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AOPA is pleased to offer the attached letter of support for the issue for
which Tony Barr has so ardently campaigned. Also attached are two documents
that AOPA members carried to Capitol Hill in March to rally congressional
support for the idea of defining who can bill for custom orthotic and
prosthetic services. (The attachments are fairly long, so I would suggest
reading them from a printed copy.)
I sincerely hope that this will end the unseemly discussion about who “really”
cares. Instead, I hope that others will join in the discussion about the
issue at hand and how we can make it happen — together. Thank you all for
your patience and understanding.
Bob Van Hook
Robert T. Van Hook, CAE
Executive Director
American Orthotic & Prosthetic Association
1650 King Street, Ste. 500
Alexandria, VA 22314
Phone: 703/836-7116
Fax: 703/836-0838
email: [email protected]
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{pntxtb (}{pntxta )}}pardplain widctlpar f4fs20 {fs24 April 21, 1
998
par
par Mr. Anthony T. Barr, Director
par The Barr Foundation
par 136 NE Olive Way
par Boca Raton, FL 33432
par
par Dear Mr. Barr:
par
par Thank you for your letter of March 26, 1998, requesting the support
of the American Orthotic and Prosthetic Association (AOPA) for the Barr F
oundationrquote s efforts ldblquote
to develop and pass legislation requiring federal standards for practitio
ners providing O&P services.rdblquote
par
par I am enclosing two position papers that call for legislation to ldb
lquote limit access to custom orthotic and prosthetic codes to qualified
O&P providers.rdblquote
Because Medicare pays facilities, not practitioners, for O&P services,
AOPA thinks it is important to establish standards for O&P facilities, as
well as for the practitione
rs that practice in them. AOPA is working with members of Congress to dev
elop legislation to accomplish this goal.
par
par AOPA is pleased to join with the Barr Foundation in the fight agains
t Medicare waste, fraud and abuse. We strongly support the need to dev
elop and pass legislation requiring federal standards for practitioners a
nd facilities providing O&P services by limiting access to custom orthoti
c and prosthetic codes to qualified O&P providers.
par
par AOPA is pleased to support your efforts. We hope that we can count
on your support in passing the legislation that will be introduced in the
near future.
par
par Thank you for your efforts on behalf of the users of O&P services.
par
par Sincerely,
par
par
par
par William W. DeToro, CO
par President
par }pardplain s1keepnwidctlpar f4 page March, 1998
par pardplain widctlpar f4fs20 {fs24
par
par
par Attached are the AOPA materials that illustrate the organizationrqu
ote s message on important legislative and regulatory issues. These pape
rs were distributed to Members of Congress during the recent AOPA Policy
Forum held in Washington, DC.
par
par The primary messages are simple:
par
par {pntextpardplainf1 ‘b7tab}}pard fi-360li360widctlpartx360
{*pn pnlvlbltpnf1pnstart1pnindent360pnhang{pntxtb ‘b7}}{fs24
The O&P profession helps people. O&P devices are custom devices and a hig
h level of skills is required to provide them.
par }pard widctlpar{*pn pnlvlcontpndec }{fs24
par {pntextpardplainf1 ‘b7tab}}pard fi-360li360widctlpartx360
{*pn pnlvlbltpnf1pnstart1pnindent360pnhang{pntxtb ‘b7}}{fs24 Su
ppliers without the necessary skills and facilities are providing many hi
ghly technical custom O&P services.
par }pard widctlpar{*pn pnlvlcontpndec }{fs24
par {pntextpardplainf1 ‘b7tab}}pard fi-360li360widctlpartx360
{*pn pnlvlbltpnf1pnstart1pnindent360pnhang{pntxtb ‘b7}}{fs24 If
Congress wants to impr
ove the quality of patient care and curtail waste, fraud and abuse in O&P
, it should establish educational standards for O&P practice and ensure t
hat all custom O&P care billed under the L-codes is supervised by qualifi
ed professionals.
