AOPA
in AdvanceBreaking News for O&P Professionals
December 24, 2007 ♦ Volume 11 Number 25
Printer-Friendly Version
| O&P News |
During the special DMEPOS Open Forum conference call on
Wednesday, Dec. 19, 2007, CMS announced that all existing DMEPOS
suppliers will have to become accredited by Sept. 30, 2009 in order to
bill and receive payment from Medicare. After that date, in order to
keep your NSC number and your ability to bill for Medicare services,
you must meet the Medicare quality standards and be accredited. If you
do not, your NSC number will be revoked. The deadline for new suppliers
has yet to be announced. Medicare will do this in upcoming MedLearn
Matters articles and revisions to the Medicare
manuals.
As a part of the Medicare Modernization Prescription Drug
and Improvement Act of 2003 (MMA), all DMEPOS suppliers must meet
certain quality standards and become accredited in order to do business
with Medicare (This requirement is not connected to the competitive
bidding program). The quality standards can be located on CMS’ Web site. CMS has
deemed ten organizations as accrediting bodies for DMEPOS
suppliers. The list of accrediting bodies can be found on CMS’ Web site.
CMS stressed that suppliers should start the process early,
as most accreditation processes take some time to complete. Waiting
until the last minute may cause you to lose your NSC number.
CMS also stated during the call that all suppliers of
DMEPOS, including podiatrists and physicians supplying orthoses,
prostheses and diabetic shoes and inserts to their patients will also
have to become accredited in order to bill the DME MAC for these items.
Questions? Contact Daniel Gurley at dgurley@AOPAnet.org
or (571) 431-0812.
2008 Medicare DMEPOS Fee Schedule
Released
The Center for Medicare and Medicaid Services has released the 2008 Medicare DMEPOS Fee Schedule. Barring any last minute action by Congress, existing HCPCS codes will receive a 2.7% increase in Medicare allowables over 2007 levels. This increase matches the increase in the Consumer Price Index for Urban consumers (CPI-U) from July 2006 through June 2007. The CPI-U is used to determine the annual increase in O&P fees.
The Center for Medicare and Medicaid Services has released the 2008 Medicare DMEPOS Fee Schedule. Barring any last minute action by Congress, existing HCPCS codes will receive a 2.7% increase in Medicare allowables over 2007 levels. This increase matches the increase in the Consumer Price Index for Urban consumers (CPI-U) from July 2006 through June 2007. The CPI-U is used to determine the annual increase in O&P fees.
New codes that directly replace
deleted HCPCS codes have been assigned Medicare Allowables that are
effective
Jan.
1, 2008.
New codes that do not replace any deleted codes will be
paid under Individual Consideration until July 2008, when fee schedules
for these codes will be published.
A link to the full 2008 DMEPOS Fee
schedule may be downloaded
here
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After months of debate, Congress passed a Medicare bill that
funds the program through the first half of 2008. The good news is that
there do not appear to be any fee cuts that would impact O&P
provider fees under Medicare. The 2.7% increase in the Medicare fee
schedule for O&P is on track to take effect Jan. 1, 2008. The
Medicare bill includes a six-month fix to avoid the 10% cuts that would
have been triggered under the Medicare physician fee schedule. This
“correction” will be paid for by some modest
reductions to the Medicare Advantage (managed care) program.
So the battle and discussions over making some substantive
changes to Medicare, including, but not limited to, the Medicare
physician fee schedule, will simply go on through the first six months
of the New Year. That means Congress and physicians are likely to find
themselves in June, 2008 facing the prospect of a large scale reduction
in Medicare physician fees, but in an even less favorable, more
politically charged environment of election-year politics.
AOPA will continue to represent the needs of orthotic and prosthetic professionals, press the effort for Medicare refinements to fight fraud and abuse, promote the qualifications of O&P providers, and monitor this Medicare situation. We will report any updates about Medicare spending as soon as they become available to us.
AOPA will continue to represent the needs of orthotic and prosthetic professionals, press the effort for Medicare refinements to fight fraud and abuse, promote the qualifications of O&P providers, and monitor this Medicare situation. We will report any updates about Medicare spending as soon as they become available to us.
Questions? Contact Steven Rybicki at srybicki@AOPAnet.org
or (571) 431-0835.
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The United States Department of Justice (DOJ) recently
announced that they are converting their Medicare Fraud Strike force
currently operating in Miami, FL from temporary status to permanent
status. The DOJ also announced that they are expanding the program into
Houston and Los Angeles, two additional hotbeds of Medicare fraud.
A spokesman for DOJ cited the success of the programs in
Miami as the primary reason for the expansion. After
operating for only part of 2007, the strike force brought cases against
120 individuals who billed Medicare for more than $408 million in
Miami-Dade County alone. DOJ hopes that the expansion of the
strike force will serve as a deterrent to those who consider committing
Medicare fraud.
