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AOPA in Advance
Breaking News for O&P Professionals
 
February 21, 2012
Volume 16, Number 4
Willow Wood March 2012

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In This Issue
O&P NEWS:
- Medicare O&P Improvements Act Introduced in Senate
- AOPA Responds to Recent Associated Press Story
- You Can Make a Difference in 2012 by Attending AOPA's Policy Forum
- Update on Steps AOPA Has Taken Regarding "Confusing Business Opportunities"
- Interim Report on CMS OTS Orthotics Listing Released
- HHS Announced Intent to Delay ICD-10 Compliance Date
- HHS Anticipates June 2012 Start for Recovery Audit Prepayment Review Demo
- HHS Releases Proposed Rule on Reporting and Returning of Medicare Overpayments
- Final Week to Register for AOPA's First-Ever FDA Compliance Workshop
- 2012 Bookstore Products Arriving, AOPA Products and Services Catalogue Now Available
- Register for AOPA's March 14 Audio Conference, "AFO/KAFO Policy - What You Need to Know"
- AOPA National Assembly Planning Committee Extends Deadline for Business Papers
O&P RESOURCES FROM AOPA
- Check Out the AOPA Job Board for New Opportunities in O&P
O&P INSIDER'S TRACK:
- People in the News
- Businesses in the News
- Send Us Your News!

Contact Us

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION
 
330 John Carlyle St., Suite 200
Alexandria, VA 22314
 
Phone: (571) 431-0835
Fax: (571) 431-0899
 
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O&P NEWS
Medicare O&P Improvements Act Introduced in Senate

AOPA is pleased to inform members that late on Friday, February 17 the Medicare Orthotics and Prosthetics Improvements Bill of 2012 was introduced into the U.S. Senate by Senators Ron Wyden (D-OR), Olympia Snowe (R-ME) and Charles Grassley (R-IA).  The bill is now officially entered as S.2125.

 

Click here to read the official text of S.2125.

 

Click here to read the floor statement Senator Wyden issued announcing the bill's introduction, and acknowledging his co-sponsors.

 

All three of the original co-sponsors are members of the important Senate Finance Committee, which is the Committee in the Senate that has jurisdiction over Medicare matters.  This is very important because our lead sponsors will be in the ideal position to try to advance the bill's provisions, and they will be engaged in discussions of major legislative initiatives where the bill might be used as an offset.

 

With the bill introduced in both Houses of Congress (introduced in the House over a year ago by Reps. Shelley Berkley (D-NV) and Glenn Thompson (R-PA) as H.R. 1958, we are now well-positioned to ask all of our attendees at this year's AOPA Policy Forum (April 17-18, 2012) to request that their House and Senate members join on as co-sponsors of the bill.

 

The presence of the Senate bill will also enhance the prospects that we can get the bill in front of the Congressional Budget Office, in hopes of having it cleared for a favorable scoring as a "saver" of government money.

 

Click here to read the press release AOPA has issued in support of the bill.

 

AOPA will continue to keep you informed of any significant developments.

 

Questions? Contact Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

  

AOPA Responds to Recent Associated Press Story

AOPA was contacted by an Associated Press reporter about two weeks ago regarding his plans to publish an article raising questions about the increasing per capita cost of prosthetic feet provided to Medicare beneficiaries in 2010 as contrasted to lower costs in 2005, despite a slight decline in the number of Medicare amputee beneficiary recipients of those devices.

 

That article appeared on February 15 and spin-off stories have appeared subsequently.

 

Click here to read the AP story.

 

AOPA president Tom DiBello and AOPA Executive Director Tom Fise spoke with the reporter for slightly over an hour.  Despite information AOPA provided, the reporter made it appear that all Medicare amputee beneficiaries are diabetics. He also quotes the Health and Human Services Office of the Inspector General's (OIG) Report which asserts that the absence of patient contact with the original referring physician should raise suspicions of fraud, when in fact AOPA informed the reporter that the original referring physician is most frequently the surgeon who performed the amputation who seldom has any further significant long term contact with the patient after the patient is discharged from surgical care.

