Synergy Orthopedics Sales Associate Training Manual

TRAINING MANUAL TEMPLATE

SALES ASSOCIATE TRAINING MANUAL

Synergy Orthopedics, LLC

“WHEN OUTCOMES MATTER” Headquarters
920 Germantown Pike, Suite 210
Plymouth Meeting, PA 19462

Ph: 610.292.8400
Fax: 610.292.0908

Company website:
www.synergyortho.com

SYNERGY ORTHOPEDICS, LLC

Job Description: Sales Representative Clinical Care Coordinator

Welcome to the Synergy Orthopedics comprehensive training program.

During your training experience you will be exposed to all that Synergy Orthopedics has to offer. Some
of your training will be specific in nature to assume you have the appropriate skill set to do your required
tasks as soon as possible.

Your feedback on the program and process is essential to the development process.

During your training you will complete a daily log indicating your achievements. You will start with a 920
Live experience covering all Human Resource events and sitting with our Operations team. Then you
will be assigned to specific observation locations. At the end of your training you will receive a certificate
of accomplishment.

Following your initial training, we will have you be included in a round of our Certified Orthotic Fitter
School where you will take a course, fitting lab and exam to become a Certified Orthotic Fitter. You will
be notified when a course has opened via email.

This guide is designed to offer you guidance through the program. Everyone at Synergy Orthopedics is
here to help you along the way.

Contact Information:

Dan Pahls
Chief Clinical Officer
[email protected]
570.499.9072

Site Coordinators: Jaime Frazier & Katie Weaver- Caitlin Agnew- Penn Medicine
Brian Bradshaw- Maryland UPMC
Sales Associates Sales Associate
Sales Associate [email protected] [email protected]
[email protected] [email protected]
Phone: 570.772.8041 Phone: 267.254.9039
Phone: 410.321.1126

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SYNERGY ORTHOPEDICS, LLC

Company Overview
Synergy Orthopedics started in 2001 and since then has been a trusted partner to many medical
practices throughout PA, NJ, MD, DC, DE and NY. Over the years, one thing has remained the
same:
The Patient Always Comes First!
Executives
John LaRocco, Chief Operating Officer
Dan Pahls, Chief Clinical Officer
Matt Lagowski, President
Management
Evelyn LaRocco, Compliance Officer
Jeff Rinehart, Regional Manager of Maryland
Jeff Ritschel, Regional Manager of Penn Medicine, Philadelphia, Bucks County and New Jersey
Steve Akenhead, Regional Manager of Delaware and Western Suburbs of Philadelphia
Jon Shreter, Division Manager of Orthotics & Prosthetics
Sarah Staley, Billing Manager
Claudia Parrales, Compliance Manager
Kimberly Howk, Reimbursement Manager
Rob Gerlach, Finance Manager
Kerry Miller, Human Resource Manager

All of the above as well as everyone else in the Company, are here to help you succeed in your
position. If you have any questions for them, please feel free to reach out.

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Sales Associate/Sales Representative Training Outline
Depending on your location, you will be assigned to one of the below locations for the
fitting/observation/supervision labs
Training Locations within Synergy Orthopedics

1. Philadelphia- Penn Medicine w/Caitlin Agnew
2. Towson- w/Brian Bradshaw
3. UPMC/SHS- w/ Jaime Frazier and Katie Weaver
While at one of the locations, you will be trained by one of our current employees. They are
there to help you with any questions you may have on any of the products/services we have to
offer.

Fitting Lab: getting description from Brian

Observation Fitting: getting description from Brian

Supervisory Fitting: getting description from Brian

Review of Policies & Procedures: You will learn how to submit claims, fill out any/all
paperwork, and what to expect when you walk into an account
Traditional and Hybrid SMARTCare Programs
Brace Claims
Bone Stim Claims
PPAs
Held Billing Procedure

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SYNERGY ORTHOPEDICS, LLC

SECTION 1: OUR COMPANY

1.1 The Start of Synergy Orthopedics
1.2 Synergy Orthopedics Today
1.3 Synergy Orthopedics Patient Care Programs
1.4 Synergy Orthopedics Vendors
1.5 Why Synergy Orthopedics is Successful

SECTION 2: SMARTCare Program

2.1 Traditional vs. Hybrid
2.2 Patient Product Agreement (PPA)

How to Fill Out a PPA

2.3 Hybrid SMARTCare Paperwork
2.4 Inventory

How to Manage Inventory Flow

2.5 Visiting an Account
2.6 Held Billing

SECTION 3: BraceClaims

3.1 Requirements for Medicare Coverage
3.2 Patient Evaluation

The Right Brace
Paperwork

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3.3 BraceClaims Process
3.4 Patient Fitting
3.5 Documentation Requirements
3.6 Patient Encounter

