2000 FECA Bulletins which have previously been issued by the DFEC but have since expired or been superseded by another Bulletin, Circular or inclusion in the FECA Procedure Manual.
|
Bulletin |
Subject |
|---|---|
|
Medical--Use of Physicians Directory System (PDS) |
|
|
Bill Payment/BPS - Bill Batch Numbers (05/00A) |
|
|
New Regulations – Privacy Act (11/99B) |
|
|
ADP - Formal Decisions/Concurrent Conditions (11/99B) |
|
|
Comp Pay--Extra Pay for Firefighters (06/00A) |
|
|
Debt Collection: Perpetual Debts. Dual Benefits (includes Computer Matches) (01/00A) |
|
|
Compensation Pay: Compensation Rate Changes Effective January 2000 (01/00A) Corrected Copy: (03/00A) |
|
|
Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2000 (02/00A) |
|
|
BPS - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment (02/00A) |
|
|
Bill Payment/BPS - Correct Coding Initiative, Part B. (03/00A) |
|
|
Automated CA-110, Telephone Message (04/00A) |
|
|
Reporting Injuries--Electronic Submission of Forms CA-1 and CA-2 (05/00A) |
|
|
Compensation Payment - Change of Address in ACPS and CMF (04/00A) |
|
|
COP Nurse Intervention (05/00B) |
|
|
Bill Payment/BPS - Pharmacy Fee Schedule Change (09/00C) |
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-01
Issue Date: November 5, 1999
Expiration Date: November 4, 2000
Subject: Medical--Use of Physicians Directory System (PDS)
Background: The PDS was originally developed to ensure that referee medical specialists would be chosen in a fair and unbiased manner, and this goal remains as vital as ever to the integrity of the Federal employees' compensation program.
Although the regulations do not impose the same rigorous requirements for second opinion medical examinations, it is the policy of the Office of Workers' Compensation Programs (OWCP) to ensure that such examinations be of the highest quality possible, and that the selection process for second opinion specialists be fair and well documented. Enhancements in the structure and use of the PDS will improve our ability to achieve those goals.
The PDS User Guide, which was published in 1991 and updated in 1993, was recently added to Folioviews as a new infobase. As it stands, this document is probably more useful from a systems viewpoint than for medical schedulers, and it does not explicitly address the role of the district office managers who are charged with overseeing the use of the PDS in their respective offices.
For these reasons, it seems desirable to provide policy guidance for managers and claims staff in addressing bypasses, additions and suspensions (previously termed "inactivations") from the system. Also, because several years have elapsed since the PDS was released and training was provided in its use, basic instruction in the use of the system for medical schedulers will shortly be provided in the form of an FECA circular.
Each district office's PDS database will soon be updated with current information (telephone numbers and addresses) for all physicians now active in the specialties previously included, as well as current information for physicians newly active in those specialties. The update will also contain listings of physicians in several new specialties and subspecialties. All specialties and subspecialties, including those newly added, are shown in Attachment 1.
On a one-time basis, the National Office will send form letters to all physicians whose PDS records are currently annotated "DOL-N" asking whether they are now willing to participate in the program. The results will allow the PDS Administrators to update their respective databases.
When the PDS User Guide is revised to include the material in this bulletin and its companion circular containing instructions for using the PDS, it will be reorganized to reflect the different responsibilities of medical schedulers, district office managers, and claims staff. Guidance for the PDS Administrator (usually the Systems Manager) will remain in its current form.
Reference: PDS User Guide; Federal (FECA) Procedure Manual, Chapter 3-500
Purpose: To provide guidance to district office personnel with respect to the use and maintenance of the PDS
Applicability: Claims Examiners, Senior Claims Examiners, All Claims Supervisors, Medical Schedulers, District Medical Directors, Technical Assistants, Systems Managers, Staff Nurses, and Vocational Rehabilitation Specialists
Action:
1. Roles and Responsibilities. The following individuals are responsible for the indicated actions in PDS:
a. Medical Scheduler. This individual is responsible for all entries in the PDS relating to scheduling specific medical appointments, including bypass codes and updating telephone and address records for physicians in the system. Only the medical scheduler(s) should select physicians; claims staff should not have access to the system.
b. DO Manager. This individual may be the District Director or designee, and contacts with physicians may be assigned to an in-house District Medical Director, at district office option. The DO Manager is responsible for evaluating complaints about specific physicians and problems with the quality and timeliness of their reports. He or she is also responsible for authorizing the addition and suspension of specific doctors. The DO Manager will have a password which will allow him or her to make these changes and also to designate a specific physician for a second opinion examination (but not for a referee examination).
c. Claims Staff. Claims Examiners (CEs) are responsible for ensuring that referee and second opinion medical specialists are chosen through PDS. They are also responsible for advising the DO Manager about medical reports which are of poor quality or very untimely, as well as complaints received from employees.
2. Medical Scheduler. The following guidance is intended to address various problems which may arise in scheduling referee and second opinion examinations.
a. Alternate Zip Codes. The zip code used should normally be that of the employee's home address, though the duty station may be used for good cause, for instance if the employee lives in a rural area and the duty station is located in an urban area with more physicians. Other zip codes should not be used unless:
(1) No physicians in the employee's zip code practice the necessary specialty. In this instance, PDS will select the closest neighboring zip code. Since zip codes are not always contiguous, it may be necessary to check a zip code map (available from the Postal Service) to find the neighboring zip code.
(2) The employee has requested an examination elsewhere. For instance, if the employee will be away from home temporarily, the zip code of the temporary location may be used.
b. Bypass and Suspension Codes. If a bypass code is used, the physician will be eliminated from consideration for a single rotation through the list. If a suspension code is used, the physician will no longer appear in rotation. While the Medical Scheduler may use bypass codes, the DO Manager must authorize any suspension from the PDS database, except for codes M, R, and P. (Suspension codes are shown in Attachment 2.)
If a physician states that he or she is not interested in taking cases from OWCP, the scheduler should ask why.
(1) If the answer reflects a short-term concern, the scheduler should find out when the physician will be able to accept cases from OWCP. For example, if the physician says he or she cannot take any new cases because the practice is totally booked and expected to be so for the next several months, a bypass code "B" should be used.
(2) If the answer reflects a more substantive concern, the scheduler should attempt to address the concern if possible. For example, physicians sometimes think that OWCP may ask them to defend their reports in court. Once they understand that this is not the case, the physician may agree to perform the examination.
However, if the physician clearly does not want to accept cases from OWCP, the medical scheduler should so advise the DO Manager, who can authorize use of the DOL "N" code to suspend the physician from rotation.
c. Interaction with Claims Staff. When an appointment has been scheduled, the medical scheduler should print a copy of the appointment screen and include it in the case file. A copy of this screen will need to appear in the case file.
Any request by a CE to select, or refrain from selecting, a particular physician should be referred to the DO Manager.
d. Interaction with DO Manager. The medical scheduler should inform the DO Manager of any unreasonably late reports. Also, any physician who asks the scheduler to be added to the PDS database (or other party who contacts the scheduler on a physician's behalf) should be advised to submit a copy of the physician's curriculum vitae (CV) to the DO Manager for consideration of inclusion in the system.
3. District Office Manager. With the new PDS database, the designated manager will need to be scrupulous about ensuring that the database is kept current.
a. Adding a Physician. The CV of any physician who expresses interest in being added to the PDS, or who is identified as appropriate by an OWCP nurse or other staff member, should be forwarded to the DO Manager, who will determine if the physician is board-certified in one of the acceptable specialties. (This must be verified with the State medical board, or with the American Board of Medical Specialties (ABMS), whose certification line can be reached at 800-776-2378 or at www.certifieddoctor.org.)
If the physician is board-certified, the DO Manager may authorize addition of the physician to the database, after ensuring (through use of the View or Browse function) that the physician is not already present on the database.
The DO Manager should retain all CVs received in an administrative file.
b. Suspending a Physician. A physician should seldom be suspended from the PDS, since bypass codes cover most situations. Only when the conduct of the physician is in question, or the quality and/or timeliness of his or her reports is at issue, should suspension be considered. The suspension codes are shown in Attachment 2.
