PECOS and Health Care Reform Highlight Top Ten Medicare Changes

ORLANDO, Fla. — This year, Medicare implemented a number of changes as a result of the Patient Protection and Affordable Care Act (PPACA), also known as the health care reform bill. As a result of the PPACA, all Medicare files must be filled within 12 months of the date of service, Joseph McTernan, director of reimbursement for the American Orthotic and Prosthetic Association, said here.

Claims received after timely filing expiration will be rejected, he said at the 2010 American Orthotic and Prosthetic Association’s (AOPA) National Assembly.

Another result of PPACA is the impact of the medical device excise tax. This tax will likely have a greater effect on the manufacturing industry, according to McTernan. He noted that it is still an important tax for the O&P industry to keep an eye on in the future. The uncertainty of the health care reform bill has left the industry bracing for its inevitable impact, according to McTernan.

“About 90% of the health care reform legislation has yet to be regulated,” McTernan said. “We may not feel much of an impact this year or even 2011. We will probably feel its impact closer to 2012 and 2013.”

Medicare also required new knee orthosis L-code policy changes to L1832, L1843, L1845 and L1850. According to McTernan, knee instability must be documented by examination of the beneficiary along with an objective description of joint laxity. Also, L-codes L1810 and L1820 are now only covered when the patient is ambulatory and has weakness or deformity of the knee and requires stabilization.

Although admittedly unsure when the policy will actually go into effect, McTernan listed the Provider Enrollment Chain Ownership System (PECOS) as one of the top ten Medicare changes this year. The implementation date has been moved multiple times. Currently, the effective date is January 3, 2011. A referring physician must have an active PECOS enrollment record by that implementation date.

McTernan advised practitioners who have any questions regarding L-code policy changes or any other changes made this year to contact AOPA.


The Top Ten Series is different every year. It is always pertaining to the most pertinent topics of the O&P industry that year. The presenters are always energetic and we had another group of them this year that were just fantastic. I always seem to learn about a topic that I was otherwise unfamiliar with. Each year we continually strive to top what we did the year before. Everyone who attends the Top Ten Series is always impressed and so am I.

— Michael Burton
President, Orthotic and Prosthetic Assistance Fund (OPAF)

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