AOPA
in AdvanceBreaking News for O&P Professionals
May 13, 2008 ♦ Volume 12 Number 10
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| O&P News |
AOPA Reps & O&P Alliance Meet with CMS
Officials
On Monday, May 5, AOPA’s executive director Tom Fise joined with representatives of other organizations in the O&P Alliance in a meeting with CMS officials to discuss quality standards and fraud and abuse issues. The genesis of the meeting dated back to the AOPA Policy Forum in Washington D.C., March 10 – 11, where CMS acting administrator Kerry Weems informed attendees that the agency intends to publish a final quality standards regulation by the end of the year and plans to initiate implementation of BIPA (the Benefits Improvement & Protection Act) in early 2009.
On Monday, May 5, AOPA’s executive director Tom Fise joined with representatives of other organizations in the O&P Alliance in a meeting with CMS officials to discuss quality standards and fraud and abuse issues. The genesis of the meeting dated back to the AOPA Policy Forum in Washington D.C., March 10 – 11, where CMS acting administrator Kerry Weems informed attendees that the agency intends to publish a final quality standards regulation by the end of the year and plans to initiate implementation of BIPA (the Benefits Improvement & Protection Act) in early 2009.
One of the
more vexing aspects of the O&P field from a regulatory perspective is that
both Congress and CMS have occasionally delivered important initiatives to help
assure the quality of providers and the care they offer to patients, only to
fall short of getting these high-profile initiatives implemented. A good
example is section 427 of BIPA, established in 2000, that required O&P
services be provided by individuals who meet specific standards in order to
receive payment from Medicare. Similarly, CMS Transmittal 656 only allows
payment in states with O&P licensure to those providers who are licensed. A
review of Medicare payment data reveals that CMS has never actually denied
payment based on lack of licensure to anyone in any of the 13 states where
O&P licensure has been enacted.
The central
premise of the meeting at CMS on May 5 was to insist that CMS had its timing
backwards—namely that BIPA 427 defined quality standards in O&P and that
the agency should not, and legally could not, publish its own quality
standards, without first publishing standards/regulations under BIPA section
427.
This is not
the first time that this message on BIPA 427 and Transmittal 656 has been
delivered to CMS officials by O&P representatives. Still, coming in
the shadow of CMS administrator Weems’ appearance at the AOPA Policy Forum, has
certainly turned the temperature up on the pot. CMS was represented at the
meeting on May 5 by its chief financial officer, Tim Hill, as well as senior
staffers Kimberly Brandt and Sandra Bastinelli. Mr. Hill indicated that he
recognized that BIPA 427 and Transmittal 656 were directed toward quality of
providers and avoiding fraud and abuse and that failure of enforcement served
to induce increased utilization, costing Medicare more.
Mr. Hill indicated that it is very unlikely that CMS will start new rulemaking processes between now and the inauguration of a new President in January 2009, but that CMS is interested in rolling out the essence of BIPA 427 and of Transmittal 656 enforcement mechanisms before the end of 2008. This was a more action-oriented response than O&P representatives have ever been given in prior meetings on this subject, and Mr. Hill said to contact him in a month if the O&P representatives had not seen any action in this direction.
Mr. Hill indicated that it is very unlikely that CMS will start new rulemaking processes between now and the inauguration of a new President in January 2009, but that CMS is interested in rolling out the essence of BIPA 427 and of Transmittal 656 enforcement mechanisms before the end of 2008. This was a more action-oriented response than O&P representatives have ever been given in prior meetings on this subject, and Mr. Hill said to contact him in a month if the O&P representatives had not seen any action in this direction.
AOPA, working independently both on
Capitol Hill and at CMS, as well as in conjunction with the O&P Alliance,
each day is conveying key facts, needs and concerns of the O&P field, both
for member facilities and on behalf of the patients we serve. We will keep our
AOPA members posted on what productive outcomes emerge from this constructive
meeting with CMS officials.
Questions?
Contact Steven Rybicki at
srybcki@AOPAnet.org or (571) 431-0835.
The O&P PAC supports O&P friendly members of Congress serving on committees that develop legislation affecting the O&P community. Access to these lawmakers to tell the O&P story is enhanced by showing our financial support through PAC donations for their campaigns.
During the 2008 Policy Forum the O&P PAC hosted two fundraisers for congressional members, Senator Ron Wyden (D-OR) and Representative Dave Camp (R-4th-MI). Senator Wyden sits on the Senate Finance Committee while Rep. Davis sits on the House Ways & Means Committee. These committees are responsible for legislation affecting the Medicare program.
