AOPA Files Response to Government's Motion to Dismiss

AOPA In Advance SmartBrief
Breaking News
December 3rd, 2013
AOPA Headlines:
Important HCPCS Code/Competitive Bidding Update
Are you using all of your important AOPA benefits?
2014 Medicare Open Enrollment Period: Deadline Extended
Become a Presenter at the 2014 AOPA National Assembly!
People in the News: Curt Bertram Named ABC President
New Business Education Programs for 21st Century O&P Entrepreneurs
Take Action on the Medicare O&P Improvement Act Today!
What’s on the Horizon? New Codes for 2014 – December Audio Conference
Upcoming AOPA Events
Be on the Lookout for AOPA Membership Renewals!
Please be on the lookout for your 2014 AOPA Membership Renewal Information in the mail this
week. Make sure to continue your access to valuable member benefits, including access to our
coding and billing experts, members-only, discounts on O&P products and
education, free online CE classes, discounts with partner businesses, etc. Login and renew online at Contact [email protected] or call 571/431-0876 to get your website
login info or to get an electronic copy of your invoice.
Important HCPCS Code/Competitive Bidding Update
The Centers for Medicare and Medicaid Services (CMS)
has released the 2014 HCPCS update. This update
includes all new, changed, and deleted HCPCS codes that
will be implemented for claims with a date of service on
or after January 1, 2014. For codes that describe orthotic
and prosthetic services, there are 24 new codes, 63
codes that have had their descriptors changed and 1 code that has been deleted. This represents a
significant number of changes in the O&P code set and represents a new reality for O&P providers
specifically in relation to 23 services that have been split into two categories; orthoses that are
provided "off the shelf" with no additional fitting and training, and those that are "customized to fit
a specific patient by an individual with expertise."
The August 2013 release of CMS' final OTS list served as a clear indication of what was to come. In
this release, CMS provided responses to AOPA's and other organizations concerns regarding the
original OTS list. The final list contained 32 codes that would always be considered OTS and
proposed the split of 23 codes into off the shelf version and custom fit versions. The creation of the
split codes essentially sets the stage for CMS to include HCPCS codes which include the term "off
the shelf" in their descriptors in a future round of competitive bidding. AOPA has voiced its serious
concerns regarding CMS' expansion of the term "off the shelf" from the statutory definition which
requires "minimal self adjustment" to include adjustments provided by the "beneficiary, caregiver,
or supplier" through multiple meetings and correspondence with CMS officials. Unfortunately, as
indicated by the release of the 2014 HCPCS file, AOPAs concerns continue to fall on deaf ears.
While the potential for inclusion of OTS orthoses in future rounds of competitive bidding is
obviously a major concern for the O&P profession, indications to date have been that it is not
imminent and may be months or possibly years away.
A larger concern, and one with potentially immediate impact, is how the split codes may affect O&P
provider's ability to bill and receive proper reimbursement for orthoses which require the expertise
and professional training of an O&P professional in order to prevent potential harm to patients.
Essentially there are now two ways to deliver the 23 orthoses that have had their codes split; those
provided without any fitting and training, and those that are customized to fit a specific patient by
an individual with expertise. The question that has now been created is who will make the decision
whether an orthoses requires proper fitting by a trained individual or can be delivered as an off the
shelf item without additional fitting and training? AOPA members must be especially cognizant of
the need to document the medical need for additional fitting and training as well as the actual time
spent customizing the device to meet the individual needs of the patient. The referring physician
should also be encouraged to document the need for additional training and fitting as well.
AOPA will continue to press CMS for answers to the questions above and make sure that its
member's best interests are properly represented.
Below are links to several resources that provide additional information regarding the new and
revised codes. The November 2013 AOPA Executive Director letter, published prior to the release
of the HCPCS file provides a thorough review of the potential impact of the code changes. In
addition, links to the AOPA summary of HCPCS additions, deletions, and changes, the August 2013
CMS final OTS list and comments, a letter to Laurence Wilson of CMS, and a brief overview of the
potential impact of competitive bidding are included.
Click here for the November 2013 AOPA Executive Director Letter
Click here for the 2014 AOPA Code Changes Summary
Click here for the CMS OTS List
Click here for the Letter to CMS Director Laurence Wilson
Click here for the Competitive Bidding Overview
The upcoming AOPA Audio conference, scheduled for Wednesday, December 11, 2013 at 1 p.m.
Eastern Time, will focus on the upcoming changes to the HCPCS codes and their potential impact
on O&P providers. The cost of the call for AOPA members is just $99 for an unlimited number of
participants per telephone line.
Registration for the call may be completed online here.
Questions regarding this issue may be directed to Joe McTernan at [email protected] or
Devon Bernard at [email protected]
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Are you using all of your important AOPA benefits?
