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OPGA MEMBER MAGAZINE

CONNECT ION

Physician Documentation Still Trumps Practitioner’s in the DME MAC Landscape . . . page 12

What 2018 Has Taught Us About How to Manage Business Risks in 2019 . . . pages 32-33

ÖSSUR ANNOUNCES NEW, NEXT-GENERATION PROPRIO FOOT® INTELLIGENT PROSTHESIS . . . page 10

WINTER 2019

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NEWS from the President

Happy New Year from All of Us at OPGA! We sincerely hope you had a successful 2018, and we would like to thank you again for being part of the OPGA Community. For the second year in a row, your Community has grown in numbers and currently represents roughly 45% of the total O&P patient care facilities in the country. We have been honored over the years to help you build successful and profitable O&P practices, and we look forward to continuing to bring new and innovative solutions that are at your disposal.

2019 promises to be an exciting year for the O&P profession. Many challenges and hurdles are present now, and undoubtedly there will be new ones arise as the year progresses. Continued cuts in reimbursement, competitive bidding for orthotics, proposed changes within the VA, and consolidation and mergers are all real threats to the independent O&P provider. However, there are many more opportunities out there that, if seized, will drastically diminish the negative consequences of these challenges and allow the independent O&P profession to continue to advance!

The core of these opportunities continues to be the charge of becoming recognized as medical professionals and not device deliverers. This will not just happen. Instead, there are

fundamental ways of how we deliver and measure care that we, as a profession, must commit to changing. Gathering outcome measures as they relate to performance of ADLs, support and participation in the prosthetic registry that Dr. Ken Kaufman is spearheading, billing CPT codes as opposed to L-codes, writing medically relevant and accurate SOAP notes when justifying medical necessity, and continuing to engage lawmakers for positive O&P legislation are all areas we must commit to performing. OPGA has resources and programs available exclusively to you that will assist in this transition and drastically minimize the challenges associated with change. Please contact me or any OPGA staff to start exploring what’s available.

The future is bright and positive momentum is building. You have OPGA’s continued commitment to advancing the profession!

Best Regards,

Todd EagenPresident, OPGA

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Table of ContentsLetter from OPGA President Todd Eagen .................................................................................. 2

O&P1 ................................................................................................................................................ 2

OPGA Member Benefits ................................................................................................................ 4-5

Breg ................................................................................................................................................... 6-8

Nymbl Systems ................................................................................................................................ 9

Össur Announces New, Next-Generation Proprio Foot® Intelligent Prosthesis .......................................................................................... 10 From Össur

Össur®................................................................................................................................................ 11

Physician Documentation Still Trumps Practitioner’s in the DME MAC Landscape ...... 12 By Kelly Grahovac, Senior Consultant, The van Halem Group

Van Halem Group .......................................................................................................................... 13

PEL...................................................................................................................................................... 14-15

Titan ................................................................................................................................................... 16

Trulife ................................................................................................................................................ 17

Drew Shoes ...................................................................................................................................... 18

HOMELINK ....................................................................................................................................... 19

Five Benefits of an Employee Training Program .................................................................. 20-21 By Jill Blaser and Megan Kraft, VGM Education

VGM Education ............................................................................................................................... 22

FLO-TECH® ....................................................................................................................................... 23

Diabetic Shoe Program Updates ................................................................................................ 24-25 By Marty Chalfin, C. Ped, L.Ped, Dia-Foot

Upcoming OPGA Webinars .......................................................................................................... 25

GAITRite ........................................................................................................................................... 26

Business Technology Snapshots ................................................................................................ 27-29 By Carol Albaugh, Secure Tech Solutions

VGM Market Data ......................................................................................................................... 30

KNIT-RITE........................................................................................................................................... 31

What 2018 Has Taught Us About How to Manage Business Risks in 2019 ................. 32-33 By Bill Wilson, VGM Insurance Services

VGM Insurance Services ................................................................................................................ 34

Staples .............................................................................................................................................. 35

Martin Bionics ................................................................................................................................... 36

mediUSA ........................................................................................................................................... 37

Innovative Ambulating Post-Operative Knee Flexion Contracture Therapy ................. 38-39 By John Kenney, BOCO, OSCI

OSCI - Guardian Brace ................................................................................................................. 40

Cintas................................................................................................................................................. 41

Pine Tree Orthopedic Lab ............................................................................................................. 42

Prudential Billing ............................................................................................................................. 43

“Same or Similar” AFO Denials: An Explanation and What to Do About It ................. 44-45

Comfort Products ............................................................................................................................. 45-46

Coyote Design ................................................................................................................................. 47

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Practice Management Software ANDY SCHMITZ 888.556.7607Nymbl System’s O&P practice management system is a game changer. It is a comprehensive, cloud-based practice management system that is 100 percent HIPAA compliant and extremely user friendly. Nymbl’s functionality allows practitioners to access patient records, submit insurance claims, schedule appointments, and purchase supplies, all from the convenience of any mobile device.

www.nymblsystems.com

Audits, Fraud and Abuse WAYNE VAN HALEM 404.343.1815The van Halem Group, LLC, a division of VGM Group, Inc., has become one of the nation’s most respected Medicare consulting and auditing firms. Collectively, The van Halem Group’s leadership team has more than 130 years of experience. Since 2006, they have helped clients navigate complex issues related to Medicare and Medicaid. The firm specializes in compliance, audits, investigations, medical review, appeals, enrollment, coding, and education.

www.vanhalemgroup.com

Secure Tech Solutions CAROL ALBAUGH 319.874.4797VGM Secure Tech Solutions offers services to protect your business and patients’ information from cybersecurity threats. Their dedicated network of experts will work to help protect your computer systems from hackers, protect your company’s data, implement new protection protocols, and determine which threat mitigation policies to put in place.

www.opga.com Under Services, click on SECURE TECH

VGM Market Data JENN ALPERS 877.908.8424VGM Market Data can help pinpoint referral opportunities and give your practice an edge over the competition. By gaining access to the largest national HCPCS claim database with referral information on more than 8 million practitioners and 1.2 billion claims, you will be able to 1) find local physicians who perform amputations, 2) rank physicians by volume of procedures/diagnoses, and 3) list key physicians and providers in your area.

schedule a free demo today! jenn.alpers@vgm.com

Buying Alliances 800.214.6742Originally formed as a buying group, OPGA continues to partner with leading product and service suppliers in the O&P industry. These partnerships offer competitive pricing to the independent O&P facility that they may not have been able to negotiate on their own. Some of the suppliers that OPGA partners with include PEL Supply, Össur, and Breg. These suppliers have a strong commitment to the independent O&P industry and bring exceptional value to our members.

Managed Care Network 888.556.7607VGM HOMELINK® eases the trouble of competing with national chains on managed care contracts. HOMELINK processes more than 100,000 referrals annually through a nationwide, community-based network of HME; custom rehab equipment; IV therapy; O&P; home health nursing; and physical, occupational, and speech therapy providers. HOMELINK’s Dealer Direct Program allows OPGA members to accept out-of-network patients.

www.vgmhomelink.com

Insurance BRET HANKS 800.362.3363VGM Insurance is the leader in insurance and surety bonds for DMEPOS providers. With more than 25 years of experience, they have the knowledge to provide the correct coverage for your company. Complimentary insurance reviews are available. VGM Insurance Services can work with you directly or with your local agent to ensure there are no coverage gaps and that you get the best value for your insurance dollar.

www.vgminsurance.com

OPGA has the ANSWER Member Benefits

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Government Relations and Regulatory Affairs 800.214.6742OPGA offers a wide array of services to members seeking help with governmental and regulatory issues. Our in-house government relations staff can help OPGA/POINT members work with federal agencies and interpret new regulations.

www.opga.com/services/government-relations

Print and Direct Mail Services 888.852.3731Strategic Imaging offers the latest in printing, variable data, and a host of “results-getting” capabilities. They are leaders in producing return on investment through relevant and targeted marketing.

