Issuu

The Magazine for the Orthotics & Prosthetics Profession

J U LY 2016

Can Medicare Nonparticipation Help Your Business? P.14

EXCLUSIVE: AOPA National Assembly Symposia Preview P.28

Ensuring a Valid Signature P.34

On the

RIGHT FOOT E! QU IZ M EARN

DESPITE BUSINESS CHALLENGES, PEDORTHIC PROFESSIONALS SEE OPPORTUNITIES FOR GROWTH P.20

BUSINESS CE

CREDITS

WWW.AOPANET.ORG

P.16 & 34

This Just In : Renewed RAC Activity for AFOs P.18

YOUR CONNECTION TO

EVERYTHING O&P

Products & Services For Orthotic, Prosthetic & Pedorthic Professionals

AOPA MASTERING MEDICARE:

ESSENTIAL CODING & BILLING TECHNIQUES SEMINAR

LAS VEGAS

EARN

NOVEMBER 14-15 | 2016

AOPA Coding Experts Are Coming to Las Vegas The world of coding and billing has changed dramatically in the past few years. The AOPA experts are here for you! The Coding & Billing Seminar will teach you the most up-to-date information to advance the coding knowledge of O&P practitioners and billing staff. The seminar features hands-on breakout sessions, where you will practice coding complex devices, including repairs and adjustments. Breakouts are tailored specifically for practitioners and billing staff. Take part in this seminar and to better your business, your staff, and your patients! Don’t miss the opportunity to experience two jam-packed days of valuable O&P coding and billing information. Learn more and see the rest of the year’s schedule at bit.ly/2016billing. In this audit-heavy climate, can you afford not to attend?

14 CEs

Top 10 reasons to attend: 1.

Get your claims paid.

Increase your company’s bottom line.

Stay up-to-date on billing Medicare.

Code complex devices

Earn 14 CE credits.

Learn about audit updates.

Overturn denials.

Submit your specific questions ahead of time.

Advance your career.

10. AOPA coding and billing experts have more than 70 years of combined experience.

Find the best practices to help you manage your business.

Participate in the 2016 Coding & Billing Seminar! Register online at bit.ly/2016billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

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contents

J U LY 2016 | VOL. 65, NO. 7

FEATURES

DEPARTMENTS | COLUMNS

COVER STORY

Views From AOPA Leadership......... 4

Chris Nolan counts down to the AOPA National Assembly

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

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

At-a-glance statistics and data

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

Research, updates, and industry news

People & Places........................................ 13

Transitions in the profession

Reimbursement Page.......................... 14

20 | On the Right Foot From self-standing practices to partnerships with other health-care providers, pedorthists work in a variety of business settings. With some CPeds choosing to offer retail options and others focusing on clinical practices, no two pedorthic businesses are alike. But today's pedorthists share a strong sense of commitment to their patients, and continue to explore new patient populations who may benefit from their services. By Christine Umbrell

18 | This Just In

Medicare Participation and Competitive Bidding

Choosing the status thatâ€™s in your best interest

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

CREDITS

Compliance Corner............................... 34

Authentic Signatures

Ensuring physician signatures are valid

P. 18

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

CREDITS

Renewed RAC Activity

Member Spotlight................................. 38

O&P professionals who provide ankle-foot orthoses are seeing an uptick in recovery audit contractor activity. Those clinicians who are thorough in their documentation, and who ensure RAC contractors are playing by the rules, are seeing the best audit outcomes.

28 | Collective Knowledge

AOPA News................................................42

AOPA meetings, announcements, member benefits, and more

P. 28

Preview five cutting-edge symposium presentations scheduled for the AOPA National Assembly in Boston. Industry experts will share the latest information on lower-limb treatment options, osseointegration, upper-limb pain, applying prosthetic principles to orthotic treatments, and more. By Deborah Conn

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

Standard Cyborg O&P Designs

Welcome New Members .................. 43

PAC Update.............................................. 44

Marketplace.............................................. 45

Careers........................................................ 48

Professional opportunities

Ad Index....................................................... 49 Calendar..................................................... 50

Upcoming meetings and events

Ask AOPA................................................... 52 ICD-10 modifiers, diabetic inserts, and more

O&P ALMANAC | JULY 2016

VIEWS FROM AOPA LEADERSHIP

Boston: The Birth of a New Era for O&P

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

OSTON HAS A UNIQUE place in American history. It was a powder keg just waiting for a spark in 1776 when our founding fathers declared outrage over taxation without representation over the Stamp Act and dumped crates of tea into Boston Harbor. From there, a series of events led to the start of the American Revolution. As a child whose family came from the Boston area, I had the privilege of visiting many of the sites where our nation was forged with my great-grandfather, who proudly shared his New England heritage and a love of history with me. In 2016 we have another historic event planned for Boston: The AOPA National Assembly returns to Boston September 8-11 at the Hynes Convention Center, with ambitious goals. We are on pace to have a record number of vendors and sponsors, not to mention a never-before-seen lineup of physicians and researchers on the curriculum. Each December, the AOPA National Assembly Planning Committee, consisting of members from industry, patient care, and academia, starts work on the upcoming meeting, and forms six main subcommittees. From there, each subcommittee has monthly meetings, in addition to the full committee meetings leading up to the Assembly. These workgroups plan the scientific and business content, along with the exhibit hall schedule of events and marketing efforts. This year we have been fortunate to work in partnership with members of the New England Chapter to ensure the local flavor of Boston shines through. The Assembly kicks off on Thursday, September 8, with a plethora of workshops and business certificate programs. The exhibit hall opens on Thursday evening with the traditional Welcome Reception. On Friday, the opening session will feature the Thranhardt Lecture Series—never before has the committee struggled with the selection of papers like it did this year. Nineteen papers had to be narrowed down to two prosthetic and two orthotic contenders. This speaks to the quality of all submissions, as the quality of our content continues to improve. The education program will wow you each day, with five concurrent education tracks showcasing the specific education you need to provide the best in patient care. Some education highlights include the following: • An update on osseointegration from primary researchers in Australia, Germany, and the United States • Grand Rounds on case studies from the Boston Marathon Bombing • Tone management programs from physical medicine and rehabilitation physicians from Spaulding Rehab Center in Boston • Views on limb salvage from an orthopedic surgeon and a vascular surgeon • “This Isn’t Your Father’s O&P” • Treating “O” more like “P”

Saturday will feature the first-ever “Expo Day,” with four hours of exhibit time and special events, as well as special deals and giveaways each hour. Attendees also will enjoy a virtual representation of the Freedom Trail we call the “Trail of Freedom,” where participants will experience a bit of Boston while making their way through the exhibit hall with our challenge game. Saturday’s closing extravaganza in the exhibit hall will begin the countdown to AOPA’s 100-year celebration in Las Vegas in 2017. And on Sunday there will be a full day of learning. As you can see, we have a great meeting in the works. I encourage you to view our program and join us for the AOPA National Assembly. I hope to see all of you in Boston this September! Chris Nolan is a member of the AOPA board of directors, and is chair of the 2016 AOPA National Assembly Committee. 4

JULY 2016 | O&P ALMANAC

Board of Directors OFFICERS

President James Campbell, PhD, CO, FAAOP Hanger Clinic, Austin, TX President-Elect Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Vice President James Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO Immediate Past President Charles H. Dankmeyer Jr., CPO Arnold, MD Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, BSPO, MPH, PhD Orthocare Innovations LLC, Mountain Lake Terrace, WA Maynard Carkhuff Freedom Innovations LLC, Irvine, CA Eileen Levis Orthologix LLC, Trevose, PA Pam Lupo, CO Wright & Filippis and Carolina Orthotics & Prosthetics Board of Directors, Royal Oak, MI Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Dave McGill Össur Americas, Foothill Ranch, CA Chris Nolan Springboro, OH Bradley N. Ruhl Ottobock, Austin, TX

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AOPA CONTACTS

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

Editorial Management Content Communicators LLC

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

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

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

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

Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@ AOPAnet.org

Don DeBolt, chief operating officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Tina Carlson, CMP, senior director of membership operations and meetings, 571/431-0808, tcarlson@AOPAnet.org Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@ AOPAnet.org SPECIAL PROJECTS Ashlie White, Manager of Projects, 571/431-0812, awhite@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

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

Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org

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

Ryan Gleeson, meetings coordinator, 571/431-0876, rgleeson@AOPAnet.org

Catherine Marinoff, art director, 786/293-1577, catherine@marinoffdesign.com

AOPA Bookstore: 571/431-0865

Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

JULY 2016 | O&P ALMANAC

Publisher Thomas F. Fise, JD

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Dartmouth Printing Company SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email almanac@AOPAnet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices. ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. Copyright © 2016 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted. COVER PHOTO: iStock.com/PeopleImages

Advertise With Us! Reach out to AOPA’s membership and more than 13,000 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net. Visit bit.ly/aopamediakit for advertising options!

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NUMBERS

The Rising Costs of Diabetic Health Care Spending for people with diabetes is much higher than for the nondiabetic population

Health-care spending for individuals with diabetes covered by employersponsored insurance (ESI) grew at a much faster pace than health-care spending for nondiabetics in 2014, according to a report released in June by the Health-Care Cost Institute. The report studied health-care claims of more than 40 million Americans younger than 65 and covered by ESI between 2012 and 2014. People diagnosed with type 1 or type 2 diabetes accounted for 5 percent of the ESI population.

MUCH HIGHER PEDIATRIC CARE COSTS

$2,613

$17,380 Average spending per capita for diabetic children 18 and younger.

3.2 Percent

Increase over previous year in spending for nondiabetics.

6 Percent

Increase over previous year in care spending for diabetics.

Average health-care spending for nondiabetics.

$16,021

Average health-care spending for diabetics.

55,291

Number of daily prescriptions for every 1,000 nondiabetics.

414,524 Number of daily prescriptions for every 1,000 people with diabetes.

Nondiabetics Diabetics 2012: $709 $1,868 2013: $733 $1,934 2014: $752 $1,944

JULY 2016 | O&P ALMANAC

$4,396

INCREASED DAILY PRESCRIPTIONS

Out-of-Pocket Spending Per Capita for Insureds With and Without Diabetes

SPENDING PER CAPITA IN 2014

“Understanding how and where we spend healthcare dollars for people with diabetes is the first step in assessing how well the health-care system is working and where improvements can be made.” —Health-Care Cost Institute Senior Research Analyst Amanda Frost

Source: “2014 Diabetes Health-Care Cost and Utilization Report,” Health-Care Cost Institute.

Average spending per capita for nondiabetic children 18 and younger.

HEALTH-CARE COSTS IN 2014 VS. PREVIOUS YEAR

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Happenings RESEARCH ROUNDUP

Amputee Gains Individual Finger Control Via Surgery and Prosthesis which is a challenge. Because of the limited number of muscles available after a hand amputation, prostheses have previously allowed only control of the thumb and fingers as a group, and single finger control was never possible,” says Gaston. “The severity of this patient’s injury was so great that replanting the lost fingers was not possible, so we collaborated on a new surgery that would allow him to have individual digital control.” Prior to surgery, Gaston and Loeffler performed cadaveric testing to ensure feasibility of their methods. They collaborated with the Hanger Clinic to determine how much bone would need to be removed from the hand to allow the prosthetic componentry enough space to maintain a normal hand length. They performed the surgery as pilot case on a partial hand amputee, and presented their research at the First International Symposium on Innovations in Amputation Surgery and Prosthetic Technologies in May in Chicago. Loeffler describes the muscle transfer as “a breakthrough that could impact how upper-extremity amputees are managed, and specific amputations are done, in the future.”

Minimal Infection Risks Found in Osseointegrated Implants A new study has found that only minimal risks for infection are generally associated with osseointegrated implants— fixtures inserted into the marrow space of the bone of the residual limb that enable bone to grow over an artificial limb. Orthopedic surgeon Munjed Al Muderis, MBChB, of the University of Notre Dame Australia’s School of Medicine, led a two-center study, in cooperation with researchers at the Radboud University Medical Centre in the Netherlands. The researchers examined adverse event data for 86 osseointegration patients, with 91 implants, during the time period from 2009 to 2013. More than one third of the patients (31 patients) experienced no side effects or complications related to the osseointegration system. Thirty-four percent (29 patients) developed a grade one or two infection that could be managed with “simple measures.” Twenty-six patients had no infection but did report complications with the orthopedic 10

JULY 2016 | O&P ALMANAC

hardware, problems with skin and soft tissue, or femur bone fractures. None of the patients reported grade three or grade four infections during the course of the study. “For amputees struggling with socket fit, the osseointegrated press-fit implant provides greater comfort, mobility, and the opportunity to function closer to an able-bodied person,” says Muderis. “We can confidently say that this type of prosthesis is a viable choice, and the new infection classification system provides an effective tool for the use in patient selection as well as infection management.” The research was published in the June 2016 issue of Journal of Bone and Joint Surgery. Muderis will present portions of this study on Sept. 9 in Boston.

