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CMS Releases the 2018 Medicare DMEPOS Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) has released the 2018 Medicare DMEPOS fee schedule which will be effective for Medicare claims with a date of service on or after January 1, 2018.  The 2018 Medicare fee schedule for orthotic and prosthetic services will be increased by 1.1% over 2017 rates. The 1.1% increase is a net reflection of the 1.6% increase in the Consumer Pricing Index for Urban Areas (CPI-U) from June 2016 through June 2017, combined with the annual Multi-Factor Productivity Adjustment (MFP) of -0.5%.

The 1.1% increase in the O&P Medicare fee schedule for 2018 represents a 0.4% larger amount than the 2017 increase of 0.7%.  Unfortunately, the 2% sequestration based reduction to all Medicare payments remains in effect (currently through 2025) meaning that Medicare fee for service payments will continue to be reduced by 2% due to sequestration.  While sequestration continues to impact Medicare reimbursement, it is not cumulative.  You will still receive 1.1% more for a service you provide in 2018 then you did in 2017 since the 2% sequestration reduction would be applied to both claims.

Download the complete 2018 Medicare DMEPOS fee schedule from the CMS website.

As always, AOPA maintains the most current Medicare fee schedule information and will be happy to provide it to AOPA members.

Questions regarding the 2018 Medicare fee schedule may be directed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.

AOPA Submits Comments and Publishes Ad on Proposed Rule That Would Limit a Veteran’s Right to Choose Their Orthotic and Prosthetic Provider

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.  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 submitted comments on the proposed rule which were due on December 15, 2017.  Read AOPA’s comments.

AOPA provided a portal for members to submit comments through AOPAvotes (now closed), which more than 250 members used.

AOPA has also published an ad in Politico, a newspaper of legislative and political news that is delivered to Congress and the White House, and read by think tanks, federal agencies, etc, seen below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

AOPA Submits Comments on CMS Proposed Change to the DMEPOS Quality Standards

On December 11, 2017, AOPA submitted formal comments on CMS’ proposed change to the DMEPOS Quality Standards that would expand the definition of the term “molded to patient model” to include custom fabricated diabetic inserts that are fabricated using a virtual or digital model of the patient’s foot and a direct milling process.  Earlier this year, the DME MACs published a correct coding bulletin that indicated that because direct milled inserts were not molded over a positive model of the patient’s foot, they could not be billed using HCPCS code A5513 and would have to be billed using A9270 which is a statutorily non-covered service.

The proposed change to the DMEPOS Quality Standards creates a pathway for Medicare coverage for direct milled inserts but a subsequent frequently asked questions (FAQ) document published by CMS indicates that direct milled inserts cannot be billed using A5513 and that reimbursement for inserts fabricated this way will be reduced by approximately 14%.

AOPA’s comments generally supported the proposed change to the DMEPOS Quality Standards but challenged the CMS proposal to arbitrarily reduce the reimbursement rate for direct milled inserts.  AOPA believes that the manner of fabrication is irrelevant and that the proposed change to the DMEPOS Quality Standards should allow direct milled inserts to be properly billed using A5513.

Read the comments.

Call for Papers

WASHINGTON, DC – The American Orthotic & Prosthetic Association (AOPA) and the 2018 Assembly Planning Committee have announced the Call for Papers for the AOPA Assembly to be held September 26‐29, 2018 in Vancouver, BC, Canada. Practitioners and health professionals, researchers, technicians and business managers have an opportunity to advance their careers, improve patient care, and gain international recognition with high-quality education presentations at the AOPA Assembly.

“Every year, the education program gets stronger and our attendees benefit from the expertise of a diverse group of presenters. We have always been known for our high quality business education, but we have such outstanding clinical and technical programs that this is a show that has it all. Presenting at the AOPA Assembly is a great way to share your work and gain recognition while contributing to the profession” said Traci Dralle, Co-Chair of the 2018 Assembly Planning Committee.

The Committee is accepting abstracts for Clinical Free Papers, the Technician Program, Business Education Program, Symposia, and Pedorthic Program. AOPA has a list of topics of special interest, including upper limb prosthetics, plagiocephaly, osseointegration, public health topics, CAD/CAM, alternative payment methods, and more. The submission deadline for all submissions is March 1, 2018.

Interested presenters can learn more on AOPA’s website.

Questions? Please contact Lauren Anderson, AOPA’s Manager of Communications, Policy, and Strategic Initiatives at 571/431-0843 or landerson@aopanet.org

Call for Papers for the 2017 AOPA World Congress

WASHINGTON, DC – The American Orthotic & Prosthetic Association (AOPA), its international partner organizations, and the 2017 Planning Committee have announced the Call for Papers for the AOPA World Congress to be held September 6‐9, 2017 at the Mandalay Bay Resort in Las Vegas, Nevada. O&P practitioners, researchers and business managers currently have an opportunity to advance their careers, improve patient care, and gain international recognition with high-quality education presentations at the World Congress.

“The National Assembly always features the best business, clinical, and technical educators in the United States and adding international talent will surely take the program to a new level. We have 11 countries represented on the Planning Committee alone, so we expect to see the brightest minds in O&P from around the world in this year’s education program” said Christopher Nolan, Co-Chairman of the 2017 World Congress Planning Committee.

The Committee is accepting abstracts for Clinical Free Papers, the Technician Program, Business Education Program, and Symposia, in addition to a special Student/Resident Poster Submission category. AOPA has a list of topics of special interest, including osseointegration, public health topics, CAD/CAM, alternative payment methods, and more. The submission deadline for Clinical, Technical, and Symposia is March 1, 2017. The Business submission deadline is February 1, 2017.

Questions? Please contact Lauren Anderson, AOPA’s Manager of Communications, Policy, and Strategic Initiatives at 571/431-0843 or landerson@aopanet.org

Action item: Tell CMS not to charge providers a toll for using advanced technology to fabricate diabetic inserts

Submit comments on the CMS proposed changes to the DMEPOS quality standards that would include a 14% reduction in reimbursement for custom fabricated, direct milled diabetic inserts. In July, the DME MACs released a clarification stating that diabetic inserts billed using A5513 must be molded over an actual model of the patient’s foot.  At that time, the DME MACs stated that the use of generic, electronic or “virtual” models where custom fabrication occurs without creation of a physical model of the patient’s foot did not meet the code descriptor for A5513.

AOPA has been in touch with CMS to voice our concern over this issue, and in September CMS proposed a change to the quality standards to allow for the use of digital or virtual models in combination with a direct milling process to meet the definition of “molded to patient model.”  However, in a FAQ 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 which takes a “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.

CMS has indicated that it intends to finalize the proposed changes by January 1, 2018, and is taking comments under December 11. AOPA has prepared comments that can be submitted on AOPAvotes.org.

Submit your comments now.