www.strategic-imaging.com

Education/Training 866.227.8171VGM Education is committed to providing affordable, quality O&P industry training programs as well as programs for long-term care organizations. Continuing education units (CEUs) are available through online ABC-and BOC-accredited courses. These courses address employee training, accreditation requirements, maintaining licensures, and ever-changing rules and regulations. By partnering with participating vendors and industry experts, VGM Education offers training on the latest products, technology, and services.

www.vgmeducation.com

Web Design, Social Media and Search Marketing 877.814.7485Get found on the internet! With more than 700 HME and O&P websites deployed, VGM Forbin will get your business found on the Web. Get a fresh new site and professional consultation from our full team of designers, developers, copywriters, social media, and search specialists.

www.vgmforbin.com

Marketing Materials 800.799.7402VGM Marketing is a graphic design and advertising agency that specializes in custom print design for the HME and O&P industries. They have offered print design and copy to the home medical industry for more than 10 years and use their combined design and marketing experience to bring brilliant marketing solutions to fruition. VGM Marketing’s expertise covers everything from logo design to complex corporate identity packages. VGM’s Off the Shelf Marketing Program offers professionally pre-designed and written cost-conscious print marketing to help members promote their business to both consumers and referral sources. The OTS Program offers a full suite of standard and customizable pieces.

www.vgmmarketing.com

Promotional Items and Apparel 855.221.1114OPGA members have access to VGM Apparel & Promotions, which has a complete line of promotional items and clothing that can be customized with your company logo. Prices are always competitive and quality is excellent!

Billing REIMBURSEMENT TEAM 800.989.7342VGM’s reimbursement team has vast knowledge of the appropriate billing and collection procedures. OPGA members have access to the expertise of Ronda Buhrmester and Dan Fedor free of charge. If you have a billing question, your answer is just a phone call away. If you are having difficulty collecting from a payer source, they can help. This is a free service available to all OPGA members.

Financial Services CHAD HAMANN 800.532.4656OPGA’s in-house financial division, VGM Financial Services, understands the needs of orthotic and prosthetic patient care providers. VGM Financial Services provides equipment financing and flexible equipment leasing programs to help OPGA members manage their cash flow.

Do you need ANSWERS? Contact OPGA at 800.214.6742 or opga.com

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The Best of Both Worlds.

www.breg.com

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The Best of Both Worlds.

Breg Quantum OA delivers the best of both worlds by #1 dynamically unloading during critical moments of pain, and #2 enriching patient experience through minimized profile and intuitive use.

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Simple quick-release buckle enclosures.

Ratchet Unloading Buckles: The thigh and the calf ratchet mechanisms make it easy for the patient to manage their own pain. Every click is measured by a number on the pad, allowing the patient to return to a desired relief level at any time of the day.

Remarkably Easy to Apply & Adjust: To apply and remove the brace, the patient only needs to interact with 1, 2 and 3 connection points. All connection points are numbered and match the numbers on the corresponding straps for ease of application.

Front of brace

Flexible thigh and calf cuffs for contoured fit and comfort.

Low Profile: Quantum’s sleek design is accomplished through its single upright design, slim profile hinges and frame contours. Patients wearing Quantum have expressed satisfaction with the “open design”.

www.breg.com

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You get optimized unloader technology in an easy to use product. For mild to severe OA patients, this solution is the best of both worlds.

Pull Mechanism: Quantum’s pull technology features the hinge on the same side as the affected compartment. The loading network as shown left, pulls from the opposite side to offload the knee for the purpose of pain relief.

Unloading

Counterforce

Pull

Pull

Counterforce

Dynamic Pull Technology: Quantum dynamically applies a load in the last 30° of extension, at the peak of OA pain. As you go into extension, the loading network increasingly pulls toward the affected compartment, applying a dynamic load which works to open up the joint space and relieve pain. As the knee moves into flexion, the load is removed, improving comfort for all day wear.

Suspension: The calf pad is made of ultra-grip material that assists in brace suspension.

The calf strap is a dual strap design, anchoring the brace on the calf to keep it in place.

Back of bracewww.breg.com

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Nymbl makes it easy to:

Nymbl Systems O&P Practice Management Software – a new comprehensive and lower-cost software designed specifically for the independent practice.

• Access and manage patient data

• Streamline billing with auto alerts and integration with ZirMed’s RCM tools

• Scheduling multiple views with the ability to text appointment reminders to patients

• Ability to quickly generate 30 different KPI reports

• Customizable WIP

• Edit and build your own forms using our customizable form builder

• Create CRM (Customer Relationship Management) tasks for referring physicians

Proud Partner of Call Ryan Mosby today to schedule a FREE one-on-one demo! Contact Ryan at ryan@nymbl.systems, or 502-640-9755.

TESTIMONIAL

“If you’re considering a new industry specific O&P EMR system that is dynamic, progressive, web-based, simple, and packed with features that allow today’s O&P professionals and businesses to thrive – look at Nymbl. It gives me confidence moving forward that we not only chose a great product and support team, but that we will be able to adapt and thrive as a private practice moving into the future.” ~OPGA Member

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Latest Generation of World’s First Bionic Ankle Features Enhanced Design and Performance Features to Reduce Risk of Trips and Falls

Össur, a global leader in orthopaedic and prosthetic technologies for over four decades, is launching a new, next-generation version of its revolutionary Proprio Foot microprocessor ankle (MPA). Proprio Foot was the world‘s first microprocessor ankle when it was originally launched in 2006, and the new version incorporates user feedback and learnings gathered over the past decade from amputees and clinicians worldwide.

A part of Össur’s family of bionic technology-driven products, the motorized Proprio Foot has artificial intelligence that enables it to sense and respond to changes in its user’s walking style and terrain. The new Proprio Foot adapts faster than the previous model, helping users walk naturally and comfortably on a variety of terrains, including stairs and ramps.

“As a leading innovator in prosthetics, Össur has pioneered many technological ‘firsts,’ said Jon Sigurdsson, president and CEO of Össur. “We continually work on developing prosthetics that closely mirror the body’s native design and function as much as possible and are relentlessly focused on developing technological solutions to address the clinical challenges faced by amputees on a daily basis.”

Reducing the Risk of Tripping and Falling

Amputees tend to fall more often than their able-bodied counterparts. According to a study conducted by W.C. Miller at University of British Columbia, more than half of all amputees reported having fallen in the prior year. According to Sigurdsson, Proprio Foot was designed to mimic natural foot motion and to reduce the risk of trips and falls by using motor-powered ankle motion in swing to provide increased toe clearance.

“Proprio Foot has been designed to reduce the risks of trips, stumbles and falls by providing increased minimum toe clearance in mid-swing. It also automatically detects the level of terrain inclination and adjusts the ankle position appropriately, allowing users to walk more easily regardless of terrain,” Sigurdsson said.

In prior field testing, Proprio Foot users reported fewer stumbles and falls, in part because the prosthesis’s active

swing phase dorsiflexion provided increased minimum toe clearance, making it more comparable with anatomical feet. The result was a 70% reduction in reported falls.

Sleek, Streamlined Design and More Power

The new Proprio Foot’s streamlined biomechanical design is based on Össur’s dynamic Pro-Flex® LP foot module and has shown to provide up to 44% more peak ankle power and a 23% increase in range-of-motion over the previous generation. Other key design features include an integrated battery capable of providing 18-36 hours of use before requiring recharge, and automatic ankle alignment to help the user maintain proper alignment across a variety of everyday footwear.

Weatherproof and appropriate for use in wet or humid conditions, Proprio Foot is compatible with Össur’s UnityTM vacuum and seal-in system, which provides secure suspension and volume management. It is indicated for low to moderately active amputees weighing up to 275 lbs. (125 kg).

The new Proprio Foot features an upgraded Össur Logic app available via smart phone or tablet, which enables prosthetic professionals to easily set up and program the prosthesis, adjust functionality for each user, and collect valuable user activity reports. The app also lets users quickly check their battery and step count, plus adjust their ankle alignment to accommodate changes in footwear.

