AOPA
in AdvanceBreaking News for O&P Professionals
August 7, 2007 ♦ Volume 11 Number 16
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O&P
News
O&P
Resources from AOPA
AOPA National Assembly Insider’s
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| O&P News |
Approximately
$112 million in
potential overpayments for DMEPOS were provided on behalf of
Medicare beneficiaries in Skilled Nursing Facilities (SNFs),
according to a report issued by the Office of Inspector General (OIG)
for the Department of Health and Human Services.
The report,
which was sent to CMS on
June 26, examined DMEPOS claims erroneously submitted to Medicare Part
B carriers for services provided to Medicare beneficiaries during a
Part A covered SNF stay. The report identified approximately $100
million in potential overpayments from 1999-2002 and an additional
$11.2 million in potential overpayments for 2003.
The OIG pointed out that prior to 2003, there were no edits in place to identify and prevent payment of Part B claims for beneficiaries in a covered Medicare Part A SNF stay. The potential overpayments in 2003 were made in spite of the implementation of edits to prevent them.
The OIG pointed out that prior to 2003, there were no edits in place to identify and prevent payment of Part B claims for beneficiaries in a covered Medicare Part A SNF stay. The potential overpayments in 2003 were made in spite of the implementation of edits to prevent them.
Potential overpayments for O&P services represented approximately 18 percent or $21.3 million. The OIG acknowledged that certain custom prosthetic devices are exempt from SNF PPS and did not include these claims in its report.
The report concluded with recommendations to CMS regarding the recovery of potential overpayments and the prevention of overpayments in the future. The recommendations, all of which were accepted by CMS, are as follows:
1. Direct the DMERCs to review the $112 million in potential overpayments from 1999–2003 and make appropriate recoveries.2. Ensure that all DMERCs have established proper controls to recover overpayments that the Common Working File edits identify.
It is expected that CMS will attempt recovery of these overpayments in the near future. As a reminder, if you provide non-PPS exempt prostheses or orthoses to a Medicare beneficiary in a Medicare Part A covered stay, you must obtain a purchase order and payment from the SNF. You may not bill the DME MAC.
Read the full report at the OIG Web site.
Questions? Contact Joe McTernan at jmcternan@AOPAnet.org or (571) 431-0811.
CMS has
established a new POS code for
services provided to patients who are incarcerated. Providers should
use POS code “09” to identify claims for services
delivered
in a prison or correctional facility.
As a reminder, Medicare Part B will only cover services for incarcerated beneficiaries when state law requires them to pay for medical services received while in prison. Otherwise, providers must negotiate payment terms directly with the correctional institution.
Questions? Contact Joe McTernan at jmcternan@AOPAnet.org or (571) 431-0811.
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Code With Confidence
Do you own AOPA's 2007 coding products? O&P businesses nationwide rely on AOPA coding products to improve their coding and billing efficiency. The 2007 CodingPro software, Illustrated Guide, and Quick Coder can be purchased
at www.AOPAnet.org or by calling (571) 431-0865.
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On August 1,
the scheduled launch date of the new NPI Registry,
CMS sent out a late-afternoon press release stating that the deployment
is being delayed again. The press release does not provide a target
date, but notes that information will soon be available on the CMS Web site.
AOPA will continue to follow this situation and report to the membership the new release date when available.
Questions? Contact Daniel Gurley at dgurley@AOPAnet.org or (571) 431-0812
Q: Is it appropriate to add L2275 (varus/valgus correction) to knee orthoses described by L1843-L1846?
A: Medicare policy states that the corrective force described by L2275 is inherent in the descriptors for knee orthoses described by L1843-L1846. In 2004, Medicare changed the descriptors for these codes to include the term “with or without varus/valgus adjustment.” Therefore, L2755 is not an appropriate addition code for these base codes.
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Have
Coding Questions?
Get
them answered
at the final in-person AOPA
Seminars of 2007!
Spend three days in Indianapolis learning how to get the maximum appropriate reimbursement for your work. To register, download a registration form and fax it to (571) 431-0899. Oct.
16–17: Coding & Billing Seminar (14 CE credits)
Go
Back-to-Back and SAVE!