Suspension from the PDS is very different from exclusion by regulation. A physician who is suspended from PDS will not be considered for referee and second opinion examinations, but may still continue to serve as an attending physician. A physician who is excluded from the program will be barred from receiving payment for any service to any employee.
c. Canvassing "DOL-N" Physicians. Periodically, the DO Manager will send a form letter asking all physicians in the DO's jurisdiction who have stated that they are unwilling to accept OWCP cases if they will reconsider their position in this matter. For those physicians who agree to accept OWCP cases, the DO Manager will authorize a change in the DOL flag from "N" to "Y".
d. Poor Quality. A physician can be suspended based upon the quality of his or her report. The DO Manager should review the documentation forwarded by the CE and decide whether suspension is proper.
If this is the first time such problems have occurred with this physician, the DO Manager should contact the physician and discuss the issues. The DO Manager should maintain an administrative file which documents the complaint and the discussion.
If more than one complaint has been received about the same physician, the DO Manager should decide if a pattern of unsatisfactory reports exists. If so, the physician should be suspended with a note indicating the reason and activate the "Completeness" flag in PDS.
e. Lack of Timeliness. A physician can also be suspended based on the timeliness of a report. The DO Manager should review the information forwarded by the medical scheduler with respect to any unreasonably late reports and decide whether suspension is proper.
For example, if a physician provides a report one month late on a complex case, the DO Manager may choose to document his or her administrative file but not to suspend the physician. On the other hand, if a physician takes several months to provide a report after many calls from OWCP, or provides no report at all, the DO Manager should suspend the physician and include a note citing the specifics of the incident.
f. Other Complaints. The DO Manager is responsible for reviewing all reports of other kinds of complaints, and for taking action if needed.
If a physician has performed multiple examinations before without reported problems, and the complaint does not appear to be supported by the evidence in the case file, the DO Manager may choose not to act on the complaint.
By contrast, if another complaint has recently been lodged against this physician, and both complaints have been supported by the case files in question, the DO Manager should authorize the suspension of the physician with a note indicating the reason.
No minimum number of complaints need be lodged before suspension. One complaint, if severe enough, can be enough to suspend a physician. Copies of the complaints supporting suspension should be kept in an administrative file.
4. Claims Staff.
a. Second Opinion Examinations. District offices that use PDS for second opinion examinations must henceforth ensure that all such examinations are scheduled through PDS. As with referee medical examinations, the CE should indicate the type of specialty required. The CE should refrain from making a specific request to select or not to select a certain physician.
Ordinarily, the scheduler will attempt to make the appointment within 60 days. The CE should indicate any special time frame within which the examination is required.
b. Copy of Appointment Screen. When the medical scheduler has made the requested appointment (for either a referee or second opinion examination), he or she will run a copy of the appointment screen and drop it in the case file. This screen print must be placed in the case file to document that the physician who performed the examination was selected through PDS.
c. Physicians Suggested by OWCP RNs. OWCP field nurses occasionally suggest physicians who can perform evaluations. This practice may continue, with the understanding that the evaluation represents a consultation, and not an OWCP-directed second opinion examination. A physician suggested by an OWCP staff nurse may be added to the PDS (and therefore used for second opinion and referee examinations) if the physician's CV is obtained and the DO Manager agrees.
An employee who declines to attend an examination arranged by an OWCP nurse may not be sanctioned for failure to do so. Only refusals to attend OWCP-directed examinations may be sanctioned.
d. Complaints. All complaints must be made in writing. If the employee complains about the conduct of the physician during the examination, the CE should forward the complaint and copies of the report, the statement of accepted facts (SOAF), and the questions to the physician, to the DO Manager (through an intermediate supervisor, if any, at district office option). The DO Manager will review the complaint and take any action necessary.
e. Poor Quality. A report may be considered inadequate for any of several reasons, including failure to address the questions posed, failure to provide an opinion within the framework of the SOAF, and/or failure to provide a response to additional questions.
If such problems occur, the CE should work with the physician to obtain the necessary information. However, the CE should also advise the DO Manager that an inadequate report has been received (again, through an intermediate supervisor, if any, at district office option). The notification should include a copy of the medical referral letter, the SOAF and questions, and the medical report.
5. Instruction and Evaluation.
a. Training. All claims staff, medical schedulers, Staff Nurses, and District Medical Directors are to be trained in the procedures set forth above within 30 days of the date of this bulletin.
b. Reports. The National Office will develop new reports to evaluate compliance with the requirements set forth in this bulletin. These reports may be incorporated into the accountability review process.
Disposition: Retain until the indicated expiration date.
NANCY L. RICKER
Acting Director for
Federal Employees' Compensation
Distribution: List No. 1--Folioviews Groups A and D
(Claims Examiners, All Supervisors, Systems Managers, District Medical Advisers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
ATTACHMENT 1 - PDS DESK AID - Specialty/Subspecialty Codes
|
Code |
Description |
|---|---|
|
AI: |
Allergy and Immunization |
|
AN: |
Anesthesiology |
|
PN: |
Pain Management |
|
CR: |
Colon/Rectal Surgery |
|
CV: |
Cardiovascular |
|
DE: |
Dermatology |
|
EM: |
Emergency Medicine |
|
FP: |
Family Practice |
|
GE: |
Gastroenterology |
|
GS: |
General Surgery |
|
HE: |
Hematology |
|
HS: |
Hand Surgery |
|
ID: |
Infectious Disease |
|
IM: |
Internal Medicine |
|
SM: |
Sports Medicine |
|
ED: |
Endocrinology, Diabetes |
|
MO: |
Medical Oncology |
|
MT: |
Medical Toxicology |
|
NE: |
Neurology |
|
NM: |
Nuclear Medicine |
|
NP: |
Nephrology |
|
NS: |
Neurosurgery |
|
OG: |
Obstetrics and Gynecology |
|
OM: |
Occupational Medicine |
|
OS: |
Orthopedic Surgery |
|
OP: |
Ophthalmology |
|
OT: |
Otolaryngology |
|
PL: |
Plastic Surgery |
|
PD: |
Pulmonary Disease |
|
PM: |
Physical Medicine |
|
PS: |
Psychiatry |
|
AP: |
Addiction Psychiatry |
|
RA: |
Radiology |
|
RH: |
Rheumatology |
|
TS: |
Thoracic Surgery |
|
UR: |
Urology |
|
VS: |
Vascular Surgery |
The specialties represented by the following new codes are used very rarely. To schedule an examination using one of them, contact Patricia Wood in the National Office at 202-693-0035.
|
Code |
Description |
|---|---|
|
CP: |
Clinical Pathology |
|
CH: |
Chemical Pathology |
|
CY: |
Cytopathology |
|
MM: |
Medical Microbiology |
|
NU: |
Neuropathology |
|
PA: |
Anatomic Pathology |
|
CH: |
Chemical Pathology |
|
CY: |
Cytopathology |
|
MM: |
Medical Microbiology |
|
NU: |
Neuropathology |
|
PR: |
Radiologic Physics |
Back to Top of FECA Bulletin No. 00-01
|
Code |
Description |
|---|---|
|
B: |
The doctor can't give an appointment in a reasonable amount of time, or the doctor is on long vacation or leave of absence. |
|
C: |
The physician (or his or her associate) was previously associated with the case, or the physician does fitness-for-duty exams for the employee's agency. |
|
L: |
The physician is too far for the employee to travel. |
|
M: |
The physician moved out of zip code area. |
|
S: |
Need a different sub-specialty. |
|
O: |
Other. (Requires a note explaining the reason.) |
|
Use of codes B and O will result in the appearance of a notes window, with the prompt Update DR Notes. |
|
|
Suspension Codes: |
|
|
M: |
Physician moved out of district office's jurisdiction (to be used only when the physician's new address is unknown. Otherwise, the new address should be entered so that it can be made available to the new district office when the PDS database is next refreshed.) |
|
R: |
Physician deceased or retired from practice |
|
P: |
The physician's phone number is missing or wrong, and directory assistance cannot provide a better number. |
|
E: |
Physician excluded under regulations or lost license |
|
D: |
Duplicate of another record |
|
T: |
Timeliness |
|
Q: |
Quality |
|
C: |
Complaint |
|
F: |
Fee |
|
O: |
Other |
|
DOL "N": |
Physician definitely unwilling to take DOL cases. |
Back to Top of FECA Bulletin No. 00-01
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-02
Issue Date: May 10, 2000
Expiration Date: May 9, 2001
Subject: Bill Payment/BPS - Bill Batch Numbers
Background: In the next several weeks, DFEC will be preparing to migrate from the Data General software that was previously used for bill batch scanning and the ECAB Pilot to the Kofax software that is used in OASIS (OWCP Automated System for Imaging Services) for bill batch scanning. Offices will use this new software for bill batch scanning well before most offices have OASIS for case files.