About Össur

Össur (NASDAQ OMX: OSSR) is a global leader in non-invasive orthopaedics that help people live a life without limitations. Its business is focused on improving people’s mobility through the delivery of innovative technologies within the fields of prosthetics and bracing and supports. A recognized “technology pioneer,” Össur invests significantly in research and product development—its award-winning designs ensuring a consistently strong position in the market. Successful patient and clinical outcomes are further empowered via Össur’s educational programs and business solutions. Headquartered in Iceland, Össur has major operations in the Americas, Europe and Asia, with additional distributors worldwide. www.ossur.com

Össur Announces New, Next-GenerationProprio Foot® Intelligent Prosthesis

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PROPRIO FOOT®

Because the world isn’t flat

© Ö

ssur

, 02.

2019

A whole new Proprio Foot. In redesigning Proprio

Foot, we first enhanced the safety and stability

features that made the original so great for low-to-

moderately active users. Next, we incorporated a

Pro-Flex LP foot module to provide 44% more toe-off

power. Add usability improvements, like single-button

functionality and an integrated battery, and we’re one

giant step closer to our goal.

Visit ossur.com/proprio-foot or ask your Össur rep about a demo today.

1. Miller, William C., Mark Speechley, and Barry Deathe. “The prevalence and risk factors of falling and fear of falling among lower extremity amputees.” Archives of physical medicine and rehabilitation 82.8 (2001): 1031-1037. 2. Kaufman, K. Risk factors and costs associated with accidental falls among adults with above-knee amputations: a population-based study. American Orthotic and Prosthetic Association 2016.(Mayo Clinic). http://www.aopanet.org/resources/research/ 3. Ludviksdottir A, Gruben K, Gunnsteinsson K, Ingvarsson Th, Nicholls M. Effects on user mobility and safety when changing from a carbon fiber prosthetic foot to a bionic prosthetic foot. Presented at Orthopadie&Reha-Technik Congress, Leipzig, May 2012.

have fallen in the last year1

52% of amputees

with half needing medical attention2

40% of falls result in injury

while using Proprio Foot3

70% reduction in falls

USA (800) 233-6263WWW.OSSUR.COM

CANADA (800) 663-5982 WWW.OSSUR.CA

Proprio_Foot_OPGA_0219.indd 1 1/4/19 10:38 AM

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2018 was an exciting year for O&P. After years of fighting, we as an industry were able to convince legislators that when it comes to providing documentation to support coverage, there were no better notes than those of the practitioner. It is, after all, the practitioner who conducts multiple consults with a lower limb prosthetic recipient to ensure that the appropriate components are selected and the patient receives the best and most comfortable fit. It is the practitioner who evaluates gait and determines, and more importantly, understands functional levels. And, it is the practitioner who gets the telephone calls when the prosthesis is not meeting the patient’s expectations and needs to be adjusted.

So, in February of 2018 it was with great cheer that we received the news that legislation was passed that instructed CMS to consider orthotist and prosthetist notes as part of the patient’s medical record. To refresh your memory, the legislation included an amendment to 13 Section 1834(h) of the Social Security Act (42 U.S.C. 1395m (h)) to include the following information:

‘‘(5) DOCUMENTATION CREATED BY ORTHOTISTS AND PROSTHETISTS – For purposes of determining the reasonableness and medical necessity of orthotics and prosthetics, documentation created by an orthotist or prosthetist shall be considered part of the individual’s medical record to support documentation created by eligible professionals described in section 1848(k)(3)(B).”

This legislation is certainly a positive development for our industry. To prove that, ask any practitioner who has been challenged with fighting an LLP claim denial through the appeals process how frustrating it has been to have only the physician’s notes to establish medical necessity. While the administrative law judges (ALJs) have, in some cases, included the notes of the practitioner when making their decisions, most often if it wasn’t documented by the physician, it was not payable. With the 2018 amendment to the Social Security Act, practitioner notes now provide additional “teeth” in the fight.

I wish that I could say this is where the story ends. However, late last year we saw an interesting plot twist. It was in November 2018 that the DME MACs published a new version of the Dear Physician letter. In the letter, the amendment to the SSA is acknowledged; however, it goes on to say that

“the O&P supplier’s notes are expected to corroborate and provide details consistent with your (physician/practitioner) records. In the event of a conflict between your notes and the O&P supplier’s record, the DME MAC would likely deny payment.” Essentially, your documentation as the O&P practitioner is considered part of the medical record as a whole. However, the DME MACs position is that without corroboration in the physician’s documentation, yours alone will not justify medical necessity for the equipment provided.

What does this mean? Ultimately, your documentation practices will not change. As you did prior to these changes, you will still need to work with the physician to ensure they are documenting the patient’s current functional capabilities and his/her expected functional potential. It is essential that the physician not only states the patient’s functional level, but also provides details to adequately support that functional level determination. The Dear Physician letter does, as is its intention, provide the criteria for documenting functional capabilities and can be provided to the physician as guidance.

Overall, the inclusion of the practitioner’s notes in the patient’s medical record should be considered a victory for the O&P industry. CMS has indicated that audit programs, specifically the Targeted Probe and Educate (TPE) program and work conducted by the Unified Program Integrity Contractors (UPICs), have contributed to large decreases in improper payment rates. These audits include scrutiny of the patient’s medical records to ensure the items provided to Medicare beneficiaries meet coverage guidelines, were medically necessary and, therefore, payable. Relying on the physician’s documentation alone often left a void when proving medical necessity. As a practitioner, you have the ability to fill in the blanks to ensure you receive reimbursement for the equipment you provided.

Want extra reassurance that your high dollar claims will pass a Medicare audit? The van Halem Group can help! Our clinical prescreen services allow you valuable insight and offer recommendations prior to claim submission. Let our experts help you and your referral sources provide a comprehensive record that ensures coverage guidelines are met. For more information on prescreen services or other offerings that support compliance, visit our website at www.vanhalemgroup.com.

Physician Documentation Still Trumps Practitioner’s in the DME MAC Landscape

Kelly Grahovac, Senior Consultant, The van Halem Group

Mitigate risk and eliminate costly fines or penalties with our proactive compliance support services:

• Monthly compliance programs

• Proactive desk audit

• Clinical prescreen services

• Consulting with our team of experts

Don’t go it alone. ContactThe van Halem Group today.

www.vanhalemgroup.com

Email: info@vanhalemgroup.com

Phone: 404.343.1815

Our firm offers comprehensive solutions to help resolve existing issues and provides the framework to implement internal controls that can reduce future risk.

Are You Experiencing a TPE, UPIC or Commercial Payer Audit?

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pelservice.com

Balancing the Costs and Benefits of Prosthetics

• Highest Quality

• Best Brands

• Better Patient Outcomes

• Latest Innovations

• Respect For You

• Service Excellence

PEL recognizes the importance of high quality pros-thetics to your practice and is pleased to announce exclusive distribution of Encore Propel gel liners. This new “go to” liner off ers quality, stability and comfort for patients. “Encore Propel is retrofi ttable with the most commonly used gel liners but costs less,” according to Mike Sotak, President/CEO of PEL. “We believe Encore Propel represents a great opportunity for practitioners to achieve positive patient outcomes and at the same time, improve the economic outcomes within their practice”

Encore Propel is another good example of how PEL continues to seek new and better products for the O&P industry, while delivering the best, most personal-ized service. If you would like to learn more about the new Encore Propel line, call PEL at 1-800-321-1264.

Clinical research shows aff ordable prosthetic fi tting is of critical importance to overall patient wellbeing,quality of life and reduction in health care cost. Patients receiving strong continuum of care after amputation including proper prosthetic fi tting and rehab show lower overall healthcare costs. In fact, according to a recent analysis by the American Medical Association Journal of Ethics, “within a year, the prosthetic device cost was almost amortized by the other costs savings” associated with fewer acute care hospitalizations, emergency room admissions and other facility based health care of patients. Plus

“patients had higher quality of life and increased independence than the matched controls who did not receive a prosthesis.”1

Despite the positive clinical and economic outcomes associated with prosthetics, the “prosthetic acqui-sition rate” is on the decline while associated costs are on the rise. “It is the increasing costs during a period of declining utilization that has captured the attention of payers and policymakers who question the cost-benefi t ratio of the technological innova-tions.”2 Clearly there is a need to balance costs and quality of care in the O&P industry.