In the first quarter of this year, the O&P PAC also donated to Representative Artur Davis (D-7th-AL) who is a member of the House Ways & Means Committee and to Representative Lincoln Diaz-Balart (R-25th-FL) who is an author of House Resolution 5615, the federal prosthetic parity bill.
Questions? Contact Daniel Gurley at dgurley@AOPAnet.org or (571) 431-0812.
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AOPA Comments on New Code Request
AOPA recently attended the CMS public
meeting on new code applications for 2009. During this meeting, which
provides the opportunity for interested parties to comment on the preliminary
coding decisions made by CMS, a member of AOPA’s Coding & Reimbursement
Committee presented comments in support of the application for a new code to
cover the Hypobaric Sealing Membrane. AOPA’s position is that the
preliminary CMS decision, which stated that the membrane was already covered in
codes L5679 and L5681, was incorrect.
This
annual meeting is open to new code applicants, and other interested parties,
and affords applicants the opportunity to present arguments against any CMS
preliminary decisions that they feel are incorrect. CMS considers this
the “appeal” mechanism for its decisions on new code applications and as such,
it is very important for applicants to take advantage of this forum if they
disagree with the CMS decisions.
Questions? Contact Kathy Dodson at kdodson@AOPAnet.org or (571) 431-0810.
Questions? Contact Kathy Dodson at kdodson@AOPAnet.org or (571) 431-0810.
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More Member Survey Results
Years in
business did not seem to impact the mix of payment
source income for O&P facilities who responded to the AOPA member survey. Leading the list
was Medicare accounting for 39.1 percent of income. Third party sources such as
Blue Cross/Blue Shield, United Healthcare, etc., accounted for 31.4 percent;
Medicaid accounted for 16.1 percent; the VA, 5.0 percent; and “Other,” 4.0
percent.
Self pay, Medicaid and VA revenue basically stayed the same over the past three years with participating firms reporting a slightly higher revenue increase from Medicare and third party payers.
Self pay, Medicaid and VA revenue basically stayed the same over the past three years with participating firms reporting a slightly higher revenue increase from Medicare and third party payers.
When asked
about other changes over the last 3
years, the overall results showed increases in the number of competitors,
reliance on technology, and the number of third-party payer contracts as well
as increases in the number of staff. Overall
the number of offices and the outsourcing of functions saw no significant
change.
When asked
if they provide and bill for other
health care services beyond the O&P area, overall only 7.6 percent of
the 211 facilities responding to this question said yes but those in business
for 10 years or less indicated a higher level with 10.8 percent of newer firms
billing for other services. Of those 16 companies billing for other services,
DME was mentioned by 9 companies; PT by 4; OT by 2; speech therapy by 1 with
other mentioned by 3.
Questions? Contact Steven Rybicki at
srybicki@AOPAnet.org or (571) 431-0835.
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Prosthetic Foot Work Group Meets
Again
The AOPA Prosthetic Foot Work Group met May
4-5. The work group, made up of representatives from AOPA member companies that manufacture prosthetic feet, has been
working to develop a proposed code set that will better describe the basic
function of prosthetic feet and additional features that may be incorporated
into them.
In addition to the proposed code set, the workgroup has been discussing the creation of testing parameters that will be used to determine whether a particular foot displays the function or features of the codes in the proposed new code set. It is the hope of the work group that these parameters will result in consistent and repeatable tests that can be performed to show that a prosthetic foot is coded correctly.
In addition to the proposed code set, the workgroup has been discussing the creation of testing parameters that will be used to determine whether a particular foot displays the function or features of the codes in the proposed new code set. It is the hope of the work group that these parameters will result in consistent and repeatable tests that can be performed to show that a prosthetic foot is coded correctly.
The
work group was formed after the Statistical Analysis Durable Medical Equipment
Regional Carrier (SADMERC) approached AOPA
and requested input into its revision of the codes used to describe prosthetic
feet. The SADMERC is interested in reducing the overall number of current
codes and creating new codes that better describe the clinical function of
prosthetic feet.
The
work group has been operating under an unprecedented spirit of cooperation, and
has provided a preliminary report to the SADMERC that was very well received.
The work group is looking forward to completing its work in the near future and
will present its final proposal to the SADMERC at that time.
