AOPA in Advance
Breaking News for O&P Professionals
December 20, 2006 ♦ Volume 10, Number 24
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Top Stories
2007 Medicare Fee Schedule for
O&P Is Released
O&P Fee
Schedule Increase
BCP
Votes to Integrate with ABC
Phone
Update: How to Contact AOPA, ABC and
NCOPE Staff
More Medicare News
ABC Criticizes "Wholesale Approval" of Accreditation Agencies
$1.3 Billion Recouped by Federal Government in 2006
State Court Rules Cranial Remolding
Orthosis is Medically Necessary
O&P Resources from AOPA
Get Up-to-Date: Order Mastering Medicare,
Version 2
Attention AOPA
Members: Your
Benefits Expire in 11 Days!
Maximize
Your Message in 2007 with the O&P Almanac
2007 AOPA National
Assembly
Attention
Manufacturers: Secure Your Booth in Las Vegas!
Top Stories
2007 Medicare Fee Schedule for
O&P Is Released
The 2007 DMEPOS fee schedule has been released by CMS. As expected, the Medicare allowables for O&P services have been increased by 4.3%. (See story below for more information.)
While many of the new codes established for 2007 have not yet been assigned allowables, they are still valid codes effective for claims with dates of service on or after Jan. 1, 2007.
Until allowables for these codes are established, they will be processed on an individual consideration basis. This means that the DME MACs may require specific documentation to support the processing of such claims. Therefore, it is imperative that you are able to justify your charges for any codes that do not yet have an allowable.
CMS has, however, established a fee schedule for the new upper extremity terminal device codes. These fees appear to have been crosswalked from the deleted terminal device codes. (Crosswalking a code is when a new code is clinically, technologically, and functionally similar to an existing code, and is assigned the same allowable amount of the already existing, related code.) Preliminary analysis shows this will have minimal impact on the Medicare reimbursement for upper extremity terminal devices.
View the complete 2007 DMEPOS fee schedule as an Excel document.
Questions? Contact Joe McTernan at (571) 431-0811 or jmcternan@AOPAnet.org.
The 2007 DMEPOS fee schedule has been released by CMS. As expected, the Medicare allowables for O&P services have been increased by 4.3%. (See story below for more information.)
While many of the new codes established for 2007 have not yet been assigned allowables, they are still valid codes effective for claims with dates of service on or after Jan. 1, 2007.
Until allowables for these codes are established, they will be processed on an individual consideration basis. This means that the DME MACs may require specific documentation to support the processing of such claims. Therefore, it is imperative that you are able to justify your charges for any codes that do not yet have an allowable.
CMS has, however, established a fee schedule for the new upper extremity terminal device codes. These fees appear to have been crosswalked from the deleted terminal device codes. (Crosswalking a code is when a new code is clinically, technologically, and functionally similar to an existing code, and is assigned the same allowable amount of the already existing, related code.) Preliminary analysis shows this will have minimal impact on the Medicare reimbursement for upper extremity terminal devices.
View the complete 2007 DMEPOS fee schedule as an Excel document.
Questions? Contact Joe McTernan at (571) 431-0811 or jmcternan@AOPAnet.org.
O&P
Fee Schedule Increase
Effective Jan. 1, 2007, the Medicare fee schedule for orthotic and prosthetic services will be increased by 4.3 percent. This represents the first fee schedule increase for O&P since 2003, when the Medicare Modernization Act instituted a three-year freeze in the O&P fee schedule amounts.
Effective Jan. 1, 2007, the Medicare fee schedule for orthotic and prosthetic services will be increased by 4.3 percent. This represents the first fee schedule increase for O&P since 2003, when the Medicare Modernization Act instituted a three-year freeze in the O&P fee schedule amounts.
There was
some concern that Congress would extend the O&P freeze in order
to fund the
reversal of a 5 percent reduction in the physician fee schedule that
was
scheduled for this year. Through
lobbying efforts by the O&P Alliance and other groups, Congress
was able to
avoid negatively impacting the physician fee schedule without affecting
O&P
reimbursement rates.
Questions?
