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OPGA Member Magazine • SUMMER 2015

OPGA Attends SBA Hearing . . page 6

Finding New Referral Sources Key to Competitive Growth in O&P Market . . . . . . . page 9

PEL Continues to Make Business Easierand More Productive . . . page 4

We promised pictures and here they are. Highlighted within this issue are OPGA Members Sara Beck and John Tyo, testifying at the SBA’s recent Regulatory Fairness Hearing. Both Sara and John did a fantastic job of articulating the impact RAC audits are having on our businesses and the patients we serve. You can be assured their words resonated with the panel members. Please go to the OPGA website Government Relations, and read more about their testimony.

For 22 years, OPGA has been committed to advocating, educating and finding new ways to strengthen your businesses. Our success follows your success. As the number of providers of O&P care has decreased due to acquisition, mergers and closings, OPGA has held firm and continues to grow slowly year after year.

As of this publication there are 420 members with over 1,200 locations. These are big numbers and represent a large percentage of the independent O&P organizations across the country.

We are well positioned to represent the independent O&P providers and the politicians recognize it.

NEWS from the President

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Dennis E. Clark, CPO, President, OPGAYour Independent Partner in the Fight of Our Professional Lives

OPGA Dedicated to Members

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Table of Contents

Letter from OPGA President Dennis Clark ................................................................................................. 2

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

Pel Continues To Make Business Easier And More Productive ................................................................4 From PEL

PEL...................................................................................................................................................................... 5

OPGA Attends SBA Hearing ....................................................................................................................... 6

Testimony of Sara Beck at SBA Hearing ...................................................................................................7

VGM Market Data ......................................................................................................................................... 8

Finding New Referral Sources Key To Competitive Growth In O&P Market ....................................... 9By Ryan Ball, Director, VGM Market Data

Össur® ............................................................................................................................................................... 10

Össur® Custom Fabrication Option Helps CPs Maximize Their Clinical Effectiveness ...................... 11

Breg® ................................................................................................................................................................. 12

brightree ........................................................................................................................................................... 13

OPGA: A Business Case For Gender Equality ........................................................................................... 14-15By Karen Edwards, The van Halem Group u\

In Memoriam: Harry Browne ......................................................................................................................... 15

Recovery Audit Contractor: What it is and What it does ....................................................................... 16-17By Pam Felkins Colbert, JD, Senior Consultant, Vice President, The van Halem Group u\

APOPPS® .......................................................................................................................................................... 18

Comfort Products Inc. ...................................................................................................................................... 18

Liberating Technologies Inc. .......................................................................................................................... 19

Wright & Filippis and VGM Insurance Donate to Athletes with Disabilities Network ....................... 20

VGM Insurance ................................................................................................................................................ 21

ACOR® Introduces New Line of Orthotics ................................................................................................... 22

ACOR® .............................................................................................................................................................. 23

How to Get Past the Gatekeeper ................................................................................................................ 24By Jennifer Heller, VGM Corporate Specialties

Pure Stride® ..................................................................................................................................................... 25

Streifeneder USA ............................................................................................................................................ 26

Drew Shoe ........................................................................................................................................................ 27

M-Brace ............................................................................................................................................................ 28

Friddles ............................................................................................................................................................. 29

biodesigns, inc. ............................................................................................................................................... 30

Comfort Products, Inc. ................................................................................................................................... 31

Trulife Precision Pro OA Knee Braces ......................................................................................................... 32

Trulife Precision Hyperextension Braces ..................................................................................................... 33

KNIT-RITE 4-way Shrinker ............................................................................................................................. 34

KNIT-RITE Shrinker Private Logo Program .................................................................................................. 35

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On April 27, 2015, OPGA attended the SBA National Regulatory Fairness Hearing in Washington, D.C. This hearing is a forum for members of the small business community to present testimony on federal regulations impacting small business. The hearing was hosted by Brian Castro, the national ombudsman of the SBA, and the Region III Regulatory Fairness Board.

Two of OPGA’s members presented their testimony about how the RAC audits are decimating their small business. John Tyo from Syracuse Prosthetics in Syracuse, N.Y., spoke about his 149-year business history that dates back to the Civil War and how the audits may cause the failure to reach the 150-year milestone next year. John also brought a patient with him and explained that he has many patients who well deserve their prostheses, including a Paralympian, but Medicare is recouping his money.

