American Orthotic & Prosthetic Association

 

AOPA In Advance

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December 16, 2003
Volume 7 Number 25

AOPA Protests CMS Decision on Stance Control

AOPA is protesting vigorously the recent Centers for Medicare and Medicaid Services (CMS) decision to include orthotic stance control devices in the same code that has been used for drop locks. Because these two devices are completely different with widely divergent costs, AOPA assumes that the Alpha-Numeric Editorial Panel (made up of CMS, Blue Cross and Blue Shield Association and the Heath Insurance Association of America), which makes final coding decisions, did not understand this new technology.

AOPA has sent a strongly worded letter to CMS detailing the new knee joint technology and why it is not comparable to a drop lock. AOPA asked also that temporary codes be assigned for the new knee joint until L codes can be developed. We will continue to pursue the issue with CMS and the medical directors to provide suggested wording for these codes. Additionally, several manufacturers of these types of devices are protesting and have asked CMS to reverse this decision. Watch the AOPA in Advance for updates.

 

Medicare Disallows Prefab Additions

In another irrational move, CMS decided not to cover addition codes for prefabricated orthoses, stating that add-ons can now only be billed with custom fabricated devices. AOPA is disputing this decision, which flies in the face of thirty years of precedent and ignores the many situations when add-on codes are absolutely necessary to make a device functional. Equally offensive, this move represents a de facto cut in reimbursement, since no change in allowables is planned to compensate for the exclusion of these additional codes.

To support the strength of AOPA's argument and voice your opinion, you should write a brief letter to your medical director. Explain the negative impact this policy will have on your patients and ask that this decision be reversed. Your letter will have the most impact if you provide specific exam-ples to illustrate your point. To obtain mailing addresses for the medical directors, visit www.aopanet.org and click on Reimbursement Services. Be sure to share your letter with AOPA by faxing it to (571) 431-0899. Questions? Contact Patrick Kelly at pkelly@aopanet.org.

 

Are Your Electronic Claims HIPAA Compliant?

All electronic claims filed by new health care providers must now be in HIPAAcompliant format in Durable Medical Equipment Regional Carrier (DMERC) Regions Aand B. It will only be a matter of time before this policy is adopted by Regions C and D, and then expanded to all providers submitting electronic claims.

Don't delay---ensure your software vendor is on track to provide you with HIPAA compliant software and your clearinghouse or billing company is HIPAA compliant. If providers and health payors are still having problems with software vendors and/or third party billing companies becoming HIPAA compliant, it is recommended to find another alternative.

Contact Virginia Torsch at AOPA with questions at (571) 431-0876, ext. 212 or vtorsch@aopanet.org.

 

New Year, New Codes, New Confusion, New Seminars

The first AOPA Coding & Billing Seminar of 2004 will be held in Las Vegas on March 15-16 at the Mirage Casino-Hotel. AOPA has arranged an exclusive room rate of $129 a night at the hotel for all seminar attendees. This room rate is $150 less than the standard rates offered by the Mirage during this time. You must make your reservations by February 13 to guarantee the rate.

Led by AOPA experts, the Coding & Billing Seminar will provide the most up-to-date information on the new codes and other new billing rules for 2004. Bring all your questions and concerns to the table during this two-day interactive seminar and get the answers from O&P industry experts.

To register, visit www.aopanet.org. Questions? Call Christopher Vinson at (571) 431-0876, ext. 235.

 

CMS Administrator to Leave Office

Centers for Medicare and Medicaid Services (CMS) Administrator Tom Scully has left his post (effective Dec. 15, 2003.) An acting administrator has replaced him until CMS names his official replacement. It is unclear what will be the priorities of the next CMS Administrator. Nonetheless, AOPA will be hard at work to ensure that the O&P voice is represented both at CMS and with congressional leaders in order to protect the interests of the O&P community. Watch future issues of AOPA in Advance for updates.

Find CMS Regional Contacts on AOPA Web site The complete list of Durable Medical Equipment Regional Carriers (DMERC) and Statistical Analysis Medical Equipment Regional Carriers (SADMERC) Medical Directors is now available for download on the AOPA Web site. Visit www.aopanet.org to view their new contact information.

 

Going Fast: Early Advertising Deadlines for O&P Almanac

Act now–the February issue of the O&P Almanac has an early advertising deadline. Entries for the "Marketplace" section are due Dec. 22. Ads can include up to 150 words of text and images must be in .tif format. The deadline for space reservations is Dec. 29 and all art is due no later than Jan. 6. Please contact Amy Clontz at AOPA with questions at (888) 557-7277 or aclontz@aopanet.org.

 

Online Access to Assembly Presentations on AOPA Web Site

If you missed any of the clinical session presentations at the 2003 AOPA National Assembly or just want to refresh your memory, look no further than the AOPA Web site, www.aopanet.org. Abstracts of the clinical session presen-tations are available only until Jan. 16 and offer summaries of the extensive clinical and business management guidance presented at this year's Assembly.

 

AOPA Holiday Schedule

The AOPA offices will be closed at 12:30 p.m. on Dec. 24 and all day on Dec. 25-26 and Jan.1. The next AOPA in Advance will be published on Jan. 6.

 

Give the Gift of Membership

With the new membership year just beginning, why not ensure that all your locations are AOPA members? For only $220 per location, you can provide your affiliates with the gift that keeps on giving throughout all of 2004–AOPA membership! Remember, if your affiliate locations are not members they will not be listed in the 2004 AOPA Yearbook or the 2004 Guide to O&P Facilities for case managers and other referral sources.

Stay a step ahead of the competition by adding an affiliate location today. Visit www.aopanet.org for a membership application or contact Gabriele Shipman at (571) 431-0876, ext. 252.

 

DMERCs Now Accepting Signature Stamps

All four DMERCs have announced that starting Jan. 1, 2004, they will begin accepting stamped physician signatures on prescriptions. Currently, only handwritten or electronic signatures are accepted.

 

O&P Insider's Track

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

Freedom Innovations, based in Corona, Calif., and Ossur North America, based in Aliso Viejo, Calif., have reached a settlement on all current litigation associated with the federal and state court cases between the two companies...Hanger Orthopedic Group, headquartered in Bethesda, Md., recently acquired two offices of Advanced Prosthetic Services Inc. in Houston and Austin, Texas and two ADL Prosthetic & Orthotic Service Inc. offices in San Luis Obispo and Atascadero, Calif...OrPro Inc., headquartered in Irvine, Calif., announced its acquisition of Franzel Orthopedic, based in Dayton, Ohio, with satellite facilities in Piqua, Ohio, and welcomed former Franzel owners Amy Yates, CPO, and Glenn Schober, CP, to the OrPro staff... In addition, twenty-two of OrPro's key O&P professionals from all over the country met in Orlando this Fall for a two-day clinical education and manufacturing summit with Orthomerica... Headquartered in Maplewood, Minn., Tillges Certified Orthotic Prosthetic Inc. hired three new staff members: Ricci Casa De Calvo, orthotist; RoxAnne Foss, BOC-CMF; and Cale Konetchy, prosthetic resident...Sheila Pasquini, Meetings Assistant of the American Orthotic and Prosthetic Association in Alexandria, Va., was presented with the organization's employee recognition award, the Star Award, for her hard work and dedication to the association's mission over the past three years.

 

Questions or Comments?
Contact us by fax (571) 431-0899 or e-mail at info@aopanet.org.

 

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