par }pardplain s1qckeepnwidctlpar f4 page {bfs28 How to Elimin
ate Fraud and Abuse of
par Orthotic and Prosthetic Devices
par }pardplain widctlpar f4fs20 {fs24
par }pardplain s17widctlpartx-720hyphpar0 f4expndtw-2 {expnd0e
xpndtw-3
In its 1994 report on “Medicare Payments for Orthotic Body Jackets” the H
ealth and Human Services (HHS) Office of Inspector General (OIG) consulte
d with certified orthotists to determine the purpose of a
body jacket and how one should be constructed. And the OIG determined th
at, ” [T]he non-legitimate body jackets in our sample were supplied by Du
rable Medical Equipment (DME) suppliers that primarily supply DME equipme
nt and supplies, not orthotics.”
par }pardplain qjwidctlpartx-720hyphpar0 f4fs20 {fs24expnd0ex
pndtw-3
par }pardplain s17widctlpar f4expndtw-2 {expnd0expndtw-3 The rec
ent OIG report on ldblquote Medicare Orthoticsrdblquote found, ldblqu
ote [D]urable medical equipment companies are more likely than orthotists
to supply questionable orthotics.
rdblquote
par }pardplain widctlpar f4fs20 {fs24
par }pardplain s2keepnwidctlpar if4 Require Qualified Providers
par pardplain widctlpar f4fs20 {fs24
par }pardplain s16widctlpar f4 {expnd0expndtw-3 The critical diff
erence between the DME and the O&P
provider is the level of education and training needed to provide compre
hensive O&P services. Comprehensive orthotic and prosthetic care require
s highly specialized and trained practitioners who design, fit and fabric
ate a customized artificial limb or
orthopedic brace for the particular needs of each patient.
par
par The American Board for Certification in Orthotics and Prosthetics (A
BC) offers a high level of credentialing standards for orthotists and pro
sthetists and accreditation for O&P facilities. It is t
he most stringent and widely recognized credentialing organization for O&
P services.
par }pardplain widctlpar f4fs20 {fs24
par }pardplain s2keepnwidctlpar if4 Limit Access to Medicare L Co
des
par pardplain widctlpar f4fs20 {fs24
par }pardplain s15ri612widctlpar f4
AOPA believes it is essential to recognize provider credentials in the de
livery of quality O&P care when attempting to legislatively stem fraud an
d abuse in the Medicare program. It is our position that one of the mos
t effective ways to check fraud and
abuse would be to limit access to the custom orthotic and prosthetic code
s to qualified O&P providers.
par pardplain widctlpar f4fs20 {fs24
par }pardplain s17widctlpartx-720hyphpar0 f4expndtw-2 {expnd0e
xpndtw-3 If reimbursement of O&P service
s were limited to qualified orthotists and prosthetists who are certified
to provide these services, the Health Care Financing Administration (HCF
A) would dramatically reduce the likelihood of future incidents of fraud
and abuse similar to the body jacket
situation.
par
par Page Two
par }pardplain s1keepnwidctlpar f4 How to Eliminate Fraud and Abus
e of
par Orthotic and Prosthetic Devices{expnd0expndtw-3
par }pardplain s17widctlpartx-720hyphpar0 f4expndtw-2 {expnd0e
xpndtw-3
par
par In addition, it would eliminate ldblquote double dippingrdblquote
by other providers who are paid a professional fee on top of the compreh
ensive L code fee. Reimbursement for L cod
es covers the cost of both the device and services component. The servic
e component includes casting, fitting, training, follow up visits and any
other additional service the beneficiary requires.
par
par
par }{iexpnd0expndtw-3 For more information contact Martha L. Rinker,
Director of Government Relations at 703/836-7116 or [email protected].
par }pardplain s1qckeepnwidctlpar f4 {bfs28 sect }sectd marg
tsxn3024binfsxn2binsxn2psz1linex0endnhere pardplain s1qckeepnw
idctlpar f4 {bfs28 How to Protect Medicare Beneficiaries
par }pardplain widctlpar f4fs20 {fs24
par }{fs24expnd0expndtw-2 The relationship between an orthotist/prost
hetist and the individual under his care is a very special one that trans
cends geography
, social class and the ability to pay. The orthotist/prosthetist establi
shes and continues a long, sometimes lifetime relationship with a patient
. Such a relationship is special because the individual depends on the p
ractitioner for mobility, comfort an
d dignity. The practitioner enters into a very close relationship during
which the practitioner must monitor physiological changes and other pers
onal conditions.}{fs24
par
par }pardplain s2keepnwidctlpar if4 Require Qualified Providers
par pardplain widctlpar f4fs20 {fs24
par }pardplain s16widctlpar f4 {expnd0expndtw-3
The critical difference between the DME and the O&P provider is the level
of education and training needed to provide comprehensive O&P services.