Sara Beck of San Joaquin Orthotics & Prosthetics presented her testimony about the unfairness of the RAC audit system and her Freedom of Information Act request for data that illustrates the national company in orthotics and prosthetics is not being audited at the same frequency or for the same reasons as all other independently owned facilities.

Sara Beck gives her testimony

This testimony was emotional and resonated with many of the SBA board members, who approached our group after the hearing with additional questions and concerns. Castro promised continued work and communication with OPGA to help rectify our concerns with the audit program and make changes to help small business and independent providers remain in business to take care of their patients.

The following day, OPGA , John and his patient hit Capitol Hill and had a number of very productive meetings with congressional members. We encouraged Sen. Schumer (NY), Sen. Gillibrand (NY), and Rep. Katko (NY) to support O&P bills S.829, HR. 1530, and HR. 1526. We also spoke about the one limb per lifetime issue that has come up in the state of New York and additional changes to the RAC program that would help sustain independently owned O&P providers and would create a more level playing field for all.

OPGA Attends SBA Hearing

John Tyo and his patient meet with Sen. Schumer’s health legislative aide (above). At right, Mike and Sara Beck with OPGA at the White House.

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April 27, 2015

First, I would like to thank National Ombudsman Brian Castro and the Regulatory Fairness Board for providing me with the opportunity to participate in today’s national hearing. My name is Sara Beck and I am the office manager and appeals specialist for a small, independent orthotic and prosthetic company in Stockton, Calif. Prior to 2012, my office was a simple provider of orthotics and prosthetics. We were passionate about our patients’ care and dedicated to giving our patients a functional life worth living. My staff quickly became one family, devoted to providing not only physical restoration but emotional peace to our patients who also became part of our family unit.

Then, CMS audits stripped my business of its financial stability and devalued our compassion and dedication to their beneficiaries. Encountering an unprecedented amount of CMS audits, we, along with all small businesses, were faced with overwhelming anxiety and financial ruin. After surviving one of the worst times in my practice, I was, then, able to reach out to other providers across the country and communicate, in depth, with referring physicians. This is when the hint of a prejudicial audit system began to surface.

O & P is a community that includes a national provider. The remainder of the industry consists of small, independent businesses. I submitted two Freedom of Information Act requests to CMS to assure that there was a level playing field between all providers in the profession. When the data came in, I was astounded by its results. It showed that CMS targeted small, independent O & P facilities with high volumes of expensive audits, while leaving a national provider seemingly unscathed by the system. It is unknown, at this time, if there are other large corporations receiving this same treatment.

As a brief example, my small practice in Stockton received approximately 55 CMS audits totaling about $250,000 within a two-year period. Forty-seven of those audits were for high-dollar prosthetic claims. The national provider also has a facility in the same area. The data shows that office received 13 RAC audits, totaling a mere $6,251.26. No prosthetic claims were audited within a five-year period. This comparison makes clear that independent providers are being treated differently, whether intentionally or not.

This lack of oversight and internal accountability has allowed the CMS audit system to run out of control. This lack of restraint has not only proven to cost taxpayers unnecessary funds, but it has caused hundreds of small O & P facilities to close their doors, leaving business owners in debt and emotional turmoil. Small O & P businesses now have to attempt to survive the blatant discrimination of CMS audits. Here’s what we know now from the data. The CMS audit program has discriminated against and targeted independent orthotic and prosthetic providers because independent providers are receiving CMS audits for all high-dollar orthotics and prosthetics at a large volume; the large corporation is not. The affects of this uneven treatment is extensive and transcends many levels of our profession.

This data, if nothing else, proves just how broken the CMS audit system truly is and how it has fatally impacted small business. The audit program is not just merely flawed, but it is critically broken. Although CMS audits are necessary to ensure the preservation of our health care system, favoritism and unlawful discrimination is not.

My love for the admirable work performed by independent O & P providers has motivated me to speak out against this devastating problem. Our patients who depend on us to walk, to function, to live, continue to spark a fire inside of me to take a stand against such a blatant disrespect to independent O & P providers. Independent businesses have such a necessary purpose in the lives of our patients, and I refuse to accept Medicare’s attempt to erase that by granting favorable treatment to a large provider. I hope that my passion, corroborated by the FOIA data, ignites the drive inside of everyone in this room to take a stand for small, independent providers and save us from drowning in CMS’ sea of discrimination and inequality. Thank you for your time and attention to this matter. And, again, I appreciate the opportunity to share my story.