SECTION 4: Bone Stimulator Process

4.1 Paperwork
4.2 Delivery Appointment

Synergy Orthopedics Terminology

PPA: Patient Product Agreement
DWO: Doctor Written Order
CMN: Certificate of Medical Necessity
LMN: Letter of Medical Necessity
ABN: Advanced Beneficiary Notice
PU: Pick Up
SU: Set Up
Dx: Diagnosis
Rx: Prescription
CPM: Continuous Passive Motion
PHI: Personal Health Insurance

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SYNERGY ORTHOPEDICS, LLC

Our Company
1.1 The Start of Synergy Orthopedics

Established in 2001 by Dan Pahls and Matthew Lagowski

Focusing on selling DJO and rehabilitation products.

John LaRocco joined in 2010

Changed the business model to include insurance billing and distribution of bracing and
rehabilitation products and services.

1.2 Synergy Orthopedics Today

Over 85 Employees

5 Locations

Headquarters: 920 Germantown Pike, Suite 210, Plymouth Meeting, PA 19462

Cherry Hill: 901 West Marlton Pike, Cherry Hill, NJ 08002

Towson: 8322 Bellona Avenue, Suite 303, Towson, MD 21204

Glen Burnie: 200 Hospital Drive, Suite 116, Glen Burnie, MD 21061

Honesdale: 232 Sunrise Avenue, Honesdale, PA 18431

Orthotic and Prosthetic Lab in Baltimore and Cherry Hill

Serving Patients in PA, NJ, NY, MD, DC, DE & VA

Serving over 250 accounts in over 350 locations
Over 180,000 patient encounters annually

Billers & Collectors have over 100 years combined DMEPOS experience

1.3 Synergy Orthopedic Patient Care Programs

TM Page |7

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SMARTCare is a program designed to support SYNERGY ORTHOPEDICS, LLC
clinics needs for DME and Braces. At Synergy Page |8
Orthopedic, we only supply the best products the
market has to offer along with all the necessary
tools to make the entire process productive for
everyone. Through the program we provide
inventory management programs, billing services
and programs, professional training, professional
fitters and consignment inventory. We are fully
dedicated to the success of your DME and
Bracing program. We supply all brands of
products (DJO, Breg, Bledsoe, Townsend_ but
our prime partners are Ossur and Hely & Weber!

TM

Bone Growth and Spinal Growth Stimulation
works to help the body heal non-union fractures
and fusion sites. At Synergy Orthopedics we are
experts on maximizing healthcare benefits to the
patient’s advantage. We select only the best
possible devices to assure the best possible
outcomes.

Experienced Prosthetics with over 40 years of
clinical experience and over 1,000 patients fitting.
Our P-Care Program specializes in upper
extremity, below knee, above knee, high activity,
bionic and power devices.

The Synergy Orthopedic Advantage - O-Care is a
program designed to offer physicians and their
patients the highest quality orthotic devise with the
highest quality patient care the industry has to
offer. Our team of certified professionals will work
directly with the doctor and the patient to achieve
the best possible results with the highest level of
patient compliance.

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1.4 Synergy Orthopedics Vendors

Primarily providing products from Össur and Hely & Weber, we will buy and stock any vendor
that the Physician requests! Össur and Hely & Weber offers very high product quality and speedy
delivery. We will not substitute inferior products to save money. Any product or brand changes
are approved by the Physicians.

Our Vendors:

1.5 Why Synergy is Successful

We are proudly accredited by Medicare and BOC

We are in-network with the following Insurance Companies:

Aetna Gallagher Bassett MVP Health Care
Aetna Better Health- PA Gateway Health Plan NJ Manufacturers
Aetna Better Health-MD Geisinger Health Plan One Call
AmeriGroup- NJ GHI Oxford Health Insurance
AmeriGroup- MD Health America Personal Choice
AmeriHealth- PA Health Options Priority Partners
AmeriHealth-NJ Health Partners Qual Care
AmeriHealth Caritas Highmark Blue Cross- DE TriCare
Capital Blue Cross Highmark Blue Cross- PA United HealthCare- AARP
CareCentrix Horizon Blue Cross United HealthCare- Community
CareFirst Blue Cross Humana Plan
Cigna Independence 65 University of Maryland Health
Cigna-Great West Independence Blue Cross System
Coventry Johns Hopkins Health System UPMC Health Plan
Crystal Run Health Plan Medicaid 1199
DMEnsions Medicare- Noridian
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We take compliance seriously and we work very hard to stay compliant.
Compliance Standing:

Internal Audits

External Audits

Synergy Orthopedics Average Medicare Jurisdiction A
Knee: 56% Industry Average
Knee: 15%
Foot/ Ankle 83% Foot/ Ankle 56%

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SMARTCare Program

Synergy Orthopedics SMARTCare Program is designed to support physician practice’s DME
and Bracing needs. We provide inventory on consignment and billing assistance.

