That's one happy baby! So Fiona Weber is almost one year old. Jimmy Weber introduced us to this little bundle of joy last year when he first brought her home from the hospital. Thanks for the recent picture Jimmy. It looks like you're doing a great job!
Widespread Prepayment Probe for HCPCS Codes L0631 and L0637 (Lumbar-Sacral Orthoses)
DME MAC A will be initiating a widespread prepayment probe of claims for the following HCPCS codes:
L0631 (LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT)
L0637 (LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT)
This review is being initiated due to a high volume of claim errors identified by the Comprehensive Error Rate Testing (CERT) contractor.
Per the Local Coverage Determination (LCD) for Spinal Orthoses: TLSO and LSO (L11470):
HCPCS Code L0631and L0637 is covered when it is ordered for one of the following indications:
To reduce pain by restricting mobility of the trunk; or
To facilitate healing following an injury to the spine or related soft tissues; or
To facilitate healing following a surgical procedure on the spine or related soft tissue; or
To otherwise support weak spinal muscles and/or a deformed spine.
If a spinal orthosis is provided and the coverage criteria are not met, the item will be denied as not medically necessary.
Suppliers will be sent a documentation request for information listed below. The requested documentation must be returned within 45 days from the date of the letter to avoid claim denials.
Documentation should include the following items:
Physician order for the item. Include both the dispensing order (if applicable) and the detailed written order which include the following elements:
Description of the item
Prescribing Physician's name
Date of the order and the start date, if the start date is different from the date of the order
Physician signature (if a written order) or supplier signature (if verbal order)
Information from the medical record that demonstrates the reasonable and necessary coverage criteria for the item(s) are met.
Proof of delivery with name, address and signature of the beneficiary or designee; the item(s) provided; date of delivery; and supplier identification.
Invoice(s) for the item(s) provided including manufacturer name and model number.
Any other pertinent information that would justify payment for the item(s) provided.
Advanced Beneficiary Notice (ABN) if one was obtained, this must be submitted with the above requested documentation.
To avoid unnecessary denials for missing or incomplete information, please ensure when submitting documentation requests that all requested information is included with your file and respond in a timely manner.
It is important for suppliers to be familiar with the coverage criteria and documentation requirements as outlined in the LCD and Policy Article. Suppliers can review the LCD for Spinal Orthoses: TLSO and LSO (L11470) and the related Policy Article (A23663) on the NHIC Web site at:http://www.medicarenhic.com/dme/medical_review/mr_lcd_current.shtml
Hely & Weber is now offering a new version of the TKO Boxer Fracture Splint. This boxer fracture splint can now be ordered in the intrinsic plus position - meaning it is prebent specifically for the ulnar gutter application.
This modified product is so cool, just open the box and put it on, it places the boxers fracture in the practitioner preferred position for fractures of the 4th and 5th metacarpal, and is easily modified when necessary. The Prebent TKO is perfect for urgent care or ER nurses who simply “hate” to apply a typical ulnar guttar splint.
You know her, but you may not recognize her. You speak with Leticia Lopez just about everytime you call Townsend Design. She is the friendly receptionist that thanks you for calling and connects you with whomever you are trying to reach in regards to your knee braces.
Leticia recently finished the Tinkerbell half marathon along with 12,000 of her closest friends at Disney. They ran to raise money for the Leukemia and Lymphoma Society. And what a success! They raised over $200,000!
Check out Patrick Dempsy sporting the Titan Thumb brace. Dr. Shepherd on Grey's Anatomy knows a good orthopedic splint when he sees one. Look how happy he is wearing that universal lacing wrist thumb hand orthosis.
Doug Reber, NJAAOP Committee Member, recently sent an email that explained:
"In light of the natural disaster that has struck New Jersey and Atlantic City in particular the Board and Directors of NJAAOP has decided to cancel our meeting scheduled for next week November 7-9, 2012. It was a difficult decision, but we believe it was the correct one, considering the statewide impact of this unprecedented storm.”
We will be refunding all registration fees. Please give us some time to process the paperwork as we file a claim on our Event Insurance Policy.
We will be back next year!!!!!! And, we hope to see you all there.
We wish everyone that has been affected by this recent storm all the best. These are difficult times. Our thoughts and prayers are with all of you.
Arlington, VA - The Virginia Orthotic and Prosthetic Assoication (VOPA) held its first annual meeting last week at the Sheraton Pentagon City. The meeting offered a full compliment of orthotic and prosthetic courses and a day-long Medicare Bootcamp to help practitioners with the compliance issues hampering so many practices.
