1998 FECA Bulletins Archive

Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 98-01

Issue Date: November 30, 1997

Expiration Date: November 29, 1998

Subject: Case File and Bill Batch Imaging

Background: While cases are before the Employees' Compensation Appeals Board (ECAB), issues often arise which are not related to the issue(s) for which the cases are before the Board. In the past, when a case file was requested by the Board, it was transferred to the National Office (T51), where the case record itself was sent on to the Board, and the case jacket, CA-800, and incoming correspondence were retained in the Branch of Hearings and Review. Claims examiners in the Branch of Hearings and Review were responsible for taking case actions on issues which were not before the Board, without the benefit of the case record or prior experience with the case.

Medical bill batches are generally retained in the district offices for a minimum of two years, after which they can be retired. Finding space for storage of bill batches has been difficult, as has retrieving particular bill batches when needed for review.

During the past several months, the Division of Federal Employees' Compensation (DFEC) has developed a pilot using imaging technology to assist in the processing of cases before the ECAB, and to enhance bill batch maintenance. Each district office has been provided with scanners, personal computers with monitors large enough to view imaged documents, imaging software, and training on how to use this new technology. A centralized imaging center has been established in the National Office. Cases going to the ECAB and medical bill batches have been imaged. An imaged case tracking system has been established to keep track of the physical case file associated with an imaged case.

Reference: FECA Procedure Manual, Chapter 2-1603.4-5, Chapter 5-0200.7.

Purpose: To describe new guidelines and procedures for case file and bill batch imaging.

Applicability: All staff in the district offices, National Office, and the FEC Imaging Center.

Action:

1. Effective November 24, 1997, when a district office receives a request for a case file from ECAB, the electronic records for the case file will not be transferred to the ECAB (T51). Instead, the district office will remain responsible for the case, and the following actions will be taken:

National Office adds the case to the imaged case tracking program;

a. the district office:

(1) runs the CASE642 report, "Image Tracking Inquiry" showing the ECAB request; this report should be run on a daily basis (see item 2 below);

(2) locates the case file;

(3) files down any documents that are loose in the file, in the appropriate order; if actions are pending a note is made on the Sequent and a call-up established by appropriate staff;

(4) completes a form CA-67 (case transmittal sheet) to list the case(s) being sent;

(5) mails (certified or overnight) the case(s) with the jackets and CA-67 to the FEC Imaging Center (FIC);

(6) enters the date that each case was mailed in the imaged case tracking program (option 38 on the FECS001 Case Management menu is "Imaged Case Update").

The case file location changes to NB1 automatically when the mailing date is entered.

b. FIC:

(1) receives the case file;

(2) images and indexes it (see items 9 and 10 below for a description of indexing);

(3) updates the imaged case tracking program with the date received, date imaged, and date mailed to National Office;

(4) delivers the case file to the National Office mail room.

Once the imaging date has been entered on the imaged case tracking program, the case location in the District Office changes to NB2 overnight.

c. The National Office:

(1) receives the case file;

(2) copies the CA-800s;

(3) marks the file "Imaged";

(4) updates the imaged case tracking with the date received, the issue code (see item 14 below), and comments (if any);

(5) delivers the case file and copy of the CA-800 to ECAB;

(6) mails the case jacket and the original CA-800 back to the district office (see paragraph 3 below).

d. When the ECAB is finished with the case file, the National Office mail room will:

(1) scan the ECAB decision and any accompanying documents; mark documents "document imaged";

(2) send the case contents and the ECAB decision back to the district office;

(3) update the imaged case tracking with the date mailed to the district office.

e. The district office:

(1) receives the case contents;

(2) places the contents back into the permanent jacket;

(3) updates imaged case tracking with the date the case was received;

(4) reviews the ECAB decision and accompanying documents and takes appropriate action.

The case location changes to NB3 automatically as soon as the received date is entered by the district office.

2. The CASE642 report, which is "Image Tracking" under the FECS002 (FECA Report Generation) Menu, lists cases which have been requested by ECAB, but for which the district office has not yet entered the date the case was mailed to the FIC. The report can be simply viewed on the screen or printed. The report should be run daily to track outstanding ECAB requests for cases. It should be noted that the existing daily report which requests cases for both ECAB and Hearings and Review will continue to include ECAB cases for at least a period of time.

3. As previously indicated, after a case file has been imaged and is delivered to the National Office mail room, the case jacket and CA-800 will be returned to the district office. The case jackets and CA-800s should be retained in the district office, either in a separate location in the file room, or another special location. Any mail received in the district office after the case has been mailed to the FIC needs to be scanned, including mail received after the case contents with ECAB decisions have been returned to the district office. If multiple copies of a document are received, such as an original of a medical report plus two copies, only one copy should be scanned and dropfiled. Prior to scanning, the district offices should ensure that the case is showing a location of NB2 or NB3 and that an accurate case file number is present on each page to be scanned. If the case location is NB1, the mail should be held until the location changes to NB2, then it can be scanned. If there are several pages of mail for the same case file, and each page does not have the case file number on it, a header sheet indicating that the following xx pages are all for case file xx-xxxxxxx may be used. Scanned mail should be stamped as "document imaged," and maintained in a batch in the file room until verification that the mail has been indexed by the FIC. The mail should then be dropfiled in the appropriate case jacket.

4. On a daily basis, the FIC will send to each office, via e-mail, a list of case files for which new mail has been indexed and appended to the case file. Each office has identified the recipients of this e-mail for their office. Receivers of the e-mail are responsible for ensuring that the responsible claims examiners are notified that there is new mail in their cases.

5. Any mail which must receive special tracking (CA-7, CA-8, CA-2a, CA-16) should be entered into the appropriate tracking system, and then given to the scanner.

6. Once a case file has been imaged, all subsequent case actions should be taken based upon the imaged case. Obviously, while the case contents are with the ECAB, the imaged case must be the basis for case actions taken. Once the case file contents have been returned from the ECAB, the imaged file becomes the official file. Except for unusual circumstances, the case file contents should not move from the file room (special location) again.

7. No imaged files and case records should be transferred between district offices while the case is before the ECAB (case location NB1 or NB2). After the case contents have been returned from the ECAB (case location NB3), the case may be transferred in accordance with existing procedures.

8. Any correspondence or internal documents produced in an imaged case that would normally be filed in the case file must be scanned and then dropfiled, in accordance with item 3 above. This includes letters (including decisions in any format) to claimants and others, payment worksheets, reports, statements of accepted facts, CA-110s, etc.

