Here at O'Connor Orthopedics we fabricate prosthetic and orthotic devices to each individual patients needs taking into consideration their age, physical condition, work, activities and lifestyle. As well we believe in having our patients tell us their desires and needs that they would like to achieve. All of this helps us derive a better outcome for the patient. Using components from all over the world we are able to fabricate our patient’s appliances here in our own laboratory to best fit their needs.
We are a nontraditional facility in that we do not manufacture our limbs as most prosthetists in the United States do, but rather we take our influences from prosthetic work from all over the world. Our prostheses and orthoses look different and feel different. We encourage you to visit our offices and talk to us about your needs and desires.
The National Association for the Advancement of Orthotics and Prosthetics has done a great job keeping the Orthotics and Prosthetics industry up to date on the Healthcare Reform act otherwise known as Obamacare. Please read the entire article below which does a great job summarizing what is taking place.
The U.S. Supreme Court announced its decision in the Affordable Care Act (ACA) case on Thursday, June 28, 2012. The Court upheld the individual mandate as constitutional based on the fact that the penalty—that individuals will be required to pay if they do not have health insurance—is a “tax.” Congress has extensive authority to regulate taxes on individuals. The other major holding is that states will have a choice in deciding whether to participate in the Medicaid expansion detailed in the ACA without jeopardizing their existing Medicaid matching funds for their Medicaid population.
There were many ironies and surprises in this decision, which totals over 125 pages between the majority and dissenting opinions. Chief Justice Roberts joined the liberal block of four justices to render this 5-4 decision, while Justice Kennedy, who was widely expected to be the “swing” vote, dissented along with the conservative block of justices and would have stuck down the entire law. Of course, this issue is highly politically charged and Republicans in the House have already scheduled a vote to repeal the entire law for mid July. This is expected to pass the House but stall in the Senate. Therefore, the fate of health care reform moves to the Presidential election, where the American people will decide whether to effectively support or repeal the law through their electoral decision.
From an O&P perspective, there is little that specifically impacts the field. However, there are many regulatory developments and trends that will impact all of health care, including O&P:
• ACA regulations are expected to be accelerated, especially the essential health benefits regulation that determines the level of O&P coverage in the state-based exchanges;
• Accountable Care Organizations (ACO’s) and other payment bundling mechanisms will pick up speed as these new delivery models are solidified and implemented;
• States legislatures and Governors will quickly turn to development of their state-based insurance exchanges and the design of their new health insurance markets which will prohibit discrimination based on health or disability status;
• The federally facilitated exchange (which applies in states that choose not to create their own exchanges) will receive significant attention as 2014 nears;
• The medical device tax and other revenue provisions of the ACA will begin to take effect although Congress will continue to find ways to lessen the impact of these provisions; and finally,
• O&P Medicare reimbursement will not be thrown into disarray (which would likely have occurred if the law were struck down).
NAAOP will continue to keep its members informed as developments on this issue occur.
O'Connor Orthopedics is now offering Expert Witnessing services in the Orthotic and Prosthetic fields. Rod O'Connor is a CPO and has been practicing for over 20 years. With so much experience in Orthotics and Prosthetics he has found that offering his expert opinion can often be helpful in a variety of cases. Lifetime estimated cost of goods can be calculated quickly and clearly using advanced coding software. After only a short time Rod O'Connor has been brought on as an advisor for over 30 cases. The cases included everything from lifetime cost of good in both Orthotics and Prosthetics in cases across the country including Orange County, Los Angeles County, and back east as well.
On top of offering Expert witnessing we can also asses a patients needs if you are concerned that a patient is not getting his or her needs met. Rod is open to talking with patients about what their best needs are and will also talk with attorneys about what may be best for their clients.
Please call us at 714.635.2650.
We do have a full service Orthotics and Prosthetics location in Anaheim, Ca and Irvine, Ca to serve Orange County, Los Angeles County, and Riverside County.
O'Connor Orthopedic & Prosthetic is now fully trained on using the all new Endolite Orion MPK knee and the all new Elan foot. Both are fully controlled by microprocessor's and now can work together to improve gait and patient safety. The Orion MPK adjusts to the patient's walking speed so that more active patient's can be assured that their prosthesis will no longer hold them back from any activities. Using computer programming we can adjust the dynamics of the knee to fit the patient's needs better than any knee before.
The Elan foot and ankle is not only an energy returning carbon fiber foot but also a computer controlled hydraulic ankle that adjusts to uneven terrain and provides active dorsi-flexion during swing phase as well as automatically adjusting to changing shoe heel heights.The elan is also an amazing choice for transtibial (below knee) amputees as it is proven to improve gait so that you can walk all day without burning out.
