta Galleria. Optimize your meeting experience. This year, the program includes two hours of unopposed exhibit time on Friday as well as one hour and 30 minutes on Saturday. Visit www. georgiasop.com or contact Erik Peterson at 770/271-7540 for more information.
APRIL 7-8 AOPA: Essential Coding & Billing Seminar. Bally’s Hotel & Casino. Las Vegas. To register, contact Betty Leppin at 571/431-0876 or bleppin@ AOPAnet.org. ■
■ April 9 AOPAversity Audio Conference–How To Use Advanced Beneficiary Notices (ABNs) Effectively. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ APRIL 10-12 International African American P&O Coalition 2014 Annual Meeting & Scientific Conference. Montgomery, Alabama. Alabama State University. The 2014 meeting will expand to two full days of lectures, hands-on demonstrations, and the annual meeting. To register or for more information, visit www.iaapoc.org.
■ APRIL 10-12 Texas Association of Orthotists & Prosthetists 2014 Annual Meeting & Scientific Sessions. Richardson, Texas. Hyatt Regency North Dallas. Special Compliance Boot Camp on April 10th. Visit www.taop. org to register or for more information. ■ May 14 AOPAversity Audio Conference–Modifiers: How and When to Use Them. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ MAY 30-31 Louisiana Association of Orthotists & Prosthetists 11th Annual Meeting. Shreveport, Louisiana. Hilton Hotel & Shreveport Convention Center. Take advantage of this opportunity to join about 100 attendees from the Louisiana, Mississippi, Arkansas, and East Texas regions. The continuing education this year will include prosthetics, orthotics, pedorthics and mastectomy tracts. For more
information, visit www.laop. org or contact Debney Brown at 504/464-5577. ■ JUNE 5-6 Delcam Orthotics Technology Forum. Chicago. Loyola University. Meetings will cover new technologies and processes designed to assist practitioners and laboratories in prescribing, designing, and manufacturing custom orthotic insoles. For more information, visit www.orthotics-technologyforum.com. ■ June 11 AOPAversity Audio Conference–The Self-Audit: A Useful Tool. Register online at http://bit.ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
July 9 AOPAversity Audio Conference–The OIG: Who Are They and 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. ■
■ August 13 AOPAversity Audio Conference–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.
■ October 8 AOPAversity Audio Conference–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.
■ 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.
■ November 12 AOPAversity Audio Conference–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.
■ September 10 AOPAversity Audio Conference–Urban Legends in O&P: What To Believe. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
■ December 10 AOPAversity Audio Conference–New Codes and Changes for 2015. Register online at http://bit. ly/aopa2014audio. For more information, contact Betty Leppin at 571/431-0876 or email bleppin@AOPAnet.org.
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O&P STUDY AND REVIEW GUIDE
www.spinaltech.com MARCH 2014 O&P Almanac
Reimbursement Page AOPA Answers
Medicare RULs, and More Answers to your questions regarding O&P RUL guidelines and billing for VA and hospice patients
receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at firstname.lastname@example.org.
What is Medicare’s reasonable useful lifetime (RUL) for orthotics and prosthetics?
The RUL for orthotics and prosthetics is determined by program instructions from Medicare. When there are no program instructions, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) may establish RULs for orthotics and prosthetics, but in no case can it be more than five years. In other words, if Medicare doesn’t establish a RUL for an item, the DME MACs may then create a RUL through policy. However, if they don’t create a policy, the RUL for an item is set at five years. Prosthetics has a RUL that is less than five years. Medicare, through the Benefits Improvement and Protection Act (BIPA) 2000, has provided program instructions for the RUL for prosthetics. In BIPA, Medicare has stated that “prosthetic devices which are artificial limbs” may be replaced at any time regardless of useful lifetime, as long as the replacement is reasonable and necessary. For orthotics, there are no direct program instructions from Medicare, so the RUL for
O&P Almanac MARCH 2014
orthotics is set at five years. There is an exception to this time span for knee orthoses. In the knee orthosis policy, the DME MACs have established a RUL ranging between one and three years, depending on the type of orthosis being provided.
Can we bill a claim to both Medicare and the Veterans Administration (VA) if the patient is eligible to receive benefits from both?
It is possible for a patient to be eligible to have coverage from both the VA and Medicare, and use both insurances for different aspects of his or her care. However, the patient must choose one of the agencies to handle his or her orthotic and prosthetic services, and may not use both insurances at the same time. A claim cannot be submitted to both agencies for the same date of service and for the same items; this includes any potential balance billing.
How do I bill for an item I delivered to a patient in a hospice?
When a beneficiary elects hospice care, he or she has elected not to receive any care or treatment for his or her terminal illness. The hospice is only responsible for providing, and is only being paid for, palliative care—care designed to alleviate the symptoms of, but not treat, the beneficiary’s terminal illness. If the device you are providing is not related to the beneficiary’s terminal illness, you may bill Medicare. When you submit your claim, you must use the GW modifier; this will indicate that the item/service you provided is unrelated to the beneficiary’s terminal condition. a
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American Orthotic & Prosthetic Association (AOPA) - March 2014 Issue - O&P Almanac