9. Each document in an imaged case file is indexed by the FIC. Indexing allows the user to identify documents needed for review more readily. Indexing categories for complete case files imaged are:

a. Medical evidence - includes medical reports, office notes, hospital records, and letters to medical providers;

b. Forms - includes only certain forms: CA-1, CA-2, CA-2a, CA-4, CA-5, CA-6, CA-7, CA-7a, CA-7b, CA-8, CA-12 (most recent two only), CA-16, CA-20, CA-800, CA-1032 (most recent two only), and OWCP-5 (also a, b, and c);

c. Decisions (most recent two, or within the past year, which ever is greatest); and

d. Miscellaneous - includes everything else.

10. For case files imaged prior to September 1997, and for new mail (in all previously imaged cases), a more extensive indexing has been/will be done, which, in addition to the categories shown in item 9, includes:

a. Payment documentation - includes payment work sheets, ACPS reports, and CA-7s and CA-8s;

b. Congressional - includes inquiries from Congressional offices and responses;

c. Communication - includes general correspondence, both incoming and outgoing, CA-110s, transmittal documents, and memoranda to the file;

d. All other forms.

11. A date is associated with all indexed documents, other than those indexed prior to November 24, 1997 and classified as miscellaneous. For the forms, the date is the date the form was signed. For medical evidence, the date is the date of the report or letter. For decisions, congressionals, and communications, the date is the date of the decision, etc. Documents are imaged in the order they are filed in the case file, and should therefore be in approximate date of receipt order.

12. If a piece of mail or an internal document has been scanned, but not yet indexed by FIC, it will not be viewable by making an inquiry using the case file number. Mail will be viewable within 18 hours if it is scanned by 12:00 noon, district office time. If the mail is scanned after noon, indexing will take an additional day.

13. When updates are made to the CA-800 in an imaged case, the paper CA-800 will be updated, and the updated CA-800 should be rescanned so that the current version may be viewed.

14. Even though many cases before the ECAB will be available through imaging in the district offices, and district offices will be responsible for maintaining the imaged case while it is before the ECAB, district offices may not take action on any issue which is simultaneously before the Board. Decisions may be issued by the district offices on issues which are not before the Board. Issue codes and comments are entered by the National Office into the imaged case tracking program, and may be viewed in the district offices under item 31 of the FECS001 query menu. For example, if a case file is with the Board for an appeal on a schedule award, the district office may take action on a claimed recurrence of disability for work. The issue codes are as follows:

01—Time
02—Civil Employee
03—Fact of Injury
04—Performance of Duty
05—Causal Relationship
06—Continuing Injury-Related Disability
07—Recurrence
08—Schedule Award
09—Overpayment
10—COP
11—LWEC
12—Pay Rate
13—Attorney Fee
14—Refusal/Obstruction of Examination
15—Denial of medical treatment
16—Failure to accept suitable job
17—Forfeiture
18—Non-cooperation with Rehabilitation efforts
19—Reconsideration Decision (not merit review)
20—Denial of hearing
21—Compensation Rate
22—Third Party
23—Other

15. The imaged record should be used to produce copies of documents from the case file, such as when a copy of the file is requested under the Privacy Act, or a copy of all medical evidence is needed for a second opinion evaluation. If the number of documents to be printed is large, printing should be done in smaller blocks of no more than 35 pages at a time. If a large number of pages are involved, the FIC should be notified. The FIC will generate a copy of the case file and mail it to the district office, so that it will be received within two days of the request. The customary charges for second copies still apply.

16. In addition to imaging case files going to ECAB, all district offices have the ability to image medical bill batches. The bill batches will be imaged after they are keyed by data entry personnel. Bill resolvers may work from either the actual bill batches, or the bill images. Detailed procedures for bill batch imaging will be issued under separate cover.

17. The appearance and functioning of the imaged document screens have been addressed in the training which has been conducted in each district office. A user guide is under development and should be available within the next month. In the meanwhile, the training materials can be used as a user guide.

18. Doubled cases will be imaged as a single case file, using the master file number. The subsidiary files are not cross-referenced in the imaged file data base. Therefore, if one wishes to view a subsidiary record of an imaged file, the master file number should be used. The presence of the CA-800 and/or CA-1 or CA-2 within the imaged record should help to delineate separate injury records.

19. Once a case has been imaged, all secondary appeals (such as a request for a hearing on a new decision, or another appeal on the case) will be conducted based upon the imaged record.

20. Cases which were transferred to T51 prior to the beginning of the imaging pilot will not be imaged. Maintenance of these files will continue to be performed by the Branch of Hearings and Review.

Training for all personnel affected by these changes should be conducted no later than November 21, 1997.

Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 3--Folioviews Groups A, B, C, and D
(All FECA Employees)

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 98-02

Issue Date: January 2, 1998

Expiration Date: January 1, 1999

SUBJECT: ADP - Automated Compensation Payment System (ACPS) and Debt Management System (DMS) Report Schedule - 1998

PURPOSE: To provide the 1998 schedule for processing the periodic disability and death payrolls under the ACPS and the DMS weekly and monthly reports for calendar year 1998.

APPLICABILITY: All appropriate personnel are to be made aware of the periods and "cut-off" dates for the ACPS periodic disability, death, and daily payrolls.

The production schedule for the DMS periodic reports is made available for the appropriate personnel. IT IS IMPERATIVE that this schedule be closely followed.

DISPOSITION: This bulletin should be retained in front of Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Attachments

Distribution: List No. 2--Folioviews Groups A and D
(Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Advisors, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 98-03

Issue Date: March 1, 1998

Expiration Date: February 28, 1999

Subject: Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 1998.

Purpose: To furnish instructions for implementing the CPI adjustments of March 1, 1998.

1. The new CPI increase, adjusted to the nearest one-tenth of one percent, is 1.5 percent.

2. The increase is effective March 1, 1998, and is applicable where disability or death occurred before March 1, 1997.

3. The new base month is December 1997.

4. The maximum compensation rates which must not be exceeded are the following:

Applicability: Appropriate National Office and District Office personnel.

Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981.

Action: On or about February 20, 1998, both the periodic disability and death payrolls will be updated in ACPS. If there are any cases with gross overrides, there will be no supplemental record created. Thus, the cases with gross overrides must be reviewed to determine if CPI adjustments are necessary. If adjustment is necessary, a manual calculation will be required.

1. Adjustment Dates.

a. As the effective date of the CPI is March 1, 1998 and the start date of the periodic and death payroll cycles is March 1, 1998, there will be no supplemental record created.

b. The CA-816, LWEC, program must be updated with the new CPI percentage. This update must be performed in each district office.

2. Adjustments of Daily Roll Payments. Since the CPI will not be in ACPS until February 20, 1998, daily roll payment cases requiring the new CPI should be held for data entry until that date.