Questions? Contact Joe McTernan at jmcternan@AOPAnet.org or (571) 431-0811.
Questions? Contact Joe McTernan at jmcternan@AOPAnet.org or (571) 431-0811.
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Chicago 2008: Assembly Session
Spotlight
Plan ahead for the 2008 AOPA National Assembly: Thursday, Sept. 11 from 8-10 AM, attend the popular “AOPA Top Ten Series.” In these informative, user-friendly sessions, you will learn the top ten strategies, solutions, ideas and answers to your most commonly asked questions. This year’s topics are:
Plan ahead for the 2008 AOPA National Assembly: Thursday, Sept. 11 from 8-10 AM, attend the popular “AOPA Top Ten Series.” In these informative, user-friendly sessions, you will learn the top ten strategies, solutions, ideas and answers to your most commonly asked questions. This year’s topics are:
-
Top Ten Questions to Ask During a Patient Intake
- Top Ten Things You Must Do to Implement a Crisis Management Plan
- Top Ten Common Mistakes in O&P Billing
- Top Ten Reasons Companies Fail Facility Accredidation
- Top Ten Internet Resources
- Top Ten Essential Pieces of O&P Documentation
- Top Ten Tips on the New Quality Standards.
The 2008 AOPA National Assembly, Taking the Chicago Assembly to New Heights, will be held at the
Hyatt Regency Chicago from September 10-13, 2008.
Click here to register.
Questions? Contact Erin Kennedy at ekennedy@AOPAnet.org or (571) 431-0834.
Click here to register.
Questions? Contact Erin Kennedy at ekennedy@AOPAnet.org or (571) 431-0834.
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Register
Now: Next AOPAversity Event Meets in Boston June 9-10
AOPA members who attended the first AOPAversity Advanced Coding and Billing sent feedback to us like this:
AOPA members who attended the first AOPAversity Advanced Coding and Billing sent feedback to us like this:
"I would like to commend AOPA for the training conferences offered. I find them to be very educational, enlightening and beneficial to many of my employees. Not only is it an easy way to receive CEUs but the conferences ensure that my employees are informed in policy changes that can effect how we operate. Keep up the good work and thanks for adding further value to our AOPA membership."
Rick FleetwoodC.E.O.Snell Prosthetic & Orthotic Laboratory
Don't miss the next “Mastering Medicare: Advanced Coding and Billing Techniques” seminar
will be held at the Hyatt Harborside in Boston on June 9-10. This two-day course
is dramatically revised from the one offered in previous years and attendance
is worth 14 business continuing
education credits. New features include:
- In-depth discussion of denials and appeals
- How to handle medical reviews and audits
- Coding of complex devices, including repairs and adjustments
- In-depth discussion on compliance with Medicare billing rules
- How to meet documentation expectations
- Hot topics of the day
- Break-out sessions for practitioners and office staff.
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Register Now: May 21 Medicare Audio Conference
“Handling Difficult Patients”
Do you ever open your appointment book and wish you could go back to bed? Everyone has difficult patients. How you choose to deal with them determines the chances for a successful outcome. Join the AOPAversity audio conference on May 21, at 1:00pm (EST), and learn some strategies to help make difficult situations a little more comfortable. Topics of discussion will include:
Do you ever open your appointment book and wish you could go back to bed? Everyone has difficult patients. How you choose to deal with them determines the chances for a successful outcome. Join the AOPAversity audio conference on May 21, at 1:00pm (EST), and learn some strategies to help make difficult situations a little more comfortable. Topics of discussion will include:
-
Identifying difficult situations before they occur
- Strategies for more effective communications with patients
- Obtaining assistance from other members of the medical community
- Separating financial concerns from clinical concerns
- Dealing with non-compliant patients
- Working with patient family members
- Releasing patients from your care
Don’t miss
this opportunity to see things from a different perspective!
Click here to register.
Questions? Contact Erin Kennedy at ekennedy@AOPAnet.org or (571) 431-0834.
Click here to register.
Questions? Contact Erin Kennedy at ekennedy@AOPAnet.org or (571) 431-0834.
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AOPAversity
April 23 Medicare Audio Conference Now Available on CD
The enormously popular April 23 “Hints on Complying with Quality Standards” Medicare audio conference is now available for purchase on CD from the AOPA Bookstore.