PHOTO: iStock.com/XiXinXing

A partial hand amputee has become the first person to have individual digit control using a functioning myoelectric prosthesis. The patient Glenn Gaston, MD Bryan Loeffler, MD recently underwent a first-of-its-kind surgery to allow for a prosthetic hand with individual control. Hand surgeons Glenn Gaston, MD, and Bryan Loeffler, MD, partnered with the OrthoCarolina Research Institute in Charlotte, North Carolina, in performing the procedure, which involved transferring existing muscle from the fingers to the back of the hand and wrist, without damaging nerves and blood vessels to the muscles. Postsurgery, the patient is able to control individual prosthetic fingers using the same muscles that controlled his fingers preamputation. “Patients who have sustained full or partial hand amputations obviously have significant morbidity and limited function,

HAPPENINGS

STATISTICS CENTER

More Than 2,600 WorkplaceRelated Amputations Reported in 2015 2015 WORKPLACE AMPUTATION REPORTS BY INDUSTRY SECTOR

11%

Other

Oil and Gas Extraction

Transportation and Warehousing

Administrative and Support and Waste Management and Remediation Service

57%

Manufacturers

Wholesale

Retail

10%

Construction Source: “Year One of OSHA’s Severe Reporting Program: An Impact Evaluation,” OSHA.

Last year, 10,388 severe injuries occurring in the workplace were reported to the Occupational Safety and Health Administration (OSHA), of which 2,644 were amputations. This information was published in a March 2016 report titled, “Year One of OSHA’s Severe Reporting Program: An Impact Evaluation.” A requirement that took effect Jan. 1, 2015, mandates that employers report to OSHA within 24 hours any work-related amputation, in-patient hospitalization, or loss of eye. After compiling all of the reports submitted for 2015, OSHA found that the majority of amputations—57 percent—occurred in the manufacturing sector, with another 10 percent occurring in the construction sector. The number of amputations taking place in the workplace may be much higher than reported, according to the report: “OSHA believes that many severe injuries—perhaps 50 percent or

more—are not being reported.” During 2015, many injury claim numbers were provided to OSHA by states’ workers’ compensation programs that were never federally reported. One of the most surprising injury trends identified by OSHA last year was a disproportionately high number of fingertip amputations among workers using food slicers in supermarket delis and restaurants. After making ED UNITfood this discovery, OSHA contacted service employees with information about the hazards of food slicers and low-cost ways to keep workers safe. The agency also developed a fact sheet, “Preventing Cuts and Amputations From Food Slicers and Meat Grinders,” and distributed the publication to more than 3,000 locations. A complete list of injury reports is available at www.osha.gov/injuryreport/ 2015_by_industry.pdf.

PUBLICATION RECOGNITION

O&P Almanac Honored With 2016 Communicator Awards AOPA’s monthly magazine, O&P Almanac, has been awarded two Silver Awards of Distinction from the 2016 Communicator Awards competition. This international awards program honors innovation and achievement in communications and public relations and marketing. The O&P Almanac was recognized in the “Content Marketing” category for the “United We Stand” package in the October 2015 issue of the magazine, which covered the grassroots campaign built in response to the proposed Local Coverage Determination and Policy Article for lower-limb prosthetics. The magazine also was recognized in the “Writing—Feature Article” category for the December 2015 cover story, “Virtual O&P.”

COVER STORY

WE STAND COVER

STORY

DEFINE AND STRENGTH DETERMINATION T RALLIED AGAINS THE PEOPLE WHO PROPOSAL LIMB PROSTHETIC THE LCD LOWER-

| O&P ALMANAC OCTOBER 2015

VIRTUAL How virtual reality coul d be the next powerful tool for the prof ession INE UMBREL

By CHRIST

24 DECEMBE

R 2015 | O&P ALMANAC

O&P ALMANAC | JULY 2016

HAPPENINGS

CODING CORNER

CMS Releases Proposed Rule for Skilled Nursing Facility Payments

DME MACs Revise Knee Orthosis Policy The durable medical equipment Medicare administrative contractors (DME MACs) have published a revision to the Knee Orthosis Local Coverage Determination (LCD) and Policy Article that became effective for dates of service on or after June 2, 2016. The primary revisions to the LCD and Policy Article include the addition of diagnosis codes from the latest version of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) that allow providers to indicate whether the encounter was considered an initial, subsequent, or sequela encounter; and incorporation of language from the durable medical equipment, prosthetics, orthotics, and supplies quality standards regarding the definition of custom-fabricated orthoses. The revision also incorporates standard documentation language found in other O&P policies. Review the revised knee orthosis LCD and Policy Article at www.medicarenhic.com.

JULY 2016 | O&P ALMANAC

In April, CMS published the annual proposed rule that will govern Medicare coverage of skilled nursing facility (SNF) services through its established prospective payment system (PPS). Included in the proposed rule is an opportunity for the public to suggest additions to the list of Health-Care Common Procedure Coding System (HCPCS) codes that are exempt from the SNF PPS system and, therefore, payable by the durable medical equipment Medicare administrative contractors as Medicare Part B services. While most prosthetic services are currently exempt from SNF PPS, there are several codes that historically have been not included in the PPS exempt list and therefore must continue to be billed to the SNF directly. These include HCPCS codes that describe partial hands and feet as well as L5987, which describes a â€œshank foot system with vertical loading pylon.â€? AOPA will provide formal comments

requesting the inclusion of these codes in the SNF PPS exempt list. AOPA believes that these codes meet the regulatory requirement for SNF PPS exclusion (low volume and high cost) and should be added to the list of HCPCS codes that are exempt from SNF PPS. View the proposed rule at www.federal register.gov.

THE LIGHTER SIDE

PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

The Amputee Coalition has announced the election of two individuals to its board of directors: Lorraine Riche, MPA, has joined the board of the Amputee Coalition. A resident of Gainesville, Virginia, Riche serves as the chief operating officer of PT Solutions, an Atlanta-based rehabilitation company with more than 20 years of experience working in health care. Riche is an entrepreneur and previously founded Physiotherapy Associates, an independent practice that served as one of the largest private practices in the community. She has served as a surveyor for medical rehabilitation for the Commission on the Accreditation of Rehabilitation Facilities for more than 16 years. Jeffrey J. Cain, MD, also has joined the board. A resident of Denver, Cain is a family physician who teaches and practices at the University of Colorado School of Medicine. A past board member of the Amputee Coalition, Cain also has served as the founding chair of the Amputee Coalition Advocacy Committee and the Medical Advisory Board. Cain is past president of the American Academy of Family Physicians and co-founder of Tar Wars, the national youth tobacco-free education program. He also is an award-winning athlete who won the gold medal in slalom in the first U.S. National Adaptive Snowboarding Championships.

Erin M.S. Aulicino, CO/L

Jim Fezio, CO

Erin M.S. Aulicino, CO/L, has joined Lawall Prosthetic & Orthotic Services in Hershey, Pennsylvania. Aulicino received her master’s of science degree in prosthetics and orthotics from the University of Pittsburgh. She worked as an orthotist for the past five years in the Pittsburgh area. Hanger Clinic Manager Jim Fezio, CO, was recognized as the 2016 Outstanding Clinical Educator by the University of Hartford Department of Rehabilitation Science. Fezio has 32 years of experience and has trained nearly 100 residents and 600 students.

Nicholas LeCursi, CO, has been appointed chief technology officer of Becker Orthopedic. He will lead research and all technological development. He continues to serve as director of research and development for Nicholas LeCursi, Becker, responsible for directing product CO development, engineering design, and manufacturing integration of new products. LeCursi also serves as a member of the advisory board for the Eastern Michigan University Prosthetic and Orthotic

Programs and the Baker College O&P Technician Program, and is a member of the Hope Center Steering Committee. Keith Senn has been named president/chief operating officer of Center for Orthotic & Prosthetic Care (COPC) Kentucky LLC. Senn, who is the organization’s former chief operating officer and managing partner, will be responsible for quality patient care, company growth, efficiencies of systems, oversight of employees, and further development and expansion.

BUSINESSES ANNOUNCEMENTS AND TRANSITIONS

Orthotic & Prosthetic Design Inc. (OPD), in collaboration with Washington University School of Medicine, Program in Physical Therapy, has been awarded a grant from the National Institutes of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health to study a carbon fiber offloading orthosis. The $185,000 grant will be used by OPD and Washington University to create and utilize new finite element analysis models and algorithms to predict the appropriate design for each individual. “The brace we’re designing will offer easy-to-use, lightweight, and effective bracing solutions” for patients with diabetic foot ulcers, says Michael Dailey, CO, MBA, vice president of OPD and the study’s principal investigator. “Creating and testing the design on the computer will save tremendous time, money, and the hassle of return visits for brace modifications.” The research team will spend the next year developing, testing, and refining carbon composite brace designs. The Össur Women’s Leadership Conference will take place September 15-17 in Orlando. The three-day education and networking event will focus on issues relevant to female O&P practitioners. Topics will include leadership development with keynote speaker Elizabeth McCormick, career development led by a panel of female O&P leaders, and product development input featuring Össur engineers. A Business Owners’ Roundtable will precede the event. The conference offers 13.75 CEUs. Contact Össur with questions or to register.

O&P ALMANAC | JULY 2016

REIMBURSEMENT PAGE

By JOE MCTERNAN

Medicare Participation and Competitive Bidding How your status affects your reimbursement

Editor’s Note—Readers of CREDITS Reimbursement Page are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 16 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

E! QU IZ M EARN

BUSINESS CE

CREDITS P.16

JULY 2016 | O&P ALMANAC

N JANUARY OF 2016, new authority granted to CMS to build on durable medical equipment (DME) competitive bidding to set pricing more broadly and nationally took effect. This authority allows CMS to use pricing established as a result of competitive bidding programs for specific DME products in certain parts of the country to be applied more broadly to those same DME products in noncompetitive bid areas. On May 19, 2016, the AOPA SmartBrief featured an article highlighting reports from CMS underscoring the success of these efforts, essentially concluding that since DME providers accepted this reduced pricing, everything must be fine at these rates. This contention could prove very important in the future as CMS continues to look for ways to reduce spending by cutting reimbursement. The May 24, 2016, SmartBrief published a link to an article in HME News citing feedback from leaders in the DME world stating that the analysis by CMS was simplistic, inappropriately using one or two small bits of isolated information, as the basis for reaching a broad generalized conclusion about the effectiveness of applying competitive bid rates to nonbid areas relative to both market-based and patient-care-based impacts. This matter is not directly germane to either orthotics or prosthetics because the authority Congress has granted to CMS with respect to competitive bidding for prosthetics and orthotics is limited to a very small subset, i.e., off-the-shelf (OTS) orthotics, and CMS has, to date, never competitively bid any such OTS orthotics devices. The changes in Medicare reimbursement referenced

in this notice do not currently have a direct impact on prosthetics or orthotics. However, AOPA tends to agree with DME industry sources quoted by HME News that the analysis seems to rest on a somewhat questionable assumption that if the nation’s largest health-care payor unilaterally, and seemingly without any rulemaking process, reduces its payment for devices, and if the impacted provider community largely continues to deliver those devices, that one can assume that the reduced payment is fair; that the impacted providers will be able to remain as viable, operating businesses in the long term; and that neither the quality of care, nor the access to care for the patient community, will be adversely impacted. The circumstance above has prompted some in the O&P industry to ask the question: What options does a provider have if that provider decides that Medicare payment is not enough? Stated differently, if, in the future, Medicare precipitously cuts O&P reimbursement, similar to what was outlined in its recent announcements about major cuts in DME fee schedule pricing, what could orthotists and prosthetists do? While entirely theoretical, this month’s Reimbursement Page outlines what it would mean to revert to being a nonparticipating Medicare provider as a potential alternative to simply accepting unsustainable reimbursement rates.

Participating Versus Nonparticipating Status

The term “participation” is often misunderstood in the context of the Medicare program. Rather than the traditional meaning of the term, which implies that

PHOTO: iStock.com/Oxford

REIMBURSEMENT PAGE

by participating you have the ability to provide services to Medicare patients, “participation” in the Medicare program only relates to how you submit claims and receive reimbursement under the Medicare program. The ability to provide services to Medicare beneficiaries is established when you enroll in the Medicare program as a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier, regardless of whether you decide to be a participating provider or not.

Providers who elect a nonparticipating status are free to make an individual decision, on a claim-by-claim basis, whether or not to accept assignment.