3. CPI, Minimum and Maximum Adjustments Listings. Form CA-841, Cost-of-Living Adjustments; Form CA-842, Minimum Compensation Rates; and Form CA-843, Maximum Compensation Rates, should be updated with the new information. Attached to this directive is a complete list of all the CPI increases and effective dates since October 1, 1966 through March 1, 1998.;

4. Forms.

a. Form CA-837, Notice to Payee, will be sent to the payees on the periodic disability and death payrolls. The notice will be sent to the payees from the National Office. The CA-837 will be addressed using the ACPS Correspondence Address File. PLEASE be sure to maintain the address file as you do with the Payee Address File and the CMF. PLEASE remember that an address change to the CMF DOES NOT automatically change the ACPS check address or correspondence address. ACPS must be accessed and the enter key must be depressed through the address areas. Be watchful for those payments being sent via Direct Deposit.

b. Any manual adjustments necessary because of gross overrides in cases should be made on Form CA-24 or CA-25. A notice to the payee should be sent from the district office.

c. CP-140 will be printed for each case adjusted. These may be drop filed in the case file.

d. If claimants write or call for verification of the amount of compensation paid (possibly for mortgage verification; insurance verification; loan application; etc., please provide this data in letter form from the district office. Many times the Form CA-837 does not reach the addressee; regeneration of the form is not possible, thus, a simple letter indicating the amount of compensation paid each four weeks will be adequate for this purpose.

Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Attachment

Distribution: List No. 2 --Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, and Rehabilitation Specialists)

Prior to 09/07/74, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest multiple of $.23 on a weekly basis ($.23, $.46, $.69, or $.92). After 09/07/74, the new compensation after adding the CPI is rounded to the nearest $1.00 on a "periodic" basis or the nearest $.25 on a weekly basis ($.25, $.50, $.75, or $1.00).

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 98-04

Issue Date: February 28, 1998

Expiration Date: February 27, 1999

Subject: Bill Payment/BPS - New Edits for Procedure Code Dates of Validity.

Background: Each year, the American Medical Association (AMA) revises the Physicians' Current Procedural Terminology (CPT) codes. The revised codes are generally effective the first day of each calendar year. The revisions usually include the deletion of certain codes, addition of others, and changes to the narrative description for some codes.

In the past, when AMA deleted a code, OWCP kept the code in the system for one year past the effective deletion date, to allow for payment of bills for the prior calendar year. After the year was over, the code was deleted.

Begin and end dates have been added to OWCP's procedure code file (v30). These begin and end dates are applicable to all procedure codes, not just the CPT procedure codes.

Three new edits using procedure code begin and end dates have been added to the bill editing program (BILL552), and are operational with the February 18 installation of the updated program.

Editing for procedure code dates of validity will allow offices to process bills using the procedure codes which were valid at the time the services were rendered, rather than having to substitute a currently valid code. In addition, it is anticipated that some charges which now suspend with edit 014 failures will either be paid or will be denied automatically with an appropriate EOB message.

Reference: Federal (FECA) Procedure Manual, Chapters 5-0200 and 5-0204.

Purpose: To advise office staff of new BPS edits which verify the validity of procedure codes for the dates of service billed.

Applicability: All bill resolution staff, contact representa- tives, claims examiners, supervisors, and systems managers.

Action:

1. Detailed edit sheets for the three new edits are attached. The sheets explain each new edit, provide resolution instructions, if applicable, and provide other relevant information. These should be inserted in the appropriate place in the expanded bill resolution job aid.

2. In addition to these new edits, several new alternate EOB messages (900 series) have been added at the request of field personnel. The new EOB messages are as follows:

942 Billed service denied. Duplicate of service previously reimbursed to the injured employee.

(This message would be used when a medical provider or health insurance carrier claims payment, and the claimant has already been paid for the same services.)

943 Billed service denied. Duplicate of service previously paid to the medical provider.

(This message would be used when the claimant or a health insurance carrier claims payment, and the medical provider has already been paid for the same services.)

944 Billed service denied. Duplicate of service previously paid to another carrier.

(This message would be used when the claimant or the medical provider claims payment, and the health insurance carrier has already been paid for the same services.)

3. A complete listing of all EOB messages and a revised con- densed edit job aid has been made available under separate cover.

4. In working with these edits, resolvers must be aware of the potential for duplicate billing due to use of more than one procedure code for the same service.

Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 2--Folioviews Groups A, B, and D
(Claims Examiners, All Supervisors, District Medical Advisers, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

February 18, 1998

MEDICAL BILL SYSTEM
EDITS

EDIT NO. 322L

SUSPEND/DENY: S

OVERRIDE: Y

EOB: This procedure code did not become valid until after the dates of service. If services have not already been paid using another code, please rebill using a procedure code which was valid at the time services were rendered.

PRIORITY: 4

BILL RESOLUTION:

1. Verify accurate keying of procedure code and dates of service.
2. Check online history to ensure that charge has not already been paid using a different procedure code. If it has already been paid, set to deny with alternate EOB 933.
3. Check the begin date for the procedure code in question. If the billed service dates predate the begin date by only one or two months, or if the bill is an old (more than two years) one which is only now being processed because of delays in adjudication, the edit failure may be overridden. Otherwise, set to deny with EOB 322 (above).

February 18, 1998

MEDICAL BILL SYSTEM

EDITS

EDIT NO. 323L

SUSPEND/DENY: D

OVERRIDE: N

EOB: This procedure code was no longer valid as of the dates of service. If services have not already been paid using another code, please rebill using a code which is valid for the period of service.

PRIORITY: 4

BILL RESOLUTION:

N/A
February 18, 1998

MEDICAL BILL SYSTEM
EDITS

EDIT NO. 324L

SUSPEND/DENY: D

OVERRIDE: N

EOB: During a portion of the period covered by these dates of service, the procedure code was not valid. Please resubmit, breaking down the period of time further, using valid codes (and units) for each period of time.

PRIORITY: 4

BILL RESOLUTION: N/A

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 98-05

Issue Date: March 5, 1998

Expiration Date: Indefinite

Subject: Bill Pay/BPS - Supervisory Sampling of Bills

Background: Recent reports from the Office of Inspector General cite numerous errors in bill processing. Some of these errors, such as failure to key procedure code modifiers, inaccurate units, overuse of bypass code 1, making payment to the wrong provider, misuse of authorizing initials, and incorrect dates of service, are due to inaccurate keying of bills. Other errors, such as inadequate authorization for bills over certain dollar limits, misuse of all bypass codes, and the failure to detect keying errors, are due to mistakes made in the bill resolution process.