Save $100 on the documentation seminar when you register for both seminars! Pay just $315 for the Documentation Seminar when you register for both (non-members $450). |
Fast Fact:
According to the most
recent Medicare data, the 10 most frequently paid orthotic codes
accounted for 42 percent of the total services paid in
2005. These
codes were, in descending frequency, L1902, L3908, L2820, L4360, L4205,
L3914, L2275, L4386, L3807 and L1825. The top 25 codes
accounted
for 65 percent of the total orthotic services paid.
If you have a coding question or interesting O&P fact you’d like to share with AOPA members, e-mail it to Joe McTernan at jmcternan@AOPAnet.org.
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CMS announced on July 27 a proposed rule that would require all suppliers of DMEPOS to furnish the Medicare program with a $65,000 surety bond. The proposed rule requires a surety bond for each National Provider Identifier (NPI), which means you’ll need a surety bond for each of your facility locations. In the release, CMS said the proposed rule would ensure that Medicare can recover erroneous payments that result from fraudulent or abusive supplier billing practices, up to $65,000.
Simply stated, a surety bond is an agreement under which one party, the bonding company, guarantees to another, CMS, that a third party, the DMEPOS supplier, will perform their duties and responsibilities in accordance with the rules and regulations of the Medicare programs.
The rule implements section 4312 of the Balanced Budget Act of 1997 and was first proposed in 2000 but never implemented. CMS noted that the $65,000 requirement is an inflation-adjusted figure from the $50,000 surety bond amount proposed in the 1997 Act.
AOPA is preparing formal comments to CMS to address the concerns of O&P providers regarding requirement of surety bonds. At the same time, AOPA has investigated the feasibility for AOPA members to obtain surety bonds through Aon, the AOPA-endorsed insurance program. Initial discussions with Aon find that most O&P providers may be able to obtain $65,000 surety bonds at a cost of under $1,000 a year, depending on the business size, location and other underwriting factors. Typically, a business is required to have equity of at least two times the bond amount, but Aon is committed to working with AOPA members to ensure that they are able to meet Medicare’s requirements.
To discuss this or other insurance issues with Aon, contact them at (800) 544-AOPA (2672).
Questions?
Contact Daniel Gurley at dgurley@AOPAnet.org
or (571) 431-0812.
Based on the
Consumer Price Index
(CPI), the proposed Medicare fee schedule increase for 2008 is 2.7
percent. This increase is not guaranteed, as Congress is looking for
additional ways to save money while funding the State
Children’s
Health Insurance Program (SCHIP). One of the ways of saving money could
be a Medicare fee schedule freeze.
The SCHIP reauthorization bill contains broad provider cuts including cuts to the hospital payment update, nursing homes and DME including wheelchairs and oxygen.
AOPA will continue to update members on this volatile issue. More details on the SCHIP bill were discussed in the July 27 Special Edition AOPA In Advance.
The SCHIP reauthorization bill contains broad provider cuts including cuts to the hospital payment update, nursing homes and DME including wheelchairs and oxygen.
AOPA will continue to update members on this volatile issue. More details on the SCHIP bill were discussed in the July 27 Special Edition AOPA In Advance.
Questions?
Contact Daniel Gurley at dgurley@AOPAnet.org or (571) 431-0812.
| O&P Resources from AOPA |
Suppliers:
Act Quickly to Get Your Products on LCodeSearch.com
Behind the scenes at LCodeSearch.com, O&P suppliers are entering hundreds of products. Participating companies include Arizona AFO, Bio Cybernetics International, College Park Industries Inc., Freeman Manufacturing Co., Ohio Willow Wood and Texas Assistive Devices LLC.
Behind the scenes at LCodeSearch.com, O&P suppliers are entering hundreds of products. Participating companies include Arizona AFO, Bio Cybernetics International, College Park Industries Inc., Freeman Manufacturing Co., Ohio Willow Wood and Texas Assistive Devices LLC.
These suppliers know that LCodeSearch.com
will be relied upon by O&P patient care facilities to match L
codes
to products. Will your products appear in their search results, or will
they see only your competitors?
AOPA supplier members can enter
an unlimited
number of products, free of charge! Your free listing includes your
product name, company name, L code(s) and category. For a single,
nominal fee, you can upgrade all your listings with a product
description, clickable Web address and up to two pictures.
But waiting until the last minute can cost you.