PEL is a leading distributor of orthotic and prosthetic components to the O&P industry. PEL, LLC is headquartered in Cleveland, Ohio.1 Source: Ethics in Rehabilitation: Access to Prosthetics and Quality Care Following Amputation. American Medical Association Journal of Ethics, June 2015, Volume 17, Number 6: 535-5462 Source: O&P in 2016 and Beyond by VGM Smart Biz, Orthotic and Prosthetic Innovation and Technology Symposium, October 28, 2016. ©2017 PEL, LLC

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There are bigger O&P supply companies out there, sure. But you won’t find one that cares more about its customers than PEL. Just ask the people who know us. Or better yet, get to know us yourself. Learn more at pelservice.com

Let’s complete someone’s life today.

The products you need. The service you deserve.

©2019 PEL, LLC

Specials now at PEL

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Purchase any two Propel™ Gel Liners at 18% off list price through March 29th

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RECEIVE

15% OFFALL TITAN PROSTHETICS

START 2019 OFF WITH A BANG!TAKE ADVANTAGE OF THIS EXCLUSIVE, LIMITED-TIME DEAL FROM TITAN O&P FABRICATIONS

Titan O&P Fabrications is offering an incredible deal to OPGA members – available only through March 31. Order now and help your patients start the New Year off right. Call 844-678-4826 today and mention you’re an OPGA member.

Titan O&P Fabrication is an ABC Accredited Central Fabrication Facility. Offer is valid from 1/1/2019 to 3/31/2019

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“These SuperMax AFOs are unbelievable - the assist is phenomenal. Really amazing difference in going up/down stairs. These devices are much lighter than my previous carbon AFO and offer significantly more support. The downstairs movement is 100% better.

The assist makes all the difference in the world. My physical therapist

says my gate is significantly improved, heel/toe strike is

good and there is no tendency to supinate. They are comfortable.

The more I walk in these new braces the better I love them.”

—Dr. G./Chiropractor

For more information and pricing contact Trulife at 1-800-492-1088 or PEL at 1-800-321-1264 | www.trulife.com

Trulife’s Carbon AFO for unilateral or bilateral drop foot patients with a moderate to high activity level.

Matrix SuperMax

Height-adjustable, heat moldable, trimable anterior shell

Shank angle increased to improve knee extension moment at mid-stance

Smooth plantar surface allows for superior transverse alignment

New foot plate design closely matches the last of a shoe

Increased stiffness in the strut and toe spring to allow smooth transition from mid-stance to toe-off

OPGA_2018_Trulife.indd 1 10/9/18 7:51 PM

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Drew Shoe Corporation 800-837-3739 www.drewshoe.com

NEW! Men’s Rocket

We are the #1 choice for orthopedic and diabetic footwear.

HCPCS Code A5500.

Drew shoe is committed to offering the most innovative styles, the latest technology and the widest range of sizes and widths

with added depth and removable inserts to accommodate prescribed orthotics.

NEW! Men’s Rocket Velcro®

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Shawn JoblinskeDirector DMEPOS Provider Relations

and Network Development

Gain access to thousands of payers with HOMELINK

www.vgmhomelink.com/why-homelink

(800) 482-1993 • homelinkreferrals@vgm.com

Experience the difference!

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Have you ever had to turn down a referral because you were out of network? Do referral sources call your competitors because they take patients you can’t?

HOMELINK can help with our Provider Direct Program:

Straightforward and simple process

Call, fax or email request to HOMELINK

HOMELINK will take it from there: verify benefits, follow up on delivery and coordinate billing

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Companies of all sizes should have some type of employee training program in place. Training is more than just meeting education requirements for compliance; it is about new employee onboarding, employee development, continuing education for licensed professionals, and leadership training for career advancement. Great training leads to better employee engagement, better productivity, and a better bottom line.

The biggest benefit of mobile learning is that you can do it WITHOUT internet connection. Even if you don’t have internet connection (say for example, the second delivery person in the delivery van), you can take courses offline and it will all sync when you are back somewhere with internet service. eLearning statistics show that companies that use eLearning for their employee training reduce training costs by up to 50 percent in addition to cutting down instruction time by up to 60 percent (CertifyMe.net). In addition to cost and time savings, here are some additional benefits of having your employee training program online:

• eLearning offers employees the opportunity to access information when they need it most.

Online training gives employees the opportunity to access information or reference materials whenever and wherever they need it. For instance, if a member of your billing and reimbursement team needs to refresh their memory regarding what information should be included on an ABN, they can simply log into VGM Education and access the ABN course to find the information that they need. This means that you can keep your employees educated about procedures and current industry hot topics and trends, which results in improved customer satisfaction and improved business practices.

• Improved knowledge retention.

When an employee is able to learn in an interactive and engaging setting, it leads to improved knowledge and skill set retention. Giving them access to engaging, reality-based scenarios and assessments enables them to digest the information more effectively and at their own pace. This allows them to fully absorb what is being taught and utilize the information in real-life work scenarios. An IBM study shows that online learners retain up to five times more material than those learning in a traditional, instructor-led session.

• eLearning is convenient and flexible.

One of the major advantages of eLearning is that employees have the ability to participate in online courses from anywhere. This eliminates a lot of time and money spent coordinating where and when a course will take place. Getting an entire team of employees together in one place for a course is not easy or efficient. eLearning allows both management and employees more flexibility to complete important “just-in-time” training as requirements change.

• eLearning allows immediate feedback and reporting.

Employees are able to get real-time feedback during an online training course. And because everything is connected online, management can also get up-to-date reports on employee course progress.

• Boosts employee engagement and reduces turnover rates.

Only 13 percent of employees worldwide are engaged at work, according to Gallup’s new 142-country study on the State of the Global Workplace (news.gallup.com). In other words, only about one in eight workers are psychologically committed to their jobs and likely to be making positive contributions to their organizations. Informed employees are more likely to remain loyal to your organization. By giving them access to self-paced, engaging course content through online training, they can further their professional goals and feel motivated to improve their performance. Employees who are better educated and knowledgeable about products and services will be a better team member and become more efficient.

Hybrid Training: Online and Classroom Education

The data makes it easy to see the value in online education for your employees, but learning cannot begin and end with a computer screen. There is value in community and social learning as well. The key to success in education is in hybrid training: finding the perfect balance of online and face-to-face training (US Department of Education). We at VGM know that there are important elements of training that are best accomplished in person; classroom training can deliver an interactive experience that allows learners to experiment with new concepts and ask questions directly to an established expert. There is also value in spending time networking and sharing thoughts together in a traditional classroom setting.

Five Benefits of an Employee Training ProgramBy Jill Blaser and Megan Kraft, VGM Education

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Education is key to success in any industry, but in the O&P industry specifically, it is vital to the success of your business. Your understanding of the billing process and the most current regulations -- through education -- has financial implications that can both positively or negatively impact your bottom line. Understanding the latest products and technology gives you the opportunity to best serve your customers with the most current options to meet their needs. Understanding disease state progression and anatomy lets you work with your customer today and into the future so they can live life to the fullest despite the situations they may find themselves in. Benjamin Franklin once said, “An investment in knowledge pays the best interest.” Choosing to invest in both online and classroom training is a win for your customers and a win for your company.

ABOUT THE AUTHORS

Jill Blaser is the design and development manager for VGM Education. A graduate of Western Michigan University, she joined VGM in 2010 after working as a writing consultant and teaching assistant in the Western Michigan Writing Center. Jill works with our subject matter experts to write various courses for VGM Education. She is interested in instructional design and works to improve the design of VGM Education courses to optimize the online learning experience for adult learners. Connect with Jill on LinkedIn or contact her at Jill.Blaser@vgm.com.

Megan Kraft is the sales director for VGM Education, a division of VGM Group, Inc. She has been with VGM Education since 2007. Megan is passionate about finding educational solutions for DMEPOS professionals that assist with their employee growth and development. Megan leads a team of sales and customer service professionals that offer innovative solutions to education needs. Megan is a graduate of the University of Northern Iowa with a Bachelor Degree in Interpersonal Communication. Connect with Megan on LinkedIn or contact her at Megan.Kraft@vgm.com.