As part of this migration, DFEC must use a consistent structure for bill batch identification numbers, to enable proper storage of the bill batches, and retrieval by the users. In the past, each district office has developed its own bill batch numbering scheme. Under the new structure, while some customization is possible, certain elements must be consistent throughout all offices.
Reference: Federal (FECA) Procedure Manual Chapters 5.0200.10 and 5.0201.2.d(3).
Purpose: To communicate new requirements for bill batch numbering.
Applicability: All bill processing and imaging staff, including data entry, bill resolution, fiscal and mail room personnel.
Actions:
1. Effective May 15, 2000, bill batch numbering schemes and batch sizes must conform to the requirements as outlined in items 2 - 9 below. These requirements are applicable only to bills that are imaged. Bill batch numbers used for other purposes (such as adjustment input) need not follow the revised scheme.
2. The first two characters (numeric) will represent the District Office. This portion of the ID is used for the imaging system only, and is not part of batch number that is keyed into the FECS programs. These characters should be the same as the prefixes used for case file numbers (01 for Boston, 02 for New York, etc.)
3. The third character (numeric) will be the last digit of the current year. For the current year, it will be 0 (zero).
4. The fourth character (alpha) will represent the current month, with A for January, B for February, etc., through L for December.
5. The fifth through eighth characters will be assigned by each district office. The office may choose to assign this portion of the batch number sequentially, or use it to designate other information, such as the type of batch, or the date of processing. For example, bill batches created in Jacksonville in March, 2000, could be assigned batch numbers as follows:
|
Imaging Batch ID |
Bill Processing Batch ID |
|---|---|
|
060C0001 |
0C0001 |
6. The bill processing batch ID (third through eighth characters) is entered into FECS applications.
7. All one-sided bills should be scanned using simplex mode (one-sided scan only), to reduce costs. At a minimum, all HCFA-1500 and UB-92 bills should be scanned in simplex mode.
8. No bill batch should be larger than 50 pages. Bills scanned in simplex mode will count as one page each. Bills scanned in duplex mode will count as two pages for each sheet of paper, since both the front and back will be scanned.
9. From time to time, there is confusion between the number 0 (zero) and the letter O (oh), and between the number 1 (one) and the lower-case letter l (el). The letter O should not be used in a bill batch ID. All alpha characters should be upper case.
10. Further information concerning OASIS will be provided under separate cover.
Training on this Bulletin should be completed as soon as possible.
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation
Distribution: List No. 3 - Folioviews Groups A,B,C, and D (All FECA Employees)
Back to Top of FECA Bulletin No. 00-02
Attention: This bulletin has been superseded and is inactive.
THIS SUPERCEDES BULLETIN 99-08, ISSUED JANUARY 4, 1999
FECA BULLETIN NO. 00-03
Issue Date: November 1, 1999
Expiration Date: November 1, 2000
Subject: New Regulations – Privacy Act
Background: FECA Bulletin No. 99-08, issued January 4, 1999, discussed new regulations involving the handling of requests submitted by FECA claimants under the Privacy Act. Paragraph five of that bulletin erroneously indicated that a claimant's access to his or her FECA claims file could be denied in only two situations. Additionally, paragraph six indicated, in error, that the 90-day appeal time did not begin to run until the requester received the denial letter. The 90-day period runs from the date of the denial. In light of these misstatements, the bulletin has been revised.
Reference: 20 CFR §§ 10.10 through 10.13 (1999); 29 CFR Part 71 effective December 1, 1998 (63 FR 56740 (October 22, 1998)).
Purpose: To inform OWCP staff, employing agencies and other interested parties of Privacy Act compliance requirements.
Applicability: Claims Examiners, Senior Claims Examiners, Supervisors, Fiscal Personnel, Technical Assistance and Systems Personnel, and Hearing Representatives.
Action:
1. All records in OWCP claim files and all copies of records relating to an on-the-job injury that are in the possession of the employer are considered to be OWCP records covered by the Privacy Act system of Records DOL/GOVT-1. Although employing agencies may establish procedures employees must follow to obtain access to employer-maintained records, any decision to grant or deny access must comply with Department of Labor rules and regulations.
2. Under the amended regulations, only OWCP may respond to requests for the correction or amendment of any FECA-related record. Employing agencies must forward any request they receive seeking to correct or amend such a record to OWCP.
3. The subject of a FECA file is entitled to receive the first copy of the file at no cost. The same rule would apply if the claimant requests copies of any documents not previously provided. OWCP or an employing agency may charge $.15 per page for each additional copy requested.
4. he filing of a request, or multiple requests, for more than one copy of a Privacy Act record will be viewed as an agreement by the requester to pay all applicable fees up to $25.00. When acknowledging a request, the disclosure officer should confirm this agreement by letter to the requester. The requester must be consulted before higher fees are assessed.
5. OWCP may require payment in advance of fees over $250.00. If such a fee is anticipated, a letter should be sent to the requester, noting the amount of the projected fee and advising the person that a designated staff person may be contacted to assist him or her in reformulating the request so that his or her needs may be met at a reduced cost.
6. OWCP may refuse to process any request submitted by an individual who has failed to pay an earlier fee, until the earlier fee is paid.
7. Any decision approving or denying a Privacy Act request must be in writing and signed by the designated Privacy Act disclosure officer. District Directors have been designated as OWCP disclosure officers. If copying of the requested documents will be delayed, an interim response should be sent indicating the reason for the delay and the date on which the documents will be mailed to the requester; this also should be under the signature of the disclosure officer.
8. As a general rule, the claimant may have access to each document in the claim file. There may be exceptions, however, such as where disclosure of medical records may be harmful to the individual. If there is question, the District Office should contact the appropriate regional office of the Solicitor of Labor to determine whether a document or documents may be exempt from disclosure. It should be noted that a request for access by the subject of the claim file shall not be denied unless both a Privacy Act exemption and a Freedom of Information Act exemption apply to the requested document(s).
9. If access to a particular record(s) is being denied, including those cases where OWCP is unable to find the requested record, the letter denying the request should include a statement of the reasons why access is being denied, and should cite to the specific statutory exemption applicable to the request.
10. When a request is denied, in whole or in part, the letter should advise the requester that he or she may, within 90 days of the date of the denial, file an appeal with the Solicitor of Labor. The appeal must be in writing and addressed to the Solicitor of Labor, United States Department of Labor, 200 Constitution Avenue, N.W., Room N-2428, Washington, D.C. 20210-0002. The requester should also be told that both the letter and the envelope should be clearly marked "Privacy Act Appeal."
11. Even if the Disclosure Officer believes that all requested documents are being provided, the letter transmitting the documents should advise the requester that if he or she does not believe the letter to be fully responsive to the request, an appeal may be filed by writing to the Solicitor of Labor within 90 days of the decision. The letter should be sent to the address set forth in Item 10. Please no longer use the letter attached to FECA Bulletin 99-08.
Disposition: Retain until incorporated into the Federal (FECA) Procedure Manual.
NANCY L. RICKER
Acting Director for
Federal Employees' Compensation
Distribution: List No. 3--Folioviews Groups A, B, C, and D. (All FECA Employees)
Back to Top of FECA Bulletin No. 00-03
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-04
Issue Date: November 19, 1999
Expiration Date: November 18, 2000
Subject: ADP - Formal Decisions/Concurrent Conditions
Background: The new imaging system, OWCP Automated System for Imaging Services (OASIS), will change the process by which case files are handled. The purpose of this system is to provide DFEC staff with an electronic case file to use in place of a paper file. Implementation of this system will have an impact on all phases of district office procedures for claims processed under OASIS. Since documents imaged under OASIS will be read-only files, no data entry will be permitted. Consequently, no CA-800 will be created for claims imaged through OASIS. While the FECS currently permits input of pay rate history, there was no automated tracking of concurrent medical conditions or formal decisions. Therefore, a new FECS screen has been developed to allow CE's to input concurrent conditions and formal decisions.
Purpose: This bulletin will provide guidelines for accessing and using the new Formal Decisions/Concurrent Conditions screen.
Applicability: Claims Examiners, Supervisors, System Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses.