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2014 Medicare Open Enrollment Period: Deadline Extended
The deadline to change your participation status with Medicare for
2014 has been extended, the open enrollment period will end on
January 31, 2014 instead of December 31, 2013. This open
enrollment period is your only opportunity to change your Medicare
participation status for 2014.
If you elect to be a participating provider, your company will be listed
in the Medicare provider directory, any claims involving a Medigap
supplement policy will be automatically crossed over by the DME
MACs, and you will be paid directly by Medicare. However, as a
participating provider you agree to accept assignment on all Medicare
claims as long as the participation agreement remains in effect and
therefore you can never bill any balances.
If you choose to be non-participating, you may decide on a claim-by-claim basis whether you will
accept assignment. This allows you to collect your full charge on non-assigned claims, even if it
exceeds Medicare's allowable.
If your company has a participation agreement in effect for 2013 and you
wish to be non-participating for 2014, you must submit a written notice to
the National Supplier Clearinghouse (NSC). Your written notice must be
postmarked by January 31, 2013. The letter must have an original signature
of your offices' authorized representative on file with the NSC. The letter
should be sent to:
National Supplier Clearinghouse
P.O. Box 100142
Columbia, SC 29202-3142
If, however, you are currently enrolled in Medicare as a non-participating provider and you wish to
change your company's status to participating, you must complete a Medicare Participation
Agreement for 2014, form CMS 460.
Click here to access the CMS 460 form.
If you do not wish to make any changes to your participation status, it is not necessary to do
anything during the open enrollment period.
Questions? Contact Devon Bernard at [email protected] or 571/431-0854, or Joe McTernan
at [email protected] or 571/431-0811.
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Become a Presenter at the 2014 AOPA National Assembly!
Share Your Expertise ▪ Advance Your Career ▪ Improve Patient Care
AOPA is excited to announce this Call for Papers for the 97th Annual AOPA National Assembly to be
held September 4-7 at the Mandalay Bay Resort in Las Vegas. Your clinical submissions, based on
sound research and strong empirical data, will set the stage for a broad curriculum of highly valued
clinical and scientific offerings at the 2014 AOPA National Assembly.
The Call for Papers requests that all interested presenters submit an abstract of their proposed
scientific paper or description of their proposed business or technical paper.
All free paper abstracts for the 2014 AOPA National Assembly must be submitted electronically
using the online form at Abstracts
submitted by e-mail or fax will not be considered.
If you are interested in organizing a scientific symposium at the 2014 AOPA National Assembly,
please complete the online submission form no later than March 10, 2014 for consideration.
Please click here to access the online submission form.
The review committee will grade each submission based on the criteria below and reach a decision
regarding acceptance of the abstracts:
* Relevance, level of interest in topic
* Quality of Scientific Content
* Quality of Clinical Content
Important Dates
Monday, March 10
Tuesday, April 10
Friday, August 1
Thursday, Sept 4
Deadline for abstract and symposia submissions
Notice of Acceptance or Rejection
Electronic version of handouts due
AOPA National Assembly begins
Should you have questions about the submission process or the National Assembly in general,
please contact AOPA Headquarters at 571/431-0876 or [email protected]
To participate or obtain additional information visit or contact Tina Moran at
571/431-0808 or [email protected]
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People in the News: Curt Bertram Named ABC President
Curt A. Bertram, CO, FAAOP assumed the role of president of the ABC
Board of Directors on December 1.
As part of ABC’s annual leadership transition, Bertram takes over the
presidency from Timothy E. Miller, CPO of Bettendorf, Iowa. Miller will
continue to serve as immediate past president. “I look forward to Curt’s
presidency,” said Miller. “He will lead the next level of strategic planning
and has already been actively involved in making sure that we are
prepared. The great thing about Curt is that once he has ownership of a
topic or a project he puts all his effort into it. As president, he is sure to
continue this tenacity and will wholeheartedly work to accomplish all of
the goals set before him and the board.”
Bertram began volunteering with ABC as both an orthotics
examiner and exam team member. Since then, Bertram has been
an integral part of ABC serving on the Executive, Finance and
Marketing Committees as well as the O&P Alliance. He has also
been an active participant in the certification exam process, having
served on the Orthotic Exam Team and as an Orthotic CPM
Examiner and Site Coordinator.
Since joining the ABC board in December 2009, Bertram has played a role in creating many of ABC’s
current policies and brings with him nearly 23 years of experience working in the orthotic and
prosthetic profession. “Curt’s long history of volunteerism and involvement in our programs makes
him a natural leader for ABC,” said Catherine Carter, ABC’s Executive Director. “I look forward to
working with him as he helps us move the board’s agenda forward.”