PHOTO: iStock.com/Tolimir

When you submit your initial application to the National Supplier Clearinghouse (NSC) to become a DMEPOS supplier, you have the option to complete and submit a Medicare participation agreement (Form CMS-460). If you do not complete the participation agreement, you will automatically be enrolled as a nonparticipating supplier. If you choose to complete this form and become a Medicare participating supplier, you are bound by the terms of the participation agreement for at least the remainder of the current calendar year. It is very important that you make an informed decision as to whether becoming a participating provider is in the best interest of your organization. If you enroll as a Medicare participating provider, you agree in advance

to accept assignment on all Medicare claims submitted during the term of the participation agreement. For every Medicare claim you submit that is approved for payment, you will receive 80 percent of the Medicare published allowed amount directly from the Medicare program. It is your responsibility to collect the remaining 20 percent from the patient directly or by submitting a claim to the patient’s secondary or supplemental insurance carrier. Alternatively, providers who elect a nonparticipating status are free to make an individual decision, on a claim-by-claim basis, whether or not to accept assignment. Theoretically, you can elect to be a nonparticipating provider and still accept assignment on all of your Medicare claims. Nonparticipating status allows you the freedom to accept assignment on some claims but not others. In the context of the potential impact of any future decision to apply competitive bidding rates to OTS orthoses in nonbid areas, nonparticipating status allows suppliers to not be tied to the reduced rates by choosing to not accept assignment on the claim. When submitting a nonassigned claim, suppliers may collect their full usual and customary

charge from the Medicare beneficiary at the time of delivery of the completed device. Nonassigned claims still must be submitted to Medicare by the supplier and, if approved, Medicare will send payment of 80 percent of the Medicare allowed amount directly to the patient. It is important to note that not accepting assignment on a claim does not change the supplier’s financial liability for services that are deemed not medically necessary by Medicare. If a nonassigned claim is deemed not medically necessary, the supplier is required to immediately refund any money collected from the patient at the time of delivery unless a properly executed advanced beneficiary notice (ABN) is in the supplier’s files. The question that remains is: How can nonparticipation status help your business should Medicare decide to apply competitive bidding rates to OTS orthoses in noncompetitive bidding areas? While this discussion remains hypothetical, as OTS orthoses have yet to be included in any Medicare competitive bidding program, let’s take a look at a potential scenario where nonparticipation status may be to your benefit. Again, this is a hypothetical scenario for illustration purposes only. O&P ALMANAC | JULY 2016

REIMBURSEMENT PAGE

$200

0 0 $1 $150

JULY 2016 | O&P ALMANAC

to bring OTS orthoses into the competitive bidding environment. While the inclusion of competitive bidding pricing does not appear to be imminent for OTS orthoses, since the decision to be a Medicare participating provider is applicable for a full calendar year, it may be prudent to review your current Medicare participation status and decide whether Medicare participation is in your company’s best interest. If you are currently a participating supplier, your next opportunity to change your status is Jan. 1, 2017. To change your status from participating to nonparticipating, you must submit a written notification on your company letterhead to NSC during the annual open enrollment period, which spans from mid-November until December 31 of each year. This letter must be signed by the authorized official for your company on file with NSC. The participation decision applies to all locations under a single tax identification number.

Encouraging Patient Advocates Beyond a provider’s option to choose Medicare participating versus nonparticipating status, another option is fostering optimal communication with your Medicare patients on any changes in Medicare’s payment policies. For example, in the recent CMS announcement on the “success” of its

Joe McTernan is director of reimbursement services at AOPA. Reach him at jmcternan@AOPAnet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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PHOTO: iStock.com/Choja

Let’s assume that the Medicare allowed amount for an OTS walking boot is $150 and your company’s usual and customary charge for this item is $200. Let’s also assume that through application of competitive bidding rates, Medicare reduces the allowed amount for a walking boot to $100. If you have elected to be a participating Medicare supplier and you submit a claim for a walking boot in this scenario, Medicare would reimburse you $80 and you could collect an additional $20 from the patient or his or her secondary/ supplemental insurance. Total reimbursement in this scenario would be limited to $100. If you have elected to be a nonparticipating provider, you could choose not to accept assignment on the claim and charge the patient up to $200 at the time of delivery. You would still be required to submit a nonassigned claim to Medicare and Medicare would send a payment of $80 directly to the patient, representing 80 percent of the reduced allowed amount as a result of the application of competitive bidding prices. While this scenario may present some business challenges relative to your patient’s willingness to pay more for the device than Medicare is willing to reimburse that patient, it remains a viable alternative to simply accepting reduced reimbursement should Medicare ultimately decide

payment reduction policies in the DME arena, it was noted that the measuring stick CMS used did not include any confirmation “that neither the quality of care, nor the access to care for the patient community, will be adversely impacted.” Medicare may not take the initiative to speak to its beneficiaries about changes, and that may be all the more reason to strengthen your own outreach to your Medicare patients. If Medicare takes steps that make it harder for you to deliver what the patient expects, poses additional steps that delay your ability to make timely delivery, and cuts payments that in turn force you to scale back services— those are all things you may want to share with your patients. If patients are unhappy or unsatisfied because Medicare’s belt-tightening results in fewer options or quality and timeliness limitations in the care they receive, then by having alerted them in advance, your patients will know that it is Medicare to whom they should voice their disappointment, rather than thinking you have somehow shortchanged them. Your patients are your best advocates—Medicare listens to them much more closely than it listens to providers. It is in your interest to take steps to ensure your patients are “in the loop” on the potential impact of new Medicare changes. While the decision to become a Medicare participating provider must be made according to the individual needs of your company, it is important to consider the impact of this decision carefully.

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This Just In

Renewed RAC Activity O&P providers must be vigilant about documentation and ensure RAC contractors adhere to limits on additional documentation requests

EPORTS OF INCREASED RECOVERY

audit contractor (RAC) activity focusing on the provision of anklefoot orthoses have surfaced, with the greatest activity noted in Jurisdictions A and D. While the existing RAC contractors have been authorized to begin new audits for some time now, pending the competition for and award of the single, national durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) RAC contract, these reports represent the first significant RAC activity focused on O&P providers since the reauthorization took place.

JULY 2016 | O&P ALMANAC

As RAC audits once again move to the forefront of the O&P universe, O&P clinicians must take the necessary steps to defend reimbursement months, or even years, from now. RAC contractors are highly motivated to identify Medicare overpayments as they receive a significant percentage of any overpayments they identify in the form of contingency payments. Below are some things that O&P professionals should consider when making operational changes within a facility to best prepare for success when the RAC contractors come calling. First, AOPA members should ensure that the RAC contractors are playing by the rules, especially when it comes to the limits to the number of additional documentation requests (ADRs) that can be made against a single tax identification (ID) number. Current regulations limit the number of ADR requests for suppliers to 10 percent of all claims submitted for the previous calendar year, divided into eight periods, each period representing 45 days. In addition, for suppliers who bill under specialty codes identifying them as O&P providers (51, 52, 53, 55, 56, or 57), the limit on ADR requests is capped at 10 ADR requests every 45 days, per tax ID. Whatâ€™s more, any services that the RAC contractors are auditing are required to be listed on

This Just In

their respective websites as “issues identified for review.” As part of their agreement with CMS, RAC contractors must publish the specific areas where they intend to perform audits before they may begin auditing those claims. Second, AOPA members should ensure that all required documentation is in place before submitting a claim to Medicare. This goes beyond basic information such as preliminary and detailed written orders. Medicare policy requires that documentation supporting the medical need for any services that are provided to Medicare beneficiaries is present within the patient’s contemporaneous medical record. While the records of the orthotist and/or prosthetist are relevant, they are, unfortunately, not considered part of the actual medical record. RAC contractors will look to the documentation provided by the prescribing physician as the primary source of

information to support the medical necessity of the items they prescribe. It is crucial that the prescribing physician maintains adequate documentation to support the medical necessity of the services he or she requests for the patient. While O&P providers have no direct control over the documentation practices of their physician partners, they can provide guidance and education to the physician community regarding what Medicare expects to see in the

patient’s medical record when making claim payment decisions. Working with the physician community today to make sure their documentation is adequate will lead to better results when a RAC contractor decides to review a claim in the future. AOPA understands the challenges orthotists and prosthetists are facing in an environment of renewed RAC contractor audit activity and is readying educational resources to help prepare its members to better meet the renewed RAC audits. AOPA hosts a free webinar for members on July 14 to share information about the renewed RAC activity and what it means for O&P. On July 21, AOPA will offer a purchase-based webinar, open to any interested party. This webinar will dive deeper into the details of preparing an O&P business to respond to increased RAC activity and strategies for dealing with RAC audits when they occur.

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O&P ALMANAC | JULY 2016

COVER STORY

On the

Right Foot

ADJUSTING TO BUSINESS CHALLENGES, CPEDS SHARE THEIR SUCCESS STRATEGIES FOR RUNNING A MODERN PEDORTHIC FACILITY By CHRISTINE UMBRELL

JULY 2016 | O&P ALMANAC

COVER STORY

Need To Know: • Today’s pedorthists work in a variety of business arrangements, ranging from self-standing practices, to partnerships with other providers, to staff positions as part of larger health-care teams. • CPeds make strategic business decisions when deciding whether to offer retail options. While some facilities stock a limited number of pedorthic shoes, others house more diverse options such as foot orthoses, custom-molded shoes, elevations, flares, rocker soles, sneakers, arch support, and more. • Some pedorthists are finding it makes sense to partner with groups of practitioners, with a goal of providing services to accountable care organizations that are seeking comprehensive health-care teams. • Many CPeds have skill sets beyond pedorthics and are cross-credentialed in areas such as orthotics, podiatrics, and physical therapy. These individuals offer added value when they join the staffs of podiatric and O&P facilities. • Amid reimbursement challenges, some pedorthic facilities are becoming less reliant on payors and more open to alternative payment solutions, with increasing numbers of self-pay patients. • New avenues of opportunity are arising for pedorthic clinicians. While diabetic patients often account for a significant percentage of patients, some CPeds are treating more athletes and pediatric patients. Fall prevention also may present opportunities for growth in scope of practice.

PHOTO: iStock.com/PeopleImages

UCH LIKE THE SHOES they fit, no two pedorthists are exactly alike—and that goes for their staffing arrangements as well. Depending on geographic location and patient population, today’s pedorthists take advantage of a variety of business models, ranging from self-standing practices, to partnerships with other providers, to staff positions as part of larger health-care teams. Some pedorthists get extremely involved in offering a spectrum of retail offerings, while others stick to the clinical side of the business. But regardless of work setting, these professionals share the same goal: providing well-fitting shoes, shoe modifications, foot orthoses, and other pedorthic devices to solve foot-related problems. And most are finding that, despite business challenges, opportunities for growth exist within the profession.

Adventures in Retail

Some pedorthists see numerous benefits in offering retail options in conjunction with their clinical practices. Retail shops come in many sizes, with some pedorthists offering a few simple orthopedic shoe choices, and others stocking large stores.

ALTHEA POWELLCHANDLER, CPed

Althea Powell-Chandler, CPed, is an example of a practitioner with a significant pedorthic retail business. At Powell Shoes Pedorthic Facility in Vero Beach, Florida, she offers foot orthoses, custom-molded shoes, elevations, flares, rocker soles, and a full-blown retail shop featuring sneakers, sandals, and over-the-counter arch support. O&P ALMANAC | JULY 2016

COVER STORY

JEFF RESER, CO, CPed

PHOTO: Lee’s Comfort Shoes

Powell-Chandler says that her business model is typical of a pedorthic facility in Jamaica, where she grew up. She says it just “makes sense” to offer a variety of shoes and inserts to people who may need one pair of specialty shoes, but who also may benefit from purchasing additional footwear from a pedorthist who can fit them properly. “A patient might wear pedorthic shoes but also needs high-heel shoes or flip-flops—why not be the person to supply them?” says Powell-Chandler, who stocks arch-supportive versions of these shoes. She believes a combined clinical care and retail store model elevates the profession by introducing more shoppers to the value of properly fit shoes—and ultimately increases brand recognition of pedorthics. Lee’s Comfort Shoes in Ohio also follows a “hybrid” business model. The chain of retail stores dates back to 1928, when the grandparents of Jeff Reser, CO, CPed, and co-owner, first opened a shoe store. Reser and his brother Jack purchased the store from their parents in 1990 and identified a need for increased expertise in fitting shoes. They typically see patients with diabetes, partial foot amputations, flat feet, and other conditions. In addition, the facility’s retail shoe stores offer specialty shoes as well as high-end athletic shoes and hard-to-find sizes. 22

JULY 2016 | O&P ALMANAC

Reser believes the hybrid business model—which he acknowledges requires a significant initial financial investment—works because pedorthics can be leveraged “as a way to supplement the shoe business.” He believes his company fills a void by offering personalized service and focusing on proper foot measurement and gait analysis when working with consumers. Those practitioners offering retail say their product offerings afford them a sense of security regarding payments because consumers pay for their products up front. This can balance out some of the more challenging reimbursement problems associated with diabetic shoes, says Powell-Chandler.