Contact Joe McTernan at (571) 431-0811 or jmcternan@AOPAnet.org.
BCP Votes to Integrate with ABC
The Board for Certification in
Pedorthics (BCP) has voted to integrate with the American Board for
Certification in Orthotics and Prosthetics (ABC) after months of
deliberating.
The integration is effective Dec.
31, 2006. As of Jan. 1, two new ABC board members will represent
pedorthics:
David C. Cardillo, C.Ped., and Dennis J. Janisse, C.Ped. All functions
of BCP will
be transferred to and governed by ABC policy. ABC will officially
change its
name to the American Board for Certification in Orthotics, Prosthetics
and
Pedorthics.
The phones are working at AOPA
(571-431-0876), ABC (703-836-7114)
and NCOPE (703-836-7114). If you have questions about:
Membership renewal and benefits, contact Kerry Stalknecht at (571) 431-0854
Coding and reimbursement, contact Joe McTernan at (571) 431-0811
2007 Assembly exhibit/booth sales, contact Kelly O'Neill at (571) 431-0852
O&P Almanac advertising, contact Amy Clontz at (571) 431-0817.
Membership renewal and benefits, contact Kerry Stalknecht at (571) 431-0854
Coding and reimbursement, contact Joe McTernan at (571) 431-0811
2007 Assembly exhibit/booth sales, contact Kelly O'Neill at (571) 431-0852
O&P Almanac advertising, contact Amy Clontz at (571) 431-0817.
More Medicare News
ABC Criticizes "Wholesale Approval" of Accreditation Agencies
ABC, one of the 11 agencies recently recognized by CMS to accredit DMEPOS suppliers, has stated its dissatisfaction with “the wholesale approval [by CMS] of all applicant organizations,” according to a Dec. 13 letter to CMS from Stephen B. Fletcher, CPO, ABC’s president.
In the letter, Fletcher laments the
fact that the agencies were recognized by CMS based on unclear criteria
and
with varying descriptions of what each agency may accredit. The letter
states
that recognizing organizations with no history of accrediting
providers, or
with dubious history, “seriously jeopardizes the integrity of
the process,
exposes beneficiaries to unnecessary risk, and is likely to lead to
increases
in utilization of O&P services.”
ABC has proposed a psychometric
validation of each agency’s accreditation standards, a
process whereby experts,
led by a facilitator, evaluate what standards accreditation agencies
should
meet and determine whether or not the agencies are in compliance. ABC
has also
proposed that accrediting agencies must not be affiliated with any
consulting
or buying group.
ABC
has requested a meeting with CMS to discuss these details.
For the
federal fiscal year ending Sept. 30, 2006, $1.3 billion in improperly
paid
Medicare and Medicaid claims were recovered by the Office of Inspector
General
(OIG), the FBI, Medicaid Fraud Control Units and other law enforcement
agencies.
The same
report indicated that in the second half of fiscal 2006, the OIG
excluded a
total of 1,885 individuals and entities for fraud and abuse, prosecuted
246
individuals, and won 153 civil actions against individuals and
organizations
attempting to defraud the Medicare and Medicaid systems.
Questions?
Contact Joe McTernan at (571) 431-0811 or jmcternan@AOPAnet.org.
The South
Carolina Court of Appeals ruled in favor of a couple seeking coverage
for a
cranial remolding orthosis to treat their daughter’s
conditions of
plagiocephaly and torticollis (musculoskeletal deformities of the skull
and
neck).
The court
reversed the decision by Blue Cross Blue Shield to deny coverage for
the
orthosis, known as a DOC Band, stating that the device was medically
necessary
to avoid further complications associated with the patient’s
conditions and was
not primarily serving a cosmetic purpose, as was argued by the
insurance
company.
O&P Resources from AOPA
Get
Up-to-Date: Order
Mastering
Medicare, Version 2
If your
office bills the Medicare
program, then you need at least one copy of Mastering
Medicare, Version 2: The ABCs of O&P Billing
and Reimbursement. This updated manual
contains a summary of the numerous changes in the Medicare program,
including:
Changes in the Medicare Supplier Enrollment Process
Information on the new Quality Standards
Changes in the Medicare Appeals Process Information on the transition from the DMERCs to the new DME Medicare Administrative Contractors (MACs).