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Continuing education. It’s part of business.

VGM Education’s online training offers proven instructional design techniques to keep your staff engaged in our courses. And, because you’re an OPGA member, YOU save money.

ONLINE LEARNERS RETAINED

more material.

$1Every investedin online education results in $30

in productivity.

18% boostOnline learning results in an

in employee engagement.

72%COMPETITIVE EDGE.

of companies believe that online learning provides a

$

26%Revenue generated per employee is

for companies that train employees using technology.

Online learning increases retention rates

25% TO 60%.

ONLINE LEARNERS RETAINED

more material.

$1Every investedin online education results in $30

in productivity.

18% boostOnline learning results in an

in employee engagement.

72%COMPETITIVE EDGE.

of companies believe that online learning provides a

$

26%Revenue generated per employee is

for companies that train employees using technology.

Online learning increases retention rates

25% TO 60%.

Source: IBM study Source: IBM study The Molly Fletcher Company

Source: CertifyMe.net Source: The Business Impact of Next Generation eLearning, 2011

Source: The Research Institute of America

Let us introduce you to:

VGM EDUCATIONWe Train Your Brain!

Contact Megan Kraft megan.kraft@vgm.com888.786.6628

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Every year and sometimes mid-year there are some changes to the Diabetic Shoe program. The purpose of this article is to outline the changes starting January 2019. And it is all GREAT NEWS!

REIMBURSEMENT CHANGES

Diabetic shoes and diabetic inserts reimbursement have increased every year since 2003. As of January 2019, the increase is 2.4%. The reimbursement for 2019 is:

• A5500 $73.21 per shoe (usually 2)

• A5512 $29.86 each of pre-fab Heat Moldable (usually 6 units)

• A5513 and A5514 $44.56 each unit custom insert (usually 6 units)

• Shoes and Prefab HM = $325.58

• Shoes and Custom Inserts = $413.78

• L5000 $523.44 Toe Fill Insert - Florida (check your state for the exact fee)

• L4361 $273.12 Cam Walker - Florida (check your state for the exact fee)

Due to competition, the prices for shoes and inserts have held relatively steady over 13 years. As such, the profit for shoes and inserts have steadily increased each year. (Disclosure: I work for Dia-Foot, and we are an OPGA supplier partner) Using Dia-Foot average prices, see the following chart:

AVG Cost Depending on Shoe Selected

REIMBURSE PROFIT OPGA MEMBER 5% DISCOUNT

(Additional Profit for you)

Shoes and Customs

$149 $413.78 $264.78 $7.45

Shoes and Pre-Fabs

$92 $325.58 $233.58 $4.60

CODING CHANGES FOR CUSTOM INSERTS

Mid-2018 Medicare introduced new coding for custom inserts.

The new code, A5514, distinguished the automated manufacturing process for custom inserts. Many companies have CNC routers that carve inserts from a virtual model of the foot. Either a scanner is used to capture the image of the foot, or the lab scans the foam box to capture this virtual model in a computer. This virtual model is sent to the CNC machine to be manufactured.

The 5513 is reserved for the “manual handmade” process. The usual process used is that the foam box is filled with plaster, and a physical model of the foot is produced. The materials are then vacuum-pressed over the physical model.

The reimbursement of the A5514 and A5513 are equal: $44.56 per unit; with 6 units allowed per patient. (K0903 code is retired).

For 2019, the K0903 code has changed to A5514. The reimbursement of A5513 (physical model) and A5514 (virtual model) are still equal. However, the supplier must know which manufacturing process was used.

Dia-Foot uses both methods, and indicates the correct coding on the packing slip, Invoice, as well as the bag of inserts for the patient.

PURCHASE CUSTOM INSERTS or MAKE YOUR OWN

Many O&P facilities manufacture their own custom inserts. The codes and reimbursements are the same as if you purchased the inserts. Be aware that if you sell or provide inserts to patients that are not yours (e.g., selling inserts to other O&P facilities), that your inserts must be submitted to PDAC for coding.

All the PDAC coding letters for Dia-Foot are available on our website.

Many facilities consider only the cost of materials when making custom inserts. The true cost of making your own custom inserts includes the cost of labor. Unless you would be sitting with your feet up watching TV, the cost of labor is not zero. As an orthotist

Diabetic Shoe Program UpdatesBy Marty Chalfin, C. Ped, L.Ped, Dia-Foot

25

or prosthetist your time is valuable. What could you be doing to grow your business rather than making custom inserts?

• Treat more patients

• Detail physicians to get more referrals

• Train staff

MORE CODING CHANGES: LT AND RT MODIFIER

Claims with date-of-service after 3/1/2019, suppliers must bill each item on two separate claim lines using the RT and LT modifiers and 1 unit-of-service on each claim line. Do not use the combination RTLT modifier on the same claim line and bill with 2 units of service (UOS).

An example of billing for diabetic shoes and custom inserts might be as follows:

A5500 LT QTY 1

A5500 RT QTY 1

A5514 LT QTY 3

A5514 RT QTY 3

SUMMARY

The Diabetic Shoe Program is more profitable than ever. It is easier than ever, particularly when the patients can get a good-looking variety of shoes. The coding and reimbursement changes are a positive development. If you have any questions, would like to get started, get back in, or get a new 2019 Dia-Foot Shoe Catalog, call Marty Chalfin 877-379-3674, or email Mchalfin@Dia-Foot.com

Marty Chalfin C. Ped; L. Ped. has been helping practitioners with the Diabetic Shoe Program since 2003. He has written various articles on paperwork and coding, and given lectures on measuring, fitting and dispensing. He is available to help you at 877-379-3674 or email Mchalfin@Dia-Foot.com.

TPE AND UPIC AUDITS FACING THE O&P LANDSCAPEThursday, Feb. 141 p.m. Central Time60 Minutes, 1.5 CEUs approved by ABC

OPGA’S SECURE TECH SOLUTIONS: COMPLIANCE, TECHNOLOGY, AND BREACHES...OH MY!

Tuesday, Feb. 191 p.m. Central Time60 Minutes, 1.5 CEUs approved by ABC

O&P IN 2019 AND BEYOND: STATE OF THE INDUSTRYThursday, Feb. 211 p.m. Central Time60 Minutes, 1.5 CEUs approved by ABC

Check out the OPGA website regularly for upcoming webinars: www.opga.com/education/webinars

UPCOMING OPGA WEBINARS

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Do you find yourself worrying about the technology at the center of your business? If you’re like most small- business owners, your mind is busy working through a wide variety of business and technology concerns, trying to figure out the ins and outs of what your business needs and the best options for your individual situation.

VGM Technologies was started to address the growing technology and security concerns of our members.

Expert Advice

“We’ve always had members contact us for advice,” said Jeremy Kauten, VGM’s chief information officer and senior vice president of information technology. This advice covers the gamut—computers, tablets, cloud technology, mobile and remote workforce, security, and VoIP phone just to name a few. “In forming VGM Technologies, we’re making sure every member knows we’re here to help no matter how big or how small your technology question is.”

Real Savings:

This advice has real savings, too. Technology is a growing cost for businesses everywhere. It can be tempting to take the most budget-friendly option. But, choosing the wrong technology can be quite costly. Seeking out VGM Technologies advice before major purchases can increase the likelihood of finding the right product the first time around. In addition, VGM Technologies has partnered with technology companies to save you money on your equipment, both hardware and software needs. From Microsoft licenses to firewalls and laptops, we can help you get the right solution at the best price!

• Firewalls

• Servers

• Laptops

• Printers/Scanners

• IT Asset Management

• Business Software

• Microsoft Services

• Backup Services

• Cloud Services

A Resource for Complicated Security Times

As technology continues to change at the speed of light, security is another aspect that must be addressed. One can hardly turn on the national news without seeing a story on the latest security breach. Orthotic and prosthetic industries have similar needs as larger national health care companies but may not have the expertise or the resources to navigate the complexities of security solutions. Give me a call to hear about our security partner that we have entrusted to assist VGM with all of our compliance and security.

