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BreakING News: AOPA Establishes Coalition to Aid Boston Marathon Bombing Victims page 7


The American Orthotic & Prosthetic Association

MAY 2013




RISE OF THE superbug

Expert advice for getting beyond the headlines and protecting staff and patients

AOPA Policy Forum Exclusive: Democracy AT WORK HIPAA Omnibus Rule Explained, Part 2

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O&P May 2013, VOLUME 62, No. 5

CONTENTS Cover Story

20 Rise of the Superbug

By Adam Stone The CDC’s recent warning about the increase in reported cases of CRE, a “superbug” that leads to fatalities in nearly half of those infected, should be a wake-up call to practitioners to ensure their own safety and health—and that of office staff. Follow these steps to reduce exposure, whether visiting patients at hospitals or seeing patients at your own facility.


26 Democracy at Work

By Adam Stone More than 100 O&P professionals converged on Washington during the 2013 AOPA Policy Forum in April. Participants met with Rep. Tammy Duckworth (D-Illinois) and CMS Medical Officer Michael Handrigan, MD, and visited individual congressional offices to express their thoughts on O&P legislation. Here, five Policy Forum participants share their experiences.



AOPA Contact Page How to reach staff


At a Glance Statistics and O&P data

42 Jobs

In the News Research, updates, and company announcements

44 Calendar



Reimbursement Page HIPAA Omnibus Rule, Part 2

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

40 AOPA Membership 00 Applications

41 Marketplace

Products and services for O&P Opportunities for O&P professionals

Upcoming meetings and events


Ad Index


AOPA Answers Expert answers to your FAQs

O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314; 571/431-0876; fax 571/4310899; email: 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 Dean Mather, M.J. Mrvica Associates Inc. at 856/768-9360, email: dmather@mrvica.com.

MAY 2013 O&P Almanac


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



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


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

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

Kelly O’Neill, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org

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

O&p Almanac

Stephen Custer, coordinator, membership operations and meetings, 571/431-0876, scuster@AOPAnet.org

Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/914-9200 x26, jrossi@strattonpublishing.com Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com Dean Mather, advertising sales representative, 856/768-9360, dmather@mrvica.com Stephen Custer, production manager, 571/431-0876, scuster@AOPAnet.org Steffanie Housman, staff writer, 571/431-0835, shousman@AOPAnet.org Lia K. Dangelico, contributing writer, 703/914-9200 x24, ldangelico@strattonpublishing.com Christine Umbrell, editorial/production associate, 703/914-9200 x33, cumbrell@strattonpublishing.com

Lauren Anderson, coordinator, membership operations and meetings, 571/431-0843, landerson@AOPAnet.org

President-Elect Anita Liberman-Lampear, MA, University of Michigan Orthotics and Prosthetics Center, Ann Arbor, MI Vice President Charles H. Dankmeyer, Jr., CPO, Dankmeyer Inc., Linthicum Heights, MD

Scott Schneider, Ottobock, Minneapolis, MN Mike Hamontree, Hamontree Associates, Newport Beach, CA Dave McGill, Ă–ssur Americas, Foothill Ranch, CA Ronald Manganiello, New England Orthotics & Prosthetics Systems LLC, Branford, CT


Immediate Past President Thomas V. DiBello, CO, FAAOP, Dynamic O&P, a subsidiary of Hanger Inc., Houston, TX

Steffanie Housman, content strategist, 571/431-0835, shousman@AOPAnet.org

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

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

Government affairs

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

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

AOPA Bookstore: 571/431-0865

Catherine Graf, JD, director of regulatory affairs, 571/431-0807, cgraf@AOPAnet.org

Alfred E. Kritter, Jr., CPO, FAAOP, Hanger, Inc., Savannah, GA

Devon Bernard, manager of reimbursement services, 571/431-0854, dbernard@AOPAnet.org Joe McTernan, director of coding and reimbursement services, education and programming, 571/431-0811, jmcternan@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

Eileen Levis, Orthologix, LLC, Trevose, PA

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

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

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


O&P Almanac MAY 2013

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Superbug and Bloodborne Pathogens The U.S. Centers for Disease Control and Prevention (CDC) has issued a warning about the increasing incidence of reported “superbug,� or CRE (Carbapenem-Resistant Enterobacteriaceae), infections, in health-care settings. U.S. hospitals reporting at least one case of CRE: by Region

by Facility Type

17.8% Northeast



All acute-care hospitals

Short-stay hospitals

Long-term acute-care hospitals










*Armed Forces, Puerto Rico, and U.S. Virgin Islands.

Source: CDC: Vital Signs: Carbapenem-Resistant Enterobacteriaceae, January-June 2012.

100,000 Number of deaths due to invasive Methicillin-Resistant Staphylococcus Aureus (MRSA) infections over the past decade.

9,000 Number of infections caused by bloodborne pathogens in the United States each year.

40%-50% Percentage of CRE-infected individuals who die from the bacteria.

Sources: OSHA, CDC. 6

O&P Almanac MAY 2013


Number of states in which at least one case of CRE has been identified.

200 72%

Number of deaths due to bloodborne pathogens in the United States each year.

Percentage of CRE episodes that occur in patients with hospitalizations.



AOPA Establishes Coalition for Victims of Boston Marathon Bombing ‘Coalition for Compassionate Care’ to ensure access to care for uninsured/underinsured with limb loss or limb impairment


mmediately after the Boston Marathon bombing last month, AOPA led the charge to form a coalition of O&P professionals to ensure victims with limb loss or limb impairment from the bombing will receive the componentry they need, and will provide devices and O&P care to those victims who do not have health insurance, or who are “underinsured” for O&P care. The Coalition for Compassionate Care, comprised of AOPA, the Amputee Coalition, the American Academy of Orthotists and Prosthetists, and the National Association for the Advancement of Orthotics and Prosthetics, has already established a scope and procedure for bombing victims to apply for O&P care assistance.

Quick Response All Americans are experiencing the shock of the Boston Marathon bombing, coupled with the desire to assist the

innocent victims of this senseless violence and mayhem. The certified prosthetists and orthotists who practice in patient-care facilities and the orthotic and prosthetic manufacturers who develop the technology and create the components for artificial limbs and customized bracing that restore mobility are in a unique position to offer needed assistance. While those victims who required an amputation as a result of the injuries they sustained from the Boston Marathon bombing have received highquality trauma and surgical treatment by first responders and the incomparable clinical personnel residing in Massachusetts’ hospitals, some patients will require specialized care. Some of the victims have the insurance or other financial means to afford the cost of replacement artificial limbs, customized bracing and other mobility aids, and the patient care needed to empower their use. But it

appears that many of the victims, some from Massachusetts and others from diverse locations outside the Boston metropolitan area, may not have any health insurance or may have health insurance plans that will not ensure access to the needed limbs and mobility assistive devices. The Coalition for Compassionate Care has been established to ensure that all victims “will walk and run again.” The coalition is committed to ensuring the availability of appropriate patient care as well as artificial limbs and other mobility devices on a compassionate access basis for those Boston Marathon bombing victims who otherwise may not have access to these devices and patient care.

Scope The Coalition for Compassionate Care will use its national network to facilitate care for any Boston Marathon bombing victim for his

MAY 2013 O&P Almanac




or her prosthetic and orthotic needs (excluding physician and hospital costs), with the sole prerequisite being receipt of a letter from the victim’s physician indicating that the patient was injured in the Marathon bombing, describing the specific needs of the patient, detailing geographic information, and attesting that the patient’s insurance coverage is insufficient to meet the costs of the prosthetic/ orthotic care the patient needs.

Eligibility/Contact Information Communications from physicians and inquiries from patients and others should be directed to Stephen Custer at AOPA, scuster@aopanet.org or 571/431-0876. If the patient has a certified orthotist/prosthetist, that practitioner should work with the patient’s physician to develop a prescription and detailed work order that specifies the componentry required. A copy of that prescription should accompany the request for assistance. In that

instance, the coalition will endeavor to secure—without cost to the patient— the specific requested clinical services including the componentry, or as close to the prescription as possible. If the patient does not have a certified orthotist/prosthetist, the coalition will identify a practitioner who can render the needed care up to and including delivering the device to the patient, the requisite fitting, patient training, and such related care. The orthotist/prosthetist can

secure assistance from the coalition to facilitate securing the componentry without cost to the patient. AOPA will publicize the availability of these services and devices to Massachusetts hospitals and surgery departments, public officials, One Fund Boston and other support agencies, and the Amputee Coalition. The coalition welcomes any assistance from companies, media, churches, and others in building awareness about this coalition, and encourages anyone to disseminate this information to others who can help in advancing awareness. Likewise, if individuals or corporations would like to join in supporting this effort, the coalition welcomes their assistance. AOPA and the Coalition for Compassionate Care extend our prayers and best wishes to all persons injured as a result of the Boston Marathon bombing for a full and complete recovery to health, mobility, and restored function, employment, and family life. a





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O&P Almanac MAY 2013

One winner and one runner-up will be selected in each of the three categories: Practitioner, Technician, and Student. All three categories will also be entered into the People’s Choice Award—where congress attendees will vote and select their favorite prostheses. •

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New Global Health Comparison Tool Unveiled The Global Burden of Disease project has been updated to include an interactive web tool. The tool features graphics showing how causes of death and disability, and risk factors for disease, differ among countries and change over time. Amputations are one of the disability factors highlighted in the data. Led by a physician and economist at the Institute for Health Metrics and Evaluation at the University of Washington, the Global Burden of Disease project provides health profiles of 187 countries produced by 488 researchers. The new tool allows the user to compare a nation to its geographic, economic, or cultural neighbors. The interactive graphs and lists may provide valuable information to health professionals and policymakers. The project incorporates the concept of the “disability-adjusted life year,” defined as the sum of years lost to premature death and years lived with disability. Various disabilities, including loss of a limb, blindness, and chronic headaches, are given the equivalents of fractions of a year of life lost. Microsoft co-founder Bill Gates provided $8.2 million for the 2010 update of the project. Researchers plan to update the data annually.