 

The reporter also ignored the fact that over the five-year period O&P's collective fee schedule increases account for a 12 percent increase in the cost of identical services. The article does underscore the critical importance of outcomes data and other evidence-based studies such as the comparative effectiveness study on prosthetic feet which is now underway with AOPA/manufacturer sponsorship.  Additional research on K-3 level patients may also be a prudent topic for subsequent consideration. 

 

The link below will take you to a five-page talking points document which includes key information we provided to the reporter as well as more detailed background on the OIG Report and its flaws.  This information may be helpful in the event you receive questions from patients or reporters.

 

Click here to read the AOPA-prepared talking points.

 

We will keep you informed of any further significant developments.

 

Questions? Contact Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

  

You Can Make a Difference in 2012 by Attending AOPA's Policy Forum

An election year offers special opportunities for building relationships with members of Congress.  They need your support and the Congressional offices will be more interested in your issues.  That's just one more reason why you should attend the 2012 AOPA Policy Forum, scheduled for April 17-18.

 

Additionally, as Health Care Reform regulations continue to be developed, it is critical that the O&P field ensure its voice is heard during this process.  The government is dealing with a budget deficit and is looking for ways to make cuts so it is more important than ever to educate members of Congress on how orthotics and prosthetics restore lives and are an essential part of the healthcare system.  Legislators need to understand how continuing coverage of these benefits for your patients pays off in the long term.  Only you and your patients can carry that message.

 

The 2012 AOPA Policy Forum is being held close to Capitol Hill, which is an ideal location for visiting the Nation's Capital and visiting your legislators.  Make a difference for the entire profession and enjoy our historic city, with easy access to all the attractions of our nation's capital from this ideal location.  All this for a low registration fee of only $125! 

 

Click here for more information about the 2012 AOPA Policy Forum. 

Click here to register for the 2012 AOPA Policy Forum.

Questions? Contact Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

  

 Assembly 2011 Banner
Update on Steps AOPA Has Taken Regarding "Confusing Business Opportunities"

As many of our members may recall, this past summer AOPA reported on patient care facility members receiving correspondences via e-mail, phone, fax and mail for a confusing business opportunity.  Essentially, AOPA members were contacted by a non-O&P company seeking to recruit practitioner talents to provide final adjustments to orthotic products the company sells over the internet.  An impression was left that the company was selected in the Round II competitive bidding process, which was erroneous as at the time no Round II bidder selections had been made.  Practioners were offered a flat $25 to provide service and to provide the necessary paperwork offering evidence of service rendered, to assist the company in being paid.  AOPA provided clarification and further facts relating to this issue in the June 28, 2011 AOPA In Advance issue. 

 

 

Further, in response to these concerns AOPA alerted CMS by sending a letter in August 2011 to Dr. Peter Budetti, Deputy Administrator and Director of the Center for Program Integrity, which included Jonathan Blum Deputy Administrator and Director of the Center for Medicare and Laurence Wilson, Director of the Chronic Care Policy Group.  The letter detailed AOPA's concerns with the communication from the DMEPOS supplier.  A response from John Spiegel, the Director of Medicare Program Integrity Group was sent to AOPA in late October.  The response indicated that CMS was in contact with the accreditation organization responsible for this particular DMEPOS supplier's quality standard compliance.  Additionally, concerns regarding the communication were voiced by AOPA's Executive Director, Thomas Fise, during a November meeting with Dr. Budetti and Mr. Spiegel. 

 

While CMS has been alerted to the issue, our patient care facility members may still see, and need to adjudge the merits of many more of these "business opportunities," in the weeks and months ahead.