Action:
Use of the Decisions/Concurrent Conditions screen is now mandatory. Concurrent conditions must be input for all newly created cases and all formal decisions issued after the date of this bulletin must be input. However, CA-800's will continue to be produced for non-imaged cases.
Accepted conditions for claims should be input into Case Management, Option #9 – Status/Accepted Conditions as is currently done. However, concurrent conditions must now be entered in Option #42 DECISIONS/CONCURRENT CONDITIONS of the Case Management menu. The F1 key permits a condition to be entered in text form. No ICD-9 coding is required. The F3 key permits modification of a line of text and the F5 key deletes a line of text. Instructions will appear at the bottom of the screen.
Any formal decision that is released must now be entered into Option #42 DECISIONS/CONCURRENT CONDITIONS. The F9 key permits toggling between the Case Decision Update and the Concurrent Conditions Update portions of the screen.
The date a formal decision is released must be noted in the DECSN DATE field. This is a required entry with the format of MM/DD/YYYY.
Valid entries for the TYPE of decision will be displayed in a drop down menu as follows:
D = District Office
R = Reconsideration
H = Hearings and Review
E = ECAB)
An entry in this field is required.
Valid entries for the ISSUE field will also be displayed in a drop down menu as follows:
01-Time
02-Civil Employee
03-FOI-Factual
04-FOI-Medical
05-Causal Relationship/No Residuals
06-Continuing Injury Related Disability
07-POD
08-Recurrences
09-Schedule Award-Paid
10-Schedule Award-Denied
11-Overpayment
12-COP
13-LWEC - 0%
14-LWEC - Actual Earnings
15-LWEC - Constructed
16-Refusal/Obstruction of Medical Exam
17-Denial of Medical Treatment/Surgery
18-Failure to Accept Suitable Employment
19-Forfeiture
20-Non-cooperation with Rehab/Nurse Efforts
21-Recon Decision-Not Merit Review (ECAB decisions only)
22-Denial of Hearing
23-Recission
24-Third Party
25-Other
Again, an entry in the ISSUE field is required.
An entry in the DISP field is required. Valid entries will again appear in a drop down menu as follows:
D = Denied
A = Affirm
R = Remand
V = Reverse/Vacate
B = Affirm/Remand (affirmed in part and remanded in part)
N = Non-merit Review
C = Acceptance (adverse decision only)
M = Modified
The use of the same issue code, in conjunction with dates, will link an appeal decision to the appropriate adverse decision on a claim. For instance, a claim may be denied initially due to causal relationship and have a decision from Hearings and Review, several reconsiderations and a decision by the ECAB. The issue code would remain causal relationship as long as that is the decision being appealed.
An entry into both the EXAM and CERT fields is required. Both the examiner and the certifier will use the location code assigned to them by their district office.
No entry is required in the EXAMINIT or CERTINIT fields. Use of examiner's initials and certifier's initials fields will be at the discretion of the district office.
New query options have also been added to Case Management and Query. Case Management Option #43 - Query Decisions/Concurrent Conditions, and Query Option #11 – Decisions/Concurrent Conditions will display all concurrent conditions and formal decisions for a particular file number. In addition, the Reported Accepted Conditions portion will display all accepted conditions for the particular case queried as well as conditions for any other cases in the database with the same SSN. This would include cases that have been denied, accepted or administratively closed.
This information will also be available from the Auto 110 menu in the near future.
Examples: A claim is initially denied as FOI (factual) on September 1, 1999. The claimant requests reconsideration of this decision on October 1, 2000. The SrCE denies the request for reconsideration as not timely filed on November 10, 2000. The initial decision would have a type code of D (district office), an issue code of 03 (FOI-factual) and a disposition code of D (denied). The second decision would have a type code of R (reconsideration), an issue code of 03 (FOI-factual) and a disposition code of N (non-merit review).
A claim is initially denied as FOI (medical) on September 2, 1999. On September 3, 1999, the CE receives the necessary medical evidence and realizes the evidence was received in the office on September 1, 1999. On September 3, 1999 the CE vacates the September 2, 1999, decision and accepts the claim. The initial denial of the claim would have a type code of D (district office), an issue code of 04 (FOI-medical) and a disposition code of D (denied). On the date the initial decision is vacated and the claim accepted, the type code would be D (district office), the issue code would be 04 (FOI-medical) and the disposition code would be R (reverse/vacate).
Disposition: Retain until the expiration date or until superseded.
NANCY L. RICKER
Acting Director for
Federal Employees' Compensation
Distribution: List No. 1–-Folioviews Groups A and D
(Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
Back to Top of FECA Bulletin No. 00-04
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-05
Issue Date: June 8, 2000
Expiration Date: June 7, 2001
Subject: Comp Pay--Extra Pay for Firefighters
Background: In 1989, OWCP determined that pay rates for COP and compensation would properly include extra pay authorized under the Fair Labor Standards Act, 29 U.S.C. 207(k), for firefighters, emergency medical technicians, and other employees who earned and used leave on the basis of their entire tour of duty, and who were required to work more than 106 hours per pay period. This policy was first addressed in FECA Bulletin 89-26, and it now appears in FECA Procedure Manual Chapter 2-900, paragraphs 7b(21) and 8c.
However, Public Law No. 105-277 amended Title 5 of the U. S. Code to define hours worked by firefighters in excess of 106 biweekly, or 53 weekly, as overtime. It also states that firefighters shall not receive premium pay authorized by other provisions of subchapter V of chapter 55 of Title 5. The effective date of this provision was the first day of the first pay period after October 1, 1998, which was October 11, 1998.
Section 5 U.S.C. 8114(e) of the FECA bars inclusion of overtime pay in pay rates for compensation purposes. As the extra pay earned by firefighters is now classified as overtime, this rule will therefore apply to these employees as of October 11, 1998. Firefighters with pay rate effective dates on or after that date are not entitled to receive the "extra pay" discussed in PM 2-900.7b(21) and 8c (either "FLSA OT" or "standby premium pay").
Public Law No. 105-277 also provided that certain firefighters would be entitled to an increase in basic pay equal to two step increases of the employee's grade at the time the law took effect.
Finally, although PM 2-900.7b(21) refers to Emergency Medical Technicians (EMTs) and other employees with similar schedules, Public Law No. 105-277 applies only to firefighters.
Reference: FECA Bulletin 89-26; FECA Procedure Manual Chapter 2-900.7b(21) and 8c.
Purpose: To advise claims staff of the provisions of Public Law No. 105-277 as they apply to the pay rates of firefighters.
Applicability: Claims Examiners, Senior Claims Examiners, Claims Supervisors, Fiscal Officers, Technical Assistants, Hearing Representatives, and Hearing Examiners
Action:
1. The procedures that follow apply only to firefighters who earned and used leave on the basis of their entire tour of duty, and who were required to work more than 106 hours per pay period. Some firefighters work fewer hours per pay period, and because their pay rates should never have included the extra increments which are the subject of this bulletin, no adjustments are needed.
2. For firefighters with pay rate effective dates (whether date of injury, date of recurrence, or date disability began) from July 21, 1987 to October 10, 1998, "FLSA extra pay" and standby premium pay should still be included in the pay rates. The calculation of these increments is described in PM 2-900.8c.
3. For firefighters with pay rate effective dates on or after October 11, 1998, "FLSA extra pay" and standby premium pay may no longer be included in pay rates. While firefighters may well work more than 106 hours per pay period, the annual or biweekly rate of pay provided by employing agencies should not include overtime.
4. Hourly rates of pay may be derived by dividing the annual rate of pay by 2756 (the number of hours in a work year for these employees, analogous to the figure of 2087 hours used for regular federal employees). The rate of pay per pay period may be obtained by multiplying the hourly rate by 106. (Or, the rate of pay per pay period may be obtained by dividing the annual rate by 26.)
5. When making loss of wage-earning capacity determinations, the step increases granted by Public Law No. 105-277 should not be considered in calculating the current pay for grade and step when injured. Rather, the original grade and step should govern the figure used.
6. District office managers will be advised by memorandum of any cases in their respective jurisdictions for firefighters (occupation code G0081) with pay rate effective dates on or after October 11, 1998. These cases must be examined to determine if the pay rates are accurate, and if not, the pay rates must be adjusted.
Disposition: Retain until the indicated expiration date.
DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation
Distribution: List No. 1--Folioviews Groups A and D
(Claims Examiners, All Supervisors, Systems Managers, District Medical Advisers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
Back to Top of FECA Bulletin No. 00-05
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-06
Issue Date: December 27, 1999
Expiration Date: December 27, 2000
Subject: Debt Collection: Perpetual Debts
Background: A recent audit by the Office of Inspector General has noted that, despite efforts to review all debts and forward all required debts to the Treasury Department for collection activity, there is another universe of debts which, although not delinquent, are not being adequately collected.
Specifically, these have been termed "perpetual debts" because, often, there are regular payments (or a payment plan) which are not adequate to meet accruing interest, hence the debt is not being reduced although it is also not showing as overdue.
It is necessary that district office staff begin taking action to review these debts and, where necessary, take action to resolve the perpetual debt status.
Purpose: To inform District Offices of the need to evaluate perpetual debts for either Treasury referral or compromise.
Reference: FECA Bulletin 98-06; FECA PM Ch.6-300
Applicability: All Claims and Fiscal staff.
Action:
1. All District Offices must take action to review all debts to locate any on which regular payments are being received over an extended period but where the payments are inadequate to pay down the debt balance in a reasonable period.
2. Any debt identified as a perpetual debt must be evaluated and either
(a) compromised to limit the repayment period (this would include waiver of charges if not previously considered); or
(b) referred to National Office for referral to Treasury per procedures outlined in FECA Bulletin 98-06; or
(c) referred to National Office for referral to the Department of Justice for compromise if the debt is more than $100,000 (or more than $600 when fraud is involved).
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.
DENNIS M. MANKIN
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)
Back to Top of FECA Bulletin No. 00-06
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-07
Corrected Copy
Issue Date: January 3, 2000
Expiration Date: January 2, 2001
Subject: Compensation Pay: Compensation Rate Changes Effective January 2000.
Background: The new GS-15, Step 10, salary was shown incorrectly in the original Bulletin. This Bulletin reflects the correct salary for GS-15, Step 10. In December 1999, the President signed an Executive Order implementing a salary increase of 3.80 percent in the basic pay for the General Schedule. The applicability under 5 U.S.C. 8112 only applies to the 3.80 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, 2000.
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, 2000. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10, which is now $100,897 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:
|
Effective January 2, 2000 |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$ 1,299.50 |
$6,306.06 |
|
Weekly |
224.91 |
1,455.25 |
|
Daily (5-day week) |
44.98 |
291.05 |
The basis for the minimum compensation rates is the salary of $15,594 per annum (GS-2, Step 1) and the basis for the maximum compensation rates is $100,897 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 $1,299.50, effective January 2, 2000. The maximum monthly compensation as provided by 5 U.S.C. 8133(e)(2) is increased to $6,306.06 per month.
Applicability: Appropriate National and District Office personnel.
Reference: Memorandum For Directors of Personnel dated December 1999; and the attachment for the 1999 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 2, 2000, 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 21, 2000.
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, 2000. 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:
| Date | Rate | Rate | Rate | Rate | Rate |
|---|---|---|---|---|---|
|
1/02/00 |
44.98-67.47 |
224.91-337.37 |
44.98 |
224.91 |
1,299.50 |
| Date | Rate | Rate | Rate | Rate | Rate |
|---|---|---|---|---|---|
|
1/02/00 |
291.05 |
1,455.25 |
(5,821.00) |
6,306.06 |
|
4. Forms. CP-150, Minimum/Maximum Compensation, will be generated for each case adjusted. It should be noted that this adjustment process re-calculates EVERY ACPS record from very beginning to current date, thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect. 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.
DENNIS M. MANKIN
Acting 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)
Back to Top of FECA Bulletin No. 00-07
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-09
Issue Date: March 1, 2000
Expiration Date: February 28, 2001
Subject: Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2000.
Purpose: To furnish instructions for implementing the CPI adjustments of March 1, 2000.
1. The new CPI increase, adjusted to the nearest one-tenth of one percent, is 2.7 percent.
2. The increase is effective March 1, 2000, and is applicable where disability or death occurred before March 1, 1999.
3. The new base month is December 1999.
4. The maximum compensation rates, which must not be exceeded, are the following:
$ 6,306.06 per month
1,455.25 per week
5,821.00 each four weeks
291.05 per day (for a 5-day week)
Applicability: Appropriate National Office and District Office personnel.
Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981.
Action: On or about March 17, 2000, 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, 2000 and the start date of the periodic and death payroll cycles is February 27, 2000, there will be a supplemental record created for the period March 1 through March 25, 2000. Effective March 26, 2000, the periodic and death payrolls will reflect the increased amount.
b. The CA-816, LWEC, program will be updated with the new CPI percentage. This update will be performed for all district offices by the National Office.
2. Adjustments of Daily Roll Payments. Since the CPI will not be in ACPS until March 20, 2000, daily roll payment cases requiring the new CPI should be held for data entry until that date. ACPS RECORDS THAT REQUIRE ADJUSTMENT SHOULD NOT BE ENTERED BETWEEN MARCH 17, 2000 AND MARCH 20, 2000. ACPS data entry may resume on March 21, 2000.
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, 2000.
4. Forms.
a. Beginning with the compensation payment cycle that covers March 26, 2000 to April 22, 2000, the Office will issue a monthly Benefit Statement to each individual receiving benefits on the 28-day periodic roll cycle. This Benefit Statement will state the gross amount of compensation, the period of compensation covered by the statement, and the pertinent deductions made from the gross compensation. For compensation payments made via paper checks, the Benefit Statement will accompany the check. For compensation payments made through Electronic Fund Transfer (EFT), the Benefit Statement will be mailed separately.
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. A CP-140 report will be printed for each case adjusted, upon specific request by a District Office.
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 a benefit statement may not reach the addressee, and regeneration of the form is not possible. Thus, a simple letter indicating the amount of compensation paid every four weeks will be an adequate substitute 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.
DENNIS M. MANKIN
Acting 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)
ATTACHMENT - Cost of Living Adjustments
|
EFFECTIVE DATE |
RATE |
EFFECTIVE DATE |
RATE |
|---|---|---|---|
|
10/01/66 |
12.5% |
09/01/80 |
4.0% |
|
01/01/68 |
3.7% |
03/01/81 |
3.6% |
|
12/01/68 |
4.0% |
03/01/82 |
8.7% |
|
09/01/69 |
4.4% |
03/01/83 |
3.9% |
|
06/01/70 |
4.4% |
03/01/84 |
3.3% |
|
03/01/71 |
4.0% |
03/01/85 |
3.5% |
|
05/01/72 |
3.9% |
03/01/87 |
0.7% |
|
06/01/73 |
4.8% |
03/01/88 |
4.5% |
|
01/01/74 |
5.2% |
03/01/89 |
4.4% |
|
07/01/74 |
5.3% |
03/01/90 |
4.5% |
|
11/01/74 |
6.3% |
03/01/91 |
6.1% |
|
06/01/75 |
4.1% |
03/01/92 |
2.8% |
|
01/01/76 |
4.4% |
03/01/93 |
2.9% |
|
11/01/76 |
4.2% |
03/01/94 |
2.5% |
|
07/01/77 |
4.9% |
03/01/95 |
2.7% |
|
05/01/78 |
5.3% |
03/01/96 |
2.5% |
|
11/01/78 |
4.9% |
03/01/97 |
3.3% |
|
05/01/79 |
5.5% |
03/01/98 |
1.5% |
|
10/01/79 |
5.6% |
03/01/99 |
1.6% |
|
04/01/80 |
7.2% |
03/01/00 |
2.7% |
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).
| >Prior to 11/1/74 | Eff. 11/1/74 |
|---|---|
|
Prior to 11/1/74 .08-.34 = .23 |
Eff. 11/1/74 .13-.37 = .25 |
|
.35-.57 = .46 |
.38-.62 = .50 |
|
.58-.80 = .69 |
.63-.87 = .75 |
|
.81-.07 = .92 |
.88-.12 = 1.00 |
Back to Top of FECA Bulletin No. 00-09
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-10
Issue Date: February 1, 2000
Expiration Date: January 31, 2001
Subject: BPS - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.
Background: Effective January 14, 2000, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobiles is increased to 32.5 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, determination has been made to apply the applicable rate to disabled FECA beneficiaries traveling to secure necessary medical examination and treatment.
Applicability: Appropriate National Office and District Office personnel.