Savvy Business Practices

While some traditional pedorthic practices are remaining viable as stand-alone businesses or offering retail solutions, others are seeking partnerships with related health-care providers. “As we see more and more organizations going to accountable

ROBERT SOBEL, CPed

care organizations, we are putting together ‘groups’ of practitioners that are more cost-effective—in the pedorthic arena as in other aspects of health care,” says Robert Sobel, CPed, president of the Pedorthic Footcare Association and former owner of Sobel Orthotics and Shoes in New Paltz, New York. In fact, partnerships between pedorthists and other health-care providers offer benefits to both parties. Podiatric practices that employ a pedorthist can rely on the pedorthist to take over the lion’s share of care for plantar fasciitis patients, freeing the podiatrist to see other patients. And physicians who send their diabetic patients to pedorthists can work in tandem to prevent ulcers and treat wounds early on, helping prevent more expensive diabetes-related health-care costs.

DENNIS JANISSE, CPed

Dennis Janisse, CPed, has noticed growth in the number of pedorthists employed by O&P facilities. “In the past, a lot of orthotists and prosthetists shied away from that part of the business. But now orthotic facilities are realizing that it can be more profitable to have a pedorthist on staff to handle that part of patient care,” says Janisse, who owns National Pedorthic Services (NPS). Sobel recommends that O&P facilities that don’t currently staff a pedorthist consider doing so—for financial reasons. “For practices looking for additional revenue streams, having a pedorthist on staff is probably going to be helpful,” he says. “For those facilities that have stayed away from doing lifts, diabetic shoes, custommolded shoes, and foot orthotics, think about what it can bring to the practice—these services can mean an increase to your bottom line, with self-pay in a lot of situations. With a pedorthist on staff, you can grow that aspect of your business.”

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COVER STORY

Many CPeds have skill sets beyond pedorthics, and can leverage those skills to offer value to comprehensive health-care groups. “A lot of CPeds are also orthotists who focus on the lower-extremity realm,” says Sobel. Other common combinations include CPed/podiatrists, CPed/physical therapists, CPed/chiropractors, and even CPed/athletic trainers, Sobel says. For pedorthists who choose not to enter into formal partnerships with other medical professionals, many opportunities remain for less formal collaboration. Powell-Chandler encourages fellow pedorthists to form partnerships to focus on the goal of optimum patient care. She has visited all of the podiatrists in her local area to introduce her services. These personal introductions “worked great,” she says. “I have a lot of referrals, plus they send patients to my retail store.” She also sends her patients to those podiatrists when they need prescriptions. Powell-Chandler also works closely with O&P professionals in her town. Powell-Chandler encourages O&P clinicians to advise patients with Charcot foot or feet prone to ulcers to visit a pedorthist. She also refers patients for O&P care when appropriate.

“For practices looking for additional revenue streams, having a pedorthist on staff is probably going to be helpful.” —Robert Sobel, CPed

JULY 2016 | O&P ALMANAC

With 10,000 people turning 65 every day, fall prevention "is a really big potential market for us. We should be educating people and providing products for fall prevention.” —Dennis Janisse, CPed

“The goal should be to keep the extremities stabilized and healed, and to be part of the health-care team to achieve that,” says Powell-Chandler. “You can’t be on an island by yourself if you want the patient to have the best care.”

Reimbursement in the ACA Era

In addition to developing creative work arrangements, some pedorthists are also relying on less traditional billing practices—and somewhat less reliant on payors. Implementation of the Affordable Care Act (ACA) mandating health insurance coverage for more Americans has been “a double-edged sword” for pedorthics patients, says Sobel. “It’s great in that a lot more people have insurance and are seeking care—but a lot of the health insurance plans do not cover pedorthic devices.” Janisse agrees: “Those consumers who are trying to find new insurance are finding very high deductibles,” he says. This trend has pushed his business toward a “cash-and-carry” model for many pedorthic items— meaning that more patients self-pay for pedorthic services. At NPS, Janisse still accepts Medicare but does not accept all forms of private insurance—opting out of accepting plans that reimburse for a lower amount than it costs NPS to provide a device. Patients who are asked to self-pay often pay at the time of service—and those payments are not subject to lengthy reviews by payors.

“Patients are realizing they don’t have insurance coverage [for the specific pedorthic devices they require], so they’re becoming more comfortable with the self-pay option,” says Janisse. “A lot of people can self-pay, then still get reimbursed—at least partially—by insurance.” Today, more than 45 percent of patients self-pay at NPS, up from approximately 10 percent in years past. By shifting to accepting fewer insurance companies, Janisse says his company has been able to lower prices for self-pay—and see a rise in profits. Another benefit of self-pay: Some consumers appear more willing to purchase add-on items. Janisse has found that patients who must open their wallets for payments are willing to consider purchasing additional items that may ultimately prevent return trips to medical facilities. For example, diabetic patients who purchase shoes may be willing to add socks, hosiery, or additional shoe selections to their tabs as long as they have their checkbooks out. Sobel agrees that, for pedorthists in higher-income regions, self-pay “is actually good for business.” In pedorthics, “our most expensive devices—foot orthotics and shoe modifications—are still significantly less expensive than typical braces and prostheses,” says Sobel. “So payment plans are in the realm of possibility for most people.”

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COVER STORY

Pedorthists situated in less prosperous regions may face greater challenges in implementing a self-pay process, but it still can be a viable option if pedorthists are willing to be more flexible in their billing procedures. “In my practice, when a patient can’t afford to lay out $400 or $500 in one lump sum, I offer a payment plan,” Sobel explains. “It really works for both parties, and I’ve only been burned once.”

Other Opportunity Areas

In addition to changing business practices, pedorthists also are experiencing evolving patient populations—from a growing number of diabetes patients to areas of opportunity related to other foot problems. For most pedorthic facilities, diabetes patients comprise a significant portion of the population. And with the aging of the baby boomers—a more active senior population than in previous generations—more patients may benefit from pedorthic care in an effort to remain mobile. “We are the last line of defense against diabetics losing a foot,” says Reser. Well-fitted shoes, inserts, and modifications can help prevent amputation—and ultimately save health-care dollars. “We prevent future costs and save insurance companies incredible amounts of money—that’s what makes the low reimbursements so shortsighted,” he says. But beyond diabetes, pedorthists can, and should, continue to make a difference in many other areas of care. “We have a lot of referring physicians who see us as ‘the diabetic shoe guys,’ but we also treat a lot of

“We need to get back to the core of what we do. Diabetic shoes are just a small part of that. Our client is [anyone] who has a foot.” —Althea Powell-Chandler, CPed

plantar fasciitis and pes planus and pes cavus feet, as well as other foot deformities,” says Sobel. In addition, the sports sector of pedorthic care seems to be growing. “I service a lot of the local colleges. Athletics is an area where pedorthics can make a big impact,” says Sobel. “If you can treat patients in junior high and high school and support their athletic pursuits, those kids can become long-term clients,” he says.

PHOTOS: Dennis Janisse, CPed

JULY 2016 | O&P ALMANAC

Sobel believes that pediatric care, in general, is an area where more should be done pedorthically. He notes that some pediatricians—perhaps due to insufficient foot training—do not refer patients who present with issues such as flat foot and high arches to foot-care professionals. He suggests that more education should be given to pediatricians. “If you don’t treat flat foot in elementary age children, they won’t feel pain now, but they often grow up and develop preventable foot issues like hallux rigidus—which can be painful in adulthood.” In fact, Sobel advocates for a national foot-care awareness program, similar to the scoliosis check children are now given during annual exams, as a preventive measure. (For more information on when pediatric patients should see a pedorthist, see “Foot Care for the Ages” in the November 2015 issue of O&P Almanac.) Janisse has identified another often-overlooked, but important, area for pedorthic care: fall prevention. “There are 10,000 people turning 65 every day,” he says. For that population, one of the most serious health-care problems is falls—which often lead to hip fractures and hospitalizations. “Some of those seniors need foot orthotics, but the shoe itself also plays a big part,” he says. “This is a really big potential market for us. We should be educating people and providing products for fall prevention.” Because there is room for growth in so many patient populations in need of pedorthic care, there is reason to see a bright future ahead for pedorthists. “We’re at a transition now—so many of us have had to make changes,” says Janisse. “But this is a viable industry, and there continues to be a great need for our services.” Powell-Chandler agrees: “We need to get back to the core of what we do. Diabetic shoes are just a small part of that. Our client is [anyone] who has a foot.” Christine Umbrell is a staff writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@ contentcommunicators.com.

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The symposia planned for the 2016 AOPA National Assembly will feature panel discussions on cutting-edge O&P topics By DEBORAH CONN 28

JULY 2016 | O&P ALMANAC

HIS YEAR’S SYMPOSIA to be

presented at the AOPA National Assembly in Boston are extraordinary, says Thomas DiBello, CO, FAAOP, chair of the Clinical Sessions Workgroup. And he should know: “I’ve been in the O&P field for more than 20 years and involved in volunteer activities since the early 1990s,” DiBello says. “I can’t remember a stronger program than the one we have for Boston.” The five scheduled symposia are different from other types of educational offerings. “In most traditional educational conferences, you have several kinds of presentations: symposia, instructional courses, free papers, and posters,” DiBello says. Free papers are presented by individuals and can be based on research, a review of the literature, or the presenter’s experience. They must be accepted by the Clinical Sessions Workgroup, which will advise the method of presentation: a podium talk, a poster, or another format. Instructional courses are sessions where the speakers are invited to present. Their courses focus on well-established concepts and techniques and are designed to bring attendees up to a higher level of competency in a specific area. By contrast, symposia are intended to present cutting-edge information on new prosthetic or orthotic concepts or approaches. “This can be knowledge based on peer-reviewed journal articles, or based on the presenters’ own experience with a new method or technique,” DiBello explains. Presenters are invited, and the workgroup assembles a panel of experts in the field who can provide different perspectives on the topic. “This year’s symposia deal with an exceptional group of topics and include the country’s—even the world’s—top people in their field,” DiBello says. On the pages that follow, O&P Almanac presents a preview of the discussions scheduled for Boston.

Treating “O” More Like “P” Friday, September 9, 11 a.m. Wendy Beattie, CPO, FAAOP Curt Bertram, CPO, FAAOP Michael Dailey, CO, MBA Eric Weber, LCPO, FAAOP Conference-goers who take part in the “Treating ‘O’ More Like ‘P’” symposium will encounter a new way of looking at orthotics. This session will explore the ways that clinical tools used in prosthetics can be applied to orthotics to improve outcomes. “In gross terms, a lower-extremity orthosis is an exoskeletal prosthesis—the difference is that the anatomy is still present but dysfunctional, hence the need for an orthosis,” explains Curt Bertram, CPO, FAAOP, one of the panel members. One example orthotists can borrow from prosthetists is to look at the three stages of alignment: bench, static, and dynamic, says Bertram. Orthotists also have to be concerned with managing joint motion—for example, using a stance-control knee joint rather than the locked knee commonly found in knee-ankle-foot orthoses. “The orthotist needs to look at providing joint range of motion where appropriate or substitute this motion—for example, using shoe modifications to simulate the rockers during the stance phase of gait,” says Bertram. “The difference is how we go about managing the ground-reaction vectors and the tools at our disposal.” Having the patient’s anatomy as part of the process, even if it is dysfunctional, makes orthotic management more challenging, as orthotists have to work around contractures, spasticity, and deformities. “In the end,” says Bertram, “alignment matters to all of our patients,

Curt Bertram, CPO, FAAOP

whether they wear an orthosis or prosthesis.” Wendy Beattie, CPO, FAAOP, will moderate the panel. Bertram will be discussing the use of the ankle-foot orthosis footwear combination in manipulating ground-reaction force and simulating the rockers of gait during stance phase. He also will discuss the importance of muscle length with regard to lower-extremity alignment, particularly the ankle and the ankle-foot orthosis. Eric Weber, LCPO, FAAOP, will talk about the use of stance-control knee joints and having a free knee joint during swing as opposed to a locked knee. In prosthetics, locked knees are rarely used for transfemoral patients. Michael Dailey, CO, will discuss materials, specifically carbon fiber and composites, and how they can be used to store and return energy in a way similar to different types of prosthetic feet. Carbon fiber and composites have the strength and rigidity needed for orthoses and the ability to store and return energy. As a result, there has been a surge in carbon fiber and composite ankle-foot orthoses that provide a higher level of function for patients than do those made of thermoplastics, notes Dailey. “We cannot directly translate prosthetic science to orthotics, but we can borrow the principles in alignment, materials, and motion to benefit our orthotic patients,” says Bertram. O&P ALMANAC | JULY 2016

Role of Patient Self-Management in Improving Quality of Care and Outcomes Friday, September 9, 11 a.m. Scott Cummings, PT, CPO George Gondo, MA Danielle Melton, MD Stephen Wegener, PhD About 2 million people live with limb loss in the United States. Amputating a limb is expensive and creates a personal burden on amputees and their loved ones. In 2012, health-care costs for amputation procedures topped $8 billion—not including prosthetic care, post-acute rehabilitation, or other follow-up care. The emotional toll is steep as well, as those with limb loss face barriers to community participation, distress from pain, and high rates of depression and suicidal thoughts. National experts will address some of these emotional issues—and ways O&P professionals can assist patients facing these issues—during the “Role of Patient Self-Management in Improving Quality of Care and Outcomes” symposium.

