Month: November 2017

On November 28, 2017, AOPA participated in a Special Open Door Forum hosted by the Centers for Medicare and Medicaid Services (CMS).  The purpose of the Special Open Door Forum was to receive input from experts and stakeholders regarding proposed changes to the DMEPOS quality standards that would expand the definition of the term “molded to patient model” to include diabetic inserts that are custom fabricated from digital or virtual models using a direct milling process.

During the Special Open Door Forum AOPA expressed its concern regarding a frequently asked questions document published by CMS prior to the forum.  In this document, CMS indicated that inserts that were fabricated using a direct milling process would be reimbursed approximately 14% lower than those that were molded over a physical model of the patient’s foot.  AOPA and other industry representatives questioned this apparent “toll” on providers who chose to provide direct milled inserts that are identical to inserts fabricated using the older technology of molding the insert over a model of the patient’s foot.  AOPA was not satisfied with the answer that was provided by CMS officials during the Special Open Door Forum and followed up with a letter to CMS reiterating the question and challenging the response provided by CMS officials.

AOPA will incorporate its concerns that were addressed during the Special Open Door Forum into its full comments on the proposed changes to the DMEPOS quality standards.  AOPA’s comments will be submitted to CMS by the December 11, 2017 deadline.

Read AOPA’s letter regarding the Special Open Door Forum.

Questions regarding this issue may be directed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.

On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule in the Federal Register entitled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2019.”  Among the provisions in the proposed rule is a section that would provide individual states with increased flexibility in defining essential health benefits (EHB) for purposes of establishing benchmark plans required by the Affordable Care Act.

AOPA submitted official comments on the proposed rule on November 27, 2017.  Our comments reflected AOPA’s consistent position that orthoses and prostheses must remain essential health benefits and any action by CMS that restricts or reduces access to O&P services is not in the best interest of quality patient care.

Questions regarding this issue may be directed to Joe McTernan at (571) 431-0811 or Devon Bernard at (571) 431-0854.

Read AOPA’s comments.

We are pleased to share that the AOPA funded research by Dr. Michael Dillon describing the incident rate and prevalence of partial foot amputation and how this compares to transtibial amputation has now been published in the journal Systematic Reviews.  The article is freely available at the link below.

https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-017-0626-0.  

The Centers for Medicare and Medicaid Services (CMS) has released the new HCPCS codes for 2018, and there were only a few minor changes. Below is a complete breakdown of the code changes which will be effective for claims with a date of service on or after January 1, 2018.

 New Codes 

Changes in Code Descriptors 

As a reminder registration is still open for the December 13, 2017 AOPAversity webinar, New Codes & Other Updates for 2018, which will focus on the changes to the HCPCS code set and any other upcoming Medicare changes which may impact your business in 2018. AOPA’s Coding and Reimbursement Committee will review the list of changes and provide appropriate comments to CMS.

Questions regarding the code changes may be directed to Joe McTernan at jmcternan@aopanet.org, or Devon Bernard at dbernard@aopanet.org.

AOPA is pleased to announce that the Centers for Medicare and Medicaid Services (CMS) has proposed a change to the DMEPOS Quality Standards that addresses AOPA’s concern regarding the recent DME MAC/PDAC interpretation of the term “molded to patient model” when used to describe custom fabricated diabetic shoe inserts.  The proposed change to the quality standards allows for the creation of a digital positive model of the patient’s foot using CAD/CAM technology that is then used to direct mill a custom fabricated insert based on the digital model.

In July, 2017, the DME MACs and PDAC issued a joint bulletin that stated that in order to meet the definition of “molded to patient model” contained in the descriptor for A5513, diabetic inserts must be fabricated over a physical model of the patient’s foot.  The bulletin went on to state that digital or virtual models that were used to direct mill custom inserts are not considered a positive model and inserts fabricated using this technique do not meet the code requirements of A5513 and therefore must be billed as A9270, a statutorily non-covered HCPCS code.  On September 28, 2017, AOPA and the American Podiatric Medical Association (APMA) submitted a joint letter to CMS expressing their concern over this bulletin as it represented a significant threat to the use of advanced technology to provide better clinical service.  In addition to working directly with the APMA, AOPA worked closely with the O&P Alliance, Representative Wenstrup’s (R-OH) office, his staff, and the House VA Subcommittee on Health to make sure that this issue remained at the forefront of the discussion.

On November 2, 2017, CMS announced a proposed change to the DMEPOS Quality standards that would include the use of digital or virtual models to direct mill custom diabetic inserts as an acceptable method to meet the definition of “molded to patient model” contained in the code language for A5513.  CMS will hold an Open Door Forum call on November 28, 2017 at 2:00 pm EST to allow experts to discuss the proposed changes to the DMEPOS Quality Standards and will accept comments on the proposed changes through December 11, 2017.  Comments on the proposed changes may be sent to CMS via e-mail at ReducingProviderBurden@cms.hhs.gov.  CMS has indicated that it intends to finalize the proposed changes by January 1, 2018.

AOPA will participate in the Open Door Forum call and will be preparing comments for submission to CMS.

Review the proposed changes.

The October 16, 2017 Federal Register included a proposed rule published by the Department of Veterans Affairs (VA) that intends to “reorganize and update the current regulations related to prosthetic and rehabilitative items, primarily to clarify eligibility for prosthetic and other rehabilitative items and services, and to define the types of items and services available to eligible veterans.”

There is a provision in the proposed rule that significantly threatens longstanding VA policy that allows the veteran to decide whether they receive O&P services directly from the VA or from a VA contracted provider.  This provision requires an immediate and powerful response.  The proposed language states the following:

“VA will determine whether VA or a VA-authorized vendor will furnish authorized items and services under § 17.3230 to eligible veterans. When VA has the capacity or inventory, VA directly provides items and services to veterans. However, VA also may use, on a case-by case basis, VA authorized vendors to provide greater access, lower cost, and/or a wider range of items and services. We would clarify in regulation that this administrative business decision is made solely by VA to eliminate any possible confusion as to whether a veteran has a right to request items or services generally, or to request specific items or services from a provider other than VA, and to clarify for the benefit of VA-authorized vendors that VA retains this discretion as part of our duty to administer this program in a legally sufficient, fiscally responsible manner.”

This language, if finalized, is in direct conflict with the current VA policy as well as the Veteran’s Access, Choice, and Accountability Act of 2014 and will significantly restrict the ability of a veteran to see the VA contracted provider of their choice for prosthetic and orthotic care.

AOPA has established a convenient pathway that will allow you to quickly express your concern regarding the VA proposed rule.  Simply visit www.AOPAVotes.org, enter some basic information, and a customized letter will be generated and sent to the VA to express your concern over the unnecessary and unreasonable provisions of the proposed rule. Send comments now.