Testimony of Sara Beck at the SBA Regulatory Fairness Hearing

By Sarah Beck, San Joaquin Orthotics & Prosthetics

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Finding New Referral Sources Keyto Competitive Growth in O&P Market

By Ryan Ball, Director, VGM Market Data

Have you ever wondered how your competitors stay in business? If you are working with the key referral sources in town, who do they work with? In today’s world of providing custom orthotics and prosthetics, with audits, endless documentation requirements and declining reimbursement, independent O&P providers must leverage business from more physicians if we are to remain relevant and thrive in difficult times. Imagine if you could, at the click of a button, identify a list of the top referring physicians in your market?

To answer that question, we first needed to identify where referrals for orthotics and prosthetics originate. Over the past year, OPGA has conducted outreach to multiple members seeking input on what type of physician specialties typically make up their largest referral sources. The consensus was that orthopedic and vascular surgeons were the largest, followed by podiatrists, family practice, physical medicine and rehabilitation and geriatric physicians make up the vast majority of referral sources, but the frequency fluctuates depending on the individual market.

After determining the specialties of the most likely physicians that provide care to a patient in need of orthotic and prosthetic intervention, we then analyzed which procedures and diagnoses are most utilized by these types of physicians. The goal is to identify physicians treating patients from pre-surgery, through amputation and post-amputation follow-up care. Obviously the list begins with above and below knee amputations, revisions, upper extremity amputations, hip and ankle disarticulation, post amputation status codes, infections of the stump, diabetes and gangrene, to name a few.

With clinical research of target physician practices treating patients in need of O&P complete, we began to identify and rank key physicians based on the volume of procedures or

diagnoses attributable to their National Provider Identifier number. In addition to this inpatient and outpatient targeting data, we can now focus on claims being submitted by orthotic and prosthetic providers to determine the breadth of local competition and their relationships with key local physicians referring for O&P. Referral source claims data is available for virtually any HCPCS or L-code. Orthotic knee bracing, spinal bracing and lower limb prosthetics are some of the more popular categories for O&P providers to target.

The diagnostic and claims data utilized throughout this research came from an exciting new program called VGM Market Data. VGM Market Data is a new, physician-level DMEPOS claims data program offered exclusively to OPGA/Point members for orthotics and prosthetics. It offers access to the largest and most

comprehensive medical claims database in the United States to target key procedures, claims, products and referral sources.

Engaging key referral sources and increasing your brand awareness is more important than ever. Valuable physicians can’t send you business if they don’t know who you are and the benefit of working with you to manage the care of their prosthetic patients. At OPGA, we hold the strong belief that when an independent orthotist or prosthetist enters the care continuum of a patient, their health outcomes increase and the

overall cost to treat that patient decreases significantly. We have a great story to tell, and now we have the ability to target the physicians we need to grow our practices and help more patients.

Contact OPGA for more information about the VGM Market Data program or visit www.vgmmarketdata.com.

Ryan Ball is the director of the VGM Market Data program

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As the prosthetics industry continues evolving, CPs are increasingly focused on clinical patient care rather than the artisanal skills that once largely defined the profession. Quality craftsmanship and custom prosthetic solutions are still very much required, but today’s professionals also must grapple with new and increasingly complex documentation and reimbursement requirements, while simultaneously managing their patient care and practice operating costs.

Össur, a valued industry partner for more than four decades, is helping lead this transition by offering affordable, reliable and efficient lower limb prosthetic custom fabrication solutions. CPs who utilize Össur’s comprehensive outsourcing capabilities can find relief from the fixed costs -- and headaches -- associated with the substantial real estate footprint, expensive machinery, sophisticated air-handling equipment, and labor investments required for practice-based fabrication operations.

“Össur acquired Evolution Industries to provide a comprehensive range of cost-effective fabrication options to meet customers’ needs, so prosthetists may dedicate their time and resources to what they do best: clinical patient care,” said Craig Mackenzie, CP, RTP(c), director of operations, Össur Custom Fabrication.