George Gondo, MA

“Studies suggest that self-management programs improve outcomes for patients with limb loss by improving self-efficacy, improving mood, and reducing the ‘bothersomeness’ of pain among patients,” says George Gondo, MA, director of research and grants for the Amputee Coalition.

The Prevalence and Impact of Pain in Upper-Limb Amputees Friday, September 9, 11 a.m. Michael Benning Phillip Stevens, MEd, CPO, FAAOP Joyce Tyler, OT

Phillip Stevens, MEd, CPO, FAAOP

Designed to highlight the impact of pain in individuals with upperlimb deficiency, “The Prevalence and Impact of Pain in Upper-Limb Amputees” will feature speakers on topics such as phantom pain, residuallimb pain, and pain caused by overuse syndromes on the sound side. “As prosthetists, we can sometimes focus so intently on the device that we lose sight of the overall well-being

of our patient and fail to recognize the impact of pain on these individuals,” says Phillip Stevens, MEd, CPO, FAAOP. Most of the time, that pain is not directly related to the prosthesis, he adds, but it still has a profound effect on the overall quality of life for these individuals. Panelists will approach the issue from several angles. Stevens will present some of literature that

JULY 2016 | O&P ALMANAC

The Coalition and its partners at Johns Hopkins University School of Medicine recently created an online self-management program for individuals with limb loss, called Promoting Amputee Life Skills. This symposium will highlight that program and discuss the benefits of selfmanagement programs, their role in rehabilitation for those with limb loss, and how such programs contribute to providing patient-centered care. Gondo will discuss how selfmanagement, peer support programs, and patient education materials are a critical part of patient-centered care. Stephen Wegener, PhD, who has developed self-management programs for patients with limb loss as well as other conditions, will provide an overview of selfmanagement principles and skills and present data supporting their efficacy. Danielle Melton, MD, a recognized expert on limb-loss rehabilitation, will discuss how self-management approaches are integrated into the rehabilitation process, and Scott Cummings, PT, CPO, will explore how these approaches can be integrated into comprehensive prosthetic care.

explores the prevalence and intensity of pain in upper-limb amputees. AMPOWER National Coordinator Carrie Davis, who has below-elbow congenital limb deficiency, will talk about her personal experiences with overuse symptoms in her sound-side extremity. Certified hand therapist Joyce Tyler, OT, will discuss some of the more common symptoms of overuse people experience and present modalities to treat them.

The premier meeting for orthotic, prosthetic, and pedorthic professionals.

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AOPAnet.org

LIGHTING the FUTURE SEPTEMBER 8-11, 2016 | BOSTON

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Join us September 8-11, 2016, for the 2016 AOPA National Assembly at the Hynes Convention Center in Boston, MA.  PLOT A COURSE FOR FUTURE SUCCESS with 5 concurrent sessions for Orthotists, Prosthetists, Pedorthists, Technicians, Business Owners and Managers

The O&P community has experienced stormy seas for the past several years with legislative challenges, rising costs, and reimbursement pressures. If you are looking for a lighthouse in the storm—join us at the 2016 Assembly. Our goal is to bring our profession together to build a strong future through clinical and business education, networking and the support of a strong supplier community.

 Cruise through the stormy seas of REGULATORY RULES with answers you can only get from AOPA  Navigate the country’s LARGEST O&P EXHIBIT HALL  Sail through spectacular general sessions with inspiring KEYNOTE PRESENTERS

 Partake in FUN NETWORKING EVENTS  Enjoy exciting and HISTORIC BOSTON BACK BAY  Catch up with the ALUMNI CONNECTION  Maneuver your way with CASE STUDIES AND SYMPOSIA  GET ONBOARD with MDs, PhDs, Wound Care Specialists, Research Scientists, Attorneys, Business Experts and Top-Notch Practitioners.

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

Visit www.AOPAnet.org to learn more, submit a paper, or to exhibit.

About Osseointegrated, Percutaneous Implants for Rehabilitation Following Limb Amputation Friday, September 9, 2 p.m. Horst-H. Aschoff, MD James P. Beck, MD Jason T. Kahle, MSMS, CPO, FAAOP Richard L. McGough, MD Munjed Muderis, MB, ChB, FRACS, FAOrthA Andreas Timmermann, CPO-G International experts on osseointegration will convene in Boston to lead the symposium dedicated to this hot topic at the AOPA National Assembly. The

Munjed Muderis, MB, ChB, FRACS, FAOrthA

discussion of osseointegrated, percutaneous implants will include a history of the procedure and offer the experiences of a number of experts who have used different types of implants. Horst-H. Aschoff, MD, is one of the forefathers of the procedure as it is performed in Germany and Scandinavia, and he is part of clinical trials now underway in the United States. He will open with an overview of 25 years of percutaneous osseointegration. Munjed Muderis, MB, ChB, FRACS, FAOrthA, will discuss the Australian experience with the integral

leg prosthesis (ILP), and Jason Kahle, MSMS, CPO, FAAOP, will present a systematic review of the efficacy of the ILP and the shaft prosthesis. Richard McGough, MD, will talk about the Compress® osseointegration prosthesis, and Andreas Timmermann, CPO-G, will offer his perspective as a prosthetist on using endo-exo prostheses. James Beck, MD, will review animal research studying long-term osseointegration of percutaneous implants and discuss how scientific collaboration may help the design of implants that will remain stable in the bone and improve longterm implant survival. Panelists will discuss the pathways and timeline for this procedure to come to full fruition in the United States. Many prosthetists are concerned that osseointegration will put them out of business, which is both not imminent and unlikely, says Kahle, as the procedure is not appropriate for many amputees, including those with diabetes and peripheral vascular disease.

Lower-Limb Treatment Options—Views From an Orthopedic and a Vascular Surgeon’s Perspective Friday, September 9, 2 p.m. Michael Dillon, PhD, BPO (Hons) John Femino, MD Luigi Pascarella, MD Donald Shurr, PT, CPO Since the 1800s, surgeons have gone out of their way to save as much length as possible in amputation, thinking that the longer the residual limb, the better the functional result, notes Donald Shurr, PT, CPO, who will moderate this symposium. Yet recent research reports that between 40 and 50 percent of partial foot amputations fail to heal, necessitating further surgery and often leading to adverse

Donald Shurr, PT, CPO

outcomes. “Other research supports the functional success of transtibial amputations with prostheses, but as yet, it is unclear which patients are better served with transtibial amputations,” he says. The “Lower-Limb Treatment Options” symposium will explore the issue, discussing published outcomes and the development of guidelines from newly acquired data.

Panelists John Femino, MD, an orthopedic surgeon and foot/ankle specialist, and Luigi Pascarella, MD, a vascular surgeon, will each discuss the question from the perspective of their training and experience. Both presenters are academic professors and researchers as well as active surgeons. Michael Dillon, PhD, BPO (Hons), will report how shared decision making may assist patients and medical professionals with resources and equip patients to participate in their own treatment. (An educational course, “Outcomes of Partial Foot Amputation Can Inform Difficult Decisions About Amputation Surgery Using a Shared Decision-Making Approach” (C 13), also will touch on this issue.)

For a complete schedule of the symposia and all of the other valuable educational sessions planned for the AOPA National Assembly, visit www.AOPAnet.org. Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

JULY 2016 | O&P ALMANAC

COMPLIANCE CORNER

By DEVON BERNARD

Authentic Signatures Follow these tips to prevent physician signatures from being questioned or invalidated by Medicare Editor’s Note: Readers of Compliance Corner are now eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 37 to take the Compliance Corner quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

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E! QU IZ M EARN

BUSINESS CE

CREDITS P.37

HE RESULTS OF PREPAYMENT reviews conducted by the durable medical

equipment Medicare administer contractors (DME MACs) routinely show that one of the most common denial reasons has to do with documentation: Documentation is either missing or is considered incomplete. However, there is another reason why the documentation provided during a review could be rejected and cause a denial: The documentation is not “authenticated by the author.” When the documentation is not “authenticated,” that means it is not signed, or the signature is illegible—either by the ordering/referring physician or by the provider who created the documentation. For example, recent results of a prepayment review for the L1940 showed that 7 percent of the denied claims included medical records that were not authenticated by the author. It is well established that the ordering/referring physician must sign the prescriptions and documents, such as the certifying statement, but Medicare requires that anyone ordering or documenting the medical necessity or need for items/services received by Medicare beneficiaries must be identifiable; each provider also must sign each and every entry in the patient’s medical record. This month’s Compliance Corner examines what constitutes a valid signature and what can be done if the validity of a signature is being questioned during a review or audit.

Valid Signatures

Three types of valid signatures may be used by the ordering/referring physician. These signature types will be considered valid in the eyes of Medicare and its contractors if certain criteria are met. O&P professionals should understand the steps that must be taken to ensure the veracity of each signature. The first type of signature, which is very rarely used, is a stamped signature. In most cases, Medicare does not accept the use of rubber stamps on any type of document, including the entries in a medical record or a prescription. However, under very rare circumstances, 34

JULY 2016 | O&P ALMANAC

it will accept a stamped signature: To be compliant with the Rehabilitation Act of 1973, Medicare and its contractors will allow for the use of a rubber stamped signature if the individual using the stamp has a disability that does not allow him or her to handwrite a signature. The second type of signature, and one that is becoming increasingly common, is an electronic signature. Medicare has not officially released guidelines on what constitutes a valid electronic signature. However, the DME MACs have issued some guidance of their own, and have stated that in order for an electronic signature

COMPLIANCE CORNER

to be considered valid, the signature should be accompanied by a statement that shows the signature was applied electronically. The DME MACs also provided some examples of what these statements or notations would include. Some examples include the following: • Electronically signed by • Authenticated by • Approved by • Completed by • Signed by An electronic signature will typically be applied to a document or medical entry in one of three ways. It can be applied by entering a unique identification number, which automatically places a “typed” signature to the document. Alternatively, an individual may manually type the signature in. Such a signature would appear as “Mike Odell, MD” or something similar. These types of signatures would need to include one of the above-mentioned notations. The signature also may be physically applied using a pad and electronic

stylus, just like when you sign for a package or sign for a credit card; it typically looks something like this:

This type of signature is more in line with traditional handwritten signatures, and could be subject to some of the rules that govern valid handwritten signatures. The third type of signature is a handwritten signature, which Medicare defines as any mark or sign by an individual to signify knowledge, approval, acceptance, or obligation. When talking about Medicare-approved or valid handwritten signatures, the key term to keep in mind is “legible.” If a signature (full name, a first initial and last name, or initials) is legible, then it is automatically considered valid. But we all know that most handwritten signatures are illegible, at best. Several precautions can help you combat the possibility that Medicare will declare a handwritten signature

illegible and invalid. First, make sure the physician prints his or her name directly under his or her signature, or make sure that beneath the signature line the physician’s name is typed. In essence, the following would be considered a valid signature, even if the signature itself were illegible:

Mike Odell, MD Also, an illegible signature may be considered valid in situations where the letterhead, addressograph, or other information on the document being signed clearly indicates the identity of the person signing the document or medical record entry. An example of this, as explained in the Medicare Program Integrity Manual (PIM), would be if a doctor within a group practice provides an illegible signature on an order, but the letterhead on the order lists the names of all of the doctors in the practice and the doctor signing the order circles his or her name.

O&P ALMANAC | JULY 2016

A signature log is simply a key or a list of typed or printed names, along with the corresponding signature.

So, if a referring doctor is using prescription pads or other forms that have his or her name and the names of his/her partners on the letterhead, be sure the physician circles his or her name. If the doctor is in solo practice, be sure his or her name appears somewhere on the form’s masthead, or on the page where the signature is located.