FECA Bulletin 94-10, issued November 2, 1993, outlined revised procedures for supervisory sampling of bills. Recent accountability reviews have shown that some district offices are not carrying out regular supervisory sampling of bills.

It is critical that thorough supervisory sampling of bills be carried out on a regular basis, and that corrective actions be taken when problems are found.

A computer-based training package for keying bills is under development.

Reference: FECA Bulletin 94-10.

Purpose: To reissue and update procedures for supervisory sampling of bills.

Applicability: Regional Directors, District Directors, Fiscal Officers, Bill Payment Supervisors, and appropriate National Office personnel.

Action:

1. Bills processed through the BPS will be sampled on a monthly basis by supervisory personnel.

2. By the tenth day of each quarter, the individuals performing the bill sampling will provide a report of the previous quarter's findings to the District Director, with proposed corrective actions, if needed. Consideration of corrective action must be given for any error detected.

3. A copy of the quarterly report (findings and corrective actions) will be provided via E-mail to the Director for FEC, with a copy to Sheila Williams, Deputy Director for FEC, no later than the 20th day of the quarter, along with a time table for the corrective actions.

4. Offices will perform two separate bill reviews: one of the physical batches; the other of individual bills. Work sheets and instructions for each type of review are attached.

5. For the batch review, 1% of the bill batches completed during the month will be reviewed. If 1% of the batches completed during a month exceeds 20 batches, then 20 batches will be reviewed. The batches should include work from all keyers and resolvers, if possible. This review will involve examination of the physical bill batches only, although further investigation may be made, when indicated. Examples of situations warranting further review include: the presence of bill with no date stamp; or the presence of a bill on an incorrect form. During the batch review, the reviewer should also make note of bills with extended service date ranges, procedure code modifiers, multiple units, high dollar amounts, and repetitions of the same procedure code for the same date of service on the same bill, for inclusion in the bill reviews.

6. For the bill reviews, a minimum of 42 individual bills should be reviewed. The bills should not be selected randomly, but should include all keyers and resolvers, and as many different bill types as possible. Bills with extended service date ranges, procedure code modifiers, multiple units, high dollar amounts, and repetitions of the same procedure code for the same date of service, as identified during the batch review, must be included in the sample. If no such bills were found during the batch review, a reasonable effort should be made to identify bills of this nature from other bill batches. Both paid and denied bills should be selected, with at least 80% of the bills being paid bills. Overnight histories should be obtained for all of the paid bills, using specific provider identification numbers and dates of service to reduce the size of the report. The on-line bill payment history will be used to evaluate certain items. The BP40 report (Register of Miscellaneous Checks Paid) will also be used.

7. The purpose of these reviews is to ensure the accuracy, quality, and security of the bill processing operation. Therefore, more extensive reviews should be made if the initial findings indicate the potential for a problem.

8. Bills will also be reviewed using these procedures as part of the Accountability Review and Management Review processes.

Disposition: This Bulletin should be retained until incorporated into the Federal (FECA) Procedure Manual, or otherwise superseded.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 4--Folioviews Groups B and D
(Fiscal Officers, Benefit Payroll Clerks and Assistants, All Supervisors, Systems Managers, Technical Assistants)

Attachment A1

INSTRUCTIONS FOR COMPLETION OF BILL SAMPLING WORKSHEET

Obtain a Central history for each paid bill being sampled. The Central history contains receive date, bypass codes, payee address, authorizing initials, units, and ineligible amounts and codes, which are not available in the on-line history. [Bypass codes and units are being added to on-line history.] The on-line history contains information on both paid and denied bills, including service dates, procedure codes, charge amounts, paid amounts, check date, EOB date, EOB numbers, and resolver ID. In addition, the on-line history displays information on bills which reject in the Central processing. The BP040 reports will also be needed.

Bill No. - The 9-digit bill number, which includes the 6-digit batch ID number and the 3-digit sequence of the bill within the batch.

Def.? - If any of the following items is found to be deficient, this box should be checked.

Approp. Form? - Was the form type appropriate for the provider type (HCFA-1500, UB-82, UB-92, etc.)? (Y/N)

Receive Date OK? - Is the receive date as stamped on the bill the same as the receive date entered on the system (as found in history)? (Y/N)

Keyed OK? - Compare the information found on the bill with the information found in history (note that service dates, procedure codes, and bypass codes are covered separately). Were the correct number of units keyed? If the bill was paid, examine the BP040 to determine whether the address on the bill matches the address to which payment was made. If the bill suspended, look at the BILL552 batch report to determine whether keying errors caused the bill to fail edits. Was the correct provider selected? (Y/N)

Auth. Amt.? - If the bill total was over the maximum for that provider type, does the bill show the initials of the authorizing individual, and are those initials in agreement with the authorizing initials in the history? (N/A, Y, or N)

Altered Charges? - Are any of the charge amounts on the bill different from the amounts on the history? If yes, were changes made to the bill, and are the changes justified? Ineligible amount codes and amounts should also be considered. (Y/N)

Service Dates OK? - Do the dates of service on the bill agree with the dates of service in the history? Be especially mindful of whether the dates on the bill reflect a single date, or a date range. (Y/N)

Bypass Codes OK? - Does the bill or history reflect use of bypass codes, and if so, were they used appropriately? (Bypass code 1 need not appear on the bill itself. Bypass codes 2 or 3 must be written on the bill. Note that if the bill was paid as the result of the bill resubmit program, the bypass code may be written on the duplicate bill report, rather than the original bill itself.) (N/A, Y, or N)

Proc. Codes - If procedure codes were required, were they used appropriately? Are the procedure codes on the bill in agreement with the procedure codes in the on-line history and the codes in history? Were procedure code modifiers present on the bill keyed? (N/A, Y, or N)

Adj. OK? - Whether the bill was paid, denied, partially paid/partially denied, or internally denied, was the adjudication of the bill correct? Case notes on the system, accepted conditions, or other information may need to be reviewed to answer this question. (Y/N)

EOB OK? - If the bill was denied, were the EOB messages that went to the biller appropriate? Review the on-line history to determine the EOB messages, and consult with the list of EOB messages to determine what they actually were. Note that if more than two EOB messages were used, only the two highest priority EOB messages will be recorded in the on-line history. The EOBs used should reflect the most appropriate message to the biller. (N/A, Y, or N)

Remarks - Any other irregularities about how the bill was processed should be noted here, including inaccurate units. If the bill rejected at Central, is there an adequate audit trail of the final disposition of the bill?

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Attachment B1

INSTRUCTIONS FOR COMPLETION OF THE BATCH SAMPLING WORKSHEET

This review is to be based solely upon examination of the physical bill batches. For "tally" items, make a tally mark (/) for each bill in which there is an error with respect to the indicated area.