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Don’t miss a day of AOPA 2008
– renew your membership today. This valuable resource for
coding and billing issues and other AOPA services
ends unless AOPA receives your membership renewal.
Call Michael Chapman at (571) 431-0843 if you need another invoice or
to review the reasons you should renew TODAY!
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Fast Fact
For 2005, the upper limb orthotic code with the highest usage was L3908 (wrist extension control cock-up WHO, non-molded, prefabricated) with 212,579 frequencies. These billings resulted in a total allowed of $9,185,595. Medical supply companies led billing with 31 percent of the total frequencies, followed by orthopedic surgeons at 25 percent and pharmacies at 13 percent. No other specialty billed more that 5 percent of the total frequencies.
For 2005, the upper limb orthotic code with the highest usage was L3908 (wrist extension control cock-up WHO, non-molded, prefabricated) with 212,579 frequencies. These billings resulted in a total allowed of $9,185,595. Medical supply companies led billing with 31 percent of the total frequencies, followed by orthopedic surgeons at 25 percent and pharmacies at 13 percent. No other specialty billed more that 5 percent of the total frequencies.
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One of the most common reasons for Medicare denial of
prosthetic claims is the omission of functional level modifiers on
knee, ankle, and foot components. These modifiers are mandatory on
these components and must be included in order for Medicare to process
your claim. The modifiers and their descriptors are as follows:
K0: Does not have the ability or potential to ambulate or
transfer safely with or without assistance and a prosthesis does not
enhance their quality of life or mobility.
K1: Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator.
K2: Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator.
K3: Has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.
K4: Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.
K1: Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator.
K2: Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator.
K3: Has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.
K4: Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.
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The Health Insurance Portability and Accountability Act
(HIPAA) Privacy rule requires that you enter into contracts with your
business associates to ensure that they protect your patients'
protected health information (PHI). A business associate is anyone who,
on your behalf, performs a function or activity involving the use of
your patients' PHI. Business associates include your medical
malpractice insurers and their underwriting agents, who may need access
to your patients' PHI when handling a claim. Business associate
agreements are not required when the sharing of PHI is for treatment of
the patient. In other words, you do not need a business associate
agreement between you and a hospital, referring physician, skilled
nursing facility, etc.
Business associates also include accrediting agencies that
review your patients’ files as part of the accrediting
process. ABC has indicated that it has included a business associate
agreement in its accrediting application process. However for
other accrediting bodies, you should contact them directly for further
information.
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Questions? Contact Steven Rybicki at srybicki@AOPAnet.org or (571) 431-0835.
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Are you satisfied with your business’
profitability? If the answer is no (and it should be) then
don’t miss the B.O.A.T. The Business Optimization
Analysis Tool (B.O.A.T) will have its pre-launch Beta testing beginning
in January. All of the participants in the 2007 Operating Performance
and Compensation study invited to enjoy a six month free subscription
to this sophisticated “profit building” tool, while
they also function as the Beta testers. The B.O.A.T provides a private
and secure Web site for each subscriber that brings together in one
place an orderly process for evaluating your economic and business
health; measuring your external market and competition; analyzing your
management processes and their effectiveness, including patient care
practices; and benchmarking financial results against budget and peer
top performers.
Questions? Contact Steven Rybicki at srybicki@AOPAnet.org or (571) 431-0835.
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Even beyond the recent interest in this particular story, having the right person with the right story can put the spotlight on a disparity in coverage that has frustrated so many amputees seeking to recover their former productive lives. National media exposure on Good Morning America, the Today Show or other high profile programs can be a springboard for more extensive media exposure and AOPA is trying to identify patients on an ongoing basis who might be willing to share their story. In addition to conveying important messages, our field may see results that can help make legislators more knowledgeable in the various states which are considering “parity” legislation, and as they consider Medicare, VA and Medicaid policy and research priorities relative to O&P.
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| O&P Resources from AOPA |
LCodeSearch.com
is gaining momentum as more and more AOPA members
are logging into this Web based quick reference site on appropriate
coding for hundreds of O&P products. AOPA
member manufacturers are adding their products and codes to the site
and the AOPA Coding and Reimbursement Committee is
verifying accuracy and resolving any coding questions. If you
don’t see products of a favored manufacturer already on the
site, remind them that as an AOPA member their
products can be added to the site free of charge. All
manufacturers will be given an opportunity to enhance their listings,
enabling them to communicate extensive product information and post
pictures, for a modest annual fee, covering all products posted on the
site.
