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AOPA in Advance
Breaking News for O&P Professionals
March 6, 2012
Volume 16, Number 5
Willow Wood March 2012

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In This Issue
- CMS Announced New Initiatives for Increased Audit Scrutiny of Medicare Advantage Plans
- National and State Updates on O&P Legislation from AOPA and the Amputee Coalition
- This Super Tuesday, AOPA Reminds Members to Attend this Election Year's Policy Forum
- VA and DOD Work Together on Joint Integrated Electronic Health Record System
- HHS Announces New Assistance to States as Part of Health Care Reform
- Medical Equipment Sales Rep Pleads Guilty to Health Care Fraud
- COPL Issues RFP for $15,000 Pilot Clinical Research Grants
- AOPA Supplier Members: Make Plans to Join AOPA's March 14 Conference Call
- Amputee Coalition Requests Presidential Proclamation Designating April as "Limb Loss Awareness Month"
- Register for AOPA's March 14 Audio Conference, "AFO/KAFO Policy - What You Need to Know"
- One Final Week: AOPA National Assembly Planning Committee Extends Deadline for Business Papers
- AAPC Approves 14 CEU's with AOPA's 2012 Mastering Medicare Seminars: Essential Coding & Billing Techniques
- Online Membership Management Available
- Check Out the AOPA Job Board for New Opportunities in O&P
- 2012 Bookstore Products Now Available
- People in the News
- People in the News
- Businesses in the News
- Send Us Your News!

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CMS Announced New Initiatives for Increased Audit Scrutiny of Medicare Advantage Plans

CMS will be conducting new audits of Medicare Advantage (also known as Medicare Part C) plans with a stated aim of reducing error rates.  CMS is required to adjust the payments to Medicare Advantage plans based on the health status of the enrollees.  For example, CMS pays Medicare Advantage plans less for healthier enrollees and more for not as healthy enrollees based on the expectation that health costs for healthier individuals will be less.  Medicare Advantage plans submit data to receive these risk-adjusted payments.


Under the Improper Payments Elimination and Recovery Act (IPERA) of 2010 CMS is required to perform annual audits of this submitted data.  CMS audits look at the submitted claim versus the clinical record.  CMS reported reducing the payment error rate by 3 percentage points (from 14.1% to 11%) for FY2010 to FY2011.  CMS plans to improve these audits to reduce the error rate further through the introduction of the final audit methodology for the Risk Adjustment Validation (RADV) program.


Click here to read the final methodology for the audit.


Additionally, CMS expects to audit around 30 unnamed Medicare Advantage contracts each year, and will perform the next round of Medicare Advantage contract audits on payment year 2011.


Questions? Contact Catherine Graf at or (571) 431-0807.



National and State Updates on O&P Legislation from AOPA and the Amputee Coalition

In the last issue of AOPA in Advance, AOPA informed members that late 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 and this means that it has now been introduced in both houses of Congress (it was introduced in the House more than a year ago by Reps. Shelley Berkley (D-NV) and Glenn Thompson (R-PA) as H.R. 1958).


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. 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.


This past week, The Amputee Coalition released a summary of its 2012 Legislative Agenda. Kendra Calhoun, President and Chief Executive Officer of the Amputee Coalition (AC), explained that the Amputee Coalition's Government Relations staff, headed by Sue Stout, Chief Communications & Director of Public Policy and Dan Ignaszewski, Manager, Government Relations, is focusing on the following states for passage of bills which attempt to obtain insurance fairness for amputees:

  • Arizona has a larger insurance bill that includes a provision that would require prosthetic device coverage, but would allow insurance companies to limit coverage to $12,500 per contract year. We have contacted legislators to advocate for a larger coverage limit like the coverage in the Louisiana law which would raise that limit to $75,000 per contract year.
  • Connecticut is expected to introduce a larger insurance bill that will include insurance fairness for amputees in the next couple of weeks.
  • Florida has introduced the bill and the AC is working on getting a hearing.
  • Idaho has introduced the bill.
  • Minnesota has introduced the bill and we have 10 sponsors.
  • New York has introduced the bill and the AC is pushing for a hearing this year.
  • Pennsylvania has introduced the bill and the AC is pushing for a hearing.
  • South Carolina is working on the bill introduction.
  • Washington state has introduced the bill and the AC is working on a hearing.
  • The AC is actively working with advocates in the following states to introduce the bill this year:  Alabama, Michigan, Nebraska, Ohio, Oklahoma, Tennessee, and Wisconsin. 