 

Questions? Contact Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

  

Interim Report on CMS OTS Orthotics Listing Released

We know that many AOPA members have been surprised and even alarmed by CMS' release of its draft off-the-shelf orthotics listing on Friday, February 10, 2012. That list had been developed as part of the process relating to its eventual publication on August 19, 2011 of its Round 2 competitive bidding list. AOPA and others reported last August that Round 2 did not include OTS orthotics. That has not changed. OTS orthotics is still not part of Round 2. The listing that CMS published last Friday is important, but it does not reverse its earlier decision to exclude OTS orthotics from Round 2 of competitive bidding, nor does it suggest any imminent plans to add OTS orthotics to competitive bidding by some other mechanism.

 

This February 10th list was published, at least in part, in response to a request emanating from the O&P Alliance Steering Committee. We knew that this list existed at CMS and what we had heard via rumors in June of 2011 was that it might not be consistent with our view of devices that would meet the statutory definition of OTS. That definition limits OTS orthotics to those items that can be used by the patient "with minimal self-adjustment.

 

A subgroup of The O&P Alliance Steering Committee met by telephone conference call on Friday afternoon February 10, 2012, within hours after CMS released the list.  AOPA Executive Director Tom Fise participated in a meeting the Alliance subgroup had on February 13 with Laurence Wilson (scheduled well in advance of this) and other CMS officials. CMS' release of its draft OTS orthotics list was one of five topics discussed at this meeting. Here is a quick summary of the perspectives Tom Fise brought into that meeting.

 

The issue has at least two dimensions: (1) what items are on the list, statutory definition, etc. what is the meaning, genesis and importance of the list, and (2) is about perspective,

 

When Laurence Wilson informed us the morning of February 10 that CMS would be publishing the OTS listing later that day, Tom Fise mentioned to AOPA President, Tom DiBello, CO, FAAOP, that we need to place this in perspective. CMS has gone through their Round 2 process and OTS orthotics is not part of Round 2 competitive bidding. Wilson was clear on this saying, "...this is not a Round II thing but rather a process to finalize a list of codes for a potential future round of bidding. (emphasis added)" AOPA has told members since Round 2 was published that we had to be vigilant to make sure OTS orthotics would not be included in a future round of competitive bidding. It must be understood that CMS is not committing to any specific action by releasing the list. CMS is just publishing for public information the list that the O&P Alliance had requested they make available to us - a list that was under consideration for Round 2 but fortunately due to efforts of AOPA and the O&P Alliance was not adopted by CMS.

 

Obviously, AOPA does not agree with the list, and we want to make that clear. But is there a potential threat at some time down the line? Yes. Is it imminent? No.

 

Last August, just days before the Round 2 list was released, AOPA told CMS that if they went beyond the statutory definition of OTS orthotics ('minimal self-adjustment') it would be detrimental to patients and would break the law. At that same time, AOPA delivered to CMS ten examples of harm that could come to patients if certain customized orthotics were sold to patients via competitive bidding, without the benefit of direct care, fitting, instruction etc., from the professional orthotist. CMS personnel referenced the ten examples in the February 13 meeting and said they found that information very helpful in their decision not to pursue competitive bidding for OTS orthotics. CMS said they would welcome similar input by the March 8 deadline for interested parties to provide input on the CMS draft list published February 10.

 

Secondly, AOPA had the opportunity to raise this question at the February 13 meeting. Namely, the CMS working definition appears to ignore one critical word in the statutory definition, and that word is "self." A device which can only be made ready for the patient with 'minimal adjustment' by the physician, professional orthotist, therapist, other health professional, supplier or caregiver DOES NOT meet the statutory definition of OTS orthotics for purposes of competitive bidding. That definition is met ONLY if the device is suitable for use by the PATIENT with minimal SELF-adjustment, i.e., adjustment capable of being accomplished by the patient himself or herself. AOPA assured CMS that it will fully flesh out the details on the statutory definition in AOPA's comments.

 

We will keep members informed. Again, this is not a reversal of policy, nor is it a budding crisis about OTS orthotics and competitive bidding. For the time being, nothing is changed. We will encourage members to submit comments in advance of the March 8 deadline, and AOPA will give further guidance on this.