Questions? Contact Devon Bernard at dbernard@AOPAnet.org
or (571) 431-0854.>> Back
to Top <<
Questions? Contact Daniel Gurley at dgurley@AOPAnet.org or (571) 431-0812.
|
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 $80 to post a job. Contact Corrinn Mullins at cmullins@AOPAnet.org or (571) 431-0860. |
AOPA
and Chase: If You’re Paying More Than 1.9%, You’re
Paying Too Much
AOPA members should check their current credit card processing rate to determine whether it makes sense to switch to the AOPA Chase Paymentech program with processing fees as low as 1.9%. Savings can amount to “found” dollars for the bottom line. As an example, if your current rate is 2.5% or more and you process $500,000 annually in credit card payments — the .6% savings can mean another $3,000 to the bottom line. That’s like a patient care facility getting a 200% return on their annual dues investment in AOPA. Or it’s the same as getting two years of AOPA membership free!
Check your rate and if you’re paying too much, call AOPA’s dedicated payments expert, Eric Mock, at (214) 849-3603. Be sure and mention your AOPA membership.
Questions? Contact Michael Chapman mchapman@AOPAnet.org or (571) 431-0843.
AOPA members should check their current credit card processing rate to determine whether it makes sense to switch to the AOPA Chase Paymentech program with processing fees as low as 1.9%. Savings can amount to “found” dollars for the bottom line. As an example, if your current rate is 2.5% or more and you process $500,000 annually in credit card payments — the .6% savings can mean another $3,000 to the bottom line. That’s like a patient care facility getting a 200% return on their annual dues investment in AOPA. Or it’s the same as getting two years of AOPA membership free!
Check your rate and if you’re paying too much, call AOPA’s dedicated payments expert, Eric Mock, at (214) 849-3603. Be sure and mention your AOPA membership.
Questions? Contact Michael Chapman mchapman@AOPAnet.org or (571) 431-0843.
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The AOPA Bookstore’s limited
supply of year-end inventory can save you BIG DOLLARS. Among
the terrific values are the O&P Business and Clinical Forms
(Version 2) the Coding and Billing suite and the Coding &
Billing/Mastering Medicare (Version 2) combo deal.
You can also pre-order the 2008 Coding Suite, which will be available in March!
Check out the specials on the AOPA
Bookstore’s Web site or call the AOPA
Bookstore at (571) 431-0865.You can also pre-order the 2008 Coding Suite, which will be available in March!
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The “Guidelines on Billing Different Venues
& Should I Participate with Medicare?” audio seminar
is now available for purchase on CD from the AOPA
Bookstore. This seminar covers
the complex rules of who to bill for services in various venues, from
inpatient hospitals and SNFs to home health and hospice care.
It covers not only the Two Day Rule, but also the differences in
billing between orthotic and prosthetic care. In addition, this seminar
discusses the pros and cons of Medicare participation and what it can
mean to your facility’s bottom line.
The cost is $99 for AOPA
members and $199 for non-members. CDs may be purchased on the AOPA
Web site; please visit the AOPA
bookstore to order.
Each informative audio seminar is worth 1.5 continuing
education credits. Past topics, also available on CD,
include: “Medicare Changes for 2007: New
Codes, New Fees, New Medical Policies;” “Why Was My
Claim Denied? Hints on Minimizing Claims Denials;”
“The New CMS-1500 Form: Get It Right the First
Time;” and “Hints on Billing for Diabetic and
Orthopedic Shoes.”
Questions? Contact Erin Kennedy at ekennedy@AOPAnet.org or call (571) 431-0834.
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The 2008 Assembly Advisory Committee met in Chicago to start
mapping out plans for next year’s Assembly (Sept. 10-13,
2008). Russ Hornfisher of Becker Orthopedic Appliance Company chaired
the Advisory Committee and led the tour of the Hyatt Regency Chicago
facilities, chairing the working lunch and overseeing the process of
planning the biggest and best National Assembly event ever.
Expect some changes reflecting the evaluations completed by
members at the 2007 National Assembly including high-level speakers and
programs that spark that “wow” quality.
Contributing to the success of the event is its outstanding location in
the heart of Chicago’s booming commercial
area. It’s a short walk to the best restaurants, top
tourist attractions and the Miracle Mile.
Questions? Contact Tina Moran at tmoran@AOPAnet.org or (571) 431-0808.
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to Top <<
| O&P
Insider's Track
|
| The Only Up-to-the Minute O&P Newsline |
Tammy Schulte, CO has joined the staff of
OrPro
Prosthetics & Orthotics clinical practice
in Waldorf, Maryland.
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Send Us
Your News!
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. Contact Steven Rybicki at srybicki@AOPAnet.org.
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. Contact Steven Rybicki at srybicki@AOPAnet.org.
>> Back to Top <<
| AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA) |
American Orthotic & Prosthetic Association
(AOPA)
330 John Carlyle St., Suite 200, Alexandria, VA 22314
Tel: (571) 431-0876, Fax: (571) 431-0899
www.AOPAnet.org