For any more information on the legislative outreach being done by the Amputee Coalition, contact Sue Stout at or Dan Ignaszewski   at


Questions? Contact Catherine Graf at or (571) 431-0807.



This Super Tuesday, AOPA Reminds Members to Attend this Election Year's Policy Forum

The above item on the movement of O&P-related bills in legislatures on the state and national levels are more significant reasons 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 or (571) 431-0807.



VA and DOD Work Together on Joint Integrated Electronic Health Record System

On February 27, Secretary of Defense Leon Panetta and Veteran's Affairs Secretary Eric K. Shinseki met to discuss shared agency interests.  As part of the meeting Secretaries Panetta and Shinseki noted that there is new leadership for the Interagency Program Office, which was established by DoD and the VA to try and build the joint integrated electronic health records system.   Updates include the report that medical providers are able to view both VA and DoD patient medical records simultaneously on a single monitor at James A. Lovell Federal Health Care Center at North Chicago.  This development is part of the Graphical User Interface program.  The Lovell Center serves as a testing ground for the partnership of VA and DoD to provide care to service members and veterans in one facility and is being utilized to test the development of a fully integrated electronic health record.


Secretaries Panetta and Shinseki plan to meet again in May to further discuss developments on this initiative; specifically to review progress on the two deliverables the Departments are committed to achieving.  The deliverables include (1) an implementation plan for the electronic transfer of medical records, to reduce costs of paper transfer of medical records and also (2) finalizing a contract for joint pharmacy capability at the Lovell Center.


Questions? Contact Catherine Graf at or (571) 431-0807.


HHS Announces New Assistance to States as Part of Health Care Reform

HHS announced three actions it will take with the aim to help states administer their Medicaid programs and build the state's Affordable Insurance Exchange.  The three actions include:


(1) Awarding $229 million in Affordable Exchange Grants to 10 states to create a Health Insurance Exchange within the state.  Click here for more information on the Health Insurance Exchanges.


(2) Providing for transparency and an opportunity for public input as it relates to the development, review and approval of Medicaid and CHIP demonstrations.  The stated goal for this transparency is to "help ensure that as these changes are proposed at the state level and reviewed at the federal level, stakeholders have an opportunity to inform the decision-making process." 


(3) Finalizing a rule that provides for State Innovation Waivers, which allows states to request waivers of the Affordable Care Act (ACA) provisions to pursue innovative strategies in an effort to provide access to high quality and affordable health insurance in the state.   The Waiver for State Innovation is described in section 1332 of ACA.  Click here for more information on State Innovation Waivers.


Questions? Contact Catherine Graf at or (571) 431-0807.


Medical Equipment Sales Rep Pleads Guilty to Health Care Fraud

In a scheme to commit health care fraud a medical sales rep promised custom fit shoes for diabetics and medical equipment for arthritis sufferers "at no cost" for Medicare beneficiaries.  As part of the plan, the medical sales rep confessed she would order as many products as she could without regard to whether the patient needed the products or requested the products once she got some of the Medicare beneficiaries' and physician information.


In response to Medicare beneficiaries' complaints about receiving unneeded or unrequested products she encouraged the Medicare beneficiaries to hold onto the products until they need them.  For complaints by individuals on behalf of the beneficiaries regarding the receipt of the products she responded that ""You know how it is, they forget what they ordered."  She also acknowledged that in instances where the product was returned by the Medicare beneficiary she did not return it to the medical equipment company where she worked, rather she provided the products to other individuals who would not have otherwise qualified for receiving the product.  This left Medicare paying for products that were not received by Medicare Beneficiaries.  Further, the sales rep kept the sales commission earned on each of the products sold.


This case is being held at the U.S. District Court in Providence, RI.  Click here to read the news release.


Questions? Contact Catherine Graf at or (571) 431-0807.