VGM Technologies exists to help members navigate business technology solutions and secure their protected health information and save some money in the process!

If you have technology or compliance and security questions and needs, please contact Carol Albaugh at 319-874-4797 or email carol.albaugh@vgm.com.

Business Technology Shapshot

By Carol Albaugh, Secure Tech Solutions

FOLLOW OPGA ONLINE! ADVANCING THE PROFESSION!

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THE EXPERTS IN ALL THINGS TECHNOLOGY RELATED

HARDWARE/SOFTWARE OFFERINGS

CYBERSECURITY OFFERINGS

BREACH PROTECTION

VGM has created SECURE TECH SOLUTIONS to address the growing security and technology concerns of our members. Consisting of eight team members with expertise in various areas of technology, this offering helps members with anything technology or security related.

No concern is too big or too small. Secure Tech Solution’s team of experts can recommend a solution that suits each company’s specific needs.

Secure Tech Solutions offers recommendations and sourcing for all equipment and hardware needed for business operations and security.

• Hardware including laptops, tablets, VoIP phone systems and network switches.

• Business operations software

• Patient home automation

It starts with a FREE security review where our experts will establish our members’ current security landscape and identify potential weaknesses.

• Vulnerability Assessment—These digital assessments will analyze a company’s online presence (corporate websites, social media accounts and more) and identify security gaps that a hacker could potentially exploit.

• Website Protection—At Secure Tech Solutions, we offer solutions to detect and reduce the likelihood of your website being hacked.

VGM’s expert cybersecurity partners can also help you develop a specific incident response plan to ensure you are prepared in the event of a breach. This includes 24/7 on-call support.

• Cyber insurance delivers the coverage you need towards remediation costs to minimize impact to your business operations and reputation should a breach occur.

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Humans can easily be tricked into clicking on links or opening malicious emails, allowing hackers access to company networks and putting their business and data at risk.

• Secure Tech Solutions has dynamic online training modules, simulated phishing attacks and onsite custom education to increase employees’ security awareness.

When it comes to HIPAA compliance, we have expert security partners who specialize in performing risk and compliance assessments that allow organizations to gauge internal controls according to the latest regulatory standards.

• HIPAAwise™ compliance program software enables our members to implement and maintain a comprehensive HIPAA compliance program with policies and procedures as directed by HIPAA, inventory and device location tracking, business associate agreement management, and much more.

A RESOURCE FOR COMPLICATED TIMES

Independent O&P providers have similar needs as larger national companies but may not have the expertise or the resources to navigate the complexities of purchasing technology and security solutions.

Secure Tech Solutions exists to help members navigate business technology solutions and secure their data.

RISK AND COMPLIANCE

For more information, contact:

Carol AlbaughOPGA Technical Solutions Consultant 319.874.4797 Carol.Albaugh@vgm.com

or visit: www.opga.com Under Services, click on SecureTech

WORKFORCE SECURITY TRAINING

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32

What 2018 Has Taught Us About How to Manage Business Risks in 2019

Lessons to Take Into the New Year

As one year draws to a close and another begins, most business owners and providers reflect on what they’ve learned. What went right, what went wrong, and what issues need to be addressed in 2019.

Every year brings new challenges, and every year we learn new lessons to continue to improve. Here’s what 2018 taught us about managing business risks in 2019.

#MeToo and What It Means for Your Business

According to the U.S. Equal Employment Opportunity Commission (EEOC), the number of workplace sexual harassment claims filed in the wake of the #MeToo movement has risen dramatically. The EEOC, which is responsible for enforcing civil rights laws in U.S. workplaces, reported receiving an increase in sexual harassment complaints of more than 12 percent in the 12 months ending Sept. 30, 2018.

So, what does all this mean to a business owner, especially the owner of a small business?

Harassment of any kind in the workplace should not be tolerated, and receiving a complaint from an employee is both a serious yet delicate matter. Employers must determine how to respond to a harassment charge, how to investigate the allegation, and what guidelines will be used to assess the validity of the claim. The employer’s response can have a dramatic effect on whether or not they’re found liable for the alleged behavior if the complaint reaches litigation.

What You Can Do

It’s in the best interest of all businesses to implement a formal sexual harassment policy. To help protect your business and your employees in the event of a sexual harassment claim, you should develop and implement a company-wide program that addresses workplace harassment. The program should include policies that outline workplace conduct, as well as reporting procedures that include at least two channels through which employees can report harassment. It’s your company’s legal duty to communicate those policies and

ensure all employees understand and adhere to them.

Consider an annual workplace harassment education program, as well. All employees should be required to attend and sign proof of participation and an agreement of understanding and willingness to comply with company standards. Such a program can demonstrate to a court that your company makes a concerted effort to prevent harassment in the workplace.

The education program should include training of specified employees who will receive sexual harassment claims and who will conduct investigations to determine whether or not the allegations are valid.

Should a claim occur, those trained employees should:

• Protect private information

• Consider any conflicts of interest

• Seek legal guidance

• Maintain confidentiality throughout the investigation

• Keep written records

Detailed records are critical as you will need to provide proof in the form of documentation. Your company will need to prove that proper steps were taken to avoid problems, to educate employees about their rights, and that when the issue took place, the company responded quickly and appropriately.

Finally, defending a lawsuit can be very costly to an organization, so health care providers should consider purchasing an Employment Practice Liability Insurance (EPLI) policy. A properly structured EPLI policy will assist in associated expenses from defending the suit, court costs, and judgments brought against an organization.

Cybersecurity, Ransomware, and Securing Your Data

The health care industry has become one of the top targets for hackers. Health care data is rich with very sensitive and very valuable information hackers can exploit.

Small businesses are particularly vulnerable to one of the latest forms of cyberattacks: ransomware. This

Bill Wilson, VP Sales and Marketing, VGM Insurance Services

33

attack involves hackers encrypting data, meaning it’s locked, and then requesting a ransom payment to unlock the files/data. According to the FBI, ransomware payments alone exceeded $1 billion in 2016.

Alarming statistics confirm why hackers target small businesses. According to the Small- to Medium-Size Business Threat Awareness Poll, a majority of small- to medium-size businesses don’t use web-based security or antivirus on all computers. Phones, tablets, computers, and laptops typically access the infrastructure and can contain patient data or access to patient data.

What You Can Do

Cybersecurity threats are an ever-evolving problem. All health care providers should create and update IT policies to address newer technologies and cybersecurity threats. Review policies at least annually, and communicate any revisions to staff members.

Other proactive steps include hiring third-party security experts to expose known threats, utilizing software that allows for IP lockdown and two-factor authentication. These measures can stop a hacker in their tracks.

But, one of the most important things you can do is train your staff. According to McAfee, 43 percent of all company data loss or breaches are caused by employees. Regular training helps build an additional line of defense, ensuring your company and customer data remain secure and protected from hackers and other online threats.

Finally, health care providers should consider purchasing a Cyber Liability insurance policy. Cyber policies can cover a business’s financial liability for a data breach.

Reducing Your Risk of RAC/UPIC/TPE Audits

Being audited by a RAC or UPIC can be incredibly stressful for any health care provider. Getting fined for billing errors that result in overpayment from an insurance carrier can be downright frightful. There are stories galore about health care providers shutting their doors because they were found guilty and fined for receiving overpayments.

Mistakes may be minor, but they can make the provider susceptible to fines and penalties. According to The van Halem Group, the average cost of a regulatory proceeding defense is $80,000, and fines and penalties can approach hundreds of thousands of dollars.

What You Can Do

It’s more important than ever to be proactive and protect your business from audits. Ensure you’re operating in compliance by investing in proactive assistance and having the correct insurance coverage.

Medical Billing Errors and Omissions (E&O) and Regulatory Defense Insurance coverage helps protect your business against alleged billing errors. It provides first-party coverage for claims brought by:

• Government agencies (e.g., CMS)

• Contractors working on behalf of the government (e.g., RACs and UPICs)

• Qui tam plaintiffs

• Commercial health insurance payers

• Similar entities

Coverage also insures for regulatory actions, such as:

• Billing error proceeding

• HIPAA violations

• Physician self-referral (STARK)

• Emergency Medical Treatment and Active Labor Act (EMTALA)

You can also choose proactive services that will help you avoid the audit in the first place. Look into your reimbursement compliance program, and pick a company with experts who will work with your compliance officer and your specific needs to develop your proactive compliance program.