Batch No. - The 6-digit batch identification number.

No. of bills - The number of bills contained in this batch, as indicated on the CA-D-9 batch cover sheet. Does this number agree with the number indicated on the BILL552 report, and the actual number of bills physically present in the batch?

Case File # - Make a hash mark here if the case file number is not present on the bill.

Provider EIN - Make a hash mark here if provider EIN is not present on the bill. If bill is for pharmacy, travel, maintenance or training reimbursement to the claimant, no provider EIN is required.

Provider address - Make a hash mark here if full provider address is not present on the bill. No provider address is required if bill is for pharmacy, travel, maintenance or training reimbursement to the claimant.

Date stamp - Make a hash mark here if there are irregularities with respect to the date stamp. Irregularities would include no date stamp, or more than one date stamp with no indication that the bill had at some point been returned.

Form - Make a hash mark here if bill is not on an appropriate form.

Back to Top of FECA Bulletin No. 98-05

Attachment A2 BILL SAMPLING WORKSHEET (Link to Image)

Attachment B2 BILL SAMPLING WORKSHEET (Link to Image)

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 98-06

Issue Date: April 10, 1998

Expiration Date: April 9, 1999

Subject: Debt Collection: Referrals to the Department of Treasury.

Background: In April 1996, the Debt Collection Improvement Act of 1996 was passed. This Act mandates referral of debts to Federal agencies that are more than 180 days delinquent to the Department of Treasury for administrative offset. The Department of Treasury has designated the Financial Management Service (FMS) to oversee the two offset programs, cross-servicing and the Treasury Offset Program.

Cross-servicing makes the Department of Treasury responsible for all collection efforts. A variety of methods are used, from letter writing to salary offsets to, in some cases, referral to a private collection agency. Any debt referred for cross-servicing will also be handled under the Treasury Offset Program.

The Treasury Offset Program maintains a delinquent debtor database nationwide, and all federal payments disbursed by the FMS will be matched against this database for potential offset. The FMS may also refer debts to private collection agencies and may undertake other debt collection duties.

Under this system, debts will no longer be transferred to the National Office for referral directly to private collection agencies.

Purpose: To inform District Offices of the change in procedure for collection of delinquent debts and to advise of specific procedures to follow for referral for administrative offset.

Applicability: All claims and fiscal staff.

Action: Debt management will continue to be handled in its preliminary stages according to current procedure. Referral of debt for cross-servicing by FMS is only to occur when a debt is 180 days or more delinquent. Referral of debt to the Department of Treasury will replace referral to Private Collection Agencies as outlined in FECA PM 6-300.12.

District Offices must monitor all debts approaching or over 180 days delinquent for possible treasury referral, and must ready cases for such referral when needed.

1. When any debt is at least 90 days but not more than 120 days delinquent, the responsible Senior Claims Examiner should review the case to ensure that a letter outlining due process requirements for debt referral has been issued, and, if not, issue one. The letter must:

a. Provide written notification of the nature and amount of the debt and of the Office's intention to collect the debt via administrative offset;
b. Give the debtor the opportunity to inspect the file for all records concerning the debt;
c. Note that the debtor has been given the opportunity to appeal the debt;
d. Note that the debtor has been given the opportunity to enter into a written repayment agreement;
e. State a specific contact name and note that the debt may be referred for litigation.

The current system-generated collection letters, Forms CA-9001 and CA-9002, have been amended to meet this requirement. Examples of these letters are attached as Exhibits 1 and 2.

2. Each month, District Office staff should review the DMS aging report and, for all debts turning 180 days old where the claimant has received proper notice as outlined above, complete the package shown at Exhibit 3 and forward this package to the attention of Sheila Baker in the National Office. A guide for completion of this form is attached as Exhibit 4. A copy of all letters and decisions concerning the debt, especially the due process letter, must be attached. Ms. Baker will request appropriate debts for transfer to District 90 under code 08, Treasury referral. No debt may be referred without National Office request.

3. The District Office may not refer debts that are:

a. In litigation or referred to the Justice Department;
b. Already with a private collection agency;
c. On appeal (this includes debts currently before the ECAB);
d. Covered by Bankruptcy.

4. The District Office must immediately stop all collection efforts. If an FMS request is made of the District Office, the National Office should be contacted immediately.

5. If a debtor contacts the District Office about the debt, only questions regarding the validity of the debt may be answered. Any questions concerning the amount due or debt balance must be referred to FMS at 202-874-6660.

Debts referred for cross-servicing will remain transferred to District 90 until they are closed or returned by FMS. The National Office will then review the debt and take appropriate action or return the debt to the District Office.

Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 2—Folioviews Groups A, B, and D
(Claims Examiners, All Supervisors, District Medical Advisers, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

FB 98-06 Exhibit 1: CA-9001

OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

Dear CLAIMANT NAME:

This letter is in further reference to your debt in the amount of $999,999.99, which resulted from the overpayment of benefits in your case. A copy of our final decision and first demand for payment, dated 01/01/1901, is enclosed. We have not received payment from you or any indication that you intend to cooperate in this matter.

If we do not receive payment, or some indication that you intend to make payment, within 30 days of the date of this letter, we may add the following charges to the debt:

1. Interest at the current rate of the U.S. Treasury Bill. It will begin to accrue as of the date of this letter.

Interest charges will be waived if payment is received within 30 days.

2. Administrative charges for sending any additional demands for payment. If necessary, the Office of Workers' Compensation Programs (OWCP) can ask a debtor's federal employing agency to recover an overpayment from the debtor's salary. OWCP can also ask the Office of Personnel Management to recover the overpayment from money payable to the debtor from the Civil Service Retirement Fund. If you do not send us a check or contact us about this debt within 30 days, and you work for the federal government or are eligible for or in receipt of a Civil Service annuity, we may pursue one of these courses of action.

Also, if your debt remains delinquent, we may refer it to the Department of the Treasury for collection by administrative offset from any federal payments which may be due you. We will assess an additional administrative cost to help defray the expense of this referral. Information about the status and delinquency of your debt is reportable to credit bureaus.

You have the following rights with respect to referral of your debt to the Department of the Treasury or to credit bureaus:

You may inspect and request copies of your records about this debt;

You may enter into a mutually agreeable written repayment agreement; and

You may request a review of our determinations about the amount of your debt, its past-due status, and its legal enforceability. To exercise this right, you must state your request in writing, state your reason(s) for challenging our determinations, and sign your statement. If you believe that any information of record concerning your debt is not accurate, timely, relevant, or complete, you must provide information or documentation to support your belief.