COPL Issues RFP for $15,000 Pilot Clinical Research Grants 

The Center for O&P Learning and Evidence Based Practice (COPL) has issued the Request for Proposals 2012-2013 Opportunities for O&P Clinical Research grants funded by AOPA.  The grants have been doubled in size to attract more research interest and in keeping with prior protocol the COPL Board will review all submissions and recommend those proposals meriting funding to the AOPA Board of Directors.

Click here to access the RFP which includes an open category of a researcher's choice in addition to specified topics.

Deadline for submission is April 30, 2012 and it is expected the review process will be completed by June 30, 2012.


AOPA Supplier Members: Make Plans to Join AOPA's March 14 Conference Call

AOPA President, Thomas V. DiBello, CO, FAAOP and AOPA Executive Director, Thomas F. Fise, JD on Wednesday, March 14 at 3:00 PM EST will host the second in a series of O&P Issue Updates created especially for Supplier members.   


The list of critical regulatory and legislative issues affecting AOPA Supplier Members has expanded dramatically in a brief period of time. The passage of the Affordable Care Act has been a prime factor.  Please join us for a conference call update on these issues that are of particular interest to AOPA supplier members at 3:00 p.m. Eastern Time, Wednesday, March 14, 2012.


AOPA President, Tom DiBello, CO, FAAOP and Executive Director, Tom Fise, JD will lead the discussion. There will be an opportunity for a question and answer period so we can make sure all of your concerns are covered.


Click here to RSVP. All who RSVP will be sent call in information and the agenda on Monday, March 12, 2012. 


Questions? Contact Steve Custer at or (571) 431-0876.


Amputee Coalition Requests Presidential Proclamation Designating April as "Limb Loss Awareness Month"

The Amputee Coalition submitted a Presidential proclamation request to President Obama to designate April as Limb Loss Awareness Month. This designation would give individuals in the limb loss community a time to rally together, support one another, educate the broader community about limb loss prevention, and raise awareness of issues members of the limb loss community face.


The Amputee Coalition is requesting that AOPA members assist with this project by sending emails in support of this request to the White House. 


Click here to read the full Call to Action with instructions on how you can help.


Click here to read the Amputee Coalition's Press Release.


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 (EST), 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 or (571) 431-0854 with content questions.


Click here to register for the audio conference.


Questions? Contact Stephen Custer at (571) 431-0876.


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One Final Week: 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 or (571) 431-0808. 



 Assembly 2011 Banner
AAPC Approves 14 CEU's with AOPA's 2012 Mastering Medicare Seminars: Essential Coding & Billing Techniques

The American Academy of Professional Coders (AAPC) supports its members to maintain a distinctive edge in their health care career by approving and providing 14 continued education credits by attending the American Orthotic & Prosthetic Association's (AOPA) Mastering Medicare Seminar: Essential Coding & Billing Techniques. Don't miss out on your opportunity to attend the ever-popular Mastering Medicare Seminar; you have 3 more chances in 2012:

  • Chicago: April 23-24 at the Westin O'Hare
  • Seattle: August 6-7 at The Hyatt at Olive 8
  • Las Vegas: October 2012 with a location TBD

Click here for more information.


Questions? Contact Devon Bernard at or call 571-431-0876.




Online Membership Management Available

Are you taking full advantage of your AOPA membership benefits?  Are your employees receiving their own copy of the AOPA In Advance Newsletter; does your staff know about the free online learning videos; white papers and monographs on various topics are also available. Make sure you and your staff are in the know by updating your membership record today.  We can add your company logo to the online membership directory just for the asking. 


Visit to update your membership account.  If you do not know your username and password contact email us at


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 or (571) 431-0835.


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2012 Bookstore Products 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.


Questions? Contact Michael Chapman at or (571) 431-0845.


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The Only Up-to-the Minute O&P Newsline
In Memoriam

AOPA received a notice of the Passing of James "Jim" Russ, CO:


James "Jim" Russ, CO, who spent more than 50 years contributing to the O&P profession, including more than 20 years as director of orthotics at Northwestern University, passed away February 25.