Order
your copy at www.AOPAnet.org/catalog or (571) 431-0865.
Members pay $175, nonmembers $350.
Back to Top
Attention AOPA Members: Your
Benefits Expire in 11 Days!
AOPA recently mailed membership invoices for the 2007 membership year. Have you renewed? The AOPA membership year ends on Dec. 31, 2006. Ensure your company stays ahead of the competition with all of the valuable AOPA member benefits, such as this newsletter and access to the critical coding, reimbursement and compliance experts you rely upon daily.
Questions? Contact Kerry Stalknecht at kstalknecht@AOPAnet.org or (571) 431-0854.
AOPA recently mailed membership invoices for the 2007 membership year. Have you renewed? The AOPA membership year ends on Dec. 31, 2006. Ensure your company stays ahead of the competition with all of the valuable AOPA member benefits, such as this newsletter and access to the critical coding, reimbursement and compliance experts you rely upon daily.
You can pay for
your 2007 AOPA membership renewal via
MasterCard or VISA. Simply fax your completed invoice with credit card
information
to (571) 431-0899. Or, send your renewal check or money order,
made
payable to American Orthotic & Prosthetic Association, along
with your invoice,
to:
American
Orthotic & Prosthetic Association
(AOPA)
PO Box 34711
Alexandria, VA
22334-0711
Questions? Contact Kerry Stalknecht at kstalknecht@AOPAnet.org or (571) 431-0854.
Maximize Your Message in 2007 with the O&P Almanac
The
February O&P Almanac will include bonus
distribution at the 2007
Hanger Fair. Purchase ad space to take advantage of this opportunity to
be seen
by even more than the usual circulation of 15,000.
Also,
find out how you can earn free product listings in the Marketplace
section of
the O&P
Almanac.
Contact
Amy Clontz for details at aclontz@AOPAnet.org or (571) 431-0817.
Back to Top
2007 AOPA National Assembly
Attention
Manufacturers: Secure Your Booth in Las Vegas!
Booth sales
for the 2007
AOPA National
Assembly (Sept. 17-20, The Venetian) are now open
to all O&P
manufacturers. The exhibit hall is already over 60 percent sold out, so
act
today to reserve a booth at the largest O&P event in the United
States!
Confirmation
letters were mailed last week to all companies that signed up for a
booth
during the priority period.
Learn more
about becoming an Assembly Exhibitor here.
Questions?
Contact Kelly O’Neill at koneill@AOPAnet.org or (571) 431-0852.
Justin Clark has
earned his credential as a
registered prosthetic technician (RTP) from the American Board for
Certification of Orthotics and Prosthetics (ABC). Clark works for Ray
Tegerstrand’s Orthopedic Appliance in Redding,
Calif…Sara Cormack has
resigned for unspecified reasons
as chief
financial officer of Langer Inc., the Deer Park, N.Y.-based
manufacturer and
supplier of O&P products…Michael
Fillauer, CPO, is the new president of Fillauer
LLC—the
fourth generation of his family to hold the role… Kevin
Loughry, CO, has joined Orthologix
of Philadelphia as part of the firm’s pediatric orthotic
management team…Michelangelo Scafidi, C.Ped., received
the Carl Riecken Lifetime Achievement Award from the Board for
Certification in
Pedorthics (BCP).
Businesses In the News
Artisan
Orthotic-Prosthetic Technologies Inc. of Tualatin, Ore.
has received three-year facility
accreditation status from ABC.
Atlantic Rim
Brace Manufacturing Corporation has moved to a new
corporate headquarters at 25B Progress
Ave., Nashua, N.H., 03062. Phone and fax numbers remain the same.
The Orthotic and Prosthetic Assistance Fund
Inc. (OPAF), based in Langhorne, Penn., recently
received a $20,000 grant from the United States Tennis
Association’s Tennis & Education Foundation and a
$5,000 grant from the
Wadsworth Golf Charities Foundation to continue funding its
“First” adaptive
sports clinics around the country.
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