You are expected to reply within 30 days. Make your check payable to the U.S. Department of Labor, OWCP, and include your FECA file number on the check. Send payment to:

District Office Lockbox Address Line 1
District Office Lockbox Address Line 2
District Office Lockbox Address Line 3
District Office Lockbox Address Line 4
District Office Lockbox Address Line 5

If you wish to enter into a written repayment agreement, contact me immediately on 999-999-9999.

Sincerely,

NAME OF SIGNER
TITLE

Enclosure(s):

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FB 98-06 Exhibit 2: CA-9002

CLAIMANT NAME

00000000000000000000000000000000000

00000000000000000000000000000000000

00000000000000000000000000000000000

00000000000000000000000000000000000

00000000000000000000000000000000000

Dear CLAIMANT NAME:

This letter is in further reference to your debt in the amount of $999,999.99, which resulted from the overpayment of benefits in your case.

Because 30 days have passed and we have not received payment or an indication that you intent to repay this money, your debt is now considered to be delinquent. Interest will therefore be assessed at the rate which applied when you received your first notice of indebtedness, or 99%. Penalty charges of 6% per year for any portion of the debt remaining delinquent for more than 90 days and administrative charges may also be added.

We may refer the debt to a credit bureau and to the Department of the Treasury for administrative offset if payment is not made within 60 days of the date of this letter. Information which will be given to a credit bureau is limited to your name, address and Social Security Number; the amount, status and history of the debt; and the program under which the debt arose, that is, the Federal Employees' Compensation Program.

Once your debt has been referred to the Department of the Treasury, administrative charges will be added to the current principal amount. These charges, which are computed as a percentage of the debt, reflect our collection cost. They are authorized by the Debt Collection Improvement Act of 1996 (Public Law 104-134). This referral will therefore result in a large increase in the size of your debt.

You may avoid these outcomes by sending your check in the amount stated above. Make your check payable to the U.S. Department of Labor, OWCP, and include your FECA file number on the check. Send it to:

District Office Lockbox Address Line 1
District Office Lockbox Address Line 2
District Office Lockbox Address Line 3
District Office Lockbox Address Line 4
District Office Lockbox Address Line 5

As you have been advised previously, you have certain rights in with respect to referral of your debt to the Department of the Treasury or to credit bureaus:

You may inspect and request copies of your records about this debt;

You may enter into a mutually agreeable written repayment agreement; and

You may request a review of our determinations about the amount of your debt, its past-due status, and its legal enforceability. To exercise this right, you must state your request in writing, state your reason(s) for challenging our determinations, and sign your statement. If you believe that any information of record concerning your debt is not accurate, timely, relevant, or complete, you must provide information or documentation to support your belief.

If you wish to enter into a written repayment agreement, contact me immediately on 999-999-9999.

Sincerely,

NAME OF SIGNER
TITLE

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CA-9002, page 2

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 98-07

Issue Date: January 5, 1998

Expiration Date: January 4, 1999

Subject: Compensation Pay: Compensation Rate Changes Effective January 1998.

Background: In December 1997, the President signed an Executive Order implementing a salary increase of 2.30 percent in the basic pay for the General Schedule. The applicability under 5 U.S.C. 8112 only applies to the 2.30 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment is effective the first pay period after January 1, 1998.

Purpose: To inform the appropriate personnel of the increased minimum/maximum compensation rates, and the adjustment procedures for affected cases on the periodic disability and death payrolls.

The new rates will be effective with the first compensation payroll period beginning on or after January 1, 1998. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10, which is now $94,287 per annum.

The minimum increase specified in this Bulletin is applicable to Postal employees.

The effect on 5 U.S.C. 8112 is as follows:

The basis for the minimum compensation rates is the salary of $14,571 per annum (GS-2, Step 1) and the basis for the maximum compensation rates is $94,287 per annum (GS-15, Step 10).

The effect on 5 U.S.C. 8133(e) is to increase the minimum monthly pay on which compensation for death is computed to $1,214.25, effective January 4, 1998. The maximum monthly compensation as provided by 5 U.S.C. 8133(e)(2) is increased to $5,892.94 per month.

Applicability: Appropriate National and District Office personnel.

Reference: Memorandum For Directors of Personnel dated December 1997; and the attachment for the 1998 General Schedule.

Action: ACPS will update the periodic disability and death payrolls. Any cases with gross overrides will not have a supplemental record created. Thus, the cases with gross overrides must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required.

1. Adjustments Dates.

a. As the effective date of the adjustment is January 4, 1998, there will be no supplemental payroll necessary for the periodic disability and death payrolls.

b. The new minimum/maximum compensation rates will be available in ACPS on or about January 23, 1998.

2. Adjustment of Daily Roll Payments. Since the salary adjustments are not retroactive, it is assumed that all Federal agencies will have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 1998. Therefore, it will not be necessary to review any daily roll payments unless an inquiry is received. If an inquiry is received, verification of the pay rate must be secured from the employing establishment.

3. Minimum and Maximum Adjustment Listings. Form CA-842, Minimum Compensation Pay Rates, and Form CA-843, Maximum Compensation Rates, should be annotated with the new rate information as follows:

4. Forms. CP-150, Minimum/Maximum Compensation, will be generated for each case adjusted. Notices to payees receiving an adjustment in their compensation will be sent from the National Office. Form CA-839, Notice of Increase in Compensation Award, will be utilized for this purpose Manual adjustments necessary because of gross overrides should be made on Forms CA-24 or CA-25 with a notice sent to the payee by the District Office.

Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 2--Folioviews Groups A and D
(Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 98-08

Issue Date: March 24, 1998

Expiration Date: March 23, 1999

Subject: November 1997 DFEC/OPM Computer Match

Background: Another DFEC/OPM computer match, designed to identify possible occurrences of prohibited concurrent dual benefit payment, was completed last month using the data for the November 8, 1997 periodic roll cycle. The data shared with OPM again included the death roll, and excluded schedule award cases. 74 cases survived the manual and automated screening processes employed by OPM. The last DFEC/OPM Computer Match was conducted in February, 1997.

With its advance copy of this bulletin, each District Office will receive a computer printout of the cases under its jurisdiction which should be screened, followed and reported on in accordance with the procedures described in FECA Bulletin 96-4 and again specified below. The presence of a case on the list should indicate that benefits were being paid by both DFEC and OPM on November 8, 1997, in apparent violation of the dual benefit prohibitions.