Authenticating Invalid or Missing Signatures

As stated earlier, authorship of a medical record entry or any other document (e.g., prescription or order) can be generally verified by using handwritten, electronic, and, in rare instances, stamped signatures. But there may be times when the author of a record is missing or unclear, such as when the signature is illegible or cannot be verified by other means (such as a printed name or any other identifying information), and the document and/or signature must be authenticated. When a document is missing a signature or the signature has been deemed illegible and invalid, there are two common and acceptable ways you may authenticate the signature and/or the medical record entry. The first method for authenticating a signature is a signature log. A signature log is simply a key or a list of typed or printed names, along with the corresponding signature. The log allows the 36

JULY 2016 | O&P ALMANAC

reviewer or auditor of your claim to examine and compare the signature in the log to the signature in question and verify that it belongs to the author of the document or medical record entry. The construction of a signature log is simple: It should include the printed name of the physician or provider and the full signature and/or the initials as they would appear on a signed document. It is not necessary to include the physician’s or provider’s credentials with your signature log, but the DME MACs and Medicare do encourage this practice so you may want to include them. The following is an example of a signature log:

compile a signature log for all of your primary referral sources, and submit a copy of the log along with your claims if they are audited. The second method for authenticating a signature is an attestation statement—a statement that allows for the signatory to attest to the authenticity of his or her signature and/or the entry made in the medical record. The attestation statement is useful when the doctor forgets to sign one of his or her entries in the patient’s medical record. This attestation statement could be submitted with your original documentation, if you believe Medicare will question a signature or the absence of a signature, or you may submit it after a claim has been denied for an invalid signature. Medicare and the DME MACs don’t have a specific or mandatory attestation form that you must use, but they have certain criteria that must be included in any attestation statement for it to be considered valid. The statement must be signed and dated by the person who originally made the medical record entry or who originally signed the document in question, and it must contain enough information to clearly identify the patient. In the PIM, Medicare has created a sample attestation statement: “I, _____ [print full name of the physician/practitioner] ___, hereby attest that the medical record entry for _____ [date of service] ___ accurately reflects signatures/notations that I made in my capacity as _____ [insert

PRINTED NAME

INITIALS

CREDENTIALS

Dr. Mike Odell

The log may be created at any time and does not need to be done prior to the signature being added to the document. It may be sent in with your original documentation, on the actual page where the initials or illegible signature are located, if you believe Medicare will question a signature. Alternatively, you may submit the log after a claim has been denied for an invalid signature. To be prepared to address an invalid/illegible signature, you may

SIGNATURE

provider credentials, e.g., MD]__when I treated/diagnosed the above listed Medicare beneficiary. I do hereby attest that this information is true, accurate, and complete to the best of my knowledge, and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.” As a side note, the attestation statement cannot be used to add new information to the medical record.

There are different rules for amending a medical record, and it can only be used to establish the validity of a current medical entry or illegible signature. In other words, the statement must be associated with a specific medical record entry. The statement may not be used to back-date a signature or medical entry, even if the attestation statement may be created at any time (even after the entry or document has been signed). That takes care of handwritten signatures, but what happens when the validity of an electronic signature is called into question? This scenario is less common, especially if the signature contains or uses one of the labels discussed previously. However, CMS and its contractors are concerned that there is the potential for misuse with electronic signatures, and as such they suggest that a system be in place that protects the documents and signatures against modification. For example, a physician must enter his or her own identification number to access a record or to add his or her signature.

If the validity of an electronic signature is questioned, you may ask the physician’s office to provide you with a statement indicating that it has established procedures that allow only the physician to attach a signature or make changes to a document. Finally, since stamped signatures are only acceptable if the signor has a disability that prevents him or her from physically signing, the only way to authenticate a stamp signature is to obtain a statement from the physician indicating that he or she has a disability and the stamp signature is in compliance with the Rehabilitation Act of 1974. This month’s Compliance Corner was framed to discuss physicians’ signatures and what constitutes a Medicare-compliant signature in regard to physician documentation. It is important to note that the rules apply to all signatures, including your own. After all, Medicare requires that all information—not just the provider’s—used in documenting

medical necessity be identifiable, meaning each entry in the medical record needs to be signed and dated. For more information about signatures, review Chapter 3, Section 3.3.2.4—Signature Requirements in the PIM, or review the MLN Matters article SE1419: “Medicare Signature Requirements—Educational Resources for Health Care Professionals.” Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@aopanet.org. Take advantage of the opportunity to earn two CE credits today! Take the quiz by scanning the QR code or visit bit.ly/OPalmanacQuiz. Earn CE credits accepted by certifying boards:

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MEMBER SPOTLIGHT

Standard Cyborg

By DEBORAH CONN

Dipping a Foot in the 3D Waters New company explores 3D-printing scanning, modeling, and printing to support clinicians

RANSTIBIAL AMPUTEE JEFF HUBER was studying

JULY 2016 | O&P ALMANAC

A practitioner scans in a below-knee patient using the Structure Sensor and Standard Cyborg.

COMPANY: Standard Cyborg OWNERS: Jeff Huber and Garrett Spiegel LOCATION: San Francisco HISTORY: 1.5 years

work of dedicated clinicians. We firmly believe that 3D printing will ultimately be core to the delivery model of O&P and will be better for patients and practitioners.” Standard Cyborg launched Design Studio to offer practitioners the tools to create test sockets printed in polyethylene terephthalate (PETG plastic), quickly and accurately. Clinicians use an iPad, provided free of charge, to scan a patient’s residual limb. The custom-built Design Studio software can accommodate transtibial, transfemoral, transradial, and transhumeral amputations, as well as hip and shoulder disarticulations, knee disarticulations, and partial-foot amputations. Once the scan is complete, the practitioner uses the software to model a socket that can be printed by the clinician or transmitted to Standard Cyborg, which will ship back the completed component in 48 hours. The user can also send

A transtibial socket designed with Standard Cyborg Design Studio is fitted on a patient.

PHOTOS: Standard Cyborg

industrial engineering at North Carolina State University in 2009 when he first encountered 3D printing. Given his lifelong experience as a patient, he had a feeling the technology would play an important role in orthotics and prosthetics. Despite his interest in the technology, he pursued another path for a few years— founding a company focused on education and the Internet. In 2014, he says, “I got a bug. I knew I wanted to explore this idea.” Huber developed his own software and built himself a 3D-printed waterproof prosthetic leg. He and his partner, Garrett Spiegel, a biomedical engineer, thought they had an interesting niche and founded Standard Cyborg to produce and market the product. The fundamental idea was to provide a simple, duplicate exoskeletal device for amputees who wanted to take part in lowlevel activities—such as going to the beach, showering, or walking though sand or mud—without damaging an expensive prosthesis. Huber and Spiegel scanned a patient’s existing artificial limb and socket to create a 3D-printed duplicate, which they laminated with carbon fiber. The result was a one-piece, lower-activity, and lower-cost option. “We spent most of last year making them for people across the country,” says Huber. “And in the process, we learned a lot about prosthetics and 3D printing and how we can apply our skills as technologists to support the

the modified scan to a central fabrication facility for carving. The company has begun exploring 3D-printed orthoses as well, including shoe inserts and ankle-foot and supramalleolar orthoses. “We’re learning what tools practitioners need to make great orthotics, as well as what plastics are appropriate for them,” says Huber. The system has been in pilot mode through the end of June, with 20 O&P facilities using the software and offering feedback. Because the technology is cloud-based, Huber and Spiegel can refine and update features on an ongoing basis. Training is offered through detailed videos, screenshare, and in person. Huber is confident that 3D printing is the inevitable wave of the future—as an aid for practitioners, not as a way to replace them. “We want to make sure they have the best tools available at their fingertips,” he explains.

MEMBER SPOTLIGHT

PHOTOS: Standard Cyborg

“We think practitioners have great intuition of what to build, so our goal is to get the product from their mind’s eye into reality as fast and as easily as possible. “The technology is still young, but it’s moving quickly. Within three years, scanners will be built in to your smartphone, so you won’t need heavy, expensive equipment. People are working on new plastics, so in the next year we should be able to print definitive sockets, and printing directly in silicone or other flexible plastics will offer a new generation of liners,” says Huber. “We’re not going to change everything overnight, but this technology should make everything better for everyone.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net. EDITOR’S NOTE: A recent announcement from U.S. Food and Drug Administration (FDA) made it clear that the same rules that apply to all medical

A practitioner accesses Design Studio through a web browser.

device manufacturers, including but not limited to company registration, product listing, device classification, medical device reporting, and the complaint reporting provisions of the FDA device good manufacturing practices regulations in 21CFR, Section 820.198,

The Source for Orthotic & Prosthetic Coding

A 3D-printed test socket

are intended by FDA to apply equally to devices using 3D printing or other “additive manufacturing” as the prelude to marketing the devices to patients. If you are interested in reviewing information about the FDA announcement and the FDA obligations, visit bit.ly/fdainfo.

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HE O&P CODING EXPERTISE the

profession has come to rely on is available online 24/7! LCodeSearch.com allows users to search for information that matches L Codes with products in the orthotic and prosthetic industry. Users rely on it to search for L Codes and manufacturers, and to select appropriate codes for specific products. This exclusive service is available only for AOPA members.

Log on to LCodeSearch.com and start today. Need to renew your membership?

Contact Betty Leppin at 571/431-0876 or bleppin@AOPAnet.org.

Manufacturers: AOPA is now offering Enhanced Listings on LCodeSearch.com. Don’t miss out on this great opportunity for buyers to see your product information! Contact Betty Leppin for more information at 571/431-0876.

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O&P ALMANAC | JULY 2016

MEMBER SPOTLIGHT

O&P Designs

By DEBORAH CONN

O&P on the Air Texas facility hosts an internet radio show to educate O&P consumers

ROM THE BEGINNINGS OF O&P Designs in 1990 in

Garland, Texas, to its present-day offices in Dallas, the facility has provided the Dallas/Fort Worth area with professional orthotic and prosthetic care for 26 years. Under the leadership of Jim Donahue, CPO, LPO, a co-founder of the business, the practice provided exclusive O&P services to the Dallas Rehabilitation Institute from 1994 to 2002. During that time, Jim Donahue and his staff operated out of a facility on the institute’s campus. The institute eventually went in a different direction, and O&P Designs moved off campus in 2002 to a new facility. O&P Designs operates out of an 1,800-square-foot space that features three patient rooms, including one dedicated to gait analysis, and a fabrication lab, where the facility produces about 90 percent of its devices.

Ed Donahue and Mel Peters host a weekly internet radio show.

FACILITY: O&P Designs OWNERS: Jim Donahue, CPO, LPO, and William Donahue LOCATION: Dallas, Texas HISTORY: 26 years

JULY 2016 | O&P ALMANAC

PHOTOS: O&P Designs

Jim Donahue CPO, LPO, in the fabrication lab

Chief Operating Officer Jim Donahue specializes in the care of transfemoral amputees and complex cases of all levels of amputation. Carol Garrison, CO, LPO, specializes in transtibial prosthetic care as well as complex orthotic cases, with an emphasis on Charcot care. Ed Donahue, a licensed orthotist and prosthetic assistant certified by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC), provides overall orthotic care, and technician Daniel Bell, an ABC-certified prosthetic assistant, also brings his perspective as a below-knee amputee to the practice. O&P Designs recently forged a relationship with the University of North Texas (UNT) Health-Care Science Center, which houses the Biomechanical Medicine Clinic led by Todd Dombroski, DO. Jim and Ed Donahue serve veterans and community members with all forms of physical challenges, from multiple sclerosis and cerebral palsy to amputations of all levels. Along with upper-extremity

expert Chris Lake, CPO, of Lake Prosthetics and Research, UNT and O&P Designs explore creating innovative accommodative devices while assisting research engineers in new designs. “One of our patients is considered the most wounded soldier since 9/11,” says Ed Donahue. “He has a hip disarticulation on one side and a hemipelvectomy on the other. One of his pastimes is parachuting. The staff of O&P Designs, along with input from the UNT clinic, adapted a distal piece for his jumpsuit so that this patient could safely land without damaging impact.” Jim Donahue says, “We find the clinic both challenging and rewarding because of the types of patients we see and the research involved in creating new designs. We are exploring the new advances in 3D printing, new forms of fabrication such as computer-assisted alignment jigs, and quicker and more efficient ways of laminating prosthetic sockets.” In addition to the facility’s website and an active Facebook page, O&P Designs sponsors another thriving communications vehicle: an internet radio show called “Breaking Down Barriers.” “I had always wanted to have a radio show to inform people about how to navigate life with physical challenges,” says Ed Donahue. “I joined forces with one of our patients, Mel Peters, a transtibial amputee, who had 30 years of experience in radio. With his expertise and my previous experience as a voice-over artist, we launched the show in January 2015.”