Reference: Chapter 5-0204, Principles of Bill Adjudication, Part 5, Benefit Payments, Federal (FECA) Procedure Manual; Instruction CA-77, Instructions for Submitting Travel Vouchers; and 5 USC 8103.
Action: Instruction CA-77, Instructions for Submitting Travel Vouchers, has been revised to reflect the indicated rate change. A copy of the revised instructions is attached to this bulletin and may be reproduced at local levels. It will not be necessary to search and locate vouchers processed subsequent to February 1, 2000; however, if inquiry is received, appropriate adjustment should be made. Vouchers being processed for travel periods after February 1, 2000, may be adjusted to reflect this increase.
Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.
DENNIS M. MANKIN
Acting Director for
Federal Employees' Compensation
Attachment
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)
ATTACHMENT - Form CA-77
Instructions for Submitting Travel Vouchers U.S. Department of Labor (For reimbursement of travel and related expenses Employment Standards Administration under the Federal Employees' Compensation Act)
Office of Workers' Compensation Programs
-------------------------------------------------------------------------------------------------------------
Note: Any item not in conformity with the following instructions and not legible will be deducted from the voucher. Both forms SF-1012 and SF-1012a MUST be submitted with a valid case file number.
Claim for necessary and reasonable expense incident to travel authorized in accordance with provisions of the Federal Employees Compensation Act may be submitted for consideration on Voucher Forms SF-1012 and SF-1012a. Travel must be by shortest route and, if practicable, by public conveyance (streetcar, bus, boat, or train).
The Office will promptly reimburse all bills received on the approved form and submitted in a timely manner. However, no bill will be paid for expenses incurred if the bill is submitted more than one year beyond the calendar year in which the expense was incurred or the service or supply was provided, or more than one year beyond the calendar year in which the claim was first accepted as compensable by the Office, whichever is later (per CFR §10.413).
Payment will be made for taxicab fare or the hire of special conveyance where streetcars, buses, or other public and regular means of transportation are not available, except where these cannot be used because of the injured employee's disability. If claim is made for payment of expenses for taxicabs or hire of special conveyances, a full explanation must be made showing the necessity thereof.
Reimbursement for transportation by automobile owned by an employee or a member of his/her immediate family or another Government employee, may be claimed when no public conveyance is available or where the physical condition of the injured employee requires the use of special conveyance.
Mileage expenses will be reimbursed at the following rates for travel during the following periods:
| Date | Rate |
|---|---|
|
January 1, 1995 - June 6, 1996 |
30 cents per mile |
|
June 7, 1996 – September 7, 1998 |
31 cents per mile |
|
September 8, 1998 – March 31, 1999 |
32.5 cents per mile |
|
April 1, 1999 – January 13, 2000 |
31 cents per mile |
|
January 14, 2000 - and after |
32.5 cents per mile |
If mileage expense is claimed prior to January 1, 1995, contact your OWCP district office for rates.
Claim may be made for parking fees. If travel must be over a toll route, toll charges may be claimed. The voucher must show the locations where travel began and ended, mode of travel, and name of the transportation company (if by public conveyance). List each item of expense separately, showing the date incurred, place, and cost of the travel.
There will be no reimbursement for meals or lodging when travel is for less than 12 hours in total. If the authorized travel was for longer than 12 hours, and a claim for meals or lodging is made, the dates and hours must be shown on the voucher. The necessity for lodging must be explained in detail. All charges must be reasonable, and will be reimbursed at the per diem rate for the locality of travel.
Any stopover or delay en route should be carefully explained. If several trips are covered by the same voucher, list each separately, indicate the purpose of each trip, and secure the approval of the attending physician, certifying that the dates are correct according to his/her records.
Original itemized receipts made out in factor of the person making payment, signed in ink or indelible pencil by the person receiving payment must be furnished for all items in excess of $75.00.
After a voucher SF-1012 has been completed, it must be signed in ink or indelible pencil in the space provided for the payee.
The travel voucher should not be submitted if there is no expense claimed.
INSTRUCTION CA-77
Revised January 2000
Back to Top of FECA Bulletin No. 00-10
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-11
Issue Date: February 25, 2000
Expiration Date: February 24, 2001
Subject: Bill Payment/BPS - Correct Coding Initiative, Part B.
Background: In August of 1999, Part A of OWCP's Correct Coding Initiative (CCI) was implemented. Since that time, coding specialists have been hired in each district office, and training has been provided to them.
Effective on or about February 25, 2000, Part B of the CCI will be implemented. Part B contains editing for mutually exclusive procedures, comprehensive/component procedures, and add-on codes. Editing for global periods will be implemented at a later date.
The source for the mutually exclusive and comprehensive/component code pairs is HCFA (Health Care Financing Administration). This information is updated quarterly. The source for the add-on codes is the AMA CPT Coding Manual. This information will be updated annually.
Mutually exclusive procedures are defined as procedure code pairs for which there is a medical impossibility or improbability that they would be performed at the same session. An example of mutually exclusive procedures is code 27332 (arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial or lateral) and code 27310 (arthrotomy, knee, with exploration, drainage, or removal of foreign body).
Comprehensive/component procedures are code pairs for which a more comprehensive procedure code includes several procedures that also have individual component procedure codes. Providers are not allowed to bill separately for a comprehensive code and the related component codes. An example of this type of coding error would be using component code 97750 (physical performance test or measurement, with written report, each 15 minutes) with comprehensive code 97003 (occupational therapy evaluation).
Add-on codes are procedures that are carried out in addition to the primary procedure performed. The add-on codes can never be reported alone. The add-on codes are listed in Appendix E of the CPT Coding Manual. An example of an add-on code is code 22632 (each additional interspace), which must be used with code 22630 (arthrodesis, posterior interbody technique, single interspace, lumbar).
At approximately the same time that the CCI Part B edits are installed, the edit for unlisted procedures (edit 364) will be activated. Information concerning this edit was provided previously, and additional information is being provided to the coding specialists under separate cover.
Reference: Federal (FECA) Procedure Manual Chapters 5-0203 and 5-0204; FECA Bulletin No. 99-29, issued August 5, 1999.
Purpose: To communicate procedures for processing bills under the CCI, Part B.
Applicability: Claims Examining, Bill Processing and CCI personnel.
Actions:
The CCI edits are applicable only to certain CPT-4 and HCPCS codes.
For some mutually exclusive and comprehensive/component code pairs, a procedure code modifier may be used to indicate that the procedures are not truly mutually exclusive or comprehensive/component. However, a modifier does not have this effect for all code pairs. The data provided by HCFA includes a modifier indicator, which is being used by the system in the CCI edits. It is critical that modifiers present on the bill be data entered when the bills are keyed. There are several additional modifiers that have recently been added to the system. Currently, all of the modifiers listed on the inside front cover of the CPT 2000 coding book are valid in the FECS system.
Seven new edits have been developed for CCI Part B. These include edits for mutually exclusive codes (edits 372 and 373), comprehensive/component codes (edits 374, 375, and 377), and add-on codes (370 and 371). Detailed edit sheets for these seven new edits are being sent under separate cover, along with the revised condensed BPS edits, and the revised EOB listing.
When errors 370, 372, and 374 are assigned, denial is automatic, and the edit failure cannot be overridden. Edit 371, 373, 375, and 377 failures result in suspensions, which must be manually reviewed and may be overridden or set to deny as appropriate.
All billing issues with respect to these edit failures, including resolution of these edit failures, should be referred to the coding specialist. The coding specialist is not responsible for other edit failures that may occur on a bill. Other edit failures on the bill should, in general, be resolved before the bill is referred to the coding specialist.
To assist in resolving CCI edit failures, and to provide information on the outcomes of the CCI editing, a "CCI Edit Report" will be produced each time BILL552 is run. This report should be provided to the coding specialist.
Job aids for resolving these new CCI edits will be provided to the coding specialists under separate cover.
Training on this Bulletin should be completed within 30 days of the issuance of this bulletin.
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.
DENNIS M. MANKIN
Acting Director for
Federal Employees' Compensation
Distribution: List No. 3--Folioviews Groups A, B, C, and D
(All FECA Employees)
Back to Top of FECA Bulletin No. 00-11
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-12
Issue Date: March 15, 2000
Expiration Date: March 15, 2001
Subject: Automated CA-110, Telephone Message
Background: In November of 1994, the automated CA-110 program was created to address the Program's lack of a comprehensive telephone call tracking system as well as various communication concerns.