For this, and future matches, we will continue to follow the procedures used in the past; that is, OPM and the responsible District Offices will directly converse and correspond in order to resolve the hits. The District Offices will continue to have National Office reporting requirements, as detailed below. However, any problems that arise with OPM, or with any other aspect of processing the match hits, should be raised with Sheila Baker (202) 219-8461 for resolution. Telephone inquiries to OPM should be directed to Eugene Wooldridge at (202) 606-0228 (or 606-0228). Written inquiries or other correspondence should be directed to the Office of Personnel Management, Retirement Inspection Branch, P.O. Box 7174, Room 2309, Washington, D.C. 20044-7174, Attention: Eugene Wooldridge.

Purpose: To inform District Offices of the procedures for follow-up review and reporting requirements concerning the "hits" identified in the November, 1997 DFEC/OPM match, and to reiterate continuing reporting requirements for the previous OPM matches.

Applicability: District Directors, Assistant District Directors.

Action: Each District Office with one or more cases appearing as hits from this match will receive a copy of a computer printout detailing the information on those cases, in a combined listing of disability and death cases. (On this printout the OPM Claim Number begins with "A" for disability cases and begins with "F" for death cases. Also, if the first digit of the OPM Claim Number is 7 or 8 then benefits are being paid under FERS rather than CSRS.) In addition, individual "hit sheets" completed by OPM are in the process of being mailed directly to the District Offices by OPM. Please note that the field identified on the printouts as "OWCP Gross" is actually the FECA 28 day payment amount converted to a 30 day equivalent for easy comparison purposes. The "OWCP Net" field is the actual 28-day gross compensation amount paid.

1. Immediately pull and review each disability (OPM "A" prefix) case listed in which the OPM gross payment amount exceeds the FECA gross payment amount. (For these cases the OPM amount is underlined on the printout.) If a review of the case confirms that the claimant is, in fact, in receipt of prohibited dual benefits, then action should be taken immediately to obtain an election from the claimant. If the receipt of dual benefits was discovered as a result of this computer match, the claimant should be advised of this. The claimant should be advised that the benefit not elected will be terminated and that he or she may dispute the dual benefit finding and proposed action. The claimant will be given 30 days to complete and return an election of benefits form. Upon receipt of the completed election form, the benefit not elected is to be terminated as soon as possible. A copy of the election form is to be returned to OPM along with a copy of the supplemental "hit sheet." If the claimant fails to make an election or to dispute the dual benefit finding within the 30 day period, the claimant should be removed from the compensation rolls as soon as possible.

2. Review the remaining disability cases (those where FECA benefits exceed OPM benefits), and the death (OPM "F" prefix) cases (as detailed below). In the disability cases where FECA benefits are greater, OPM will seek the election and return a copy of the election along with a completed OPM "hit sheet" to DFEC.

3. In death/survivor cases (OPM "F" prefix), an informed election must be made before either benefit is terminated. Please remember that split elections can be made. In fact, several de facto split elections were discovered during previous matches; that is, there appeared to be dual benefits situations when in fact different beneficiaries were receiving OPM and FECA benefits. In other cases split elections have been made as a result of the matches. It is important that truly informed elections are made in these cases. During the 3rd match you were advised of our revised policy regarding the revocability of elections in death cases.

That change was formalized by revision to the regulations. However, OPM maintains that survivor elections are irrevocable; that is, that once an election of FECA benefits is made, the beneficiary may not subsequently elect OPM benefits, unless the FECA entitlement is later determined to have been mistaken, or there is a third-party credit absorption.

Therefore, included in the information provided to a beneficiary in order for him/her to make an informed election should be a statement that an election of OPM benefits can later be changed to elect FECA benefits, but that the reverse is not possible. In addition, an informed election should be based on a comparison of each beneficiary's benefits. Where the total converted gross FECA benefit is greater than the total OPM benefit, OPM will obtain the election of benefits and return a copy of the election along with a copy of the OPM "hit sheet" to DFEC.

Where the total OPM benefit exceeds the total converted gross FECA benefit and the review of the file confirms that the claimant is, in fact, in receipt of prohibited dual benefits, then action should be taken immediately to obtain an election from the claimant. If the receipt of dual benefits was discovered as a result of this computer match, the claimant should be advised of this. The claimant should be advised that the benefit not elected will be terminated and that he or she may dispute the dual benefit finding and proposed action. The claimant will be given 30 days to complete and return an election of benefits form. Upon receipt of the completed election form, the benefit not elected is to be terminated as soon as possible. A copy of the election form is to be returned to OPM along with a copy of the supplemental "hit sheet." If the claimant fails to make an election or to dispute the dual benefit finding within the 30 day period, the claimant should be removed from the compensation rolls as soon as possible.

4. In any case which results in a DFEC overpayment, the District Office should take immediate action in accordance with the overpayment procedures specified in Part 6 of the Procedure Manual.

5. Each DFEC overpayment case should be reviewed in order to determine whether the usual notifications concerning the prohibition against receiving concurrent retirement and compensation payments have been made. If so, the assumption must be made that the claimant is not without fault when such an overpayment occurs. Thus, except where this assumption is overcome by the evidence in the case file, a CA-2201 should be released immediately. Examiners are reminded that the supporting memorandum should explicitly detail the notification made.

6. When the appropriate overpayment letter is released, a 30-day call-up should be placed in the file. As soon as possible after a final decision has been released, administrative offset should be requested from OPM.

7. Initial review of all the listed cases should be completed and a report submitted by May 1, 1998 and quarterly thereafter until each "hit" is resolved. This review should confirm or refute the information supplied, the receipt of dual benefits and, where receipt of dual benefits is confirmed, determine whether or not there is an election of benefits on file. Each report must include, as appropriate:

a. The FECA case number and beneficiary name for each listing.

b. For death cases, the name, date of birth and relationship to the decedent should be listed for each eligible beneficiary.

c. Periods for which FECA benefits have been paid (specify schedule award periods).

d. Was the payment of dual benefits discovered through this match? (yes/no)

e. Is there an election on file? (yes/no) If yes, a copy of the election letter should be attached.

f. Have compensation payments been terminated? If so, effective on what date?

g. Is there an overpayment of compensation? (yes/no)

h. Is DFEC responsible for recovery?

i. What is the amount of the OPM overpayment?

j. What is the amount of the FECA overpayment transferred to the Accounts Receivable ledger?

k. Dates of subsequent due process and collection actions, including issuance of overpayment letters, final decision, release of SF-2805 to OPM requesting offset, etc. (Note: The current version of the SF-2805, Revised October 1988, should be used.)