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New Business Education Programs for 21st Century Entrepreneurs
Survive and Thrive
Bottom-line, profit-oriented business programs for O&P
If you missed the 2013 O&P World Congress, don't let this opportunity to participate in these
important programs pass you by.
1. Everything You Need to Know to Survive RAC
and Prepayment Audits in a Desperate Environment
2. Competitive Bidding: Devastation to Orthotic Patient Care OR Just a Passing Storm?
3. Food and Drug Administration (FDA) Compliance for Patient Care Facilities, Manufacturers
and Distributors
4. Your Mock Audit: Are You Ready for the Auditor to Examine Your Claims Record?
You and your staff can now have a private viewing of business saving strategies and earn CE
credits at the same time. Learn more about each session here.
One low price for your entire staff
« Review the videos as many times as you'd like.
« No travel expenses
« Dependable, factual information from a reliable source
« Only $59 (AOPA Members or $99 Non Members) per session
« Special Offer. Buy three, get one free
Questions? Contact Betty Leppin at [email protected] or (571) 431-0876
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Take Action on the Medicare O&P Improvement Act Today!
Adding to the excitement of the 2013 O&P World Congress, the Medicare Orthotics and Prosthetics
Improvement Act of 2013 (H.R. 3112) was introduced by Rep. Glenn Thompson (R-PA) and Rep.
Mike Thompson (R-CA) on September 17, 2013. It takes a very constructive approach to tackling
fraud and abuse while saving the Medicare program and taxpayers money.
It prohibits the Centers for Medicare and Medicaid Services (CMS)
from making any payment for orthotics and prosthetics to a
provider who is not appropriately licensed (if a state requires
licensure) or certified by ABC, BOC, or a certifying organization
with similar requirements. These much needed reforms will
assure that only qualified O&P practitioners will be paid for
serving Medicare beneficiaries. Also, since eligibility for payment
will be linked to the qualifications of the providers and the
complexity of the device the patient needs, patient quality of care
will also be assured. Additionally, taxpayer dollars will be saved
through a reduction in poor outcomes and repeated charges for
follow up O&P care that would not be necessary if a qualified
provider served the patient in the first instance.
We very much need your help to create a ground swell of support for this bill. We are asking you to
contact your Representatives and ask them to sign onto and become a co-sponsor of the Medicare
Orthotics and Prosthetics Improvement Act of 2013 (H.R. 3112) via the Thompson 'Dear Colleague'
Letter. Rep. Tammy Duckworth (D-IL) and Rep. Dutch Ruppersberger (D-MD) have already signed on
as cosponsors. AOPA can meet with legislators and their health staffers to recruit and encourage
them to become co-sponsors, but a Representative is unlikely to co-sponsor a bill, unless and until
they sense that their support is also important to their constituency.
You can make this happen if you agree to send a letter to your Representatives. Below please find
a draft email that you may insert your information and send directly and immediately to your
Representatives, asking them to co-sponsor the Medicare Orthotics & Prosthetics Improvement Act
of 2013 (H.R. 3112).
Click here to send a letter to your representative!
Questions? Please contact AOPA at 571/431-0876 or email [email protected]
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What’s on the Horizon? New Codes for 2014 – December Audio Conference
HIPAA requires all payers to use HCPCS Codes. The end of the year marks the beginning of New Codes
and Modifier changes that will be effective January 1st, 2014. Do you have a plan in place? The ability to
make sure your practice is sound may prevent unnecessary audits down the road. As we welcome a new
year, join AOPA on December 11th for an AOPAversity Mastering Medicare Audio Conference that will
focus on New Codes and Medical Policy Changes for 2014 and why it’s an important part of your
business operation. An AOPA expert will address the following issues during the Audio Conference:
Learn about new HCPCS codes effective January 1, 2014.
Discuss verbiage changes to existing codes and how they may affect your business.
Find out which codes will no longer be used as of January 1, 2014.
Discover other changes to the HCPCS system.
Find out AOPA's interpretation of why the changes took place.
The cost of participating is always just $99 for AOPA members ($199 for nonmembers) and any number
of employees may listen on a given line. Listeners can earn 1.5 continuing education credits by
returning the provided quiz within 30 days and scoring at least 80%.
Contact Devon Bernard at [email protected] or 571/431-0854 with content questions.
Register online at Contact Betty Leppin at [email protected] or 571/4310876 with registration questions.
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Upcoming Events
Dec 11, 2013
What’s on the Horizon:
New Codes for 2014
Telephone Audio Conference
Learn more or register online here
Jan 8, 2014
New Year, New Opportunity:
Are you billing for all that you can?
Telephone Audio Conference
Learn more or register online here