SADMERC to Rescind Policy on Prefabricated Orthoses Add On Code

NAAOP is pleased to report that its efforts, and the efforts of other O&P organizations, to challenge the SADMERCÂ’s recent coding decision regarding add on codes have been successful. NAAOP has verbally confirmed that the SADMERC will rescind its policy prohibiting the use of add on orthotic codes in conjunction with prefabricated orthotic base codes. This represents a clear victory for NAAOP and the O&P community in maintaining quality orthotic care.

Officials with the SADMERC stated during a recent conference call that “A formal article rescinding the advisory is forthcoming and a clarification letter will be issued in the next publication cycle.” Pursuant to this statement, the advisory was removed from the SADMERC website and the SADMERC will continue to work on this issue and make recommendations to add on codes where appropriate.

On December 23, 2003, NAAOP wrote to the SADMERC and DMERC Medical Directors, stating that the new “coding clarification” policy would adversely impact practitioners and the Medicare program, and would deprive patients of necessary options that enhance the comfort, stability, and, most-importantly, function of orthoses.

Not only does the action by the SADMERC to rescind the advisory elimination the immediate reimbursement impact of the decision, it also eliminates the need to challenge the process in which the coding advisory was issued. The SADMERC originally issues this advisory without following proper notice and comment procedures. Had the coding advisory been allowed to stand, additional policies may have been issued in the future using the same flawed procedure and averting proper notice and comment guidelines.

Please join NAAOP today to ensure that we are able to remain active and vigilant on behalf of the O&P community. Please contact NAAOP at (800) 622-6740 or on the web atwww.naaop.org.

  • Written by NAAOP

O&P Facilities’ Obligation to Provide Interpreters

“In a response to the message sent on the listserve regarding an O&P facility’s obligations to provide interpreters to deaf or hard of hearing patients, the following describes an O&P facility’s rights and responsibilities under the Americans with Disabilities Act of 1990 (“ADA”).

O&P facilities are considered “public accommodations” under Title III of the ADA, regardless of the size of the business or number of employees. As a public accommodation, an O&P facility has a responsibility to provide “effective communication” through its policies and procedures with the public, including patients. “Effective communication” does not require the provision of an interpreter for every patient who requests it or who is deaf or hard of hearing. In many instances, note taking and the use of other auxiliary aids and services to achieve effective communication are perfectly acceptable. However the complexity of the communication is largely what determines what form of communication would be considered “effective.” For a routine patient encounter, an interpreter is not required absent extenuating circumstances. However, if the patient encounter involves a more complex set of communications and consideration of more complicated issues, an interpreter may well be required by the ADA.

If the patient requests an interpreter, the practitioner should engage in a dialogue with the patient and/or his/her representative or family members to arrive at the method of communication that suits the particular needs of the patient and the circumstances of the patient visit.

If an interpreter is determined to be required, the O&P facility is obligated to pay for the interpreter entirely and may not impose a surcharge on the patient, even if the reimbursement for the patient service is less than the cost of the interpreter needed for that patient visit. The cost of interpreter services are measured against the revenues of the entire operation, not against the individual requiring the interpreter. In other words, the provision of interpreters or other auxiliary aids and services to deaf and hard of hearing patients is a cost of doing business with the public.

This response is provided to the O&P community as a service of the National Association for the Advancement of Orthotics and Prosthetics (NAAOP). Although drafted by NAAOP’s General Counsel, Peter W. Thomas, it does not constitute legal advice.”

  • Written by NAAOP

House passes a $45 billion legislative package impacting federal health care programs.

This afternoon, the House passed a $45 billion legislative package impacting taxes, trade and federal health care programs. The package now goes to the Senate for consideration.

The massive bills were quickly compiled over the last several days by Senate and House Republican leaders and, among other things, would prevent a scheduled 5% cut in Medicare physician payments in 2007, freezing payments at their current levels. Beginning in July 2007, physicians could receive 1.5% bonus payments in exchange for submission of data on quality measures.

Of importance to NAAOP, the legislation would not cut the O&P Medicare fee schedule and, therefore, O&P will maintain its 4.3% update in 2007. Also, in terms of disability-related policy, the legislation would extend the Medicare therapy cap exception process for an additional year, allowing beneficiaries requiring extensive therapy services to exceed the current Medicare therapy limit.

In order to pay for the physician payment freeze and other costly provisions, lawmakers are targeting the Medicare Modernization Act’s (MMA) “stabilization fund” – set up to entice insurance companies to participate in the Medicare prescription drug program. Other cost-saving provisions include a .5% reduction in Medicaid provider taxes (preempting expected CMS regulations that would have cut payments by 3%) and an “audit program to identify and collect on inaccurate Medicare overpayments and underpayments to specialized contractors.”

During House debate, many Democrats raised concern regarding the procedures and timeframe surrounding consideration of the bill. However, the legislative package is expected to face much greater opposition in the Senate from Members who oppose several of the trade provisions as well as some of the high cost items. Senate rules technically allow debate on the measure until Sunday, but leadership is hoping that they will be able to invoke cloture earlier than that.

We will keep you updated as developments occur.

For a copy of the summary of the healthcare provisions in the bill provided by the House Ways and Means Committee, please contact NAAOP at info@naaop.org.

  • Written by NAAOP