The cost is $99 for AOPA members and $199 for non-members. Each informative audio conference is worth 1.5 continuing education credits. Past topics, also available on CD, include: “Tips on Getting Paid”, “Why Was My Claim Denied? Hints on Minimizing Claims Denials;” “The New CMS-1500 Form: Get It Right the First Time;” and “Guidelines on Billing Different Venues & Should I participate with Medicare?”
Click here and visit the AOPA Bookstore for a complete list of available topics.
The enormously popular April 23 “Hints on Complying with Quality Standards” Medicare audio conference is now available for purchase on CD from the AOPA Bookstore.
The cost is $99 for AOPA members and $199 for non-members. Each informative audio conference is worth 1.5 continuing education credits. Past topics, also available on CD, include: “Tips on Getting Paid”, “Why Was My Claim Denied? Hints on Minimizing Claims Denials;” “The New CMS-1500 Form: Get It Right the First Time;” and “Guidelines on Billing Different Venues & Should I participate with Medicare?”
Click here and visit the AOPA Bookstore for a complete list of available topics.
Questions?
Contact Erin Kennedy at
ekennedy@AOPAnet.org or call (571) 431-0834.
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| O&P Resources from AOPA |
2008 Audio Conference Schedule
AOPA has
rolled-out this year’s informative series of audio conferences. During
these one-hour sessions all held at 1:00 pm
(EST), AOPA experts will provide
up-to-the-minute information on the following topics:
May 21: Handling Difficult
Patients
June 18:
Stark/Anti-Kickback Laws
July 16: How to Market your
Practice
August 16: VA
Issues
September 17: How to Not
Get
Sued
October 15: Fraud and Abuse
November
19: New Codes for 2009
The value of these audio conference is obvious:
THEY’RE FAST - No wasted time here. Get right to the heart of the matter in a 1-hour block designed to easily fit into your busy schedule.
The value of these audio conference is obvious:
THEY’RE FAST - No wasted time here. Get right to the heart of the matter in a 1-hour block designed to easily fit into your busy schedule.
THEY’RE CONVENIENT
- No airlines. No travel. No time out of the office.
Listen from
the comfort and convenience of your desk.
THEY’RE
EASY - A telephone is all you need. Just dial in, punch in your access code,
and you're in. That's it. Follow along with the audio conference handouts
provided in advance.
THEY’RE
ACTIONABLE - Our audio conferences provide money-saving tactics you can start
using right away.
THEY’RE
IDEAL FOR MULTIPLE LISTENERS - Use a speakerphone and as many people as you
want can listen in - at no extra cost to you. Many facilities use these sessions
as a cost-efficient, time-efficient means of training staff and reinforcing key
issues in a fresh new manner that they will remember and act on.
THEY’RE
AFFORDABLE - Priced at $99 for members and $199 for non-members, it is a
fraction of the cost of travel and attendance fees for other in-person
conferences or seminars.
Each telephone seminar is
worth 1.5 Continuing Education Credits; further details on obtaining Continuing
Education Credits will be sent via e-mail shortly before each seminar.
Click here to register.
Questions? Contact Erin Kennedy at ekennedy@AOPAnet.org or (571) 431-0834.
Click here to register.
Questions? Contact Erin Kennedy at ekennedy@AOPAnet.org or (571) 431-0834.
Membership Matters: Contact Aon’s
Affinity Insurance Brokerage Service
AOPA has joined forces with Aon’s
Affinity Insurance brokerage service to make personal health care more
affordable for members. Get your free quote today online at www.affinityhealthinsurance.com
or call (888) 470-2121.
In light of
the recent increases in the cost of medical bills and health insurance
premiums, AOPA is now helping
members meet the challenges of health costs. Aon’s new Affinity partnership
with AOPA offers members a wide
variety of plans for medical coverage, including plans for individuals and small
businesses and access to over 400 top health care providers.
Also, dedicated specialists at Aon’s Affinity will help members find the best coverage plan for them based on members’ individual needs. The benefits don’t end there. Aon’s Affinity will also design a personalized benefits package for your office, which can include medical, life, disability, and vision coverage.
Also, dedicated specialists at Aon’s Affinity will help members find the best coverage plan for them based on members’ individual needs. The benefits don’t end there. Aon’s Affinity will also design a personalized benefits package for your office, which can include medical, life, disability, and vision coverage.
Questions?
Contact Michael Chapman at mchapman@AOPAnet.org or (571) 431-0843.