O&P Almanac MAY 2013

U.S. Diabetes Costs Soar to $245 Billion The American Diabetes Association (ADA) released research in March indicating diagnosed diabetes costs in the United States have risen 41 percent over the past five years. The estimated $245 billion per year includes $176 billion in direct medical costs and $69 billion in indirect costs. Researchers examined the increased financial cost, use of health resources, and lost productivity caused by diabetes. Nearly 26 million U.S. adults and children have diabetes, and another 79 million are estimated to have pre-diabetes. Diabetes is the leading cause of nontraumatic lower-limb amputations in the United States. States with the highest cost burden for diabetes include California and Florida. The ADA study found that medical costs for people with diabetes are 2.3 times higher than for those without the disease. “The cost of diabetes is rising at a rate higher than overall medical costs, with more than one in 10 health-care dollars in the country being spent directly on diabetes and its complications, and more than one in five health-care dollars going to the care of people with diagnosed diabetes,” says Robert Ratner, MD, ADA’s chief scientific and medical officer. The complete study was published in the April issue of Diabetes Care.










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CMS Announces 2 Percent Reduction

CMS To Hold DMEPOS HCPCS Public Meeting CMS is scheduled to hold a meeting June 4, 2013, to discuss preliminary determinations for applications for new durable medical equipment and accessories and O&P Health-Care Common Procedure Coding System (HCPCS) codes and payment determinations for the 2014 update. The meeting provides a forum for interested parties to make oral presentations or to submit written comments in response to preliminary coding and payment determinations. The discussion will be focused on responses to CMS’s specific preliminary recommendations and will include all items on the public meeting agenda. The draft agenda, including a summary of each request and CMS’s preliminary decision, is expected to be posted on the HCPCS website at least four weeks before the meeting. The public meeting will be held in the main auditorium of the CMS central building, 7500 Security Blvd., Baltimore, MD 21244. Written comments may be sent via email to HCPCS@cms.hhs.gov or via mail to Jennifer Carver or Kimberlee Combs Miller, HCPCS Public Meeting Coordinator, CMS, 7500 Security Blvd., Mail Stop C5-08-27, Baltimore, MD 21244.


O&P Almanac MAY 2013

CMS has announced a 2 percent reduction in Medicare payments, which went into effect April 1, 2013, as part of the mandatory reductions in federal spending, known as sequestration, required by the Budget Control Act of 2011. Medicare fee for service claims for durable medical equipment, prosthetics, orthotics, and supplies, including claims under the durable medical equipment Competitive Bidding Program, will incur a 2 percent reduction in Medicare payment based on whether the date of service, or the start date for rental equipment or multiday supplies, was on or after April 1, 2013. The claims payment adjustment will be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments. Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2 percent reduction.


people in the news

Physicist Louis Bloomfield, PhD, a physics professor at the University of Virginia, has invented a type of silicone rubber that is both rigid and fluid—a viscoelastic solid. The material has compliant, adaptive characteristics that may be useful for contact points in prosthetic devices. U.S. Paralympian April Holmes, a sprinter and gold-medal winner, has been named to the list of “Top 10 Women to Honor in Paralympic Sports” by the International Paralympic Committee.

Renee Knight Woodberry has been appointed the newest board member of the Orthotic and Prosthetic Activities Foundation. Erik Schaffer, CP, owner and president of A Step Ahead Prosthetics, created a realistic-looking, high-heeled transfemoral prosthesis for ABC’s Grey’s Anatomy character Dr. Arizona Robbins, giving her the appearance of having an above-knee amputation.

In MEMORIAM Candice Kasuyama, CO, passed away January 28 at the age of 46. She graduated from the California State University program of O&P in 1990 and joined what was then Orthomedics. She spent more than 20 years with what was to eventually become Hanger Clinic; for several years she managed Hanger’s Los Angeles Orthopaedic Hospital office, specializing in pediatric orthotics. Kasuyama spent one year with Prosthetic and Orthotic Group Inc. in Southern California before the illness that eventually took her life forced her to leave the O&P field.

Gregory “Greg” Ferrell Scott, CP, who served as AOPA president (1989-1990) and owned Webb’s K.E. Karlson in Portland for many years, passed away March 6. He found great satisfaction helping those that needed it most. Scott graduated in 1956 from Marquette High School in Yakima, Washington, and the University of Portland in 1961. Surviving Scott are his wife, Susan, children, sisters, and grandchildren.

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DME MAC A Initiates Prepayment Probe for L0631, L0637 Due to a high volume of claim errors identified by Comprehensive Error Rate Testing contractor NHIC, the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor has announced it will initiate a widespread prepayment probe of claims for two lumbar-sacral orthoses, as follows: • L0631: Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding,


Alliance Orthotics & Prosthetics has announced a new location at 2921 Country Club Road in Denton, Texas. The Amputee Coalition has announced a peer support affiliation agreement between the Coalition and MedStar National Rehabilitation Hospital. The Board of Certification/ Accreditation (BOC) has introduced additional features to the online web portal for accredited facilities at my.bocusa.org. MyBOC provides facilities with the ability to notify BOC

O&P Almanac MAY 2013

For information regarding coverage criteria and documentation requirements, read the Local Coverage Determination for Spinal Orthoses: TLSO and LSO, L11470, and Policy Article A23663.

BUSINESSES in the news

5280 Prosthetics, Littleton, Colorado, and Vertikle Enterprises, Cheyenne, Wyoming, were awarded first place and $25,000 in the University of Northern Colorado, Greeley, Monfort College of Business Entrepreneurship Challenge. The company develops products that enable prosthetic devices to communicate with their users, relaying data to improve fit, function, and the user’s general health.


shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment. • L0637: Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment.

of updates and changes at any time of the day or night. BOC also has won a Stevie Award for Sales & Customer Service at the seventh annual Stevie Awards ceremony in Las Vegas. BOC was recognized for its exceptional customer service department. The Orthotic and Prosthetic Activities Foundation (OPAF) has announced that Becker Orthopedic, Troy, Michigan, and BOC are bronzelevel sponsors for 2013. OPAF also has launched First Row, adaptive rowing and sculling using ergonomic rowing machines. Össur has been named one of “10 Companies That Are Helping Us Live Longer Lives” by the online site best-bsn-to-msn.com for nursing programs. Össur was cited for its smart prosthetic legs.

Ottobock, Duderstadt, Germany, has won iF product design awards for the Patella Pro orthosis, the Michelangelo Hand, and the Soft Backs orthosis line. Ottobock representatives accepted the awards as part of Creative Business Week in Munich, Germany. Prosthetics Outreach Foundation has announced collaborations with engineering students from the University of Washington and Washington State University to research improvements in prosthetic foot designs for individuals with amputations in Sierra Leone, and ultimately improve local prosthetic limbs and components in other developing countries. The Racquetball Rehabilitation Clinics, a new national program sponsored by the Military Racquetball Federation, is hosting clinics at Arizona State University for wounded service members to get back into the game.


Finger Prosthesis Developed in Seattle Colin Macduff, a Seattle Navy veteran and bike enthusiast who lost his finger in an accident, has created an unusual prosthesis. Macduff drew on his education, training, and love of bikes to make a finger prosthesis that gives him the dexterity to do whatever he wants, including working in the bike shop in his garage. Macduff designed a biomechanical finger using pieces of bike handlebars. The device is designed to grab a tool rather than make a tight fist, he says. With just three moving parts, the design was awarded a U.S. patent, and Macduff is now fitting other amputees “to give hope back to patients to function again, to do their job, [and] to do the simplest things like grab a coffee cup.”

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Alligator Debuts Prosthetic Tail At the Phoenix Herpetological Society, an injured alligator has been fitted with a lifelike prosthetic tail. The animal’s caretakers were aided by local experts from Midwestern University, a health-care college in Glendale, Arizona, and the CORE Institute in Phoenix, which specializes in orthopedic and prosthetic care for humans. Alligator tails generally comprise about half of their body length, and are used for everything from swimming to constructing muddy “gator holes” to stay cool during periods of drought. Early designs were rejected because they took on water and sank. The final design is a three-foot-long rubber tail, attached with nylon straps. A temporary inflatable water wing slipped over the prosthetic tail helps the alligator stabilize in the water while it acclimates to the prosthesis.