A good compliance program will mitigate the cost of itself, and you’ll see a return on your investment through better processes, efficiencies, and quality of care. And, a Medical Billing E&O and Regulatory Defense policy will mitigate the cost of alleged billing errors and the fines and penalties assessed because of them.

The beginning of a new year is the perfect time to start implementing risk-mitigating changes. From sexual harassment to cybersecurity to audits, there are plenty of areas for businesses to grow and improve. Use the lessons we learned in 2018 to better manage your business risk – for 2019 and beyond.

Let us fit you with custom insurance solutions designed for the O&P profession

Enhance your OPGA membership with benefits including:

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The perfect fit for a productive workday.

Thousands of ways to create your perfect seat.Visit www.StaplesAdvantage.com/sites/WorkplaceSeries

to order or contact your Stategic Account Leader, Brian Studier at 319-533-1958 or brian.studier@staples.com.

Introducing fully-customizable Staples®Workplace Series™ 500 chairs.

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• The flat hinge construction enables the brace to be worn under clothing.

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M.4s® PCL dynamic4-point rigid frame brace with extension / flexion limitation for treating injuries of the posterior cruciate ligament.

The latest product in medi‘s brace family holds the tibia in the desired position by actively exerting a force via the PCL protection pad. The brace is very comfortable to wear with its light, flat construction and the comfortable non-slip pads. This leads to high patient compliance which makes treatment safer and increases the patient‘s mobility.

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Innovative Ambulating Post-Operative Knee Flexion Contracture Therapy

A more effective treatment than DynaSplint for post-operative knee flexion contractures

John Kenney, BOCO

Post-operative knee flexion contracture/gait extension deficits can be difficult to quickly and effectively treat. Knee stiffness and range of motion deficits are relatively frequent complications after total knee arthroplasty (TKA), which has been reported in up to 25 percent of patients (Choi, H.R., Siliski, J., Malchas, H, et al., 2014). Traditional knee flexion contracture orthotic therapy includes recumbent knee passive stretching devices such as the DynaPro Flex Knee and spring loaded dynamic braces such as DynaSplint. The primary complaints of traditional contracture bracing options are that patients dislike sleeping for weeks at a time with Low Load Prolonged Stretch (LLPS) braces, and historically, the last 5 to 8 degrees of extension gains can be very difficult to obtain with current technologies.

It is important to review post-operative knee flexion contracture etiology to understand the significant benefits of an ambulating extension assist knee brace to effectively reverse post-operative knee contractures as an alternative to LLPS braces. There are four treatment objectives to effectively reverse the flexion contracture and eliminate extension deficits in gait:

1. Eliminate knee subluxation: a knee flexion contracture is a combination of the weakening of the quadriceps and a shortening and thickening of the flexor muscles and the hamstring. As the hamstring shortens, it pulls down on the tibia and creates subluxation in the knee joint. Because of knee joint subluxation, LLPS braces cannot provide the needed LLPS therapy to the tissue from the knee joint to the lower leg. To effectively reverse knee subluxation, physical therapists utilize a “glide” stretch to effectively stretch the tissue affected by the knee subluxation. A “glide” stretch is applied by gently pushing down on the upper leg just above the knee while simultaneously pushing up

below the knee joint and pulling the joint open prior to executing an extension stretch. A “glide” stretch is very effective to therapeutically lengthen the tissue affected by knee subluxation. Unfortunately, effective “glide” stretches can require thousands of repetitions prior to restoration of full range of motion.

2. Lengthen the shortened muscles and hamstrings: there are two recognized therapies for lengthening shortened muscles, passive and active stretching. Muscle shortening is a loss of muscle cells (sarcomeres) due to reduced demand for muscle length. Creating a sustained and prolonged muscle lengthening demand is the mechanism for muscle growth (sarcomere addition) provided by LLPS braces. Active stretching using a knee brace with an extension assist to provide an active lengthening stretch with each step is an equally effective alternative method of treatment to passive stretching.

3. Weakened quadriceps muscles: “to keep the hamstrings long, you must keep the quadriceps strong!” Quadriceps activation and strengthening is required to achieve the last 5 to 8 degrees of lost range of motion (LROM). No LLPS bracing technology provides any quad strengthening. Knee subluxation plus quadriceps weakness is the primary reason for the difficulty in obtaining the last 5 to 8 degrees of LROM and eliminating extension deficits in gait.

4. Quadriceps Avoidance Gait (QAG): the majority of patients with a significant post-operative extension deficits have Quadriceps Avoidance Gait. It takes thousands of improved steps with a normalized gait (full extension) to eliminate QAG. More importantly, a poor loading response at the ankle caused by the QAG results in a significant reduction of quadriceps activity, which perpetuates weak quads. Effective therapy to reverse a flexion contracture/extension deficit in gait must include an active extension assist, gait correcting, leg strengthening knee brace.

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Sport EXT RehabilitatorTM Knee Brace

The Sport Ext Rehabilitator Knee Brace uses strategically placed pneumatic air bladders on the thigh (above the knee), on the calf (below the knee) and at the knee joint to eliminate subluxation of the knee joint prior to effective active stretching. Up to 10 inch pounds of elastic bands can be attached to the dual uprights to create an active extension stretch with every step. In an hour of activity, the average patient takes 1,000 steps. Wearing the Sport EXT a minimum of three hours a day results in approximately 90,000 active extension stretches to lengthen shortened flexors and the hamstrings in 30 days. Clinical studies of Rehabilitator technology on OA patients has demonstrated quad strengthening of 54 percent in 90 days of brace wear, which is three times more effective than physical therapy alone in

strengthening the quads. Clinical studies also demonstrate significant improvements in un-assisted gait extension through routine use of the brace. Because Rehabilitator technology is the only treatment that simultaneously lengthens the hamstrings while strengthening the quads, the last 5 to 8 degrees of LROM recovery is not an issue. Patients love the opportunity to walk their way to a healthy leg as opposed to having to sleep for weeks at a time in an uncomfortable night stretching brace!

The Sport EXT RehabilitatorTM is prescribed for knee instability due to post-surgical extension deficits and is PDAC approved as L1845 or L1852. Contact Customer Service at 800 375-0207 for more information.

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SPORT EXT REHABILITATOR™

Clinically more effective than DynaSplint!

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BRACE SELECTION INDICATION STABILITY PAIN RELIEF

UNBRACED PAIN RELIEF

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IMPROVE QUADS /

HAMSTRING STRENGTH

IMPROVES KNEE

EXTENSION

IMPROVES FOOT

PLACEMENT

GAIT RETRAINING WITH RETAINED

EFFECT

TREATS KNEE FLEXION

CONTRACTURE

SPORT EXT REHABILITATOR™

Reverse Knee Flexion Contracture w/Gait

4 4 4 4 4 4 4 4

COMPETITIVE DYNAMIC BRACE

Knee Flexion Contracture 4 4

U.S. Patents7,608,051 / 7,963,933 / 8,057,414 / 8,308,669 / 8,376,947

Ideal orthotic therapy to reverse post-operative knee flexion contractures and extension deficits in gait.

Only therapy to simultaneously strengthen the quads while lengthening the hamstrings.

Active extension assist technology provides an active extension stretch with every step.

Realizes approximately 10 degrees ROM improvement a month including the last 10 degrees.

Provides a therapeutic “glide” stretch with every step; estimated 90,000 active stretches in 30 days with 3 hours wear a day.

Eliminates Quadriceps Avoidance gait.

Ideal for post-TKA extension deficit therapy.

Ordered for knee instability due to extension deficit.

L1845 or L1852

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S UNIFORM RENTALA uniform program makes life easier by providing durable, comfortable garments and hassle-free service to control employees’ appearance.

SIGNATURE SERIESSignature Series is our exclusive line of designer restroom dispensers. Signature Series delivers a family of restroom dispensers with a sleek, functional and customizable design.