Össur’s 37,000-square-foot facility features the most advanced design and fabrication technologies available today, including CNC carving and CAD design capabilities. State-of-the-art design and fabrication of lower limb prosthetic sockets is available nationwide in just 1-5 days and encompasses standard

materials like fiberglass and carbon fiber to specialty materials and designs like Synthex and Revolimb.

Customers can order everything from check sockets to definitive sockets and complete legs, and in configurations from Symes to hip disarticulation. Components from Össur or other manufacturers can be specified, or customers may supply their own components.

“Whether combining basic componentry or creating unique, complex configurations, our ABC-accredited fabrication operations can easily address whatever changes in volume occur, whether due to seasonal shifts in demand, staff changes, or practice growth” said Kim De Roy, CPO/PT, Össur’s vice president of sales, marketing and education prosthetics – Americas.

Co-located with Össur Custom Fabrication in Orlando, Fla., is Össur Academy, where Össur provides professional education and training for customers who want to maintain their own fabrication services, including regional fabrication operators across the U.S.

For more information, please visit http://www.ossur.com/ custom-fabrication

Össur Custom FabricationServices Help CPs Maximize Their Clinical Effectiveness

OPGA WILL BE EXHIBITING AT THIS UPCOMING MEETING

July 16-18 Alabama Prosthetic & Orthotic Association

We invite you to stop by our table and say hello!

David McGill, VP of Reimbursement and Compliance, Össur Americas

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OPGA: A Business Case for Gender Equality

When your business faces a change in your industry, it is always challenging to modify your business practices to keep up. As we have all seen with the recent RAC audits, the companies that are quickly responding and changing their documentation and billing practices are experiencing the most success. In keeping with that, as we face positive changes in the industry, the practices that adapt and are first to market with acceptance will also be the ones who reap the most reward. As you read in the Spring issue of OPGA Connection, the number of female practitioners in O&P has risen 748 percent in the past 20 years, and our O&P student population is now 52 percent female. This is an exciting influx of new talent. A more diverse practitioner pool, which brings with it new approaches and ideas, will make our industry even stronger. However, as an Össur survey of 133 female practitioners found, 56 percent of these professionals believe the O&P industry does not support gender fairness in the workplace. Successful companies want to be able to attract and retain high performers and continue to grow their business. Fair gender practices are now a fundamental part of achieving this.

As stated by the Australian Government’s Workplace Gender Equality Agency, “Gender equality is achieved when people are able to access and enjoy the same rewards, resources and opportunities regardless of whether they are a woman or a man. The aim is to achieve broadly equal outcomes for women and men, not exactly the same outcome for all individuals.”1

The business case for gender equality is strong. Studies show that fostering a workforce that promotes gender equality can help your organization to:

1. Attract the best employees – A company which is as attractive to women as it is to men will have access to the entire talent pool and is more likely to have a competitive advantage in attracting the best talent available.

2. Reduce cost of staff turnover – Both women and men are more likely to remain with an organization they view as fair. Additionally, replacing a lost employee can cost 75 percent or more of their annual wage. So by fostering

1. Workplace Gender Equality Agency, The business case for gender equality, www.wgea.gov.au

gender diversity, a company will retain staff and reduce the cost of turnover.

3. Enhance organizational performance – Multiple studies have shown that gender equality in the workplace and on teams working together brings diverse and varied perspectives which result in greater innovation, increased customers, and higher revenue.

4. Improve patient care – A strong, fair work environment filters down to your patients and the care they receive. An employee who is educated to recognize and eliminate biases will, in turn, be better educated to work with patients of both genders.

5. Minimize legal risks – A written and enforced sexual harassment policy combined with a respectful, fair work environment, reduces the risk of employee litigation and the likelihood of litigable events occurring.

6. Enhance your company’s reputation – O&P is a field where innovation and care for individuals is the hallmark of what we do and what attracts our patients to us. A company that exhibits and promotes its progressive, fair business practices as well as its technological innovation will be a leader in the field.

So how can your business improve its practices to ensure you are attracting and retaining the young professionals who will grow your business in the coming years?