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MAY 2013 O&P Almanac



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HIPAA Compliance Adjust your business practices to comply with changes in patients’ right to privacy and other Omnibus Rule requirements


he Department of Health and Human Services’ (HHS) final Health Insurance Portability and Accountability Act (HIPAA) Omnibus Rule went into effect March 26 and has a mandatory compliance date of Sept. 23, 2013. Several changes from the Health Information Technology for Economic and Clinical Health (HITECH) Act to the final Omnibus Rule may have an impact on your current business practices and HIPAA policies and procedures. The changes have been divided into four categories. In the April 2013 issue of the O&P Almanac, the Reimbursement Page covered the first two, business associates and business associate agreements, and breaches and breach notifications. This month, we will cover the final two parts of the rule: patients’ privacy and rights, and compliance and enforcement.

Patients’ Privacy and Rights The HITECH Act laid some groundwork for granting patients additional protection and rights in how their protected health information (PHI) could be used, disclosed, or accessed, and the Omnibus Rule now immortalizes those protections. The changes to patients’ privacy and rights 16

O&P Almanac MAY 2013

that may have a direct effect on your facility are outlined here. First, a patient has a right to request that you don’t disclose his or her PHI or notify an insurance company or third-party biller of treatment he or she is receiving from your facility. If a patient makes this request and pays for the service or item in full, then you are obligated to grant the request and not disclose the PHI. Second, the sale of PHI for any reason or purpose is now prohibited, unless the patient provides direct authorization of the sale. A sale is defined as receiving any type of remuneration (financial or otherwise, directly or indirectly) for PHI. Finally, patients have expanded rights in terms of accessing their PHI. A patient has the right to request a copy of his or her PHI in any form. So, if you maintain electronic records and a patient requests an electronic copy of his or her PHI, you must provide an electronic copy. In addition, you must provide a copy of any requested PHI within 30 days; if you cannot provide it within that 30-day timeframe, you may use a one-time 30-day extension. If you are using the 30-day extension, you must provide the patient, in writing, an explanation of the delay.

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Reimbursement Page

violation. The maximum amount for a violation in tier 3 is $50,000 for each violation, not to exceed $1.5 million. If no attempt is made to correct the violation, tier 4 will apply, and the penalty will be $50,000 per violation, not to surpass $1.5 million in one year for the same violation.

First, review your policies and procedures and determine if they already cover how to discover and handle breaches of PHI, and that you have effective means of notification in place. Also, if a patient requests that you disclose his or her PHI to a third party or designated individual, you must comply with the request—provided the request was made in writing, was signed by the patient, and clearly identified the recipient of the PHI. How do these enhanced patients’ rights affect you? Some changes may require you to update your Notice of Privacy Practices (NPP). However, if you revised your NPP in response to the HITECH Act in 2009/2010 and those revisions encompass the changes in the final Omnibus Rule, then new NPP notices may not be required.

Compliance and Enforcement With the HITECH Act, HHS adopted a tiered approach for handling civil monetary penalties for violations. This has not changed dramatically with the issuance of the final Omnibus Rule. Tier 1 encompasses “did not know” or “reasonable diligence” violations. These are HIPAA violations that occur without your knowledge, and couldn’t have been foreseen due to your policy and procedures. These also are violations that occur because you do not have a complete understanding of the laws. In tier 1, the minimum penalty


O&P Almanac MAY 2013

Breaking Down the Tier Penalty System

is $100 per violation, not to surpass $25,000 in one year for the same violation. Tier 2 covers “reasonable cause,” or violations where you were unable to comply with the standards, but made attempts to become compliant. The definition of “reasonable cause” was updated to include someone who knows of a violation but lacks the conscious intent associated with willful neglect (discussed in the next tiers). This means you attempted to comply, but for some reason were unable to do so; you were not intentionally ignoring the laws. In tier 2, the minimum penalty is $1,000 per violation, not to surpass $100,000 in one year for the same violation. The maximum amount for a violation in tiers 1 and 2 could reach $50,000 for each violation, not to exceed $1.5 million. Tiers 3 and 4 are linked because they both hinge on the term “willful neglect.” This means that you intentionally or willfully ignored your obligations under the HIPAA statutes. Tier 3 will be applied if you take actions to correct the violations. Tier 3 carries a minimum penalty of $10,000 per violation, not to surpass $250,000 in one year for the same

What does this tier system mean? In simple terms: no more free passes. The new system will allow for increasing penalties depending on your culpability and negligence, and result in a fine of at least a $100 per violation. You may argue your case and possibly lower your fine, since the Secretary will look at six factors to determine the penalty (e.g., extent of the violation, harm caused by the violation, and past history of compliance). The burden will be yours to prove that the violation was not caused by willful neglect but rather reasonable cause or due diligence. Note that you could be held liable and eligible for civil monetary penalties based on the actions of your business associates or their subcontractors, even if you are completely compliant with HIPAA. It will all depend on how much authority is granted to the covered entity and/ or the business associate under the business associates agreement, so review those agreements carefully. When you conduct staff training in regard to these new policies and the new procedures you create, stress the importance of employees’ individual compliance. This is critical because employees can be held responsible for violating HIPAA. The HITECH Act allows the Office of Civil Rights to investigate and impose fines on individuals for violating any part of HIPAA. This includes any criminal violations, as long as the Justice Department is not also seeking criminal charges. One other important change: In the past, investigations into HIPAA violations were only conducted on a


complaint-driven basis. HHS would investigate covered entities only if a complaint had been lodged against them. This is no longer the case; under HITECH, and subsequently the Omnibus Rule, HHS is required to conduct proactive compliance audits. HHS also is required to conduct compliance reviews if a preliminary audit or review indicates HIPAA violations due to “willful neglect.” It is not certain how or what may trigger an audit, or if the audits will be random, but you will need to prepare: Make sure all of your HIPAA policies and procedures are up-to-date and accurate, and ensure your staff is aware of the policies.

Take Action Now To recap, some of the changes that were brought about by the final Omnibus Rule published on January 25 include the following: • Business associates are directly liable for compliance with certain HIPAA requirements. • New, strengthened limitations have been placed on the use and disclosure of PHI for certain functions (e.g., marketing, fundraising research, etc.). • Patients’ rights have been expanded in requesting copies of PHI. • Patients’ rights have been expanded in terms of what may be disclosed by a covered entity. • The ‘‘risk of harm’’ threshold has been replaced with a more objective standard. So what should you do to be compliant by the Sept. 23, 2013, deadline? First, review your policies and procedures and determine if they already cover how to discover and handle breaches of PHI, and that you have effective means of notification in place. If these are not in place or addressed in your current policies and procedures, update them immediately. Second, review your current NPP to determine if they must be updated

Reimbursement Page

Updating Your Notice of Privacy Practices When reviewing or rewriting your NPP, be sure to address several key issues. Keep in mind that not all of these will apply to your facility, so be sure to examine your business practices carefully. •

Include a statement informing patients they have the right to be notified if there is a breach of their PHI.

Include a section explaining patients have a right to request that their PHI not be disclosed to a health plan if they agree to pay in full for the service, and that you are required to agree to that request.

Include a statement that other uses or disclosures not described in the NPP can and will only be made after receiving authorization from patients, and that authorization may be revoked at any time.

Include a statement indicating that any uses and disclosures for marketing purposes and disclosures that constitute a sale of PHI will require patient authorization, and that authorization may be revoked at any time.

If you plan to contact patients for fundraising purposes, include a statement that allows patients to opt out of receiving fundraising communications.

and revised. (See above.) Make sure your notice accurately describes the policies and procedures in place for each provision listed in the notice. Your revised notices must be ready to go by September 23; that’s when you’ll need to start providing them to new patients. You are not required to reissue the updated notices to your previous patients, unless they request a copy, but you should post the updated versions in a prominent location. Keep in mind that you may not have to redo your notices. If you revised your notices in response to the enactment of the HITECH Act, and these revisions encompass the changes in the final Omnibus Rule, then new notices are not required. If you are unsure if you should revise your NPP, have your attorney review your current NPP to make the final determination. Third, review your current business associate agreements to determine

whether/how much they need to be amended. For example, your new business associate agreements should explain how the business associate will report any security incidents and how it will handle breaches. In addition, determine when the business associate agreement expires. If it has expired, then a new agreement will be required, and it must meet the new requirements. If it has not expired, begin negotiations with the business associate and establish a timeframe to modify the agreement before the final compliance deadline of Sept. 23, 2014. Finally, be sure to educate your employees on the recent changes. a Devon Bernard is AOPA’s manager of reimbursement services. Reach him at dbernard@AOPAnet.org.

MAY 2013 O&P Almanac


Rise of the Expert advice for protecting staff and patients


O&P Almanac MAY 2013



he news reports are scary. Media and health officials are raising concerns that it may soon be too late to prevent the spread of so-called “superbugs,” describing these bacteria as “deadly” and “defying drugs of last resort.” For anyone working in health care—including O&P— these headlines might be unpleasant, but they shouldn’t be ignored. That’s because many pathogens are increasingly being passed around in health-care settings. In the first half of 2012, nearly 200 hospitals and acute-care facilities treated at least one patient for the lethal “superbug” known as carbapenem-resistant Enterobacteriaceae, or CRE, according to new data from the U.S. Centers for Disease Control and Prevention (CDC). Others such as Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C-Diff) are becoming increasingly common. O&P professionals are entirely vulnerable to these new strains of treatment-resistant infections. But with care and planning, it is possible to minimize the threat to self and staff.

