2006 Fee Schedule Released
CMS has released the 2006 DMERC fee schedule. To download the PDF, click here.  There are no increases in fees for L codes due to the three-year O&P payment freeze that began in 2003.

Note: The fee amount for code L0637 (previously K0646), is incorrect.  When this K code was converted to code L0637, the fees dropped to a range from $60.35 to $80.46.  This reimbursement amount should be the same as its old K code, K0646 ($844.13 to $1,125.50). 

AOPA is working diligently with CMS to get this corrected before the 2006 fees go into effect Jan. 1, 2006.

As an AOPA member, you have unlimited access to on-staff experts who can answer all of your coding, billing and reimbursement questions, as well as questions related to the 2006 fee schedule.

Questions can be directed to AOPA Reimbursement Experts Virginia Torsch at vtorsch@AOPAnet.org or (571) 431-0876, ext. 212, or Joe McTernan at jmcternan@AOPAnet.org or (571) 431-0876, ext. 211.

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Coding Alert: 2006 List of L Codes Exempt from SNF Billing
The 2006 list of prosthetic L codes that are exempt from the Skilled Nursing Facility (SNF) prospective payment system is incomplete. AOPA is currently investigating why the list does not contain the following new 2006 codes for replacement sockets for upper limb prosthetics, which are already a covered benefit:

AOPA is working with CMS to get this list corrected as soon as possible. 

Questions?  Contact Virginia Torsch at vtorsch@AOPAnet.org or (571) 431-0876, ext. 212.

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Not Yet Renewed? The AOPA Membership Year Ends in 9 Days!
Don't miss a minute of the reimbursement advice, legislative analysis and compliance tips you receive in this newsletter: Renew your AOPA membership today!  The AOPA membership year ends on Dec. 31, so act now! 

CMS Now Has Authority to Adjust Fee Schedule
CMS has issued a final rule that will give it greater authority to adjust Medicare payments for certain Medicare Part B services, including O&P. 

The rule, scheduled to take effect on Feb. 13, 2006, will give CMS and the DMERCs the authority to increase or decrease Medicare fee schedule payments by as much as 15 percent a year to align reimbursement rates with current market prices.  This is a result of statutory regulations from 1985 that provided the Secretary of the Department of Health & Human Services (HHS) with the authority to increase or decrease the Medicare fee schedule.  This final rule formalizes this authority.

The public will have the opportunity to comment to CMS or the DMERC on each proposed change in the Medicare fee allowable that might be undertaken persuant to this new authority.

Questions?  Contact Virginia Torsch at vtorsch@AOPAnet.org or (571) 431-0876, ext. 212.

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AOPA Secures Delay in Requirement for SADMERC Review of Diabetic Shoes and Inserts
Last week, AOPA expressed its serious concern to Medicare officials regarding a new requirement published by Medicare in a recent Local Coverage Decision and Policy Article stating that shoes billed using code A5500 and inserts billed using codes K0628 and K0629 must represent products that have been reviewed by the SADMERC and placed on the product classification list as of Jan. 1, 2006.  AOPA disagreed with this requirement for several reasons:

• We do not believe that CMS has the authority to refuse payment on a device simply because the SADMERC has not reviewed and coded the item. 
• In addition, K0629 represents custom items that are made for each patient, not prefabricated devices, and therefore cannot be sent to the SADMERC for coding. 
• Finally, AOPA argued that a Jan. 1 implementation date is totally inadequate.

Due to AOPA's intervention on this issue with the SADMERC, Medicare officials have decided  that the requirement will be rescinded in order to re-evaluate beneficiary access and the verification process for code descriptors of diabetic shoes and inserts. If reissued, it would not be expected before July 1, 2006.

Questions?  Contact Joe McTernan at jmcternan@AOPAnet.org or (571) 431-0876, ext. 211.

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Changing Your 2006 Medicare Participation Status?
If you are changing your Medicare status from a non-participating to a participating facility, you must submit a 2006 Medicare Participation Agreement (CMS-460) postmarked no later than Dec. 31.  To download the PDF of this file, click here.  

If you intend to maintain your current participation status through 2006, no action is necessary. 

If you currently participate in Medicare but will not be participating in 2006, you must send a written letter to the National Supplier Clearinghouse (NSC) indicating your decision to the following address:

National Supplier Clearinghouse
Palmetto GBA, AG-495
P.O. Box 100142
Columbia, SC 29202-3142

Remember, the decision whether or not to participate in the Medicare program has no bearing on your ability to submit claims.  The difference between the two types of status is that participating providers agree to accept assignment on all Medicare claims and therby are always paid directly by Medicare.  Non-participating providers can make a claim-by-claim decision on whether to accept assignment or not, giving them the ability to collect balances over Medicare's allowed amount in may cases.
  