When used together the Endolite Elan & Orion are an unstoppable combination for any above knee amputee and O'Connor Orthopedic & Prosthetic is now fully trained and fitting patients with them. Please call us for more information or a free consultation.
Recently Medicare's PDAC (Pricing, Data Analysis, & Coding) department has instituted a variety of new regulations for any DMEPOS vendors that may or may not supply medicare patients with custom articulating AFO's (L1970), custom spiral AFO's (L1960), and custom AFO (L1940). These new LCD (Local Coverage Determinations) require that any DMEPOS supplier that wants to bill Medicare prove to medicare that they are supplying Medicare patients with a device that actually is one of the above devices.
Starting September 1rst, all DMEPOS providers must submit to Medicare the process in which they manufacture each of the above devices so that Medicare can verify it is being made appropriatlycorrectly. This regulation follows an already long list of LCD requirements that Orthotic and Prosthetic providers across the nation must follow to bill medicare.
O'Connor Orthopedics is working closely with the PDAC review department to make sure we are certified to bill these codes by September 1rst. Our Coding verification Applications have already been sent in and the PDAC review board has notified us that they did receive them. Please contact us if you have any questions about what is going on in Medicare Region D within the Orthotic and Prosthetic domain at Admin@OConnorOrtho.com.
BELOW IS THE ACTUAL ARTICLE POSTED BY PDACDMEPOS.
Coding Verification Reviews for Custom Fabricated Ankle-Foot Orthoses
Recently the Durable Medical Equipment Medicare Administrative Contractors (DME MACs), in conjunction with the Pricing, Data Analysis and Coding (PDAC) contractor, have added coding verification reviews for various products to the Local Coverage Determinations (LCDs) and related Policy Articles. Questions have arisen about what manufacturers or suppliers must submit when responding to a coding verification review for a custom fabricated item.
A custom fabricated item is one that is individually made for a specific patient. No other patient would be able to use this item. A custom fabricated item is a device which is fabricated based on clinically derived and rectified castings, tracings, measurements, and/or other images (such as x-rays) of the body part. The fabrication may involve using calculations, templates and components. This process requires the use of basic materials including, but not limited to plastic, metal, leather or cloth in the form of uncut or unshaped sheets, bars, or other basic forms and involves substantial work such as vacuum forming, cutting, bending, molding, sewing, drilling and finishing prior to fitting on the patient.
There are two categories of custom fabricated items and the requirements for submission of samples differ:
Custom fabricated by a manufacturer/central fabrication facility: These items are constructed by a manufacturer or central fabrication facility and then sent to someone other than the patient. Manufacturers must send a representative sample of a completed product and a description of their custom manufacturing process to the PDAC. Once reviewed by the PDAC staff and correct coding is determined, this category of custom fabricated items will be listed on the PDAC’s Durable Medical Equipment Coding System (DMECS).
Custom fabricated by a supplier: These items are individually fabricated by a supplier from raw materials and are dispensed directly to the patient by the entity that fabricated the orthosis. For coding verification, the supplier must submit written documentation that lists the custom Ankle-Foot Orthosis (AFO) manufacturing processes and all components that will be a part of the base code for that AFO orthosis. The supplier must provide a narrative description of the item to include anatomical reference points, a list of the materials that were used and a description of the custom fabrication process (including photos of the process) used for this type of orthosis. These custom fabricated items must be listed on the PDAC’s DMECS in order to be billed using a custom fabricated code.
Custom AFOs which currently require a coding verification review are:
ANKLE FOOT ORTHOSIS
ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, CUSTOM-FABRICATED
Mike Schultz is an adaptive athlete that has deisnged his own prosthetic knee to enable himself to race motocross after a traumitc amputation. This young man refused to give up his dreams of racing even after facing very tough circumstances. His FOX Racing shock custom knee is designed to be used on a motocross bike and as you can see by video he has not slowed down. It is inspirational to see people out there with determination like Mike's.
Today we delivered Dan Ruth's below knee prosthesis. Dan is a very active man who works in the garage building custom Hot Rods and racecars. Dan lives outside Phoenix Arizona and travels all the way to us to get what he considers the best prosthetic legs. We built dan an ultra light weight carbon fiber socket with the Ossur Icelock 600 titanium system, the Ossur TotalShock pylon and the Ossur VariFlex LP foot.
After receiving the leg and wearing it for a few days Dan wsa nice enough to send us a letter stating how great the leg is and that "The socket fits GREAT and the workmanship is SUPERB!!!!" So excited to hear that Dan is loving his new leg.