Scope of the Threat The CDC paints a grim picture of the superbug situation, with Director Thomas Frieden, MD, MPH, calling the present situation a “nightmare” and a “triple-threat.” “They’re resistant to nearly all antibiotics,” he explains, referring specifically to the latest infectious agent, CRE. “They have high mortality rates, killing half of people with serious infections. And they can spread their resistance to other bacteria.” So far, CRE has been found only in hospitals and nursing homes, but officials fear it could spread to the wider community. It is most likely to strike immune-compromised people who are hospitalized for a long time or living in a nursing home. “Unfortunately, it doesn’t seem like anything is slowing their spread,” says Costi Sifri, MD, an infectious disease physician and hospital epidemiologist at the University of Virginia Health System.

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“Five years from now O&P will be in a much better place, but in the meantime we really need to understand the simple things that are the key to protection.” —John F. Schulte, CPO, FAAOP

Getting Help

in his practice, too. With four practitioners and six staffers, “we are as much at risk as anyone else in the medical profession,” he says. “People come in with open wounds and healing wounds; they have blisters and sores. Diabetics come in with holes in their feet. It’s as prevalent for us as it is for dentists and everyone else.” In addition to being transmitted by direct contact, bloodborne pathogens can be passed along through a range of common instruments: disposable tape measures, cast saw blades, and hand tools such as scissors, contouring instruments, and the like. Given these high risks for O&P practitioners and staff, some in the industry are raising alarm bells—and also offering guidance for avoiding infection.

Photo: CDC/James Gathany

In 2001, only 1.2 percent of the common family of bacteria, Enterobacteriaceae, were resistant to carbapenem antibiotics—the strongest class available. By 2011, that figure had jumped to 4.2 percent. Superbugs have been found in 42 states. Wayne Rosen, CPO, C.Ped, FAAOP, of Pembroke Pines, Florida, knows the threat all too well. An orthotist, prosthetist, and pedorthist, he contracted MRSA in 2005 while in the hospital for surgery related to his Crohn’s disease. “That was the last thing I wanted. Once you have it, you are always susceptible to it,” he says. Because his immune system is weakened by Crohn’s, “the chances of me getting it again are very, very real.” On account of his compromised state, and confounded by a prolonged series of antibiotic treatments, Rosen had to stop seeing patients in the hospital for five years. He won’t go into operating rooms anymore, or to nursing homes—anyplace where superbugs are likely to thrive. He also is well aware that if they can live in hospitals, they can live

Thomas R. Frieden, MD, MPH, current director of the CDC


O&P Almanac MAY 2013

Protection against CRE, MRSA, and other infectious elements begins with education—and getting educated begins with getting assistance. Many resources are available to help the O&P community find its bearings, says Chris Robinson, CPO, FAAOP, assistant professor of physical medicine and rehabilitation and assistant director of orthotics education at Northwestern University Prosthetics-Orthotics Center. For many in O&P, proper practice will begin at the front door of the hospital, where the nursing staff is not only trained in disease control but also typically under instruction to share that knowledge with anyone who asks. Larger hospitals also will have an infection control specialist on hand to share best practices. These resources are a vital link for O&P practitioners, says Robinson. Realistically, most in the profession are hard-pressed to keep up with the latest news and practices when it comes to infectious disease: They need the help of those who follow the situation daily. “The average practitioner has a lot of obligations through the course of the week, so even just keeping up with the information to protect yourself and your colleagues is an inherent challenge,” he says. “I don’t think the average practitioner can read every peer-reviewed journal cover to cover every month.”

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Tips From the CDC To help contain the spread of drug-resistant disease, the Centers for Disease Control recommends keeping the following items available and ready:

• Gloves—to protect hands • Gowns/aprons—to protect skin and/or clothing • Masks—to protect mouth/nose • Respirators—to protect respiratory tract from airborne infectious agents • Goggles—to protect eyes

Photo: CDC/ Amanda Mills

• Face shields—to protect face, mouth, nose, and eyes

A health-care provider donning a pair of beige latex gloves in order to protect himself during his subsequent interaction with his next patient.

In addition, the CDC specifies these practices for use of gloves and gowns: • Wear gloves for potential contact with blood, body fluids, or contaminated equipment. • Do not wear the same pair of gloves for the care of more than one patient. • Do not wash gloves for the purpose of reuse. • Perform hand hygiene immediately after removing gloves. • Wear a gown to protect skin and clothing when contact with blood or body fluids is anticipated. • Do not wear the same gown for the care of more than one patient.


O&P Almanac MAY 2013

Yet even when armed with information from nurses, specialists, and other resources, O&P practitioners run high risks. This is where John F. Schulte, CPO, FAAOP, comes into the picture. A clinical educator with Fillauer Companies, he is an infectious disease evangelist to the O&P community, traveling the country with words of caution and prevention. Schulte has strong personal reasons for pursuing the cause. Twenty-five years ago he walked into a nursing home and walked out with an increasingly intense skin itch, which a physician diagnosed as scabies. “I went to his office, he took a scalpel and scraped between the web of my fingers, and said: ‘Yup, there you go.’ I saw live skin mites crawling around there and I thought, ‘Oh my God!’ I had three young kids at the time,” Schulte recalls. “I am not a germophobe at all, but I have been very conscious about personal hygiene and how to protect myself ever since then,” he says. “The superbugs are everywhere. You need to be aware of it. You need to protect yourself and others.” O&P may be especially susceptible to infection. Sharp edges, cutting surfaces, and even the practitioner pool can contribute to risk. “It’s a predominantly male field, and men’s skin in general is drier,” says Schulte. “So they may have a hangnail, or they may have dry, cracked skin. You run your hands on your eyes and it’s a direct entry into the body’s systems. You can scratch yourself on a cast saw blade. All these things can help these bugs get into your system.” The nature of the work, too, creates inherent hazards. “If a technician in the lab is going to grind a spot on a device that needs to be relieved, anything from those grindings can become airborne,” says Schulte. “The germs are in the air in the immediate area and that technician is breathing in it.

Heat will relieve pressure, but it also will atomize materials and germs will become airborne.” Understanding all these inherent risks, Schulte recommends these steps for putting protection into practice: • Wash thoroughly. “It has to be a focused hand-washing. I see so many people rub their fingers under the flowing water but they don’t use friction and they don’t use a lot of soap. That does nothing,” he says. • Clean equipment. “We need to be aware of our everyday tools: tape measures, scissors, indelible pencils. Anything that touches the body can harbor these germs. Use a sterilizing solution similar to Cidex, either to wipe them down or leave them in a solution like a hairstylist does. Then you can use the same tool for different customers but it will be sterilized. [Many practitioners] don’t do that at all. We cut something off a device and we throw the instrument back in the drawer for the next person.” • Use barriers. “Avoid skin-to-skin contact. Always wear gloves. If not, use hand sanitizer before and then wash afterwards. Practitioners need to have hand sanitizer on their person, in their pocket,” Schulte advises. Note that over-the-counter hand sanitizers protect for two minutes. 3M makes Avagard D, a heavy-duty sanitizer that lasts for six hours. • Mask your mouth. “If you are going to be cutting anything that will bring the particles up into the air, then you should be wearing a mask,” he says. “The key for those is keeping them clean, wiping them out, and putting them in the storage bag—and changing the filters every single time.” • Protect others. “If you work in a hospital situation, anything that is used in the room stays in the room: your pencil, your measuring tape.”

Photo: CDC


• Follow chain of command. Office staff are covered under Occupational Saftey and Health Administration rules, so an infection could drive a worker’s compensation claim. All staff should follow the same guidelines as the practitioner. If a patient comes in with a bag containing a device that needs adjusting and has rubbed a sore, no one should touch that bag. It should immediately go into a red bag and be taken to the lab, where a technician should be made aware of the possible pathogens. The practitioner should clean the device before proceeding. • Clean, clean, clean. Keep your office spotless, says Schulte. “The dust is in your lab, on your work bench; it may have been two weeks since you saw patient X and modified his device, and yet his superbug lingers. And when

you clean off your desk with an air hose, for example, it now becomes airborne.” Put in perspective, the rise of the so-called superbugs is cause for diligence, not panic, experts say. Thorough procedures can significantly reduce risk—and processes are improving every day. “Medicare has stopped paying [for the portion of the claim related to bloodborne pathogens], so in most hospitals if you come back positive for MRSA you get a head-to-toe skin wash every day for three days,” Schulte explains. “Five years from now O&P will be in a much better place, but in the meantime we really need to understand the simple things that are the key to protection.” a Adam Stone is a contributing writer for O&P Almanac. Reach him at adam. stone@newsroom42.com.

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k r o W


E d u cat i n g C on g ress , one mem b er at a t i me

By Adam Stone


O&P Almanac MAY 2013

From left to right, Paul Leimkuehler II, orthotic resident; Jim Leimkuehler; Greg Leimkuehler, CPO; Paulette Vaughn; Senator Rob Portman; Ryan Arbogast; Lonnie Holt, patient; Bill Leimkuehler, CPO.


he AOPA 2013 Policy Forum has raised the bar for O&P advocacy. On March 12 and 13, supporters poured into Washington, D.C., from around the nation to press their case for fair laws and commonsense regulations. More than 100 O&P professionals came to the Capitol, where AOPA had arranged some 350 appointments for them with legislators and aides. An amputee and a U.S. Representative for Illinois’s 8th congressional district, Tammy Duckworth (D-Illinois) spoke extensively with attendees. She addressed their priorities, including opposing a plan to competitively bid custom devices. Duckworth also asked the assembled O&P professionals to encourage elected officials to add their signatures to a letter to the U.S. Department of Health & Human Services (HHS) Secretary Kathleen Sebelius, raising concerns about the Recovery Audit Contractor program. RAC audits and prepayment reviews took center stage through much of the forum, with providers sharing stories of frustration and financial hardship.