MEMBER SPOTLIGHT

PHOTO: O&P Designs

The weekly, two-hour program has covered topics ranging from financial and emergency preparedness to returning to work and travelling with physical challenges. Among the show’s recent guests was Paralympic medalist John Register, who competed in swimming in 1996 and won Silver in the long jump in 2000. Carl Caspers, who pioneered vacuum socket technology, has been on the show several times. “We were the first radio show in the country to do a full segment on what was happening when Medicare proposed rule changes that essentially rolled back coverage to the 1970s,” says Ed Donahue, referring to the proposed Local Coverage Determination and Policy Article on lower-limb prosthetics. “Dan Ingaszewski, director of government relations and marketing for the Amputee Coalition, came on to discuss the proposals.” “Breaking Down Barriers” has listeners all over the world, according to Ed Donahue, with an average of

Ed Donahue works in the lab.

20,000 listeners hearing each episode. The show is just an extension of O&P Designs’ commitment to its patients and to anyone who faces physical challenges. “Working with patients is always a pleasure,” says Jim Donahue. “You can have a bad day and then watch

someone walk for the first time. It makes all your problems pale in comparison. And that’s what we do.” Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

We cordially invite you to attend the

During the 2016 AOPA National Assembly

Friday, September 9 6:00-8:00 PM

The Sheraton Boston Hotel Commonwealth Room (Level 3)

This is a special event and will require a separate registration fee. For additional information about the Wine Tasting & Auction or to register, contact Devon Bernard at dbernard@AOPAnet.org. O&P ALMANAC | JULY 2016

AOPA NEWS

SEPTEMBER 14

OCTOBER 12

Fill in the Blanks: Know Your Forms

Register for the September 14 Webinar Are you filling out all of your forms correctly? Join AOPA experts for the September 14 webinar and get answers to these questions: • Are your prescriptions compliant with Medicare? • Are you putting all of the correct information on proof of delivery forms? • Do you require a letter of medical necessity for your claims? • When should the certifying statement be signed by the doctor?

Knee Orthosis Policy: The ABCs of the Local Coverage Determination and Policy Article

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit. ly/2016webinars. Contact Ryan Gleeson at rgleeson@ AOPAnet.org or 571/431-0876 with questions. Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2016billing.

JULY 2016 | O&P ALMANAC

Join AOPA experts for the October 12 webinar, and find out everything you need to know about the proposed Local Coverage Determination (LCD) and Policy Article for knee orthoses: • Examine which addition codes can be used with each base code. • Determine what documentation is needed for each type of knee orthosis. • Determine when you may use the KX modifier on a KO claim. • Review all other pertinent information found in the LCD and Policy Article. AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit. ly/2016webinars. Contact Ryan Gleeson at rgleeson@ AOPAnet.org or 571/431-0876 with questions. Register for the whole series and get three free webinars! The series costs $990 for members and $1,990 for nonmembers. All webinars that you missed will be sent as a recording. Register at bit.ly/2016billing.

AOPA NEWS

Don’t Miss the 9th Annual Wine Tasting & Auction

OPA WILL HOST the 9th Annual

Wine Tasting & Auction on Friday, September 9, from 6 to 8 p.m. during the 2016 National Assembly. This can’t-miss event provides attendees with a unique opportunity to mingle, network, learn about, and taste a variety of wines—most importantly, the event raises awareness of and funds for AOPA’s government relations outreach. Let’s keep the tradition of success alive and make the 9th Annual Wine Tasting & Auction the most successful ever. Please join in the fun during this “good cause” and add

BOURBON

CIGARS

CRAFT BEER

to the continued success of the Wine Tasting & Auction by donating today. Your special donations are what make this event unique. Your donation may be one of the gems of your cellar, jewelry, artwork, wine glasses, a bottle of your favorite spirit, cigars, etc. We also have a team of personal shoppers who can locate that perfect item for you if you would prefer to make a monetary donation. Please consider donating today. The donation form is available on AOPA’s website. Contact Devon Bernard with questions at dbernard@AOPAnet.org or 571/4310854. We look forward to seeing you at the 2016 National Assembly and the 9th Annual Wine Tasting & Auction.

JEWELRY

TIFFANY CRYSTAL

VACATIONS

WELCOME NEW MEMBERS

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an www.AOPAnet.org official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership. At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership. At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Ascent Orthotics & Prosthetics Inc. 7336 S. Yosemite Street, Ste. 210 Centennial, CO 80112 303/770-0100 Category: Patient-Care Facility Paul Hendrickson

Capron Podologie Avenue de L’Europe Coriolis Montchanin, France 71210 33-38577-3060 Category: Supplier Level 1 Alen Sabarovic

Click Medical P.O. Box 775245 Steamboat Springs, CO 80477 970/670-7012 Category: Supplier Level 1 Jimmy Capra

LegWorks 307 S. Van Ness Avenue San Francisco, CA 94103 408/692-5633 Category: Supplier Level 1 Brandon Burke

Fusiform Medical Devices 5000 Thayer Center Oakland, MD 21550 714/623-3711 Category: Supplier Level 1 Param Shah

Qdesign S.r.l. Via E. Fermi, Ste. 19-21 Bientina, Italy 56031 39-058748-9794 Category: Supplier Level 1 Matteo Patalocchi

Lake Area Prosthetics & Orthotics 505 W. College Street Lake Charles, LA 70605 337/474-2989 Category: Patient-Care Facility Ronnie Bias

Is Your Facility Celebrating a Special Milestone in 2016? O&P Almanac would like to celebrate the important milestones of established AOPA members. To share information about your anniversary or other special occasion to be published in a future issue of O&P Almanac, please email cumbrell@ contentcommunicators.com.

O&P ALMANAC | JULY 2016

AOPA O&P PAC

ACH YEAR, THE O&P PAC organizes fundraising events for members of Congress who have been supportive of O&P. For each event, AOPA members make a personal contribution to the member's campaign and spend time with the member talking about a variety of issues, including health care and the provision of O&P. These events are a unique way to share O&P concerns, get to know a member of Congress, and get a congressional update; they have been very successful in getting Congress to understand O&P concerns. In addition, each year the O&P PAC sponsors events that allow AOPA members to learn more about the activities of the PAC , and provides them with the opportunity to get involved. The following individuals and PACs have donated directly to a candidate’s fundraiser or to an O&P PAC* sponsored event:

• Hanger PAC

• Scott Schneider

• Ryan Arbogast

• Eileen Levis

• Rudolf Becker III

• Pam Lupo, CO

• Keith Smith, BSME, MBA

• Gregory Bernhardt, CP

• Jeff Lutz, CPO

• David Boone, BSPO, MPH, PhD

• Dave McGill

• Peter Thomas, JD

• Doug Call, CP

• McGuireWoods PAC

• Thomas Watson, CP

• Maynard Carkhuff

• Michael Oros, CPO, FAAOP

• Jim Weber, MBA

• Jeff Collins, CPA

• Susan Paul

• Ashlie White

• Charles H. Dankmeyer Jr., CPO

• Andrew Pedtke

• James Young

• Thomas Fise, JD

• Tom Powers • PPSV PAC

• James Young Jr., CP, FAAOPP

• Rick Fleetwood, MPA • Elizabeth Ginzel, CPO

JULY 2016 | O&P ALMANAC

• Rick Riley • Brad Ruhl

• Chris Snell • Clint Snell, CPO

*Due to publishing deadlines this list was created on May 24, 2016, and includes only donations/contributions made or received between Jan. 1, 2016, and May 24, 2016. Any donations/contributions made or received on/or after May 24, 2016 will be published in the next issue of the O&P Almanac. This list does not contain individuals who have directly contributed to the O&P PAC; those individuals have been listed in previous installments of the O&P PAC Update in the O&P Almanac.

PHOTO: iStock.com/Franckreporter

• Alston Bird PAC

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level, which have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House, Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community. To participate in and receive information about 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.

MARKETPLACE ALPS EasyLiner™ ALPS EasyLiner is formulated with EasyGel, which contains an antioxidant blend that is an effective hydroxyl scavenger and has been reported to have beneficial effects to the skin. It features a flat encapsulation for additional comfort, and high performance fabric for more durability. The EasyLiner is available in 3-mm and 6-mm uniform thickness, or tapered 6/3-mm distal to proximal. For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com. ALPS is located at 2895 42nd Avenue N., St. Petersburg, FL 33714.

Introducing Precise Insoles by Amfit Amfit is proud to announce a prefabricated, functional insole in 24 sizes. Confidently offer a noncustom orthosis with biomechanically engineered arch support built right in. Millions of unique foot shapes formed the basis for designing a ready-towear insole with true functional support and the widest size range on the market. Most high-quality premade insoles offer less than 10 shell sizes. Precise insoles were designed to bridge that gap so you can offer a high-quality, functional orthosis when full custom isn’t an option. • Twenty-four sizes • Integrated length, width, and arch height • Anatomically correct design • Functional shell with no crack guarantee • Forefoot comfort insert • Stabilizing deep heel cup • Tablet-style digital sizing guide Opt for the Starter Kit (36 pairs, digital sizer, mount, and display materials) or order by the pair. Ask about introductory specials at sales@amfit.com or 800/356-FOOT (3668), x264.

Amfit: It’s Your Patient, Shouldn’t It Be Your Orthotic Design, Too? Take complete control for the ultimate in patient satisfaction with Amfit Lab Services. • Carbon fiber (flex and firm) • Polypropylene (flex, semiflex, rigid) • Five EVA styles and densities • One- to four-day turnaround • Diabetic-specific program: three pair for $60, includes shipping • Foam box processing • Contact Digitizer 3D digital casting system • Equipment rental and lease programs available. Thirty years specializing in custom foot orthotics and orthotic technology, we will help move your practice forward while saving time and money. Contact Amfit Inc. today at 800/356-FOOT(3668), email sales@amfit.com, or visit www.amfit.com.

DDA™ Orthosis The sophisticated DDA™ (Dynamic Dorsi-Assist) Orthosis is designed to dynamically stretch the gastroc muscles, offsetting equinus contracturing. The use of a series of posterior articulations allows for a virtual unrestricted range of plantar or dorsiflexion. The DDA™ Orthosis incorporates two elastic straps attached to the distal foot section and proximal calf section. These straps can be adjusted to compensate and/or offset varus and valgus tendencies while maintaining constant dorsi-assistive force. The DDA™ Orthosis incorporates an important telescoping calf section feature that allows for shortening or lengthening of the soft tissue/musculature, which can also be locked out, if applicable. For more information, call 800/837-3888 or visit www.anatomicalconceptsinc.com.

O&P ALMANAC | JULY 2016

MARKETPLACE

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

New Stealth MPK by DAW Industries THK-5PSOMPK This latest new technology detects instantly any change in knee 3D positioning. The programmable Stealth microprocessor instantly translates the data and provides the optimum extension-flexion resistance. Its advanced pneumatics with unheard-of high compression ratio never requires adding fluid. It can easily be set to provide the desirable resistance while walking down an incline or stairs. For more information, call DAW Industries Inc. at 800/252-2828, email info@daw-usa. com, or visit www.daw-usa.com.

Sure Stance K3 Knee by DAW Industries THK-4PSC This ultralight, true variable cadence, multiaxis knee is the world’s first nonmicroprocessor, four-bar stance-control knee. The positive lock of the stance control activates up to 35 degrees of flexion! The smoothness of the variable cadence, together with the reliability of toe clearance at swing phase, makes this knee the choice prescription for K3 patients not qualifying for a microprocessor knee. For more information, call DAW Industries Inc. at 800/252-2828, email info@daw-usa. com, or visit www.daw-usa.com.

Child Variable Cadence Multiaxis Knee TK-4POC NEVER HEARD OF BEFORE: This ultralight miniaturized knee provides the ultimate in function and dependability for the active above-knee child amputee or smaller petite adults. Designed as a four-bar pneumatic polycentric, the knee’s instantaneous center of rotation is projected proximally to the patient’s residual limb. The specially engineered alloy construction accommodates the most active child amputee or lightweight adult with uncompromising strength and durability. For more information, call DAW Industries Inc. at 800/252-2828, email info@daw-usa.com, or visit www.daw-usa.com.

JULY 2016 | O&P ALMANAC

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue. For more information, call at 800/301-8275 or visit www.hersco.com.

Introducing the Fuzion™ Family of Orthoses Patients experience greater fit, function, and freedom with Orthomerica’s new Fuzion line of custom orthoses. The Fuzion’s design and materials ensure greater patient compliance for a variety of challenging clinical indications. Available for both select adult and pediatric patients.

Key benefits: • Proprietary heat-adjustable plastic makes patient management much easier vs. traditional orthoses • New treatment options for patients historically not candidates for orthotic intervention and management • Fuzion’s compression design holds the patient in a secure, comfortable position while assisting with spasticity management • Accommodates volume changes. Call 877/737-8444 or visit www.orthomerica.com.