Questions?  Contact Joe McTernan at jmcternan@AOPAnet.org or (571) 431-0876, ext. 211.

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Ensure Quick and Easy Coding in 2006
Now available for pre-order: 2006 CodingPro CD-ROM, 2006 Illustrated Guide and 2006 Quick Coder.  In addition to providing direct coding and reimbursement advice, AOPA experts have developed these products to assist your facility in receiving the appropriate payment for your O&P services. For pricing and to purchase the products, visit www.AOPAnet.org. 

 Questions? Contact Kerry Stalknecht at kstalknecht@AOPAnet.org or (571) 431-0876, ext. 254.

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Questions? Contact Walt Gorski at wgorski@AOPAnet.org or (571) 431-0876, ext. 209.

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Get HR Savvy with 2006 AOPA Telephone Audio Series
You can now register your facility for all of the 2006 "Powerful Personnel Strategies" telephone audio seminars, worth 1.5 CEs each.  Experts from Administaff, a leading professional employer organization, will provide you with insights and strategies on how to handle those vexing personnel issues which can take a toll on any company in 2006.  The dates and topics are:

For pricing information and to register, click here. Questions? Contact Heather Franklin at hfranklin@AOPAnet.org or (571) 431-0876, ext. 205.

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Are You Innovative?
Demonstrate your commitment to the O&P field and gain national recognition for your work by being a presenter at the National Assembly in September: Submit a clinical or business abstract today!  The deadline to submit is Jan. 31.  View submission requirements and submit your abstract online at www.AOPAnet.org.

Questions? Contact Tina Moran at tmoran@AOPAnet.org or (571) 431-0876, ext. 208.

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Secure Exhibit Space for the Largest O&P Trade Show, the AOPA Assembly!
2005 Assembly exhibitors: Reserve a prime location now for your company in the exhibit hall for the 2006 AOPA National Assembly in Hollywood, Fla., (Sept. 27-30, The Westin Diplomat Resort & Spa).  Simply return your application, signed contract and 50 percent deposit before Feb. 28.  Download exhibit space materials at www.AOPAnet.org. 

Suppliers: Get Bonus Distribution with Your Ad in February Almanac!
The February O&P Almanac will be available to attendees at the Hanger Educational Fair, Feb. 6-10.  Don't miss this opportunity to advertise your company's products and services and receive bonus distribution!  Reserve your ad space by Jan. 4; send all artwork by Jan. 10.

The Only Up-to-the Minute O&P Newsline
State and federal authorities labeled South Florida "ground zero" for Medicare and Medicaid fraud, with 28 cases totaling $20 million in Medicare or Medicaid losses in 2005.  The FBI office in Miami has added new agents, investigators and prosecutors to crack down on fraud and abuse practices.

Businesses In the News
The Amputee Coalition of America (ACA) announced that individuals can shop online at www.iGive.com and donate a portion of their purchases to support the ACA's programs and activities at no extra charge…Omincare Labs of Champaign is planning to move from its current location in Effingham, Ill., to 502 S. Vine St., U, Urbana, Ill. The new office is expected to open in March of 2006 under a new name, Omni Prosthetics and Orthotics.  On Nov. 16, Ohio Willow Wood filed separate lawsuits in federal court against ALPS South Corporation and DAW Industries Inc.  The lawsuits charge infringement of intellectual property rights owned by Ohio Willow Wood relating to Alpha® products.  No court dates have been set for these new lawsuits.

People In the News
Andy Wolfe has joined the Omaha office of Nebraska Orthotic & Prosthetic Services (NOPS).  He will be providing the full spectrum of orthotic care with an emphasis on pediatric bracing…Michael Brncick, CPO; Donald ‘Deane' Doty, CPO; and Kristine Wilson, Ph.D. are the three newest members of the American Board for Certification in Orthotics & Prosthetics (ABC) board of directors…Mickey Howard, CO, Dennis Plew, CO, and Dean Wasylyshen, prosthetist, all employees of the orthotic and prosthetic department at the Indianapolis Veteran's Hospital, were honored with the Marine Corps League's Distinguished Certificate of Merit on Nov. 10.  The award recognizes meritorious service and devotion to the welfare of hospitalized veterans and their families.

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The next edition of AOPA In Advance will be published on Jan. 10.  Renew now to avoid a disruption in benefits, including this newsletter!