Comprehensive orthotic and prosthetic care requires highly specialized a
nd trained practitioners who design,
fit and fabricate a customized artificial limb or orthopedic brace for t
he particular needs of each patient.
par
par The American Board for Certification in Orthotics and Prosthetics (A
BC) offers a high level of credentialing standards for orthotists and pro
sthetists. It is the most widely recognized credentialing organization f
or O&P services.
par }pardplain widctlpar f4fs20 {fs24
par }pardplain s2keepnwidctlpar if4 Limit Access to Medicare L Co
des
par pardplain widctlpar f4fs20 {fs24
par }pardplain s2keepnwidctlpar if4 {i0
AOPA believes it is essential to recognize provider credentials in the de
livery of quality O&P care when attempting to legislatively stem fraud an
d abuse in the Medicare program. It is our position that one of the mos
t effective ways to check fraud and
abuse would be to limit access to the custom orthotic and prosthetic code
s to qualified O&P providers.
par }pardplain widctlpar f4fs20 {fs24
par }pardplain s2keepnwidctlpar if4 Eliminate Limits
par pardplain widctlpar f4fs20 {fs24
par }pardplain s17widctlpartx-720hyphpar0 f4expndtw-2
Coverage for all orthotics and prosthetics must include the following: ac
cessories and supplies which are used to achieve the therapeutic benefits
or to ensure the proper functioning; replacements when required because
of irreparable damage, wear, loss or
change in the patient’s physical condition; and repair and replacement.
par pardplain qjwidctlpartx-720hyphpar0 f4fs20 {fs24expnd0exp
ndtw-2
par }pardplain s1keepnwidctlpar f4 sect sectd margtsxn3024binf
sxn2binsxn2psz1linex0endnhere pardplain s1keepnwidctlpar f4 Pag
e Two
par How to Protect Medicare Beneficiaries
par pardplain s2qjkeepnwidctlpar if4 {i0
par }pard s2keepnwidctlpar
par pardplain widctlpar f4fs20
par pardplain s2keepnwidctlpar if4 Access to Qualified Provider
par pardplain widctlpar f4fs20 {fs24
par }pard qjwidctlpartx-720hyphpar0 {fs24expnd0expndtw-2 The org
anized field of orthotics and prosthetics believes that the patients’ fre
edom to choose a qualified O&P provider must be maintained.
par }pard widctlpar {fs24
par }pardplain s17widctlpartx-720hyphpar0 f4expndtw-2 line {i
expnd0expndtw-3 For more information contact Martha L. Rinker, Director
of Government Relations at 703/836-7116 or [email protected].
par }pardplain widctlpar f4fs20 {fs24
par }pardplain s15ri612widctlpar f4
par pardplain s1keepnwidctlpar f4 sect sectd marglsxn2880margt
sxn2880binfsxn771psz1linex0endnhere pardplain s1keepnwidctlpar
f4 Page Two
par Balanced Budget Act of 1997
par pardplain s2keepnwidctlpar if4 {i0
par }
par
par Surety Bonds
par pardplain widctlpar f4fs20 {fs24
par The BBA requires DME suppliers and home health agencies to secure a
surety bond by January 1, 1997. The regulations for the HHA bonds have b
een released.
par }pard li360widctlpar {fs24
par }pardplain s15ri612widctlpar f4 The draft Supplier Standards,
dealing with {ul all} Medicare Part B suppliers, has been released. The
Standards include a possible surety bond requirement for O&P providers
par
par AOPA supports the efforts of the Medicare program to stop fraud and
abuse, however it is our position that providers of custom O&P devices sh
ould be exempted from any surety bond require
ment. One of the most effective ways to check fraud and abuse is to limi
t access to the custom orthotic and prosthetic codes to qualified provide
rs.
par
par
par pardplain s17widctlpartx-720hyphpar0 f4expndtw-2 {iexpnd0
expndtw-3 For more information contact Martha L. Rinker, Director of Gove
rnment Relations at 703/836-7116 or [email protected].
par }pardplain s15ri612widctlpar f4
par pardplain widctlpar f4fs20
par }
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