MARKETPLACE K1/K2 Solutions

design. dexterity. intelligent motion.

Ottobock has the perfect solution for your lower-activity transfemoral patients. Choose from products like the 3R62=N for its advanced stance flexion in combination with the lightweight split toe 1C11Terion, and create the right solution for your patient’s needs. Call your local sales representative at 800/328-4058.

Custom Silicone Leg Covers Ottobock Custom Silicone acts as your extended workbench, fabricating aesthetically pleasing and high-quality silicone covers for leg prostheses. Precise and individual, each cover is designed to your patients’ unique appearance. Call us at 800/665-3327.

•

Smarter: Uses simple gestures to change grips.

•

Faster: Boost digit speed by up to 30 percent.

•

Smaller: New form-fitting anatomical design reduces profile in every dimension. For more information, contact Touch Bionics Inc. at (855)MY iLimb or visit www.touchbionics.com.

2016 AOPA Coding Products Get your facility up to speed, fast, on all of the O&P Health-Care Common Procedure Coding System (HCPCS) code changes with an array of 2016 AOPA coding products. Ensure each member of your staff has a 2016 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors. • Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • Illustrated Guide: $185 AOPA members, $425 nonmembers • Quick Coder: $30 AOPA members, $80 nonmembers Order at www.AOPAnet.org or by calling AOPA at 571/431-0876.

O&P ALMANAC | JULY 2016

AOPA NEWS

CAREERS

Opportunities for O&P Professionals

Pacific

Job location key:

ABC-Certified Practitioners Wanted!

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

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge. Include your company logo with your listing free of charge. Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations. O&P Almanac Careers Rates Member $482 $634

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

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

Nonmember $678 $830

ONLINE: O&P Job Board Rates Visit the only online job board in the industry at jobs.AOPAnet.org. Member Nonmember $85 $150

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

A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.

JULY 2016 | O&P ALMANAC

Cammy Lucero, CEO Email: Cammy@Summitonp.com Website: www.summitonp.com

Mid-Atlantic

Color Ad Special 1/4 Page ad 1/2 Page ad

Job Board

Willamette Valley, Oregon Coast, Central Oregon Summit Orthotics & Prosthetics is a locally owned, growing, independent O&P group with eight current locations spanning the Willamette Valley, Oregon Coast, and Central Oregon. We are seeking CPOs and CPeds to be a part of our team, providing patient-centered care with expert knowledge and compassion. Bilingual applicants are encouraged to apply. We offer a competitive salary and benefits including paid vacation and holidays, medical, dental, and 401k. Send résumé to:

CPO/BOCPO

Louisville, Kentucky At Center for Orthotic & Prosthetic Care (COPC), our staff of orthotic and prosthetic professionals is committed to our mission of providing the highest level of patient care possible. COPC is a private partnership that enjoys the privilege and challenge of serving in leading and renowned medical centers in Kentucky, Indiana, North Carolina, New York, and Pennsylvania. Due to an opening at one of our patient-care facilities in Louisville, Kentucky, we are seeking a CPO, or Kentucky-licensed BOCPO, with a minimum of five years’ clinical experience. Candidates must possess excellent communication, organizational, and interpersonal skills, and the demonstrated ability to provide the highest-quality patient care. This position offers a competitive salary, relocation assistance, and excellent benefits including medical, dental, disability, 401K, certification and licensure fees, and continuing education expenses. If you meet these requirements and have an interest, please submit your résumé, in confidence, to:

Center for Orthotic & Prosthetic Care (COPC) Fax: 502/451-5354 Email: dkoch@centeropcare.com

CAREERS

Southeast CPO

BUILD A

Atlanta, Georgia Georgia Orthopedic Resources is seeking a CPO to manage an established Atlanta area office. This professional must be experienced, self-motivated, and possess leadership qualities with good communication skills. Pay is based on experience and will be given profit share. Must be able to serve pediatric and adult population. Knowledge of OPIE software is a plus. Please send résumés to:

Better BUSINESS WITH AOPA

Visit www.AOPAnet.org/join today! Learn how AOPA can help you transform your business into a world class provider of O&P Services with:

Email: Jake@gaorthoresources.com

Coding, Billing and Audit Resources Education, Networking, and CE Opportunities

Check us out at: www.gaorthoresources.com

Advocacy Research and Publications Business Discounts

ADVERTISERS INDEX

Company

Page Phone

Website

ABCOP - American Board for Certification in Orthotics, Prosthetics, & Pedorthics Inc.

703-886-7114

www.abcop.org

ALPS South LLC

800-574-5426

www.easyliner.com

5, 27

800-356-3668

www.amfit.com

Amfit Anatomical Concepts Inc.

800-837-3888 / 330-757-3569 www.anatomicalconceptsinc.com

Baker College

810-766-4359

email: pedorthics-fl@baker.edu

BCP Group

615-550-8774

www.bcpgroup.com

ComfortFit Orthotic Labs Inc.

888-523-1600

www.comfortfitlabs.com

DAW

1 800-252-2828

www.daw-usa.com

Hersco

2 800-301-8275

www.hersco.com

Orthomerica

7 800-446-6770

www.orthomerica.com

Ottobock

C4 800-328-4058

www.professionals.ottobockus.com

ROMP

www.rompglobal.org

Touch Bionics

www.touchbionics.com

855-694-5462

O&P ALMANAC | JULY 2016

CALENDAR

2016

August 4-6

Alabama Prosthetic & Orthotic Association. Embassy Suites Birmingham-Hoover, Birmingham, AL. For more information, visit www.alabamapoa.org.

July 13

Strategies and Levels: How To Play the Appeals Game. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

August 10

The Supplier Standards: Are You Compliant? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

July 29-30

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

August 1

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

August 1

ABC: Application Deadline for ABC/OPERF Resident Travel Award. Four residents will be selected to present their Directed Study Research project at the 2017 Academy Annual Meeting and receive $2,500 plus complimentary meeting registration. For more info or to apply, go to operf.org.

August 11-12

Orthomerica Whole Limb Solutions Seminar. Milwaukee. Earn 14 CEUs and increase your referral sources as a Certified OWLS Practitioner by attending this ABC-accredited seminar in Milwaukee. Tuition is $495. Each attendee receives a $200 coupon. For more information, visit www.orthomerica.com/education and register today as seating is limited.

August 12-13

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

August 12-13

Texas Chapter of the American Academy of Orthotists and Prosthetists: Annual Meeting. Grand Hyatt on the Riverwalk, San Antonio. Contact Leslie Gray at 214/648-1006, email secretary-treasurer@txaaop.org, or visit www.txaaop.org.

No Application Deadlines BOC offers year-round testing for all of its exams and has no deadlines. Candidates can apply, test when ready, and receive their results instantly for the multiple-choice and clinical-simulation exams. Apply now at http://my.bocusa.org. To learn more about our nationally recognized, in-demand credentials, visit www.bocusa.org or emailcert@bocusa.org.

www.bocusa.org

Calendar Rates Let us

your next event!

JULY 2016 | O&P ALMANAC

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

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

CREDITS

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines. Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email landerson@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.

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR August 18-20

Virginia Orthotic & Prosthetic Association. Hyatt Regency Reston, Reston, VA. For more information, visit www.vopainfo.com.

September 1

ABC: Application Deadline for Certification Exams. Applications must be received by September 1 for individuals seeking to take the December Practitioner CPM exams and November Written and Written Simulation certification exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

September 8-11

October 12

KO Policy: The ABCs of the LCD and Policy Article. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

November 9

Don’t Miss Out: Are You Billing for Everything You Can? Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

99th AOPA National Assembly. Boston. For exhibitors and sponsorship opportunities, contact Kelly O’Neill at 571/431-0852 or koneill@AOPAnet.org. For general inquiries, contact Betty Leppin at 571/431-0876, or bleppin@AOPAnet.org, or visit www.AOPAnet.org.

November 14-15

AOPA Mastering Medicare: Essential Coding & Billing Techniques Seminar. The Tropicana, Las Vegas. Register online at bit.ly/2016billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Seminar

December 14

September 14

Fill in the Blanks: Know Your Forms. Webinar Conference Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

September 23-24, 2016

POMAC (Prosthetic and Orthotic Management Associates Corporation) Fall Continuing Education Seminar. LaGuardia Airport Plaza Hotel, New York. Contact Drew Shreter at 800/946-9170, ext. 101, or email dshreter@pomac.com.

New Codes and What Lies Ahead for 2017. Register online at bit.ly/2016webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. Webinar Conference

Motion Control

SUPERCOURSE - FALL 2016 AUGUST 17 - 20, 2016

Fillauer Headquarters, Chattanooga, TN

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The 4-day SuperCourse fee is $1,350.00 CEUs: 28 (estimated) ABC/BOC For more information or to register for the SuperCourse, email: info@UtahArm.com

115 N. Wright Brothers Dr. • Salt Lake City UT 84116 Phone: 801.326.3434 • Fax: 801.978.0848 Toll Free: 888.MYO.ARMS • www.UtahArm.com

| JULY 2016 51 O&P Almanac Calendar Ad SuperCourse Fall 2016.indd 1 O&P ALMANAC 5/11/16 12:11 PM

ASK AOPA CALENDAR

Medicare Mandates Deciphering the rules for ICD-10 modifiers, diabetic inserts, and more

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

If a Medicare patient is receiving diabetic inserts but he or she is not receiving shoes, do we still need to obtain a certifying statement from the certifying physician?

The answer is yes and no. If the most recent certifying statement on file is less than one year old, then you would not need a new certifying statement. If the most recent certifying statement on file is older than one year, you would need to receive a new statement. If you were not the provider of the original shoes and you wish to provide the new inserts, you must receive documentation in writing from the original provider of the shoes, and that documentation must indicate that the shoes meet the Medicare requirements for therapeutic shoes.

Now that some of the new diagnosis codes associated with the 10th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) include a left, right, or bilateral diagnosis, must we continue to include directional modifiers (LT and/or RT) on claims?

Yes, you must continue to include the directional modifiers on your claims even if the ICD-10 being reported includes an indication of side. The majority of the Medicare medical polices still contain a phrase or directive stating that if a claim is billed without the RT and/or LT modifier, the claim will be denied, and denied as incorrect coding. Also, if you are billing bilateral items on the same date of service, you must include both items on the same claim line and use the LTRT modifier with two units of service, and not one unit of service.

JULY 2016 | O&P ALMANAC

If we have multiple locations, can our delivery acknowledgement forms/proof of delivery forms list all of our addresses, with check-off boxes to indicate which office the items or services were delivered to, or may we circle the applicable address?

There is not a Medicare prohibition that would limit you from having all of your facility locations listed on your proof of delivery forms. The only requirement is that the form include the address where

the item was delivered. However, the address listed on the proof of delivery form must be the physical address of where the item was delivered to the patient; if you deliver an item to a patient in his or her home, you must have a space where you can clearly write in the patientâ€™s home address as the delivery address. If a claim has been reviewed and denied, and is being appealed, can the contractor handling the appeal deny the claim for a different reason?

For the most part, the answer is no, with two main caveats. The first caveat concerns the date you filed a reconsideration or redetermination, or first or second level of appeals. If these were filed before April 18, 2016, then it is possible the contractor could deny your claim for a separate reason. But if the appeals were filed after April 18, 2016, then it is very unlikely that the contractor will deny your claim for a different reason. The second caveat depends on whether the denial is a result of a complex preor postpayment review; if so, then the contractors may not alter the original denial reason, and the same holds true for a postpayment automated review. However, if the denial is the result of an automated prepayment review, the contractors may alter their denial reason after each level of appeal.

ECUADOR EARTHQUAKE: CALL FOR DONATIONS ROMP IS ACTIVELY SEEKING DONATIONS OF NEW OR SLIGHTLY USED PROSTHETIC COMPONENTS TO AID THE VICTIMS OF THE DEVASTATING EARTHQUAKE IN ECUADOR.

How You Can Help With more than 500 deaths and 4500 injuries, Ecuador needs our help now more than ever. Support relief efforts by donating the following: •

Feet (pediatric and sizes 21-26)

•

Modular components (tube clamps, pyramids, socket adaptors, pylons, foot adaptors)

•

Liners (all sizes and types, preferably new)

•

Knees (functional, all types)

•

Supplies (synthetic casting tape, stockinette 2”, 3”, 4”)

•

Prosthetic socks (all sizes, new socks only)

Any overflow components that are not needed for earthquake victims will be used to deliver care to meet the needs of the Ecuadorian public. Please send all donations to: Eric Neufeld, Range of Motion Project 2425 S Colorado Blvd #100 Denver, CO 80222 United States For more information, visit www.rompglobal.org

For monetary donations, visit WWW.CROWDRISE.COM/ROMP-ECUADOR-EARTHQUAKE

Go on, get wet!

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