AOPA experts will need to
review and approve your
coding recommendations before they can be published. Get your products
in early to help ensure that your products can be viewed by customers
when LCodeSearch.com
is launched at the 2007 AOPA National
Assembly in Las Vegas.
To begin entering your product data now, simply visit LCodeSearch.com
and click on "Manufacturers: Enter Your Products Here!" Then, log in
with your AOPA member user name and
password. You can download instructions on how to enter
data (PDF format) here.
Need help? Contact Joe McTernan at (571) 431-0876, ext. 211.
Questions? Contact Meredith
Mengel at mmengel@AOPAnet.org
or (571) 431-0832.
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Need
Help? Find it Here.
Reach more prospective employees with the only
interactive, O&P-specific online employment network: the O&P Job Board
AOPA members pay only $75 to post a job. Contact
Corrinn Mullins at cmullins@AOPAnet.org or (571) 431-0860.
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Sept.
17–20
The Venetian
Resort, Hotel and Casino, Las Vegas
Early
Bird Pricing Ends Aug. 13: Register online now.
Time is running out!
There are
only a few days left to take
advantage of early-bird savings on Assembly registration! AOPA members
registered before Aug. 13 will pay only $545 for a full-conference
registration. After Aug. 13, the price goes up to $645.
Don’t Wait to Register
The special
rate of $199 per night for
your luxury suite at the Venetian Resort, Hotel and Casino is only
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Questions?
Contact Tina Moran at tmoran@AOPAnet.org or (571) 431-0808.
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Get
your products in front of Assembly Attendees!
The Oct. O&P Almanac
is the official AOPA Assembly Issue, and
the ONLY magazine that’s hand-delivered to
attendees’ rooms and distributed at registration.
Exhibitor Special Include your company brochure, product catalog or CD in the Almanac distribution bag—it’s hand-delivered to attendees’ rooms! Materials needed by Aug. 30.
Contact Amy Clontz at aclontz@AOPAnet.org or (888) 557-7277, option 2
for details.
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Do you know the tales and trials
of the O&P profession? In celebration of AOPA’s
90th birthday, this newsletter is featuring an
O&P trivia question in every issue up to the Assembly.
Question #9: Which
three organizations helped to develop the L code system in the late
1970s?
(Click through to www.AOPAnet.org for the answer!)
Missed the previous week’s question or answer? Visit www.AOPAnet.org to view them all.
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| O&P
Insider's Track |
| The Only Up-to-the Minute O&P Newsline |
Kathleen P. Bloch is the new
vice president and chief financial officer of Langer Inc.,
the Deer Park, N.Y.-based provider of medical products targeting the
long-term care, orthopedic, orthotic and prosthetic markets…
Michael Chapman has
joined AOPA
and is working on special projects in the membership and marketing
departments… Kara Davis has
received the Outstanding O&P Student Award from Eastern Michigan University
(EMU)… Don DeBolt
is AOPA’s
new chief operating officer… Ryan Dougherty has
joined Coastal Prosthetics & Orthotics of
Norfolk, Va. as a resident prosthetist. Jennifer Fayter joins
Comfort
Products of Croydon, Penn. as the new company
sales manager… Erin Kennedy
has joined AOPA's
meetings and conventions department… Theresa
McLeod, CMF, COF, and Rick Sevier, ROPA,
C.Ped., L.Ped., have been appointed to the board of
directors of the Board
for Orthotist/Prosthetist Certification (BOC)
and are serving one-year terms… Amanda Vidovic
has been promoted to marketing associate for PEL Supply,
based in Cleveland.
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Eastern Michigan University
has received full accreditation from the Commission on Accreditation of
Allied Health Education Programs (CAAHEP) for their post-graduate
programs in orthotics and prosthetics. EMU plans to increase
enrollment, and expanded to 18 the number of openings for their next
class, beginning in September 2007.
ReAble
Therapeutics Inc., an Austin-based medical device
maker, acquired DJO
Inc., a
Vista, California-based orthopedic sports medicine company, for $1.18
billion. The deal is expected to close in the fourth quarter of 2007.
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New
employee? New office? Tell us! Share your news with the over
15,000 readers of the O&P Almanac and AOPA
In Advance newsletter. E-mail Jacob Strauss at jstrauss@AOPAnet.org.
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