Perhaps the most dramatic moment came, however, when a CMS representative addressed the gathered practitioners. CMS Medical Officer Michael Handrigan, MD, found himself in the hot seat as one practitioner after another rose to voice their discontent. Their impassioned stories told of an industry beset by financial injustice and dogged by a system in which auditors can tie up cash flow for months or years, leaving practitioners virtually powerless to serve their patients. While unable to provide specific numbers or talk about potential remedies, Handrigan did offer a willing ear—and perhaps a conduit back to CMS decision makers. Although we don’t know if CMS will respond to any of these powerful stories, at least practitioners got the satisfaction of telling their tales to a CMS representative in the presence of one another. On the pages that follow, five Policy Forum participants share their impressions of the event and their hopes for change in Washington.

Jan Saunders figures it’s better to do something rather than wait for matters to unfold on their own. “Whether it is going to be fruitful or not, you can’t just stand by and not try to get something done. There is so much apathy in our industry, you need to try to get the snowball rolling,” says the owner of Saunders Prosthetics & Orthotics in Kissimmee, Florida. As a survivor of the dreaded CMS RAC audit, Saunders knows firsthand how badly change is needed. “I don’t know that my problem is really with CMS as much as it is with the companies they have hired to do their auditing process—[the CMS contractors] have almost free rein,” he says. “The problem I have is that the rate of overturning their findings is dramatically high when it reaches an administrative law judge, but you can’t pay your bills in the 20 months it takes to get to that judge.” So Saunders went to Washington to drive change—or at least to have his voice heard. He believes he did indeed get heard.

Jan Saunders While at the Policy Forum, the practitioner met with Reps. Tammy Duckworth, Richard Nugent (R-Florida), Alan Grayson (D-Florida), and Daniel Webster (R-Florida), along with a slew of legislative aides. He got a promise from Representative Webster that the congressman would call HHS Secretary Sebelius directly to express AOPA concerns. “It couldn’t have gone any better,” he says. MAY 2013 O&P Almanac


Jim Leimkuehler

Jim Leimkuehler went to the Capitol on behalf of Cleveland-based Leimkuehler, Inc. and its six practitioners in three offices. While worried about the audits, he’s even more uneasy about whether there may be misguided government plans to categorize custom devices as off-the-shelf commodities subject to competitive bidding. “My biggest concern is the competitive bidding. I don’t want to see O&P going into a lot of that. It would just be a huge shift for the industry, and it would be difficult to adapt to,” he says. “O&P is such a customized field; it just doesn’t fit into competitive bidding correctly.” With Congress seemingly in perpetual gridlock, Leimkuehler says he is unsure how much the efforts of O&P advocates may achieve this year, but he says there’s no better way to move the needle than by direct lobbying. “Everything Congress does is waiting until the last minute. They are not making any decisions until they are absolutely forced to, but this is still our only avenue, so we have to pursue it, even if it is challenging,” he says. “We have to work within the system, and this is the system.” Back from D.C., the practitioner says his first eye-opener involved the sheer scale of the Capitol complex. “We were bouncing back and forth between the House side and the Senate side,” he says. “It can be a lot just to figure


O&P Almanac MAY 2013

out how to get around there, with all the security. It turns out the thing to do is to stay under the building, especially if you can get a pass from a representative, which helps to get you through security.” The day went well. Leimkuehler met with aides, often in crowded hallways. He scored direct conversations with a couple of legislators too. Still, he knew when he had hit a stalemate. Rep. Jim Renacci (R-Ohio) comes from a professional background in durable medical equipment (DME), an industry that has already been subjected to competitive bidding. Many DME practitioners have been driven out of business as a result, so when the topic came up, “he had zero sympathy for what our industry was going through.” Paulette Vaughn of PEL Supply Co. in Cleveland says she came not only to represent her distributorship but also to represent those who rely on her services. “I’m hearing all these stories from our customers, especially about these RAC audits. It’s just terrible what is happening in our industry,” she says. Along with six others from Ohio, she met with at least five legislative aides. Although she’d hoped for face time with actual lawmakers, she came to understand that the aides are the ones who take in information and process it on behalf of their

bosses—and that’s not necessarily a bad thing. “They seemed to have experienced people in these positions. …One person told us she had been doing this for 17 years. These were knowledgeable people,” she says. “The whole experience was amazing. I am so inspired,” says Vaughn. Her big takeaway had to do with the process itself and the eagerness of lawmakers to hear directly from those they serve: “They all told us what makes a difference is to hear from the constituents. So now I’d like to see our patients contact their representatives and senators.” In this experience as part of an organized group lobbying their legislators, Vaughn felt she had a kind of privileged access not enjoyed by other visitors to the Capitol. “We crossed

Paulette Vaughn

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MAY 2013 O&P Almanac


Michael S. Relle Michael S. Relle with Sen. David Vitter and father Michael K. Relle.

paths with tours, but we were more on the inside. We were in the offices, talking to staff, really seeing how government was running,” she says. That inside view could sometimes be a little nerve-racking: “I hadn’t really understood how much time and energy these members of Congress put into this, talking about late night negotiations where O&P gets tossed into the box with competitive bidding in order to find some more money. It’s very scary.” Michael Relle went to Washington with concerns that his very livelihood was at stake. “I want to be sure that we are still going to be able to provide orthotics and prosthetics to our patients,” he says. At Orthotic & Prosthetic Specialists in Covington, Louisiana, “It’s getting more and more difficult to get things approved, authorized, and paid for by health insurance companies, be it government institutions or private entities,” he says. “We have had to hire on extra staff just to deal with some of the denials and appeals.” The best way to remedy the situation is to go directly to those who lay out the rules and regulations. “We want our elected officials to be aware of these issues. They need to know that because of the bureaucracy, we cannot provide care to some of our patients. I hope that is not their intent,” says Relle, who also is president of the


O&P Almanac MAY 2013

Louisiana Association of Orthotists and Prosthetists. Back home, Relle says he was especially affected by the chance to share notes with his colleagues. “It was good speaking to other people in the industry, just to find out what kind of problems they are having. Lo and behold, we are all having the same problems. It’s not specific to any one geographic area,” he says. “I’m glad to see that our industry is being proactive in trying to combat some of these things.” Relle and his colleagues got direct access not just to aides but to several lawmakers as well. “I didn’t expect that at all, and all of the individuals we spoke to were favorable. They took the time to listen, they were knowledgeable on the problems we were having,” he says. “I had this stereotype that maybe we would be bothering them, but, in fact, they are supposed to be working for us, and it was good to see that they were still taking that seriously. They sat down with us, and they listened thoughtfully,” he says. Josh Marcus, a Miami attorney, knows he has a special role to play in lobbying events. An above-elbow amputee (caused by a Jet Ski accident while in law school), he knows he can command attention. “Getting the word out there on coverage issues is extremely important to me. The

more providers are covered, the more patients will get access to muchneeded health care,” he says. Marcus should know: He fought a three-year battle with his insurance company for coverage. Marcus came as much to learn as to lobby. “I am hoping just to understand a little better the issues that are affecting orthotists and prosthetists. I have been doing a lot of research and reading, but these particular issues— the government contractor audits and the competitive bidding—I just want to get more up to speed on those,” he says. “Mostly I want to get involved as a voice for the industry at large. I want to get to know the people at AOPA, the people who are leading these efforts.” After the fact, he believed his personal condition helped him score points. “When you sit face-to-face with people, it’s hard for them not to sympathize,” he says. He spoke with aides about a range of issues, from RAC audits to insurance fairness. “If they don’t hear us bringing these issues to light, then they are never going to hear it. So, these are the baby steps that lead to good legislation and fair administrative rules,” he says. “It was very exciting, watching democracy at work.” a Adam Stone is a contributing writer for O&P Almanac. Reach him at adam. stone@newsroom42.com.