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AOPA and Chase: If You’re Paying More Than 1.9%, You’re
Paying Too Much
The
partnership between AOPA and Chase
Paymentech credit card processing has been a huge success. Members are saving
hundreds and in some cases thousands of dollars annually by switching. Check
out what two of your fellow members had to say about the program:
“[Savings] close to $500 per month! I’m very thrilled about the change! Switching processors was as smooth as could be… I did not hear any single complaint at all from our Brace places. Our sales rep Eric Mock was terrific!”
Joe SansoneC.E.O.TMC Orthopedic Amputee and Prosthetic Center
“As a start-up company, we have had many offers for credit card processing services. We are very satisfied with the ease and convenience that the Chase Paymentech option has offered. The forms were simple and the customer service was very accommodating to making sure we were set up quickly and effortlessly. If only all things toward getting a business running were this simple!”
John Horne CPO, C.Ped.President/FounderIndependence Prosthetics-Orthotics, Inc
Don’t waste
another minute. Fax your latest credit processing statement to (214)849-3650
Attn: Eric Mock for an analysis and see how much you could save by switching to
Chase Payment. Be sure to indicate that you are a member of AOPA.
Questions? Contact Michael Chapman mchapman@AOPAnet.org or (571) 431-0843.
Questions? Contact Michael Chapman mchapman@AOPAnet.org or (571) 431-0843.
|
Need Help? Find It Here.
Reach more prospective employees with the only interactive, O&P-specific online employment network: the O&P Job Board.AOPA members pay only $80 to post a job. Contact Corrinn Mullins at cmullins@AOPAnet.org or (571) 431-0860. |
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LCodeSearch.com: Quick Response to Coding Questions
LCodeSearch.com is gaining
momentum as more and more AOPA members
are logging into this Web-based quick reference site to find appropriate coding
for hundreds of O&P products. AOPA
member manufacturers are adding their products and codes to the site and the AOPA Coding and Reimbursement Committee
is verifying accuracy and resolving any coding questions.
If you don’t see products of a favorite manufacturer already on the site, remind them that as an AOPA member their products can be added to the site free of charge. All manufacturers will be given an opportunity to enhance their listings, enabling them to communicate extensive product information and post pictures, for a modest annual fee, covering all products posted on the site.
Questions? Contact Devon Bernard at dbernard@AOPAnet.org or (571) 431-0854.
If you don’t see products of a favorite manufacturer already on the site, remind them that as an AOPA member their products can be added to the site free of charge. All manufacturers will be given an opportunity to enhance their listings, enabling them to communicate extensive product information and post pictures, for a modest annual fee, covering all products posted on the site.
Questions? Contact Devon Bernard at dbernard@AOPAnet.org or (571) 431-0854.
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| O&P Insider's Track
|
| The Only Up-to-the Minute O&P Newslin |
People
in the News
Adrianne Smith, an American Board Certified orthotist with five years of orthotic and prosthetic experience in Tennessee, has joined Fillauer O&P as an Orthotic Practitioner. Adrianne’s education includes a Bachelor’s Degree in Biology and Chemistry from Delta State University, as well as post graduate studies in Orthotics and Prosthetics from Northwestern Univeristy. She is currently a member of the American Academy of Orthotists and Prosthetists and the Tennessee Society of Orthotics and Prosthetics.
The Amputee Coalition of America wants you to submit your nomination for the ACA’s Awards of Excellence. These awards go to ACA members who have worked throughout the previous year to improve the lives of people living with limb loss or limb difference. Contact Brandon Cox at bcox@amputee-coalition.org for more information.
Adrianne Smith, an American Board Certified orthotist with five years of orthotic and prosthetic experience in Tennessee, has joined Fillauer O&P as an Orthotic Practitioner. Adrianne’s education includes a Bachelor’s Degree in Biology and Chemistry from Delta State University, as well as post graduate studies in Orthotics and Prosthetics from Northwestern Univeristy. She is currently a member of the American Academy of Orthotists and Prosthetists and the Tennessee Society of Orthotics and Prosthetics.
The Amputee Coalition of America wants you to submit your nomination for the ACA’s Awards of Excellence. These awards go to ACA members who have worked throughout the previous year to improve the lives of people living with limb loss or limb difference. Contact Brandon Cox at bcox@amputee-coalition.org for more information.
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Send Us Your News!
The next AOPA in Advance will
arrive in your inbox on May 28. 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
| AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) |
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