Provide education to all staff on recognizing and eliminating unconscious biases. These “biases” are the unconscious ways we perceive and respond differently to the behaviors of others based on their gender (for some of the top biases, see the February 2015 Össur Women’s Leadership Blog, www.Ossur.com/OWLI).

Ensure management is trained to identify and deal with discrimination. And ensure the nondiscriminatory policies also apply to management.

Establish a policy that ensures that men and women are compensated equally. This includes equal pay for performing the same work as well as equal treatment for recruitment, training, hiring and promotion.

Establish a policy that strictly and specifically forbids any form of sexual harassment. Describe in detail the

Karen Edwards, Director, Össur Women's Leadership Initiative; Senior Area Manager, Prosthetics

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professional consequences that will result from harassment. Provide employees with an avenue for reporting such activity directly to human resources without fear of retribution.

Establish Family Leave policies. Work with your human resources department and management personnel to make sure that family leave is available to both men and women.2

Publicize your company’s efforts to promote gender equality. Promote your positive efforts and showcase your company’s successful female employees as proof. Make sure your customers and referral sources see you as an industry leader.

Recognize gender equality benefits everyone. The generation of practitioners currently entering the field has grown up experiencing and expecting more equality than ever before. And the majority of working men now also have a working spouse or partner; hence, they are more equal participants

2. Cindy White, Demand Media, http://work.chron.com/ promote-gender-equality-workplace-10258.html

in their household. Gender fairness supports and provides opportunities for everyone.

Join the Össur Women’s Leadership Initiative. O&P practitioners of both genders are encouraged to participate in OWLI (register at www.Ossur.com/OWLI) for free leadership training via blogs, webinars and more. The bottom line: There is an extremely strong business case for gender equality in O&P. Our profession is rapidly becoming more diverse. Making improvements in your business now will strengthen your current staff, attract and retain the best future staff, bring in new patients and referral sources, and allow your business to continue to grow.

The profession of prosthetics lost a tremendous asset recently with the passing of Harry Browne, CP, of Upper St. Clair, Pennsylvania, following a brief illness. Harry had been serving as the Director of Prosthetic Development for Trulife for the past

four years. Harry’s Trulife family is devastated by the sudden loss of a dear friend and colleague. For so many at Trulife he was a teacher, a resource, and a jovial travelling companion.

Prior to his time with Trulife, Harry was a clinician with Hanger Clinic in Pittsburgh, PA for seven years and Blatchford’s in England for over 20 years. Harry embraced the challenges and appreciated the satisfaction that comes with being a prosthetist - with a zeal few could match. He possessed so many of the traits that make a clinician effective. He was

intelligent and thoughtful, creative and clever, diligent and determined. Harry was a teacher at heart, often taking young practitioners under his wing and mentoring them as they embarked on their journey. The goal was always to improve the patient’s condition- whatever the starting point, he wanted them to be able to do more.

The lives of so many in the prosthetic community, certainly Harry’s Trulife family, but also his peers, colleagues and patients around the world are better because of Harry Browne! He truly left his mark on the Prosthetic world with his knowledge and intellect, his ability to teach, his delightful personality, and of course, his signature hair style! Harry will be missed, but never forgotten, by his Trulife family.

Harry leaves behind his beloved wife, Judith, and three daughters of whom he was so proud; Hannah, Lucy, and Freya. Trulife extends our heartfelt condolences to the Browne family during this most difficult time. The world has lost a true gentleman and a terrific “mate."

In memoriamHARRY BROWNE 1954 – 2015

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We’ve saved our clients over $25 million in overpayments and claim denials.

Real people with real solutions.

Real Solutions

for Real Risks

Is your business experiencing increased

audits and appeals?

We have the team of real people that can provide real help.

Whether you’re being audited or appealing, our team of former Medicare contractor employees can help with:

P Proactive claims audits to identify risks

P Reactive claims audits to respond to the government

P Help in ADR Responses and Tracking

P Appeal Preparation

Call us today for more information. 404-343-1815

By Pam Felkins Colbert, JD, Senior Consultant, Vice President, The van Halem Group

The Recovery Audit Contractor is a CMS Medicare contractor that identifies overpayments and underpayments (a rare find indeed!) to providers and suppliers. The RACs are NOT fraud and abuse contractors. Actually, if the RAC suspects or identifies fraud, it is to refer the matter to the ZPIC. The RAC began as a demonstration project from 2005 – 2008. CMS determined the project was very successful when it returned over $900 million in overpayments to the Medicare Trust Fund and $38 million returned to providers. Due to this success, the RACs became a permanent and national program in 2009 with four RAC jurisdictions.