 

Questions? Contact Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

HHS Announced Intent to Delay ICD-10 Compliance Date

HHS plans to postpone the compliance date for ICD-10 by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).  Entities Covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 codes.  HHS will be announcing the new compliance date sometime in the future.  HHS Secretary Sebelius provided that, "We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead.  We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our healthcare system."  

 

Questions? Contact Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

HHS Anticipates June 2012 Start for Recovery Audit Prepayment Review Demo

Prior Authorization of Power Mobility Devices (PMDs) Demonstration and the Recovery Audit Prepayment Review Demonstration, delayed from the January 1, 2012 start date are expected to move forward on or after June 1, 2012. 

 

More applicable to O & P than the Prior Authorization of PMD is the Recovery Audit Prepayment Review Demonstration.  This demonstration will allow Medicare Recovery Auditors (RACs) to review claims prior to claims being paid to ensure that the provider complied with all Medicare payment rules.

 

The RACs will focus on specific types of claims that are considered to have historically high rates of improper payments.  The demonstration will focus on 11 states; states with high numbers of fraud/error prone providers (FL, CA, MI, TX, NY, LA, IL); and high claims volume/short in-patient hospital stays (PA, OH, NC, MO).  CMS' stated goal of the demonstration is to avoid the traditional "pay and chase" method of going after improper payments after the payment is made by preventing improper payments from occurring.  For more information on these demonstrations, please click here.

 

Additionally, in response to provider and supplier concerns CMS also revised the Prior Authorization of PMDs demonstration.  To learn more about the changes please click here.

 

Questions? Contact Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

HHS Releases Proposed Rule on Reporting and Returning of Medicare Overpayments

The proposed rule, published in the Federal Register on February 16, 2012, would require that providers and suppliers receiving funds for services under Part A and Part B of the Medicare Program report and return overpayments by no later than the date which is 60 days after the date on which the overpayment was identified; or any corresponding cost report is due, if applicable. 

 

The proposed rule would require a person to make written reports by using the self-reported overpayment refund process set forth by the applicable Medicare contractor to report and return overpayments, except if the person satisfies the reporting obligations by making a disclosure under the OIG's Self-Disclosure Protocol resulting in a settlement agreement using the process described in the OIG Self-Disclosure Protocol.  The OIG Self-Disclosure protocol is available here.

 

Comments on the proposed rule are due by April 16, 2012.  The proposed rule can be accessed here.

 

Questions? Contact Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807.

 

Final Week to Register for AOPA's First-Ever FDA Compliance Workshop

Join AOPA on February 24, 2012 in Baltimore, MD at the Sheraton Inner Harbor for an exclusive one-day seminar examining the compliance policies required of O&P by the US Food and Drug Administration (FDA). FDA regulatory compliance awareness is important to provide O&P manufacturers, suppliers, component manufacturers, and distributors with a basic understanding of FDA regulations that apply to the O&P industry. Regulatory compliance training is critical for ensuring your organization's understanding of applicable FDA regulations as it relates to manufacturing & distributing practices, medical devices & device classification, and forms, fees, and key contacts. Penalties are severe if your company is in non-compliance ranging from fines to product recall. 

 

AOPA is offering this compliance training in the wake of reports from members of increased FDA activity. A major interest is whether FDA good manufacturing practices (GMP) applies to O&P Patient Care Facilities, especially those with central fabrication activities.

 

Click here to register.

 

Questions?  Catherine Graf at cgraf@AOPAnet.org or (571) 431-0807 with content questions. And contact Steve Custer at scuster@AOPAnet.org or (571) 431-0876 with registration questions.

 

  

2012 Bookstore Products Arriving, AOPA Products and Services Catalogue Now Available

AOPA's 2012 Products and Services Catalogue contains a comprehensive index of all events, resources, business solutions and products that AOPA provides. Make sure that your practice is taking advantage of all AOPA services that are provided at either no cost or reduced cost to members including AOPA's newsletters, the O&P Almanac magazine, business management monographs, meetings, webcasts, audio conferences, and reference manuals. 