LAB COAT PROGRAMWith our innovative lab coat program, we will ensure the proper fit, repair, laundry and garment tracking in addition to helping keep the wearer safe.

FIRST AID SERVICEComprehensive first aid service helps keep your workplace ready for injury or illness with products including: bandages, tapes and gauze, antiseptics and ointments, burn care and control, pain and illness and much more.

AUTOMATED EXTERNAL DEFIBRILLATOR (AED)Get the leading edge medical technology with ongoing support and training to help protect your employees and customers.

CLEAN RESTROOM PROGRAMRestocking service ensures your restrooms have essential hand care, paper, and odor control products. Serviced by a Cintas professional.

SHOP TOWEL SERVICE Cintas will provide a continuous supply of reusable, freshly laundered shop towels.

MICROFIBER MOPS & TOWELSRental microfiber mops and wipers that provide superior cleaning results.

SIGNET™ CLEANING CHEMICAL SERVICEWith Cintas and Signet™ Cleaning Chemical Service, you will always have cleaning chemicals in stock without having to carry inventory.

Enhance your image and help keep your facility clean and safe with custom solutions from Cintas

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For more information contact the National Service Team at 800.795.7368 or NationalServiceTeam@cintas.com.

161136 R1015

SAFETY CENTER SERVICEThe exclusive Safety Center™ allows timely and consistent service of your PPE including: safety glasses, gloves, hearing protection, hard hats, high-visibility apparel and much more.

FIRE PROTECTIONWe help keep your facility safe and compliant with all applicable regulatory code through our exclusive Value Inspection Program (VIP) – complete with a compliance guarantee for added peace of mind.

SAFE FLOOR PROGRAMMats and mops help capture and remove dirt and moisture, helping keep your floors clean and safe.

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Start improving patient outcomes with impulse! modifiable foot orthoses – available from Pine Tree Orthopedic Lab.

Reasons to check out impulse! orthoses:

Proven sensomotoric concept

Long-term durability and superior performance

Improved patient outcomes

Boosts your bottom line

To learn more or place an order, contact Matt Bertrand, C.Ped., Business Development Director with Pine Tree Orthopedic Lab.

P: 207-320-3599 • E: mbertrand@pinetreeorthopedic.com

www.pinetreeorthopedic.com

Extensive experience and a proven track record – that’s what you get when you partner with Prudential Billing for your Orthotics and Prosthetics collection needs. Our team of consultants can help with all aspects of your billing and collection process, from initial insurance verification through final payment.

OUR AREAS OF EXPERTISE INCLUDES:

• Insurance verifications

• Prior authorizations

• Denial management

• Claim appeals

• And many more!

REDUCE YOUR COSTS AND IMPROVE YOUR COLLECTION PROFITS WHEN YOU CHOOSE THE ORTHOTICS AND PROSTHETICS BILLERS WITH A REPUTATION FOR EXCELLENCE. CHOOSE PRUDENTIAL BILLING.

PROVIDING THE SERVICES YOU NEED TO BE SUCCESSFUL

www.prudentialbilling.org

Email: info@prudentialbilling.org

Phone: 888.862.9377

Exclusive discount offered to OPGA members!

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“Same or Similar” AFO Denials:An Explanation and What to Do About It

Practitioners may have experienced that claims for prefabricated and custom AFOs are being occasionally denied by Medicare and some private carriers. EOBs give reason code: M3.

This is the result of enforcement of a Medicare rule is that prefabricated or custom AFOs can be paid for only once, per side, every five years. The “same or similar” policy states that a beneficiary cannot get another device within this period, unless the AFO is lost, stolen, or irreparably damaged.

AFOs considered to be within the same or similar category include:

L1900, L 1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2106, L2108, L2112, L2114, L2116, L 2126, L2128, L2132, L2134, L2136, L4350, L4360, L4361, L4370, L4386, L4387, L4396, L4397, L4398, L4361

The rule is not provider-specific meaning that if a patient received an AFO from another provider within the past five years that was billed to Medicare, the claim for a “same or similar” device may be denied.

Providers may avoid claim denials by using the online portals of each of the two DME carriers, Noridian and CGS. It’s first necessary to register to use the portal.

To check on patients whose primary residence lies in DME MACs B and C, sign up for the CGS portal; to check on patients who reside in DME MACs A and D, sign up for the Noridian portal. Once registered, you can check whether patients have received an AFO by entering their NPI, PTAN, last five digits of the TIN, the beneficiary’s new Medicare ID, the beneficiary’s first and last name, the beneficiary’s date of birth, and the HCPCS code. Link to register is included at end of this document.

If the query yields no results, the patient should be eligible for coverage.

If the query shows that a device has been provided on the same side within the last five years, another AFO will not be eligible for coverage unless you can successfully achieve coverage based on the fact that the first device was lost, stolen, or irreparably damaged, or some other reason. If this fails, you need to explain to the patient that Medicare will not pay for it. If the patient wants the item, they will have to pay for it. Have them sign an ABN and submit the claim with a GA modifier.

Most patients have never received an AFO, so this enforcement of a longstanding policy should be of minimal impact. Providers who have provided patients multiple AFOs as part of a staged approach to care are advised to consider how this policy impacts on patient financial responsibility.

“Same or similar” denials are also being sent by some Medicare Advantage carriers. These insurance companies should be contacted to find out if they have their own way for you to easily determine patient prior utilization.

If a Medicare AFO claim has been denied when it was provided to address a different condition than first treated, the claim can be contested by filing for “Redetermination.”

Most patients who are prescribed prefabricated or custom AFOs have never had one provided in the past. Given the current climate, providers are encouraged to use the Medicare portal to confirm whether they can be confident of being paid. The ease of use and value of providing AFOs most certainly makes this extra step worthwhile.

The American Podiatric Medical Association and the American Academy of Orthotics and Prosthetics are both working to amend the interpretation of the rule such that a second device, provided to treat a different condition, is allowed within the five-year window.

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Useful links:

Medicare website explaining the M3 denial code:

https://med.noridianmedicare.com/web/jadme/topics/same-or-similar/ss-and-abns

Details of the “same or similar” policy:

https://med.noridianmedicare.com/web/jadme/policies/lcd/active

Medicare Portal Registration and Patient Eligibility

Regions A, D: https://med.noridianmedicare.com/web/jadme/topics/nmp

Regions B, C: https://www.onlineproviderservices.com/cgs_ops/

Redetermination form:

https://med.noridianmedicare.com/documents/2230703/6501021/Redetermination+Request

Josh White, DPM, CPed is the founder of SafeStep, VP at OHI and is a member of the American Podiatric Medical Association’s DME Workgroup.

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Thermacryl is a styrene-free, heat-moldable thermoplastic that’s recommended for ALL types of containment sockets and orthopedic parts that may need to be “heat relieved” after fabrication. The fast-setting formula produces exceptional physical properties when fully cured at room temperature.

• Extremely easy to work with and pigment

• Forms thin wall fabrications with smooth finishes and excellent strength

• Produces bubble and tack-free thermoformable laminates with excellent fiber wet out

• Will not crush your EVA liner from excessive pressure while curing

• Laminated sockets may be over laminated without any special surface preparation

Thermacryl is available in 1, 2 and 4 gallon jug kits that include BP150 powder hardener.

Find out how Thermacryl can save you time and money while increasing your shop productivity.

REDUCE COSTS, INCREASE PRODUCTIVITYWITH THERMACRYL HEAT-ADJUSTABLE THERMOPLASTIC RESIN

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QUIK GLUE

Two different set times WHITE - 30 SECONDS BLACK - 60 SECONDS

Ideal Multi-Purpose Adhesive

New name same great adhesive.QUIK GLUE - (formerly known as Coyote Quick Adhesive)

Phone (208) 429-0026 | www.coyotedesign.com

Now in Two Sizes50cc and 220cc

IT STICKSWe’re not pulling your leg

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1111 W. San Marnan Dr.PO Box 1467

Waterloo, IA 50704800-214-6742www.opga.com

www.pointhca.comA Division of

VGM Group, Inc.