In 2013, the RACs reported a $3.65 BILLION in overpayments collected and $102.4 million in underpayments repaid to providers and suppliers. The overpayments total do not include the costs, various levels of appeals, etc., which reduces the return to the Trust Fund (http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Downloads/FY-2013-Report-To-Congress.pdf)

The remarkable increase in RAC audits has put a huge financial burden on providers and suppliers to just respond, much less appeal these audits and have monies recouped until appeals are had. Unfortunately, appeals of RAC audits have overwhelmed the Administrative Law Judges also and their workload has hit an all-time high that is completely unsustainable. This backlog has resulted in a two-year wait just to be assigned an ALJ and at least another year for a hearing, while the RACs have the recouped funds.

CHANGE is on the way!For years, providers, suppliers, Congress and now the ALJs have complained about the RACs and the extreme volume of audits and appeals with a huge overturn rate. FINALLY, CMS is responding!

First, as CMS RAC contracts expired and were put out for bid in 2014, CMS “responded” to “industry feedback” and made numerous changes to the RAC program to be more effective and efficient. Some of the changes include:

• Enhanced oversight, reduced provider burden and more program transparency.

• Changes will be effective with each new contract.*

• As RACs are rebid, they will no longer audit all claims types.

• The RAC jurisdictions are rezoned from A, B, C and D to RAC jurisdictions 1, 2, 3, 4 and 5.

o RACs 1, 2, 3 and 4 will audit Part A and Part B claimso RAC 5 – National DMEPOS, Home Health and Hospice

• Dec. 30, 2014 award of the new National RAC for DMEPOS and Home Health and Hospice to Connolly, LLC.*

Second, CMS RAC “improvements” under the new contracts include:

• Additional Document Requests limits will be established based on a provider’s compliance with Medicare rules; lower denial rates will equal lower ADR limits, and providers with higher denial rates will have higher ADR limits. The ADR limits will be adjusted as a provider’s denial rate decreases.

• RAC look-back period will be limited to six months from the date of service versus the current three-year look-back period. (If hospital submits the claim the look back is three months from date of service.)

• ADR limits will incrementally apply to new providers under review.

• Broaden RAC topics for audit to include ALL claim/provider types.

• RACs will have 30 days to complete complex reviews and notify providers of findings.

• RACs must wait 30 days to allow for discussion with the provider before sending to the MAC for adjustment and must confirm receipt of discussion with provider request within three business days.

• RACs will NOT receive a contingency fee until after the second level of appeal is exhausted.

• RACs must maintain an overturn rate of less than 10 percent at the first level of appeal - excluding claims denied due to no or insufficient documentation or corrected during appeal process.

• RACs will be required to maintain an accuracy rate of at least 95 percent and failure to do will result in a progressive reduction in ADR limits. CMS will use a

Recovery Audit Contractor (RAC) – What is it and What has it Done?

We’ve saved our clients over $25 million in overpayments and claim denials.

Real people with real solutions.

Real Solutions

for Real Risks

Is your business experiencing increased

audits and appeals?

We have the team of real people that can provide real help.

Whether you’re being audited or appealing, our team of former Medicare contractor employees can help with:

P Proactive claims audits to identify risks

P Reactive claims audits to respond to the government

P Help in ADR Responses and Tracking

P Appeal Preparation

Call us today for more information. 404-343-1815 1717

validation contractor to assess RAC identifications and ensure accuracy of RAC automated reviews.

*ALL the NEW RAC contract awards are under bid protest. None of the RAC program changes will go into effect until the new contracts are finally awarded. The below link provides a full list of improvement changes for the RAC program (http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Downloads/RAC-Program-Improvements.pdf).

PROACTIVE Internal Audits = lower ADRs and fewer RAC auditsWith the coming changes to the RAC program, there is a great opportunity to reduce the time, money and risks dealing with RACs. While it may appear that having a National RAC for DMEPOS and Home Health and Hospice is not a “good” thing, we believe it will be very beneficial. Many contractors have no background and little understanding of the DMEPOS and Home Health and Hospice worlds. These areas have their own “language” in billing codes, as well as policies and procedures and coverage issues that many don’t know or understand. At least with this “specialty” RAC, they should have more expertise

and better understanding to perform audits, which will hopefully reduce the “nuisance” audits.