 

Click here to see AOPA's 2012 Products and Services Catalogue.

 

Of particular relevance to members, the 2012 Quick Coders have arrived and are now available for purchase and shipping. 

 

Questions? Contact Michael Chapman at mchapman@AOPAnet.org or (571) 431-0845

 

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Register for AOPA's March 14 Audio Conference, "AFO/KAFO Policy - What You Need to Know"

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

  •        What documentation must exist in order to use the KX modifier on your claim
  •        What are the coverage rules for  AFOs with ambulatory vs. non-ambulatory patients
  •        How to bill for repairs to AFO's and KAFO's 

The audio conference beings at 1 PM (EDT), the cost of participating is $99 per line for AOPA members ($199 for non-menbers), and any number of employees may listen on a given line. Listeners can earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Contact Devon Bernard at dbernard@AOPAnet.org or (571) 431-0854 with content questions.

 

Click here to register for the audio conference. 

 

Questions? Contact Stephen Custer at scuster@AOPAnet.org (571) 431-0876.

 

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AOPA National Assembly Planning Committee Extends Deadline for Business Papers

Due to overwhelming requests for a submission deadline extension, the National Assembly workgroup has extended the submission deadline to March 15. Examples of presentations and topics of interest include: 

  • Business Operations and Administration
  • Contract Negotiating
  • Finance/Billing/Collections
  • General Management/Customer Service
  • Healthcare Administration
  • Outcome Studies
  • Human Resource Management or Diversity Training
  • Communications
  • Reimbursement
  • Legal Issues
  • Legislative and Regulatory
  • Managed Care and Capitation
  • Marketing/Public Relations
  • Professional and Personal Development 

Click here to submit your business presentation for consideration as a general business program or the Sam E. Hamontree Award.

 

Questions? Contact Tina Moran at tmoran@AOPAnet.org or (571) 431-0808.

  

O&P RESOURCES FROM AOPA

Check Out the AOPA Job Board for New Opportunities in O&P   

If you need a position filled at your business or are interested in looking at other job possibilities within the O&P field, check out the AOPA Online Job Board. The online job board sports a freshly updated look and an easy-to-navigate profile creation system.


And remember: if you advertise on the Online Job Board and decide to also advertise in the O&P Almanac, then you'll receive a 5 percent discount on the cost of advertising in the Almanac and on the Job Board.

 

Questions? Contact Steven Rybicki at srybicki@AOPAnet.org or (571) 431-0835.

 

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O&P INSIDER'S TRACK
The Only Up-to-the Minute O&P Newsline
  
People in the News

Medi USA announced the promotion of Marc Bechler to O&P District Manager.

 

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Businesses in the News

Ability Prosthetics & Orthotics, Inc. announced its recent sponsorship of Project Enduring Pride, which provides "outreach capabilities" to assist the seriously wounded in gaining confidence, independence, and courage to return to the civilian community as productive members of that local society.

 

The Amputee Coalition announced its participation in the Amputee Coalition Limb Loss Summit to review the U.S.Department of Veterans Affairs (VA) System of Care Preservation Amputation Care and Treatment program (PACT).

 

OPAF & The First Clinics announced that Central Brace & Limb will be hosting an introduction to scuba clinic for those with physical challenges. Additionally, OPAF announced that First Volley Adaptive Tennis Clinic and Shriners Hospital for Children/Philadelphia partnered once again for a clinic in Cherry Hill, New Jersey.

 

Send Us Your News!
The next AOPA in Advance will arrive in your inbox on March 6. So if you have a new employee or a new office, tell us! Share your news with the over 15,000 readers of the O&P Almanac and AOPA In Advance newsletter. Contact Steven Rybicki at srybicki@AOPAnet.org
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AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

330 John Carlyle St., Suite 200, Alexandria, VA 22314
Tel: (571) 431-0876, Fax: (571) 431-0899
www.AOPAnet.org