2.1 Traditional vs. Hybrid

What is Traditional SMARTCare?

A Traditional SMARTCare is when a practice or clinic has inventory of their choosing on
consignment and Synergy Orthopedics does 100% of the billing. Synergy Orthopedics walk-in
sites and accounts that are staffed by Synergy Orthopedics are also considered a Traditional
SMARTCare account.

What is Hybrid SMARTCare?

A Hybrid SMARTCare is when a practice or clinic that has inventory of their choosing on
consignment and Synergy Orthopedics does a portion of the billing. The account will decide
which insurances they would like to bill and Synergy Orthopedics will do the rest.

2.2 Patient Product Agreement (PPA)

A PPA is the form used whenever Synergy Orthopedics is billing a patient’s insurance. PPAs are
used in both Traditional and Hybrid SMARTCare Programs. It is important that the PPA is
completely filled out. If there is any information missing, the claim cannot by billed. A claim is not
a sale until the claim is billed.

How to Fill Out a PPA

1. Section 1
a. Product barcode sticker(s)
b. Patient Name

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a. Provider Name and NPI#

3. Section 3
a. Provider Signature (must be wet, no stamps)
b. Date (must be Date of Service (DOS)

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4. Section 4
a. DX Code- must be specific and indicate R/L (Right/Left)

5. Section 5
a. Patient Information must be filled out by patient
b. Delivery address- address of where the product was dispensed/account address

6. Section 6
a. List Insurance Company Name

7. Section 7
a. Leave blank unless Worker’s Comp and Auto case
b. If it is a Worker’s Comp/Auto case, the following must be included:

i. Company Name

ii. Adjuster Name and Number

iii. Claim Number

iv. Date of Incident (DOI)

v. PHI (Personal Health Information)

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8. Section 8
a. Patient’s Signature with DOS

9. Section 9
a. MEDICARE ONLY- Patient Signature with DOS

Once the PPA is completely filled out and signed, the pink copy does to the patient.

Print out the patient demographics, photo ID and insurance care and attach to the white copy.
This is the completed packet that the billing department needs to order to bill the patient’s
insurance.

PPA Encounter Form is needed when a Synergy Orthopedics Employee is fitting the patient
directly. The form must be filled out to document the patient encounter and should be included
in the PPA packet.

2.3 Hybrid SMARTCare Paperwork

In addition to the PPA form, there is other paperwork for the Hybrid SMARTCare Program.

Before the account can dispense the DME, they have to check the patient’s insurance and the
billing guide to determine if Synergy Orthopedics is billing or is the account is billing.

• If Synergy Orthopedics is billing, they must complete a PPA form

• If the account is billing, they must place a product barcode sticker on a Sticker Sheet

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PPA Packet Example:

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PPA Packet Example:

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PPA Packet Example:

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PPA Packet Example:

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Billing Guide Example:

2.4 Inventory

SMARTCare inventory is typically on consignment, meaning Synergy Orthopedics owns the
product.

Inventory is re-stocked on a 1:1 ratio (they use it, we replace it) based on the barcode stickers
on PPAs and Sticker Sheets.

It is important to keep track of product flow to ensure inventory levels do not drop and to manage
shrinkage. Take note of what product is leaving the account and what product is coming in.

How to Manage Inventory Flow
1. Create an inventory list for the account that you can make copies of
2. For every account visit, count up the barcode stickers for each product that you have

on either a PPA or Sticker Sheet. Make note on your inventory list with the date of
your visit.
3. When the orders are placed via email, check off what has been ordered to make sure
everything is being replenished 1:1.

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Inventory Flow Example:

Inventory counts are done quarterly. Take this opportunity to order any product that is low and
remove any excess or unused product.

When a return needs to be processed, a Bracing Product Return Authorization Form must be
completed. Returns are only accepted under certain conditions:

• Items that are unneeded must be returned within 3 business days of the product
being dispensed. The product must be unused and in original packaging.

• Poorly fitting or ineffective items can be exchanged within 7 business days.
• After 7 days, we will only follow the manufacture warranty for exchanges.

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Bracing Product Return Authorization Form Example:

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2.5 Visiting an Account

It is important to make your account staff and personnel aware that you are their resource for
any DME related questions. You should develop a friendly and professional relationship with all
personnel.