For all providers and suppliers, effective internal auditing and monitoring of your claims will reduce errors. If you reduce errors in billing, it will lower your denial rates. With lower denial rates, the RAC ADRs will be reduced accordingly. And remember, RACs are only paid if they recover an overpayment or an underpayment. If they don’t find errors and make overpayments in your claims, they’ll move on to the next provider or supplier. Finally, you now have some control and ability to reduce the number of RAC audits. Perform internal audits. KNOW your numbers. REDUCE your errors.

The van Halem Group, a division of VGM Group, Inc., has become the nation’s most respected Medicare consulting and auditing firm. Collectively, our leadership team has over 130 years of related experience. Since 2006, we have helped our clients navigate complex issues related to Medicare and Medicaid. We specialize in compliance, audits, investigations, medical review, appeals, enrollment, coding, education and training.

Learn more at www.vanhalemgroup.com

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Wright & Filippis and VGM Insurance Services Donate $1,000 to Athletes with Disabilities Network

VGM Insurance Services is celebrating its 25th anniversary by making a splash and helping providers give back to their communities.

As part of their Quarter Century of Caring campaign,

the insurance company is giving away a total of $25,000 throughout the year to companies that provide the most compelling nominations of a local charity. Now almost halfway through the campaign, VGM Insurance has already given away $12,000 to deserving charities across the nation!

“We’ve made it easy for O&P businesses to participate and make their case for donating to their local charities,” said Mike Kloos, president of VGM Insurance.

“This is an exciting opportunity to partner together for a good cause and a great way to celebrate 25 years of protecting and supporting our customers.”

A recent winner of one of the $1,000 donations was the Athletes with Disabilities Network of Rochester Hills, Mich. ADN was nominated by long-time OPGA member Anthony J. Filippis of Wright & Filippis.

The Athletes with Disabilities Network strives to promote a better quality of life for people with physical disabilities by creating awareness and offering opportunities to get involved with athletic, recreational and educational activities nationwide. ADN organizes a number of programs and scholarship opportunities including the Athletes with Disabilities Hall of Fame, the Extremity Games, as well as a Mentoring and Outreach program.

In his nomination, Anthony said that “My father, Tony Filippis Sr., established the Athletes with Disabilities Hall of Fame. I am currently the Board Chairman of ADN. Wright & Filippis has sponsored ADN for many years and will continue to do so in the future.

“ADN is my charity of choice because they serve many people who otherwise may not have the opportunity to participate in sports. Participating in sports helps people to mentally gain confidence, which leads to a higher quality of life,” Filippis stated.

VGM Insurance Services is still accepting nominations as part of their Quarter Century of Caring Campaign. All nominations will remain eligible throughout the year and providers may nominate a different charity each month if they so choose. To learn more about the campaign and to nominate your favorite charity, visit www.vgminsurance.com/25years.

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Anthony J. Filippis of Wright & Filippis (right) and Bill Wilson of VGM Insurance Services donating $1,000 to the Athletes with Disabilities Network of Rochester Hills, Mich.

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Acor Orthopaedic, established in 1972, is family-owned and operated, located in Cleveland, Ohio, and has been a leader in the custom molded footwear, prefabricated foot orthotics and fabricating materials market for over four decades. We have been a preferred supplier of custom molded footwear to the growing family of OPGA members since 2000, and now offer OPGA substantial discounts on our entire line of prefabricated foot orthotics and custom Gauntlet AFOs.

This year, Acor is introducing a new line of orthotics, our Sole Defense® EZ-Fit Orthotics. EZ-Fit Orthotics utilize advanced materials to increase support, improve cushioning and have an overall thickness that is 40 percent thinner than our traditional orthotics! This makes them easier to fit and ideal for a retail solution. Many options and price points are available.