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Making a Difference


Practitioner and patient unite for the good of the industry—and you can, too


concern. In total, 35 members of Congress signed ou know you’ve got a hot-button issue on to the letter to HHS Secretary Sebelius. when a senator’s office takes the initiative Why did Tyo’s visit inspire Gillibrand’s to advocate for your cause. That’s exactly office to take the initiative in contacting AOPA? what happened after John Tyo, BOCP, CP, visited Because Tyo did one very important thing: the office of Sen. Kirsten Gillibrand (D-New He followed AOPA’s suggestion and brought York) during the March 12-13, 2013, AOPA a patient to the Policy Forum. As Tyo later Policy Forum. Gillibrand’s office followed up recounted, the patient not only made AOPA’s Tyo’s visit by contacting AOPA to let staff know case in a dramatically persuasive manner, he that Tyo had shared with them the letter to also put a real, human face on O&P and our Health and Human Services (HHS) Secretary issues. Together, Tyo and his patient Kathleen Sebelius, signed by Reps. were able to convincingly focus Tammy Duckworth (D-Illinois) and attention on how RAC audits and Brett Guthrie (R-Kentucky), which prepayment reviews are not accomaddresses AOPA’s concerns with the plishing the objective of reducing Recovery Audit Contractor (RAC) fraud and abuse problems or errors program and its interference with on claims. They are, however, patient care. throwing roadblocks in the path Guthrie and Duckworth subseof delivering patient care, leading quently issued a “Dear Colleague to many delayed device deliveries Letter” to all members of the House or non-payment for services and of Representatives urging them to devices already delivered. “sign on” and add more voices of Sen. Kirsten Gillibrand


O&P Almanac MAY 2013



The letter to HHS Secretary Sebelius that members of Congress signed on to is available at www. AOPAnet.org, and can be accessed by the “Legislative and Regulatory” pull-down menu on the homepage and selecting Policy Forum. If the names of your senators and representatives aren’t on the letter, do yourself and your patients a favor: Call, email, or write your elected officials and request they send their own letters. A model letter can be accessed from the webpage on which the list appears. Last month’s O&P Almanac presented a timely rundown of Policy Forum activities. To make the investment of time, energy, and money for those activities really pay off, each individual AOPA member needs to help us keep the momentum established during the Forum going by further distributing to their elected officials the materials shared with members of Congress during the event. Perhaps you could share the materials with your congressperson or senator when he or she visits your facility for a tour. The most successful facility tours also feature patients who can share their stories of recovery and hope gained through your O&P care. On our website, AOPA has a complete how-to kit that spells out everything from A to Z. To download the kit, use the same ‘Legislative and Regulatory” pull-down menu and select “Contact Your Legislator.”


O&P Almanac MAY 2013

You’ll find a sample tool kit of various documents, including an overview of congressional staff and their titles, positions, and responsibilities. The Facility Visit Guidelines document covers everything from crafting the invitation to arranging for press coverage, photos, and the follow-up “thank you” to the member of Congress and appropriate staff. AOPA will provide timely issue papers and talking points covering all the main advocacy agenda items that AOPA is working on at any one point. Of course the RAC audits should be the headline issue for current visits, and AOPA has considerable back-up information on this pressing problem.

Upon completion of the tour and the visit, summarize what was presented and try to get as many photos as possible of your elected officials with you, your staff, and patients if possible. Send pictures to AOPA for the AIA Smartbrief and the O&P Almanac, as we’ll want to report on your experience to inspire others to follow your lead. The tool kit also provides a glossary of terms and a very basic how-to piece on grassroots lobbying. Holding a fundraiser for a candidate or legislator is a slam-dunk way to build a relationship that works for the future. A piece on the importance of holding a fundraiser and an outline of how to host a successful fundraiser completes the package. The O&P field has serious issues with the RAC and Comprehensive Error Rate Testing audits plus the prepayment reviews. CMS is not listening to our community, so we must find voices they will listen to—and members of Congress can be those proactive voices. But remember, you must take the lead; it’s your job to recruit them—one by one. AOPA can back you up, provide support, and share information, but the ball is in your court. a


Registration Is Now Open for 2013 World Congress

About the Congress The 2013 World Congress presents a whole new world of collaboration and opportunities for practitioners in the Western Hemisphere and beyond to participate in a forum similar to opportunities available to practitioners in Europe. AOPA and its partners, The U.S. National Member Society of the International Society for Prosthetics and Orthotics (USISPO); the German Association of Orthopaedic Technology/con.fair.med; the Amputee Coalition; the Canadian Association of Prosthetics and Orthotics; Uniting Fronteras; and the Mexico Member Society of ISPO invite you to participate in the 2013 World Congress to be held Sept. 18-21 at the Gaylord Palms Resort in Orlando. The 2013 World Congress has it all. The trade show is jam-packed with fresh ideas and innovative solutions, and the education program is filled with the latest techniques in patient care and practice management training. Gain all of the tools you need to serve your patients successfully at the 2013 O&P World Congress—a premier international event!

The 2013 World Congress already is the most talked-about event for 2013—it is the premier destination for the world-wide orthotic and prosthetic community. Register today to participate in an expanded National Assembly as AOPA and partners from around the world work to create an O&P World Congress experience for all O&P practitioners.

Not Your Ordinary Orlando Meeting In addition to premier scientific and business education by leading experts, World Congress attendees will have the opportunity to participate in a special event at Universal Studios on Friday, Sept. 20. Luxury coach buses will transport you to Universal Studios for a memorable event as the park closes to the public. You and your colleagues will have exclusive access to the Island of Adventures at Universal. Special entertainment, refreshments, and exclusive access to the park are all included in this optional event.

Mastering Medicare: AOPA’s Essential Coding & Billing Techniques Renaissance Phoenix Downtown Hotel • June 13-14, 2013 • Phoenix Join your colleagues June 13-14 at the Renaissance Downtown Hotel in Phoenix for AOPA’s “Mastering Medicare: Essential Coding & Billing Techniques” seminar. AOPA experts will provide the most 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: Essential Coding & Billing Techniques” seminar in Phoenix at www.bit.ly/AOPApho. Questions? Contact Devon Bernard at dbernard@aopanet. org or 571/431-0854. MAY 2013 O&P Almanac



Clinical Documentation: The Dos and Don’ts— Join the Audio Conference June 12 What are the most vital pieces of documentation necessary to support your claim? Find out by joining AOPA on June 12 for an AOPAversity Mastering Medicare Audio Conference that will take the helm on what is expected in clinical documentation. An AOPA expert will address these expectations during a role-play scenario of practitioner and medical reviewer, and will explain why this is a critical force in your business operation. The following topics will be covered:


• Methods for taking notes and understanding when you should document • Use of SOAP and the timing of chart notes • Words to avoid and words to emphasize in progress notes • Working with referral sources to make sure they are documenting properly.


O&P Almanac MAY 2013

AOPA members pay just $99 ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@ AOPAnet.org or 571/431-0854 with content questions. Register online at www.bit.ly/2013audio. Contact Steve Custer at scuster@AOPAnet.org or 571/431-0876 with registration questions.

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

ial c e p S gs! n savi

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


Navigate the Maze: Get to Know the Appeals Process—Join the Audio Conference May 8 What type of information should and should not be included in an appeal? Join AOPA on May 8 for an AOPAversity Mastering Medicare Audio Conference that will focus on navigating the curves of the appeals process, and explain why it’s an important part of your business operation. An AOPA expert will address the following issues during the audio conference: • The five levels of appeals • Helpful hints on filing appeals • Strategies to achieve a successful appeal • Evaluating the necessary information to include in an appeal. AOPA members pay just $99 to participate ($199 for nonmembers), and any number of employees may listen on a given line. Participants can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon

Bernard at dbernard@AOPAnet.org or 571/431-0854 with content questions. Register online at www.bit.ly/2013audio. Contact Steve Custer at scuster@AOPAnet.org or 571/431-0876 with registration questions.

Follow AOPA on Facebook and Twitter Follow AOPA on Facebook and Twitter to keep on top of latest trends and topics in the O&P community. Signal your commitment to quality, accessibility, and accountability, and strengthen your association with AOPA, by helping build these online communities. Like us on Facebook at: www.facebook. com/AmericanOandP with your personal account and your organization’s account! Follow us on twitter: @americanoandp, and we’ll follow you, too! Contact Steffanie Housman at shousman@ AOPAnet.org or 571/431-0835 with social media and content questions.

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

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

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

MAY 2013 O&P Almanac



Social Media & Your O&P Practice, Part 2: Pinterest Recently, some marketers have argued that the most underutilized social media platform is Pinterest. Businesses of all sizes that take advantage of this photo-driven platform are reaping great rewards. AOPA Content Strategist Steffanie Housman offers some advice for taking advantage of this newer social media platform.


What’s Pinterest? Pinterest was started by an architect looking for new ways to share his portfolio. He developed the social media platform, which enables users to “pin” or clip pictures onto boards that they name. As an example, here is a board that Great Steps O&P created. On Pinterest, like most social media platforms, you have followers. You can “like” the images that others have posted, and you can re-pin them to your own boards. What is interesting about Pinterest is these images link back to different sites. This is extremely useful for businesses. Let’s take an O&P example. You have a blog post that you published with your patient’s permission, featuring fantastic photos of your patient climbing a mountain with the prosthetic leg you crafted. You could pin those photos to an appropriate board. If anyone clicks on your photo, it links directly back to your company and your post. Everyone will know it is your facility that allowed your patient to achieve that feat. Additionally, you have the opportunity to craft descriptions for each pin. You want to do this in a conversational voice that will engage the end user.

How can I succeed with Pinterest? Pinterest works best with fantastic photography. You don’t have to hire a photographer to do this, but identify someone on staff who is good at, and enjoys, taking pictures. That staff member can stretch and develop his or her skills to become the new in-house photographer! Make sure your staff photographer has access to photoediting tools. Some computers may come with this feature pre-installed, or you can find online photo-editing sites, such as picmonkey.com.



What are the benefits of Pinterest? Using Pinterest will allow you to engage with a new audience with fantastic images, direct traffic back to your website, and visually promote the work you are doing. Remember that you are connecting with a different type of learner on Pinterest. Take advantage of the marketing potential and the emotional connection you can have in a picture. After all, they say a picture is worth 1,000 words.

