Archives

Volume 6, Number 25
December 17, 2002

Coding Heat-Moldable Liners

At its meeting earlier this month, the AOPA Coding Committee discussed how to code heat-moldable roll-on gel liners. After reviewing material from two manufacturers, the committee came to the recommendation that these liners should not be coded as custom liners (K0558 or K0559.) Since these liners are purchased as prefabricated items and later modified by the facility, the committee deemed that they fall into the Centers for Medicare and Medicaid Services' (CMS) definition of prefabricated and should therefore be coded with K0556 or K0557.

Shortly after the Coding Committee meeting, but before the committe announced its recommendation, AOPA received word that one of the manufacturers of the liners in question was notified by CMS that these liners should be coded using the prefabricated codes of K0556 or K0557—a determination that was consistent with AOPA's recommendation.

Be especially careful when coding these liners, as CMS will be closely monitoring the use of the new K codes. If CMS sees inaccurate coding, i.e. where a facility has used the custom fabricated codes for these prefabricated liners, an audit could be triggered or CMS may regard these codes as fraudulent billing. If CMS concludes that these codes are being used fraudulaently, the codes could be deleted.

2003 Medicare Fee Schedule

CMS has published the 2003 Medicare Fee Schedule, which can be viewed at the
CMS Web site, http://cms.hhs.gov/providers/pufdownload/default.asp.

Most of the allowables for the new HCPCS codes established for 2003 are not yet available, so AOPA members should check back frequently for updates to this file. Medicare payments for O&P devices will increase 1.1 percent over last year's reimbursement rates.

CMS has also told the Durable Medical Equipment Regional Carriers (DMERCs) that hard copies of new or revised medical policies should no longer be mailed to all suppliers. Suppliers are expected to obtain policies from the DMERC Web sites. Links to all four of those Web sites can be found in the reimbursement services area of AOPA's Web site www.aopanet.org.

O&P Suffers Under Medicaid Cuts

Across the country, state budget shortfalls pose serious risks to the continuation of coverage for orthotic and prosthetic serveices under state Medicaid programs. The National Governors Association (NGA) recently issued a report indicating that states are now facing the worst fiscal crisis since World War II.

The NGA report includes findings that 29 states plan to implement reductions or freezes to Medicaid provider payments, 15 states plan to reduce Medicaid benefits and 18 states plan to restrict eligibility.

The crisis in states' budgets is due in part to the rapidly escalating costs of Medicaid expenditures. State Medicaid costs make up approximately 20 percent of all state spending. In 2002, Medicaid spending grew at an unprecedented annual rate of 13.2 percent—the fastest since 1992.

The impact of these budget shortfalls has been clearly seen in Massachusetts where O&P coverage under its Medicaid program will be eliminated as of Jan. 1. AOPA is working with its members in the state to head off these cuts, but the prospects do not seem promising.

AOPA urges all state O&P associations to explore whether their states are considering changes to O&P related Medicaid payments and coverage. AOPA firmly opposes any effort to cut back on O&P services and believes that states should not balance their budgets on the backs of physically challenged individuals who require these valuable services. For more information, contact AOPA's director of government affairs, Walt Gorski, at
(571) 431-0809.

HIPAA Privacy Rule Guidance

If you have found sections of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy ruleconfusing, you are not alone. In an effort to provide guidance on the more befuddling sections of the privacy rule, the Department of Health and Human Services' Office for Civil Rights (OCR) has made documents available on their Web site clarifying the details of the following provisions:

1. Incidental uses and disclosures of protected health information (PHI);
2. Minimum necessary information;
3. Personal representatives;
4. Business associates;
5. Uses and disclosures for treatment, payment and health care operations; Marketing;
6. Disclosures for public health activities;
7. Research;
8. Disclosures for workers' compensation purposes;
9. Notice of privacy practices for PHI;
10. Restrictions on government access to health information; and
11. Miscellaneous questions about the privacy rule.

The guidance can be found on the OCR Web site: and includes a short background on each of the listed provisions, followed by an explanation of how the rule works. Specific examples are also provided to assist health plans, health care providers and other covered entities to interpret the often vague HIPAA regulations. Additional guidance on other areas of the HIPAA privacy rule is expected within the next few months.

O&P Training Seminar for DMERC Region A

On Jan. 13, the Pennsylvania Orthotic and Prosthetic Society will host an O&P Training Seminar for DMERC Region A. The Ombudsman for Region A will cover such topics as billing, documentation, policies, HIPAA and more. The seminar will be held in Philadelphia at Harry J. Lawall & Son, Inc. For more information about attending, please call Lori Gregory at
(800) 735-4627, ext. 102.

Get Help With Codes and HIPAA

The first AOPA HIPAA Compliance Seminar in 2003 will be held in Las Vegas on Feb. 7 at the Treasure Island Hotel & Casino, following the Coding & Billing Seminar on Feb. 5-6. This will be the final HIPAA Compliance Seminar before the HIPAA privacy rule goes into effect on
April 14, 2003.

The Coding & Billin Seminar also led by AOPA experts has the most up-to-date information on the latest HCPCS coding changes for 2003 and more.

For more information or to register visit AOPA's Web site, www.aopanet.org or contact Holly Montondon at hmontondon@aopanet.org.

HIPAA Resources

The AOPA HIPAA Compliance Guide contains the extension request form, as well as sample forms and office policies and procedures that you can adapt to your facility.

Cost: $289 AOPA members. To purchase, call the AOPA Bookstore at (301) 362-6910. Questions? Contact AOPA's HIPAA Specialist Virginia Torrsch vtorsch@aopanet.org or
(571) 431-0876, ext. 212.

O&P Insiders' Track

New York Assemblyman Matthew Mirones, CPO, was one of three individuals honored last month with the Distinguished Citizens Award, presented by Learning For Life, a program for children with disabilities. Mirones received the award due to his extensive history of social involvement through his prosthetics company, Arimed Orthotics, Prosthetics & Pedorthics Inc., Brooklyn, N.Y…TEC Interface Systems founders Carl Caspers and Scott Schneider were named National Award Nominees at the Ernst & Young Entrepreneur of the Year^® Awards and were inducted into the Entrepreneur of the Year Hall of Fame.

Seattle Systems, Poulsbo, Wash., donated a Malibu Cervical Collar to a charity group that recently went on a humanitarian mission to Cuba…Sunny Hills Orthopedic Services Inc., Fullerton, Calif., celebrated its 20th anniversary by hosting an open house last month. The single office, 8,000 square-foot facility is owned by Randy McFarland, CPO, and has six practitioners, an on-site fabrication laboratory and a support staff of 12.