The exhibit hall (pictured above) was situated alongside the meeting rooms and saw steady traffic throughout the entire meeting. The meeting space was located on the top floor of the hotel and the exhibit hall offered a panoramic view of Washington DC. The meeting space outclassed any O&P event this year.
"We worked hard to get the most relevant speakers to present course material," said Elizabeth Mansfield, VOPA meeting planner. "The Medicare Bootcamp attracted practitioners from as far away as Los Angeles." Virginia practitioners came from all over the state: Norfolk, Virgina Beach, Newport News, Roanoke, and Richmond were all represented.
"It was good to see all these new faces." Said Tony Culver from Grace Prosthetics. "And as a vendor it was great to spend some time in Arlington and Washington DC. The local restaurants were awesome - great onion rings! I even won a Kindle at the silent auction."
Anthony Velasquez, owner of US Orthotics said, "This was a well organized meeting with an impressive turnout."
The Affordable Care Act (ACA) established a 2.3% federal excise tax on medical devices, to be administered by the IRS and Treasury. This tax will pay for some of the costs related to the new law. The tax is effective in January, 2013.
On June 7, the Republican majority U.S. House voted to repeal this tax. But the matter faces a much larger challenge in the Democratic majority Senate. The President has also promised to veto the House bill. Under congressional rules, the only way to eliminate this as a provision of the law is to identify “offsets” that would create another way to raise the same amount of money as the medical device tax.
This tax presents significant risks of tax to both O&P component suppliers as well as patient care facilities. The tax applies to a “finished device” -- so it should not be applicable to components, only fully fabricated devices. In some cases the tax would be paid by a manufacturer that ships a finished product, and in other cases, it would need to be paid by an O&P provider that fabricates all or a portion of the device in their shop.
AOPA has been lobbying Congress for the past year with the objective of exempting O&P component suppliers and patient care facilities from this excise tax.
While AOPA -- and other medical device manufacturers -- support repeal of the entire tax, AOPA feels there is a clearer path, unique to O&P, that could allow for exemption due to language in the ACA law that exempts devices delivered at retail to an individual patient for their own use.
For example, eye glasses and hearing aids are specifically exempted related to the retail, individual patient use provision.
AOPA began its dialog with the IRS and Treasury in early 2011, trying to provide an overview on O&P, how devices reach the individual consumer/patient, and why O&P devices qualify under the retail exemption. AOPA also identified there are existing FDA regulations for medical devices which describe “retail O&P patient care facilities” meaning there is prior identification that O&P is defined as retail.
Treasury published draft regulations in February which seemed to indicate favorable treatment to O&P, seemingly granting AOPA’s requested eligibility for retail exemption -- but leaving a few aspects that required clarification.
AOPA submitted comments to Treasury endorsing Treasury’s preliminary opinion to exempt O&P, but also seeking expansion of the exemption to include manufacturers. The reasoning behind this is that the retail exemption for O&P facilities would be thwarted if the tax were to be applied anywhere higher in the distribution chain -- i.e. if the manufacturers/suppliers were taxed, then the manufacturers/suppliers would likely pass on the cost to the patient care facilities through increased prices. The O&P facilities would have to try to pass these costs onto the patient or absorb the added cost because their are assigned rates of reimbursement associated with billing codes.
AOPA testified at public hearings held by IRS/Treasury in May, reinforcing these same points. The ball is back in the IRS/Treasury’s court. AOPA seems to be confident that there will be some form of exemption for O&P providers and potentially manufacturers as well. But the government’s final decision isn’t predictable or guaranteed to exempt O&P patient care facilities, and the provision to exempt manufacturers is even less certain.
It is interesting that O&P providers could get exempted, but other providers (physician offices, PT clinics) that dispense single patient use devices may not have a similar exemption. Since these other medical entities do not routinely fabricate braces, they probably wouldn’t have to directly pay the excise tax to the government. Rather, it would be the manufacturer that ships them a finished product that would be responsible for paying the excise tax. It is unlikely that the manufacturers will be able to absorb the full cost of the tax, and will likely make adjustments to their pricing.
One of the complicating provisions seems to indicate that the tax applies to the list price of the device, not the selling price (discounted charges). This could be intended to prevent manufacturers from finding creative pricing strategies to try to minimize the amount of the excise tax.