The frequency you visit an account with depend upon the volume of product they use, but
typically you should make a visit 1-2 times/week.

To help keep your accounts organized, create a binder that has tabs for each account. In that
tab, you can make any notes about the account, keep your paperwork organized as well as your
inventory flow sheets.

There are a few forms and tools each account should have to help them navigate DME on a
daily basis. Is it your responsibility to make sure the account has everything they need:

• PPAs
• Sticker Sheet (Hybrid Only)
• Bracing Product Return Authorization Form
• Flow Chart to help Understand the paperwork process
• Product Catalog to help know what products they have a sizing information
• Product Labels to help keep the closet organized and to identify boxes
• About Your DME Card to help patients understand who is providing the DME and answer

frequently asked questions

There are a few things you should do during every account visit:

• Say Hello to everyone and let them see you in case they have any questions. Be sure
you are not disrupting their work flow

• Gather all of the PPAs and Sticker Sheets and review. If there is information missing,
make sure you obtain it before you leave the account

• Fill out your inventory flow sheet
• Check their inventory. Scan the levels to make sure nothing is low and straighten up the

products so it looks presentable

At the end of each day, you will ship your paperwork to Synergy Headquarters so Inventory
Control can order product, and the claims can be billed. Inventory Control will provide envelopes
and shipping labels. Be sure to keep track of how many PPAs each account has for the week.
Every Friday, you will send your PPA count to your Manager.

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Product Catalog Example: SYNERGY ORTHOPEDICS, LLC

Product Label Example:

Flow Chart Example: About Your DME Card Example:

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2.6 Held Billing

A claim is not a sale until it has been billed. Claims cannot be billed unless all required information
is included.

Although you should be checking your claims an gathering missing information before you send
them in, sometimes things slip through the cracks. In that case, the claim will end up on Held
Billing until the missing information is obtained.

The Held Billing report comes out every week on Wednesday evening. Every week, you should
be checking the report and looking for any claims under your name, account or provider. There
will be a code to indicate what information is needed.

Gather and submit information as quickly as possible so the claim can be billed.

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Brace Claims

Verification of Benefits and Precertification is required for devices over $500/$800. These claims
will go through the BraceClaims process before the brace can be ordered. This also pertains to
custom foot orthotics.

3.1 Daily Update for Bracing and Bone/Spine Stim
Claims

1. Daily report listing all submitted BraceClaims and their status
2. Check daily, you are responsible for keeping tabs on your claims

3.2 Patient Evaluation

Finding the right brace:

1. There is not one brace that works for every patient. It is important to talk with the
patient and ask about their history, possibly instability and goals they want to achieve
with their new brace

2. Once you have a good idea of their overall lifestyle, you should have a couple braces
in mind that will work for the patient

3. It is helpful to take the same measurements every time, so you have all the
information you need when choosing the brace size. These measurements include:
a. Circumference 6 inches above mid patella; 3 inches above mid patella; mid
patella; 3 inches below mid patella; 6 inches below mid patella and caliper
measurement
b. If patient requires a custom Ossur brace, make sure to use SmartMeasure

4. Showing a sample of the brace you have in mind for the patient gives them an idea
of what they will be using on an everyday basis

Inform them of the verification of benefits & precertification process and give a time frame of how
long it will take.

Paperwork

1. Cover Sheet
a. From: Your Name
b. # of Pages: including cover page
c. Method of shipping
d. Patient Name
e. Date (date submitted to BraceClaims
f. Product Description
g. Product # from Manufacturer
h. Shipping Location and Address
i. Check off boxes of documents included- Place in order listed

2. Billing and Rx Form

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a. Representative Name, Phone, and Shipping Address
b. Doctor Name, Phone, Signatures (or attached Rx) with Date
c. RT/LT
d. Patient Ready/Custom and Category
e. Patient Information
f. Insurance Information: Company Name
g. Patient Initial on Return Policy
h. Patient Signature and date for Consent for Treatment and Insurance Verification
3. Rx
4. Patient Demographics, ID and Insurance
5. Provider Documentation
a. Must meet requirements
6. Initial Visit Encounter Form- all that apply
7. Submit to BraceClaims
a. Scan and email or fax

3.3 BraceClaims Process

Similar to the Held Billing report, a BraceClaim can be put on hold for missing information.

1. VOB and Precert
2. Collect payment and/or give to Inventory Control to order

a. If a patient has an OOP greater than $100, we will collect payment before
ordering. If a patient has an OOP less than $100, we will order and send a bill.

3. If additional documentation is required, use the “Additional Information Cover Sheet”,
check all that apply and submit to BraceClaims.