The use of the automated form has become widespread, and use of the data on these forms has been helpful both on a District Office and National Office level to address ongoing communication concerns. A current such concern is the level of service given to requests for authorization for physical therapy and other medical services. In light of this, the current automated CA-110 has been enhanced to include additional codes to address the level of response given when a request is telephonic. This will allow offices (as well as the National Office) to track level of responsiveness and to assure that all authorizations which are sought are answered timely.
Reference: FECA Bulletin 95-2
Purpose: To outline and provide guidance for the use of enhancements to the automated CA-110.
Applicability: All District Office and National Office personnel who use CA-110 forms to record and track responses to telephone messages.
Action:
1. When any telephone call is received that addresses an authorization for a medical service or procedure (including requests for physical therapy), an automated CA-110 should be used. This is true whether authorization is given immediately (therefore requiring no further response) or whether further communication is necessary. This procedure does not differ from that outlined in FECA Bulletin 95-2.
2. The PTA and OMA codes now in existence for physical therapy and other medical authorizations are now to be used only by a person initially taking a telephone call, whether in a contact office or off of the voice mail system. Any response where the caller actually speaks to a claims examiner concerning the authorization should use one of the new codes outlined in item 3.
3. There are now six new codes available to indicate the level of response to an inquiry for physical therapy or other medical authorization. These codes should be used to specify the type of answer given to any authorization request. They are:
PTAI - Physical Therapy Authorization, Interim
PTAS - Physical Therapy Authorization, Substantive
PTAF - Physical Therapy Authorization, Final
OMAI- Other Medical Authorization, Interim
OMAS- Other Medical Authorization, Substantive
OMAF- Other Medical Authorization, Final
"Interim" should be used if the telephone call was answered, but the authorization sought was not yet granted or denied; generally this will be the case if more information is necessary prior to a decision and if the response given to the person contacting the office is brief. In such an instance, a response in further depth will be required, whether telephonically or in writing.
"Substantive" is the appropriate status if the caller was advised of some indication of the current status of the case, but an answer on the authorization remains unavailable. An example of this is a surgery request, where a second opinion has been scheduled to address the issue. Advising a caller of the appointment's existence and date would be sufficient to make the response substantive.
"Final" should only be used if the authorization sought was given or denied during the telephone call. Note that any decision on authorization should be appropriately documented in the case file and in the FECS.
4. While coding in the automated CA-110 will address the level of response to a request for authorization, the actual data concerning the period of any such authorization should be recorded as appropriate in other FECS applications--that is, authorization for physical therapy should be recorded in Case Management item 34, and any other authorization should be the subject of a Case Management note and, possibly, the addition of an ICD-9 procedure code.
Disposition: Retain until incorporated into the Federal (FECA) Procedure Manual.
DENNIS M. MANKIN
Acting Director for
Federal Employees' Compensation
Distribution: List No. 3--Folioviews Groups A, B, C, and D
(All FECA Employees)
Back to Top of FECA Bulletin No. 00-12
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-13
Issue Date: March 27, 2000
Expiration Date: March 27, 2001
Subject: Reporting Injuries--Electronic Submission of Forms CA-1 and CA-2
Background: As efforts continue to streamline the adjudication and case management process, employing agencies have sought the ability to submit initial claim forms electronically, eliminating the mailing lag time that is occasionally involved with paper submissions.
Agreements are now in place for this to happen, and programming allowing this type of submission is complete. Shortly, employing agencies will begin to submit batches of forms CA-1 and CA-2 electronically. The first agency to do so will be Veterans Affairs(VA), which will submit both their own claims and, in the future, claims as a batching representative for other agencies, forwarding claims from various smaller employers. It is anticipated that both the Department of Defense and U.S. Postal Service will follow soon thereafter.
Purpose: To inform all DFEC staff of the impending submission of initial claim forms electronically.
Applicability: Claims Examiners, Senior Claims Examiners, Supervisors, Fiscal Personnel, Technical Assistants, Systems Personnel, and Hearing Representatives.
Action:
1. Batching agencies (such as the VA) will submit a daily batch of new claim forms for all employing agencies they represent. This batch will be submitted electronically to the Branch of Coordination and Control in the National Office (NO). The files will be retrieved in NO Sequent and placed in a directory accessible to DFEC. They will then be archived (to retain a record of information submitted), assigned a batch number (typically the agency identification and a date), and then copied to a working directory.
2. The files will then be translated electronically and edited to ensure that they are in the proper format and contain all required information. Any errors will be noted via electronic communication to the submitting agency.
3. All properly submitted and translated files are then placed in a directory on the Sequent, sorted by District Office, in fixed format. All information received is then added to an NO cross-reference table which will be used to track the case number assigned by the DO. The employing agencies submitting information in this fashion will retain the paper claim forms supporting the electronic data submitted.
4. The files are then transmitted to the DO and the data is placed into CA-1 and CA-2 database files in the DO. Each DO should set up an e-mail list so that a report, created when the files are received in the DO, may be e-mailed notifying DO management of the receipt of a new batch. This group should be created on the DO level and entitled "DO Name CA-1/2 Group." Included should be the Regional Director, District Director, Systems Manager, Case Create Supervisor (if different from Systems Manager), and William Cole, Chief, Branch of Coordination and Control. Case files must be created within 48 hours of receipt of this e-mail.
5. The case create staff will then review electronic CA-1 or CA-2 forms online. The screen on which this will be done approximates the current paper CA-1 or CA-2. It can be accessed as a sub-menu to item 01 in Case Management on Sequent.
6. After the claim form is reviewed, a case number will be assigned by the case create clerk just as if a paper form were received. When the case number is entered, the system will automatically add the case to case management and pull all necessary info from the electronic form without the need for further keying. The postcards generated via current case create procedures will also be run automatically.
7. The electronic CA-1 or CA-2 will be printed and placed into the paper file (in offices not yet using the OASIS system). This screen print does not, currently, approximate the paper form CA-1 or CA-2 in format, although all of the information it contains is identical. The system is being enhanced so that the printout, will, eventually, mimic the paper forms in style and format.
If a DO is currently imaging new files, the electronic CA-1 or CA-2 will be printed and scanned into OASIS so it may be reviewed onscreen along with all other case documents. Case files will be routed to claims examiners in the same manner as those created from paper claim forms. Claims examiners will also be able to access a sequent query screen (query item 13) showing the online claim form for both imaged and non-imaged cases should they so choose.
Disposition: Retain until incorporated into the Federal (FECA) Procedure Manual.
DENNIS M. MANKIN
Acting Director for
Federal Employees' Compensation
Distribution: List No. 3--Folioviews Groups A, B, C, and D
(All FECA Employees)
Back to Top of FECA Bulletin No. 00-13
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-14
Issue Date: April 12, 2000
Expiration Date: April 11, 2001
Subject: Compensation Payment - Change of Address in ACPS and CMF
Background: Recent OIG audit findings indicate a need to modify the process of changing addresses in ACPS and CMF to ensure that adequate separation of duties exists. It has been demonstrated that such separation is necessary, not only for the effective processing of compensation payments, but also for the security of our mission and accountability of OWCP in disbursing monies from the Compensation Fund.
Reference: FECA Procedure Manual Chapter 2-401.3a, and Chapter 5-308.5n. and 5o.
Purpose: To emphasize the importance of separation of duties between the personnel who receive the written request for an address change and initiate action to make the change in the ACPS or CMF, and the personnel who verify and enter the change for the purpose of directing compensation payments. In addition, to provide procedures for all FEC offices and to ensure that personnel affected by these procedures know how to implement them.
Applicability: Regional Directors, District Directors, Fiscal Officers, Bill Payment Supervisors, Claims personnel, and appropriate National Office personnel.
Actions: Satisfactory procedures for handling changes of address in the CMF and ACPS include several elements described as follows:
1. The action to change an address must be initiated by the claimant/payee or authorized representative in written form. A telephone contact is not sufficient to cause OWCP to change an address.
2. No person with ACPS access will be involved in the process of changing addresses for directing compensation payments. This includes address changes for checks and EFT account information. Both the person who enters the change of address into the system and the person who verifies it will be non-claims personnel. That is, they are not to have access to any other claims payment options in the ACPS menu. Each District Office will designate the appropriate staff person(s), and the list of such persons will be maintained in the District Director's office. The District Director's list will be updated immediately as changes in this responsibility occur.