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 38

O&P Almanac MAY 2013

CE Credit Presentations Category. Credits will be recorded by ABC and BOC on a quarterly basis. AOPA also offers two sets of webcasts: Mastering Medicare and Practice Management. • Mastering Medicare: Coding & Billing Basics: These courses are designed for practitioners and office staff who need basic to intermediate education on coding and billing Medicare. • Practice Management: Getting Started Series: These courses are designed for those establishing a new O&P practice. Register online by visiting http://bit.ly/AOPAwebcasts.


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

George Breece Maynard Carkhuff Thomas DiBello, CO, FAAOP Michael Martin, CO, FAAOP Rick Stapleton, CPO

The O&P PAC advocates for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. To achieve this goal, committee members work closely with members of the House and Senate to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in the O&P PAC, federal law mandates that you must first sign an authorization form. To obtain an authorization form, contact Devon Bernard at dbernard@AOPAnet.org. *Due to publishing deadlines this list was created on March 21, 2013, and includes only donations received between Feb. 27, 2013, and March 21, 2013. Any donations received or made after March 21, 2013, will be published in an upcoming issue of O&P Almanac.


24/7 Expert Coding Advice 24/7 •

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

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

This exclusive service is available only for AOPA members.

Contact Lauren Anderson at 571/431-0843 or landerson@AOPAnet.org.

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

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.

MAY 2013 O&P Almanac


AOPA Applications

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



Member Benefits

A Step Ahead Prosthetics

Orthotic & Prosthetic Designs LLC

21 A Street Boston, MA 01803 781/365-1639 Category: Affiliate Member Parent Company: A Step Ahead Prosthetics, Hicksville, NY

7855 S. Emerson Avenue, Ste. S Indianapolis, IN 46237 317/882-9002 Fax: 317/882-9003 Category: Affiliate Member Parent Company: Orthotic & Prosthetic Designs, Columbus, IN

American Orthotic & Prosthetic Center Inc.

Rinella Orthotics Inc.

36076 Lankford Highway Belle Haven, VA 23306 800/328-9077 Fax: 757/548-5657 Category: Affiliate Member Parent Company: American Orthotic & Prosthetic Center Inc., Chesapeake, VA

Crosswalk Prosthetics Inc.

717 Highway 67 S., Ste. 10 Priceville, AL 35603 256/353-7175 Fax: 256/260-1187 Category: Patient-Care Member Amy Thomas

1890 Silver Cross Blvd., Ste. 445 New Lenox, IL 60451 815/717-8970 Fax: 888/415-8025 Category: Patient-Care Member Daniel Rinella

Spinal Kinetics Inc. 190 Duffy Avenue Hicksville, NY 11801 516/513-1274 Fax: 516/484-7138 Category: Patient-Care Member Judith Tiberie a

Denham Orthotics & Prosthetics 600 Whitney Ranch Drive Henderson, NV 89014 702/898-6000 Fax: 702/898-6080 Category: Patient-Care Member Dave Denham, MS, CO

Experience the Benefits of AOPA Membership Membership in AOPA is one of the best investments that you can make

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



Experience the Benefits of AOPA Membership

in the future of your company.

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

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

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

O&P Almanac MAY 2013

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

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

Join today!


Camber Axis Hinge from PEL in three sizes PEL Supply offers the Camber Axis Hinge® from Becker Orthopedic in three sizes to meet patient needs. In addition to the existing medium and large sizes, the newest small size is for pediatric and light-weight patients under 90 lbs (40.5 kg). All sizes feature: • Adjustable range-of-motion ankle joint • Anatomical axis alignment for thermoplastic orthoses • Seven color-coded range-of-motion keys • Eliminates need for posterior stop mechanisms • Permits solid ankle design changes to articulated motion with variable stop settings • Three sizes (small, medium, and large) • Optional black noncorrosive finish. For more information about the Camber Axis Hinge®, or any other popular products from Becker Orthopedic, contact your friendly PEL customer service representative at 800/321-1264, or email customerservice@pelsupply.com. Registered customers may order online at www.pelsupply.com.

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

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

SYMBIONIC LEG™ by Össur®. Move Naturally. SYMBIONIC LEG is the first commercially available, complete bionic leg that combines an MPK and a powered, microprocessor ankle. It provides unmatched toe clearance for enhanced safety and enables transfemoral amputees to confidently traverse terrain they might otherwise avoid, without the gait deviations commonly seen in MPK users. SYMBIONIC LEG is insurance billable using existing, approved L-Codes and, when used with RHEOLOGIC Workbench software, offers the ability to document actual user cadence variation to reduce insurance reimbursement risk. To learn more about the SYMBIONIC LEG by Össur, call 800/233-6263 today, or visit www.ossur.com/sbl.

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

MAY 2013 O&P Almanac



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

North Central CPO Twin Cities, Maplewood, Minnesota

- 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

& Prosthetic



DISCOVER more AOPA advertising opportunities.


American Orthotic

mediakit Rates effective


O&P Since

Jan. 1, 2013

Call Dean Mather, advertising sales representative, at 856/768-9360 or email dmather@mrvica.com.





O&P Almanac MAY 2013

Job Duration—Career Position Title—CPO Submit resume to—a.holm@tcopinc.com Company Website—www.tcopinc.com Location—Twin Cities, Maplewood, MN Tillges Orthotic and Prosthetic is growing! To help facilitate this growth we are currently accepting resumes for an experienced CPO (two plus years). Position is based out of our Maplewood, Minnesota, facility. Some local and regional travel could be required. Job requirements: • Self-motivated with solid clinical background. • Candidate must be organized and have the ability to create and solidify relationships with referral sources. Tillges Certified Orthotic Prosthetic Inc. believes that the future of our business depends on the quality of our staff. Therefore, we make it our business to hire the best… and treat them well. Our friendly staff operates in a fastpaced, team environment providing camaraderie, support, and fun. We can’t make the O&P business stress-free, but we help you manage that stress by using state-of-the-art systems and with reasonable workloads and schedules. We believe in offering a competitive salary/benefit package and advancement opportunities within our strong, and growing, company. TCOP Inc. is an aggressive, ABC-accredited facility with an outstanding reputation in the O&P industry. For more information on Tillges, visit www.tcopinc.com. For consideration, contact:

Attn: Chief Operating Officer TCOP Inc. 1570 Beam Ave., Suite 100 Maplewood, MN 55109 Email: a.holm@tcopinc.com Website: www.tcopinc.com




Licensed CPO & Residents


Gainesville/Jacksonville, Florida Opportunity for a skilled and experienced licensed practitioner as well as a resident who has completed an orthotic residency and is looking for a prosthetic residency opportunity. We are a productive and growing mobile O&P facility with offices throughout Florida. Seeking a hard-working and self-motivated practitioner/ resident with a strong clinical and interpersonal background to help continue our growth. Ideal candidacy for a CPO consists of at least five years of clinical experience, energetic, self-driven, organized, communicative team player, with good interpersonal skills; Spanish speaking a definite plus. We offer a very competitive salary and excellent benefit package along with opportunity for career growth. Relocation assistance is available if needed. If interested, email resume to:

Monterey Bay Area, California Competitive Western United States O&P business seeking a certified prothetist/orthotist in Salinas, located in the beautiful Monterey Bay area of California. We are seeking a seasoned practitioner with experience in practice management, clinical expertise in outpatient and inpatient settings, and a willingness to work within a dynamic team. Unlimited business opportunities available in an expanding local market. Competitive salary, benefits, and bonus plan. Interested parties should email inquiries/resume to:

Email: jwiley@pacmedical.com Fax: 888/853-0002

Email: markselleck@bellsouth.net

Tina Mann

Clinic Manager

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

View our current positions and apply online at: www.hanger.com/careers or scan the QR code.

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

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

Available Positions: Clinic Manager Valdosta, GA

Morgantown, WV Orthotist

Wichita, KS Hammond, IN Cary, NC Auburn, CA Phoenix, AZ

Tucson, AZ Richland, WA Jacksonville, FL Pensacola, FL Beaufort, SC

Prosthetist / Orthotist Johnson City, NY Williamsport, PA Chambersburg, PA Tamarac, FL

Buffalo, NY Burbank, CA Redding, CA Vancouver, WA

Prosthetist Hazel Crest, IL

Bullhead City, AZ

MAY 2013 O&P Almanac



■ YEAR-ROUND TESTING BOC Examinations. BOC has year-round testing for all of its examinations; candidates can apply and test when ready. Candidates can apply and test when ready, receiving their results instantly for the multiple-choice and clinicalsimulation exams. Apply now at http://my.bocusa.org. For more information, visit www. bocusa.org or email cert@ bocusa.org.

2013 ■ MAY 8 AOPAversity Audio Conference—Navigate the Maze: Get to Know the Appeals Process. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■ MAY 13 WillowWood: Alpha DESIGN® Liners. Mt. Sterling, OH. Half-day course teaches how to use OMEGA software files to create custom liners. Attendees can practice with all aspects of the software, including file import, liner creation, liner fabrication and Design liner options. Credits: 4.0 ABC/4.0 BOC. Visit www. willowwoodco.com.

May 13-18 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was March 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■

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


■ MAY 13 WillowWood: OMEGA® Training. Mt. Sterling, OH. Covers basic and advanced software tool use and shape capture by scanning. ‘By Measurement’ shape creation and custom liners discussed. Includes extensive handson practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: 4.0 ABC/3.75 BOC. Visit www. willowwoodco.com.