3.4 Patient Fitting

1. Paperwork
a. Additional Information Cover Sheet
i. Original date submitted to BraceClaims
ii. Representative Name
iii. Number of pages including cover sheet
iv. Date of delivery and submission
v. Check signed DME ticket
b. Signed Billing and Rx Form
i. Patient signature and date for acknowledgement of delivery
c. Signed Delivery Ticket
i. Delivery address- where patient is fitted
ii. Patient signature and date for acknowledgement of delivery
d. Brace Fitting Encounter Form

2. Patient will leave with the following:
a. Brace, box and manufacturer’s instructions
b. Pink copy of PPA
c. Medicare Supplier Standards
d. Survey

3. Submit to BraceClaims- claim is finished

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Delivery Ticket Packet Example:

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Delivery Ticket Packet Example:

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Delivery Ticket Packet Example:

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Delivery Ticket Packet Example:

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3.5 Documentation Requirements

There are specific documentation requirements and guidelines that Medicare sets when
evaluating a patient’s claim for pre-fabricated orthoses coverage. Most commercial insurance
follow Medicare’s guidelines.

1. When requesting a pre-fabricated knee orthosis, the following must be documented:
a. Patient must be ambulatory
b. Recent injury to or a surgical procedure on the knee that s described and dates
included
c. Diagnosis and objective description of instability to include specialized tests
i. Valgus/Varus stress
ii. Anterior Drawer
iii. Lachman
d. Plan must include description of the prescribed brace

2. When requesting a pre-fabricated AFO/KAFO the following must be documented:
a. Patient is ambulatory
b. Has weakness or deformity of foot and ankle
c. Requires stabilization of foot and ankle for medical reasons
d. Has potential to benefit functionally from AFO
e. Plan must include description of the prescribed brace

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3. When requesting a pre-fabricated spinal orthosis, the following must be documented:
a. Product must be for reducing pain by restricting mobility of the trunk or:
b. Facilitate healing following an injury to spine or related soft tissues or;
c. Facilitate healing following a surgical procedure on the spine or related soft
tissues or;
d. Support weak spinal muscles and/or a deformed spine
e. Plan must include description of the prescribed brace

If a patient requires a product that is not covered by Medicare, they must fill out an ABN
(Advanced Beneficiary Notice of Noncoverage). Reasons Medicare would not cover an item are:

1. Patient has received same or similar product within product’s reasonable and useful
lifetime

2. Medicare does not deem the product medically necessary (example: foot orthotics)

3.6 Patient Encounters

1. Finding the right fit
a. Some products require measurements, others are universal
b. Most upper extremity braces are Left/Right specific

2. Fitting the patient
a. Start by taking the product out of the packaging and showing the patient how to
properly disassemble the brace
b. Explain to the patient how the brace works and why it will help their diagnosis
c. Put the brace on the patient, while simultaneously explaining how each step
works
d. Have the patient return demonstration
e. Show patients there are also instructions that come with the brace
f. Ask if they have any questions
g. Give patient pink copy receipt

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ABN Example:

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BoneStim Process

4.1 Paperwork

1. BoneStim Fax Cover Sheet
i. Fracture reports dates 1st report- 2nd report: must be 90 days of No Healing
“Non-Union” status
ii. Patient Name
iii. Product Description

iv. BoneStim Part#
2. Billing and Rx Form
3. BoneStim Order Form

i. Model number corresponds according to the body part being treated
ii. Patient Information
iii. Insurance Coverage
iv. Medical Information
v. Physician Information
4. Certificate of Medical Necessity CMS- 847 Osteogenesis Stimulators
i. Section A

1. Patient Information
2. Supplier Name
3. Facility
4. Physician Information
ii. Section B (Must be completed by provider)
1. Length of need
2. Diagnosis codes (ICD-10)
3. Answer questions 6-12
4. Name of the person answering the questions (Name; Title;

Employer)
5. Section C

a. Description of the Equipment/Cost
6. Section D

a. Physician Attestation/Signature (no stamps)/ Date
b. Patient Orthotic Encounter Form
c. Photo ID (front/back)
5. Once all paperwork is complete, submit to BraceClaims. The claim will appear on
the Daily Update for Bracing and Bone/Spine Stim Spreadsheet

4.2 Delivery Appointment

1. Discuss features with patient:
Power Button
Set-up process
Stim field and strap application
Charging process
Treatment time
STIM on track app

2. Delivery paperwork is the same as BraceClaims

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BoneStim Packet Example:

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BoneStim Packet Example:

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BoneStim Packet Example:

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BoneStim Packet Example:

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BoneStim Packet Example:

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