Born and raised in Toledo, Ohio, Russ attended Roosevelt Warm Springs Institute for Rehabilitation in Georgia and graduated in 1957. He took a job in New Orleans for the company now known as Hanger Prosthetics and Orthotics, assisting patients in the selection and use of orthotic equipment. In 1959, he joined the staff at the Institute of Physical Medicine and Rehabilitation in Peoria, Illinois, where he also opened a private practice. Three years later, he moved to Cincinnati to work for Surgical Appliance Industries.


Russ began his teaching career in 1968 at Northwestern University's Feinberg Prosthetics-Orthotics Center, and he eventually became director. While at Northwestern, Russ helped establish a state-of-the-art orthotics department at Mary Free Bed Hospital & Rehabilitation Center in Grand Rapids, Michigan, in 1976. There, he also helped create the first orthotics residency program in the United States.


Russ won the 1997 "Outstanding Educator" award from the American Academy of Orthotists and Prosthetists. He also won awards from Northwestern Feinberg School of Medicine for his commitment to the education of orthotists.


Russ retired in the mid-1990s but kept in touch with colleagues, former students, and others in the field on an almost daily basis. "Jim was a 'warrior for professionalism' for orthotics and prosthetics and never lost his passion for promoting O&P as a profession, lifting us beyond the standards that would be required for an industry," says Michael Burton, O & P consultant and close family friend. "No student who ever sat through one of his lectures will ever forget what he taught them about orthotics, and life. He challenged everyone to be their best." Russ is survived by his wife, Janice; three daughters, Kathy Biondi, Nancy Mier, and Leslie Russ; and several grandchildren.


AOPA received a notice of the passing of Lothar Wehmeier:


Lothar Wehmeier passed away at his home in Kailua Kona, Hawaii on

December 22, 2011.


Lothar studied at the Bundes Fach Schooler (Professional School) to complete his master's degree in Orthotics and Prosthetics in 1961. He then went on to manage a large orthotic and prosthetic company in Berlin from 1962-1966 where he developed friendships with Dr. Max Nader the owner and director of Otto Bock and other prominent European industry innovators. In 1966, he was offered a position in the USA. He moved to New Jersey, servicing hospitals in the metropolitan area of NJ and NY. One of them was NYU, where the Orthotic and Prosthetic department was on the same floor as the Occupational Therapy department. While working with both departments, his problem-solving mind helped to develop, modify and engineer many new orthotic devices.


Working from the basement of his house, he designed devices and brought them to market. From the success of these items arose the idea of starting a manufacturing company and in 1969, Rehabilitation Technical Components, Inc. (RTC) was founded in Hillside, NJ (until its move in 2000). In 1972, The Smithsonian celebrated 200 years of Rehabilitation and exhibited eight of his items.


He is survived by his wife, Yolanta Wehmeier. 


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People in the News

The American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) announced the release the 2011 Practice Analysis of ABC Credentialed Mastectomy Fitters.


The Amputee Coalition announced the hiring of Dawn Draayer as Development Director. The organization also announced that Dan Berschinski, a decorated war veteran and amputee, has been elected to serve a three-year term on the its Board of Directors.


Arizona AFO, Inc. announced the hiring of Melissa Sheller as its U.S. Account Manager.


Hanger Clinic announced the addition of three practitioners:

  • Roy Stafford, CO joins its patient care clinic in Yuba City/Oroville/Chico, California;
  • Nichols Alberty, CP to its Tahlequah, Oklahoma patient care facility; and
  • James DiGiulio, CP to its Philadelphia, Pennsylvania patient care clinic. 

Rick Fleetwood, former AOPA Board Member and CED of Snell Prosthetic & Orthotic Laboratory, was named executive of the year at the 2012 Arkansas Business of the Year Awards.


Businesses in the News

Allard USA  announced the launch of Dralla Foundation a non-profit organization, and during its first year, the Dralla Foundation has funded programs for 13 different organizations.


OPAF & The First Clinics announced that Endolite is a 2012 Gold Level Sponsor.


Send Us Your News!
The next AOPA in Advance will arrive in your inbox on March 20. 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
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330 John Carlyle St., Suite 200, Alexandria, VA 22314
Tel: (571) 431-0876, Fax: (571) 431-0899