Acor offers eight styles of gauntlets and three trim lines for reinforcement to suit all of your patient needs. Gauntlets can be lined with X-Static® fabric, the silver fiber for maximum protection and comfort. X-Static® is a pure silver fiber that is woven directly into the fabric and incorporated into our footwear, insoles and fabrication materials. Here are just a few of the excellent qualities of X-Static®:

• Kills bacteria: Stops bacterial and fungal growth without the use of harmful chemicals. X-Static® eliminates 99.9 percent of bacteria and fungi within one hour.

• Destroys odor: X-Static® naturally eliminates the growth of odor-causing bacteria, by binding with ammonia and denatured proteins, resulting in instant odor reduction.

• Defends against hot spots and blisters: Hot spots and blisters can occur due to heat buildup and friction. X-Static® evenly distributes heat throughout the silver fibers, thereby protecting your feet against these problems.

Acor® has also been known over the years for its many innovations and an exemplary selection of materials. Things like Tri-Lam®, P-Cell®, QuikFormable®, Microcel Puff®, QuikStrip™ Wheels, Skived Blockers and the use of X-Static® with their materials are all firsts introduced by Acor.

Speaking of firsts, PORON® XRD® is now available from Acor! XRD® stands for Extreme Impact Protection. It is lightweight material that is engineered to absorb up to 90 percent of energy when impacted under high strain rates. This product is infused with an anti-microbial protectant, which will help prevent the growth of bacteria that can cause stains and odors. Under the foot, the foam’s memory-like properties provide a contoured fit for each user. XRD® raises the bar when it comes to comfort, control and protection.

It is our goal to ensure that we provide every OPGA member with quality products, unparalleled service and timely deliveries, all at a cost-effective pricing structure. We are committed to our continued, long-standing relationship with the OPGA and hope to see each and every one of you at the AOPA show this September. You can view all of our products on our website www.acor.com and download our catalogs, or call one of our technical support representatives for a copy. Free samples of any of our prefabricated foot orthotics are available upon request for any OPGA member.

ACOR Introduces New Lineof Orthotics

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There it is again, that stony glare from the other side of the counter, the barrier that is the gatekeeper. Seemingly more difficult to get past than St. Peter, you approach in a friendly way with confidence that your products and services can help their patients. Yet again, no matter the niceties in their reply, you know where you were just told to go. You ask yourself, “Where did I go wrong?” “How do I gain entry?” “Are these visits worth my investment?” Very good questions, but the wrong ones, asked too late. Start with what you don’t know.

What’s their squidgy? A tough exterior at work doesn’t mean they don’t have a squidgy side. Get to know them better. Their squidgy is not just their softer side but their fun, adventurous and passionate sides outside of work. Be genuine, find something in common, don’t fabricate something in common and strive to evoke their squidgy. This approach can open doors.

How do I figure out their squidgy? Social media, of course! Even if their profile on Facebook is private there is still valuable intel. Is their profile picture a picture of a pet, car or destination? If they are on LinkedIn, you can get their previous job, university and community involvement information from their profile. Being in the same industry, you may even find a common LinkedIn connection you can ask for help.

Now translate the information you gathered into relationship building strategies that appeal to their squidgy, such as ask about their personal interests, an organization they support, or give them a thoughtful promotional product that speaks to their

personal interests, not their job duties. Taking a genuine interest in the gatekeeper’s squidgy can persuade them to help you reach your goal of assisting their patients.

A key contact appointment was your goal? The goal cannot be as short-sighted as an opportunity to close a sale. Insincerity has a way of bubbling to the top, deteriorating the relationship will ultimately lead your key contact to believe you cannot be trusted with their patients. Be sincere in all you do. Focus on the relationship and how you can benefit their business and patients; a generous nature will help you not only reach your goal but sustain it.

Has a poor first approach locked the gate? Eternity aside, the gates are not generally locked forever. How many times has a company you worked with failed to show up, so you called in a competitor? Simply being genuinely interested in their success and showing up can break down barriers. Circumstances change daily, if your company offers something unique (as it should) then eventually they may try to locate you. By providing a functional promotional product for use in their office, your information will be readily available when their need arises.

This evolved approach to selling means instead of working to get past the gatekeeper, you build genuine relationships by appealing to their squidgy, give thoughtful and functional promotional products and simply show up, which will help you work through the gatekeeper, transforming them from a barrier in to an advocate.

How to Get Past the Gatekeeper

By Jennifer Heller, VGM Corporate Specialties

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