Follow-up reporting for this match and for unresolved cases from prior matches should continue quarterly (by the 15th day of the first month of each quarter, i.e., 7/15, 10/15, 1/15, 4/15) until final resolution of the matter, until, for example, either the debt has been collected in full, a repayment schedule has been established and met at least once, or the account is otherwise closed. The final report should describe the repayment plan and/or date of payment. For example, the final report should show that a CA-2201 was issued on July 7, 1998; a final decision was issued on August 11, 1998 finding an overpayment of $2000; an SF-2805 was issued on September 22, 1998; the first payment of $200 was received from OPM on December 1, 1998; the debt will be recovered by October 1999. (Note: For OPM debts, reporting may cease once the OPM overpayment amount has been reported. You no longer need to report any actions on OPM debts beyond this point.)

Disposition: This Bulletin should be retained until all actions have been completed.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 6
(Regional Directors, District Directors, Assistant District Directors, Chiefs of Operations, Systems Managers, Technical Assistants and National Office Staff)

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 98-10

Issue Date: June 29, 1998

Expiration Date: June 28, 1999

Subject: Bill Payment/BPS - Preparations for Changes to Pharmacy Bill Processing

Background: On approximately July 15, 1998, systems changes will be put in place which will change the way pharmacy bills are processed. These changes involve new forms and data requirements.

Currently, when a pharmacy bill is processed as a reimbursement to the claimant, it is not necessary to enter any of the provider information into the system. In some offices, particularly those in the eastern regions, a large proportion of pharmacy bills are submitted as claimant reimbursements. As a result, entries for many pharmacies in those areas are not present on the district office provider files.

When the changes go into place, provider information will be required on all pharmacy bills. The National Office is mailing notices to both claimants and pharmacies, to advise them of the upcoming changes. Copies of the letters which are being released are shown as Attachment 1 and Attachment 2. However, it is difficult to disseminate the information to the pharmacies involved in the claimant reimbursements, since payments have not been made directly to them, and they are not on the provider files.

Reference: Federal (FECA) Procedure Manual Chapter 5-0200.

Purpose: To notify District Offices of changes in billing form requirements, and to provide instructions for adding pharmacy providers to the provider files.

Applicability: All staff.

Action:

1. Effective immediately, the Universal Claim Form (see Attachment 3) is an acceptable form for submission of pharmacy bills. The form is not required until July 15, 1998. Note that there are different versions of the form, all of which are acceptable.

2. Effective immediately, the Form CA-915 (Attachment 4) may be used for claimant reimbursements, except for travel. The CA-915 is to be used along with the form required according to the provider type, i.e., HCFA-1500 for physicians, UB-92 for hospitals, Universal Billing Form for pharmacies, etc. The CA-915 is not a required form.

3. Effective immediately, when a claim for pharmacy reimbursement from a claimant is received, the following steps should be taken:

a. Perform a provider inquiry (option 08, FECS001 Query Menu), to determine whether the pharmacy is on the provider file. To do this, the tax identification number and zip code will be needed.

b. If the provider is already on the provider file, the bill should be processed as it usually would be.

c. If the provider is not on the provider file, the bill should be forwarded to the secure provider file update individual(s) for addition of the pharmacy to the provider file. This can be done either before or after the bill is keyed.

d. If 50 pharmacy bills are checked in this way and all of the pharmacies are on the provider file, it is not necessary to screen any more bills.

e. If the office finds that pharmacies are not on the provider file, they should continue to screen incoming pharmacy reimbursements, and update the provider file, until the volume of pharmacies not on the file has diminished to no more than one in ten of those screened.

f. Care should be taken in making provider file updates, that duplicate entries are not made.

4. Whenever a pharmacy provider (provider type F) is added to the provider file between June 8, 1998 and July 15, 1998, a copy of Attachment 1, "Important Notice for Pharmacy Providers" should be sent to the provider.

The National Office will be monitoring additions of pharmacy providers to the provider file.

Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 3--Folioviews Groups A, B, C, and D
(All FECA Employees)

NOTICE: NEW REQUIREMENTS FOR PHARMACY BILLS

This notice applies to medical bill payments made by the Office of Workers' Compensation Programs (OWCP), under the Federal Employees Compensation Act (FECA).

EFFECTIVE JULY 15, 1998 - NEW FORMS AND CODES

• Universal Billing Form will be required for all pharmacy bills, even for reimbursement to the injured employee. The form is to be completed by the pharmacy. A copy of the form is attached for your reference.

• For reimbursement to injured employees, a Form CA-915, claimant reimbursement form, will be preferred. This form is used in addition to the Universal Billing Form. A copy of the CA-915 form is attached.

• All claims for prescription payments must be coded using National Drug Council (NDC) codes, and also contain the prescription number, refill number, decimal quantity, date filled, and the tax identification number and full name and address of the pharmacy.

• Bills not submitted properly will be returned or denied.

EFFECTIVE JULY 15, 1998 - ELECTRONIC BILLING

• OWCP will be able to receive pharmacy bills from pharmacy providers electronically by electronic data interchange (EDI).

WHAT DOES THIS MEAN FOR THE FECA BENEFICIARY?

• Pharmacy bills will be processed faster.

• Direct billings from pharmacies involve less paperwork than reimbursements to injured employees. If your pharmacy is not already billing OWCP directly for medications prescribed for your work-related conditions, you may wish to discuss this matter with them. Many pharmacies are willing to bill OWCP directly.

• Electronic billing by pharmacies will eliminate paperwork, and be processed faster.

• You may begin to use the new forms immediately.

Pharmacies are also being sent information about these changes. You may wish to discuss these changes with your pharmacy. Pharmacies wishing to bill electronically should contact their clearinghouse.

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IMPORTANT NOTICE FOR PHARMACY PROVIDERS

This notice applies to medical bill payments made by the Office of Workers' Compensation Programs (OWCP), under the Federal Employees Compensation Act (FECA), which provides workers' compensation coverage for civilian employees of the Federal government.

NEW FORMS AND CODING REQUIREMENTS - EFFECTIVE JULY 15, 1998

• Universal Billing Form will be required for all pharmacy bills, and is to be completed by the pharmacy.

• All claims for prescription payments must be coded using National Drug Council (NDC) codes, and also contain the prescription number, refill number, decimal quantity, date filled, and the tax identification number and full name and address of the pharmacy.

• Bills not submitted properly will be returned or denied.

ELECTRONIC BILLING - EFFECTIVE JULY 15, 1998

• OWCP will be able to receive pharmacy bills from pharmacy providers electronically by electronic data interchange (EDI).

• Contact your EDI clearinghouse for further information.

WHAT DOES THIS MEAN FOR PHARMACY PROVIDERS?

• Pharmacy bills will be processed faster.

• Electronic billing by pharmacies will eliminate paperwork, and thus be processed even faster.

• You may begin to use the Universal Claim Form immediately, if you do not already.

• If you do not routinely bill OWCP directly for pharmacy services, begin doing so. Injured employees prefer to do business with pharmacies which perform direct billing.

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