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

Member Rate

Nonmember Rate

25 or less................... $40..................................$50 26-50......................... $50..................................$60 51+................... $2.25 per word................$5.00 per word Color Ad Special: 1/4 page Ad.............. $482............................... $678 1/2 page Ad.............. $634............................... $830 BONUS! Listings will be placed free of charge on the Attend O&P Events section of 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. 44

O&P Almanac MAY 2013

■ MAY 14-16 WillowWood: OMEGA® Training. Mt. Sterling, OH. Covers basic and advanced software tool use and shape capture with OMEGA Scanner. ‘By Measurement’ shape creation and custom liners discussed. Extensive hands-on practice in capturing and modifying prosthetic and orthotic shapes. Must be current OMEGA facility to attend. Credits: 19.25 ABC/19.25 BOC. Visit www. willowwoodco.com. ■ MAY 16-18 PA/MD/DC/VA AAOP Chapter Annual Meeting. Sheraton Station Square Hotel. Pittsburgh. Contact Beth Cornelius at 814/4555383 or Joseph Carter Jr. at 814/455-5383. For more information, visit www.oandp. org/membership/chapters/ maryland.

■ MAY 16-18 Western Mid-Western Orthotics and Prosthetic Association. Reno, NV. WAMOPA Annual Meeting. Peppermill Resort & Casino. 24 CEU Credits with the best value in our industry. Visit www.wamopa.com for program and golf tournament updates, or call Steve Colwell at 206/440-1811. ■ MAY 29 - June 1 The Midwest AAOP Chapter Annual Meeting and Scientific Session. Lake Geneva, WI. The Grand Geneva Resort. For more information, visit www.oandp. org/membership/chapters/ midwest. ■ June 1 ABC: Practitioner Residency Completion Deadline for March Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email info@abcop.org, or visit www. abcop.org/certification. ■ JUNE 3 Using Closed-Cell Foams: Understanding, Techniques, Hands-on. From Jon Fogg, C.Ped, Mike Jakob, Orthopaedieschuhmeister. Nora Systems Inc. Salem, NH. Approved CEUs: 4 ABC/4 BOC CEs. Contact Jon Fogg at 770/880-9786 or Jonathan. Fogg@nora.com. The course, hotel, airport transportation, as well as meals are provided.

■ JUNE 5 WillowWood: LimbLogic® Technicians, via WebEx, 1:30 PM ET. Learn the essential elements for elevated vacuum socket fabrication. Learn unit operation features and diagnostics that keep the LimbLogic system optimal for patient use. Credits: 2.5 ABC/2.5 BOC. Visit www. willowwoodco.com.

Join us!

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

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

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

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

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

For more information, contact us at worldcongress@AOPAnet.org or visit www.opworldcongressusa.org.


■ JUNE 7 National Pedorthic Services. Milwaukee. Contact: Nora Holborow at 414/438-6662 or nholborow@npsfoot.com. Visit www.npsfoot.com for more information.

JUNE 12 AOPAversity Audio Conference—Clinical Documentation: The Dos & Don’ts. For more information, contact Stephen Custer at 571/431-0876 or scuster@ aopanet.org. ■

■ JUNE 13-14 AOPA: Essential Coding & Billing Seminar. Renaissance Phoenix Downtown Hotel. Phoenix. To register, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

JUNE 20 WillowWood: LimbLogic® Practitioners. Mt. Sterling, OH. Course focuses all the clinical aspects of LimbLogic from operation to appropriate usage. Work with patient models & complete a fully operational LimbLogic socket to an initial dynamic fitting stage. Credits: 7.0 ABC/7.0 BOC. Registration deadline is May 30, 2013. Contact 877/665-5443 or visit www.willowwoodco.com. ■

JULY 1 ABC: Application Deadline for Certification Exams. Applications must be received by July 1, 2013, for individuals seeking to take the September 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic & prosthetic technicians. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■


O&P Almanac MAY 2013

■ JULY 8-13 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams was May 1, 2013. Contact 703/836-7114, email info@abcop.org, or visit www. abcop.org/certification. ■ JULY 10 AOPAversity Audio Conference—Networking for the Future: Building Relationships With Your Referrals. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

■ JULY 18-20 The Florida AAOP Chapter Annual Meeting. Orlando. Hyatt Regency Grand Cypress For more information, visit www.oandp.org/membership/ chapters/florida. ■ JULY 26-27 ABC: Orthotic Clinical Patient Management (CPM) Exam. Georgia Institute of Technology, Atlanta. The application deadline for this exam was May 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■ AUGUST 1 ABC: Practitioner Residency Completion Deadline for September Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703-836/7114, email info@abcop.org, or visit www. abcop.org/certification.

■ AUGUST 2-3 Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. San Antonio. Grand Hyatt on the Riverwalk. Contact Katie Brinkley, 940/243-4198, email secretarytreasurer@txaaop.org, or visit www.txaaop.org.

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

■ AUGUST 2-3 ABC: Prosthetic Clinical Patient Management (CPM) Exam. Georgia Institute of Technology, Atlanta. The application deadline for this exam was May 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification.

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

August 14 AOPAversity Audio Conference—Don’t Get Stuck With the Bill: Medicare Inpatient Billing. For more information, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org. ■

■ AUGUST 16-18 National Pedorthic Services— Educational Course: Custom Foot Orthosis Fabrication. Milwaukee. For more information, contact Brian Dalton at 414/438-6662, email bdalton@npsfoot.com, or visit www.npsfoot.com. ■ SEPTEMBER 1 ABC: Application Deadline for Certification and Clinical Patient Management (CPM) Exams. Applications must be received by Sept. 1, 2013, for individuals seeking to take the November 2013 ABC certification exams for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians or December/January CPM exams for orthotists and prosthetists. Contact 703/8367114, email info@abcop. org, or visit www.abcop.org/ certification.

■ SEPTEMBER 16-21 ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, and orthotic and prosthetic technicians in 250 locations nationwide. The application deadline for these exams is July 1, 2013. Contact 703/836-7114, email info@ abcop.org, or visit www.abcop. org/certification. ■ September 18-21 O&P World Congress. Orlando. Gaylord Palms Resort. Attend the first U.S.-hosted World Congress for the orthotic, prosthetic, and pedorthic rehabilitation profession. To register, contact Stephen Custer at 571/431-0876 or scuster@aopanet.org.

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


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

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

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

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

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

AUGUST 6-9 CAPO Conference. Halifax, Nova Scotia. World Trade & Convention Centre. Marriott Halifax Harbourfront. For more information, visit www. prostheticsandorthotics.ca/.


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

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

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










American Board for Certification in Orthotics, Prosthetics & Pedorthics




Board of Certification/Accreditation




DAW Industries




Dr. Comfort

5, C3







Hersco Ortho Labs




KISS Technologies LLC




Orthotic and Prosthetic Study and Review Guide



Össur Americas Inc.




Otto Bock HealthCare




PEL Supply





MAY 2013 O&P Almanac


AOPA Answers

Rules on RULs

Answers to your questions regarding Medicare’s reasonable useful lifetime determinations


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 jrossi@strattonpublishing.com.


What is Medicare’s reasonable useful lifetime (RUL) for orthotics and prosthetics?


The reasonable useful lifetime for orthotics and prosthetics is determined by program instructions from Medicare. When there are no program instructions, the DME MACs may establish RULs for orthotics and prosthetics, but no RUL can 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; if the DME MACs don’t create a policy, the RUL for an item is set at five years. Prosthetics have a RUL that is less than five years. Through the Benefits Improvement and Protection Act (BIPA) 2000, Medicare has provided program instructions for the RUL for prosthetics. According to BIPA, “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. In the External Breast Prostheses policy, the DME MACs also have established a RUL that is less than five years. A silicone breast prosthesis has a RUL of two years, and a foam, fiber, or fabric breast prosthesis has a RUL of six months. For orthotics, there are no direct program instructions from Medicare, so the RUL for


O&P Almanac MAY 2013

orthotics is set at five years. Knee orthoses are the only exceptions to the five-year orthotics RUL. In the Knee Orthoses policy, the DME MACs have established a RUL ranging between one and three years, depending on the type of knee orthosis. KOs described by codes L1810–L1830 have a RUL of one year, and those with L1831, L1832, and L1835 codes have a RUL of two years; all other KOs have a RUL of three years.

Q. A.

Can we deliver an item based solely on a dispensing/initial order?

Yes. The initial, or dispensing, order allows you to see the patient, treat the patient, and deliver an item to the patient. However, you may not bill for the item you provided until you have received a signed detail prescription. If you deliver an item based solely on the initial order, you must make sure that the final detail prescription contains a separate date indicating the start date of the order.


If the KX indicates that the proper documentation is on file, why don’t I include it on all claims?


You should have all documentation on file to support the level of services you are providing, but the KX is not required for all claims. The answer is found in the full Medicare definition of the KX modifier: The requirements specified in the medical policy have been met. This means that if a medical policy has set forth special documentation criteria for billing, you must meet all of the criteria in order to bill, and that is when you use the KX. Four O&P medical policies currently require the use of a KX modifier: AFO/KAFO, KO, Orthopedic Shoes, and Therapeutic Shoes for Persons With Diabetes. a

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May 2013 Almanac  

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

May 2013 Almanac  

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