3. The source document for the address change must be signed by the claimant/payee or the authorized representative. A typical example of a source document would be a letter from the claimant/payee or representative. Another common document for this purpose would be a standard form such as the SF-1199a, which is used to switch from receiving the mailed check at the home address to receiving payment by EFT (electronic funds transfer), where the compensation payment is deposited directly into the claimant's bank account from Treasury. An existing EFT address (bank account number or routing number) should be changed in ACPS with a signed SF-1199a form or a similar form generated by the financial institution and signed by an institution official. We strongly encourage the use of the SF-1199a; however, any official bank document is acceptable so long as it is accompanied by the original signature of the claimant.
4. The person initiating the change of address action and the non-claims person entering the change into ACPS must initial and date the input documents. The person who completes the action by verifying the accuracy of the change on the output document (also a non-claims person) must initial and date the output document. With all changes of address, the payment must be treated as an initial payment, and as such must be certified by a person qualified to certify payments.
5. All ACPS payment inputs requiring certification must be documented with the following:
Source documents (i.e., a letter from the claimant/representative, CA-7, or SF-1199a).
Input documents (CA-25, screen prints, etc.)
All output documents (e.g., CP-030, CP-040, CP-045, CP-230, CP-285).
Source documents must be present for any certified input. For any EFT changes, such as in routing or account number, the source document must be either an SF-1199a or a similar form. Any form must include information provided by the bank and must be signed by the claimant/representative and, preferably, by an official of the financial institution.
Whoever pulls and distributes outputs must assure that outputs are delivered to a single person designated by management in each unit/area. This person will then assure that all outputs are properly distributed.
The source document, input document and output document, once certified/verified, must be stapled or spindled together in the case file. All such documents must be retained, and no output document may be discarded.
6. If your District Office currently has satisfactory procedures in place for processing changes of address in the ACPS and CMF (which adhere to all of the stipulations described above), they should be continued.
7. District Office managers must ensure that all affected personnel are aware of this process and recognize its importance. Adherence to these procedures will be monitored biannually in the accountability review process and annually during the OIG's Consolidated Financial Statement Audit.
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual Chapter 2-401 and Chapter 5-308.
DENNIS M. MANKIN
Acting Director for
Federal Employees' Compensation
Distribution: List No. 1 - Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
Back to Top of FECA Bulletin No. 00-14
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-15
Issue Date: September 18, 2000
Expiration Date: September 17, 2001
Subject: COP Nurse Intervention
Background: The President's Federal Worker 2000 initiative directs the Secretary of Labor to reduce the overall occurrence of injuries by 3 percent per year, while improving the timeliness of reporting of injuries and illnesses by agencies to the Department of Labor by 5 percent per year, reduce the occurrence of such injuries by 10 percent per year for those work sites with the highest rates of serious injuries and reduce the rate of lost production days by 2 percent per year.
In order to meet these goals, OWCP has placed strategic emphasis on prompt adjudication and payment of benefits, early intervention in new injuries, active disability management and prompt, appropriate return to the workplace. It is felt that early intervention during the Continuation of Pay (COP) period will have a favorable impact on these goals by permitting early identification of injuries that may result in additional lost time after the COP period.
To this end, OWCP is implementing a nurse intervention program during the COP period that will be solely telephonic in nature and will be limited to thirty days of case management. Such early intervention depends on prompt submission of claim forms by employing agencies, since any cases with an initial work stoppage date more than thirty days prior to the date the case is received by OWCP will not be considered for this program.
Although nurse intervention will not be extensive during the COP period, the nurses' medical knowledge and experience will permit them to identify cases that will require more extensive nurse intervention due to the severity of the injuries, contemplated surgical intervention, or other such issues. They will also be able to discuss injured workers' medical concerns and offer advice.
Changes have already been made to the Case Create program which prompts the case create clerk to enter the date the employee stopped work (if applicable) and the date the employee returned to work, if available, for all lost time traumatic injury cases. This data will be used to identify cases appropriate for COP telephonic nurse intervention.
Triage codes will be used by the COP telephonic nurses, or Telephonic Case Managers (TCM) in cases with no full-time return to work. The codes, which will be checked off on the COP/RTW Case Worksheet, allow the TCMs to alert the district office regarding cases in need of follow-up action. The triage codes are: "1" - no return to work due to surgery, invasive diagnostic testing, hospitalization or catastrophic injury; "2" - no return to work due to other reasons; "3" - part-time return to work; "4" - claimant not cooperating with nurse.
System enhancements are planned to include new QCM status codes for COP-QCM cases and to automatically create QCM records on accepted cases with triage codes.
Purpose: To provide COP telephonic nurse guidelines for Staff Nurses, TCMs, and claims staff.
Applicability: Regional Directors, FEC District Directors, Claims Examiners, Supervisors, Technical Assistants, Staff Nurses and Vocational Rehabilitation Specialists
Action:
Staff Nurse Responsibilities
1. Each District Office should recruit COP/TCMs from the existing TCM nurses or existing field nurse pool. Cases assigned to the COP/TCM can be in addition to cases assigned in the normal rotation. If a selection is made from the existing TCM nurses, the fees paid for cases assigned under the COP nurse intervention program will not be counted toward their income cap. The Staff Nurse (SN) should recruit at least two COP/TCM per state/territory serviced by the district office and must ensure that each COP/TCM possesses all RN licenses needed to cover their assigned area.
2. COP/TCM intervention will be telephonic only and is limited to a maximum intervention period of thirty days. No extensions of this thirty-day period will be permitted.
3. In those cases where there is no "RETURN TO WORK DATE" and fifteen days have elapsed since the date the claimant stopped work, a daily report will be produced listing those injury claims with no return to work. (See Attachment 1 - Sample COP/RTW Tracking Nurse Referrals.) All traumatic injury cases with lost time will be reported, including unadjudicated cases. This report will be e-mailed to the SN for assignment to the COP/TCM. She or he will then e-mail this list to the COP/TCM for action. This listing will show claim number, date referred, and employing agency (EA) contact name and telephone number for each selected case. The claim number will remain on the list until the COP/TCM enters a date of first telephone call or the case is closed. The daily e-mail listing received by the SN will be sorted first by state and then by date referred with the most recent referrals appearing at the top of the list.
4. The COP/TCM will be reimbursed at a "global fixed fee" rate of $100.00 per case. This amount represents reimbursement for both the professional and administrative services on the case and will be paid only at case closure using the unique code: COPTN (COP telephonic nurse). Reimbursement must be claimed on an HCFA-1500 and submitted with the completed COP/RTW Case Worksheet.
5. Once the COP/TCM has closed a case, the SN will forward the COP/RTW Case Worksheet with any recommendations to the CE.
COP/TCM Nurse Responsibilities
1. Upon receipt of the e-mail list from the SN, the COP/TCM will access a web-based "home page," which will provide relevant claimant information for all cases referred. (See Attachment 2 - Sample COP/RTW Case Update screen.) Claimant information available to the COP/TCM will include: the claimant's name and telephone number, date of birth, date of injury, a narrative diagnosis, the employer's name and telephone number, and case status. The COP/TCM will also be able to ascertain whether the claim has been reviewed by the CE or is a short-form closure case. This information will appear as Initial Claim Adjudication, and will be Short Form Closure; Pending; Accepted, Denied. If the case is in a denied status, no further input will be permitted. A prompt at the bottom of the screen will state RECORD COMPLETE/CLOSED; NO FURTHER UPDATE ALLOWED.
2. After accessing the "home page," if the record is not complete or closed, the COP/TCM will initiate a telephone call to the EA to ascertain the claimant's return to work status. If contact with the EA is unproductive, the COP/TCM should initiate contact with the claimant to discuss return to work capabilities/status.
3. The "home page" will also permit access to the new COP/RTW Case Update screen for data entry by the COP/TCM. If the claimant has returned to work, the COP/TCM will input into this screen the date of the telephone call, to whom the call was made, the date of the claimant's return, whether the return was part-time or full-time, and whether the return was to regular duty or light duty. In cases where the claimant is losing intermittent time from work, the "DATE RETURNED TO WORK" will be the claimant's most recent return to work. The COP/TCM should also respond to "DID THE CLAIMANT USE 45 DAYS OF COP?" prompt, with "Y" for yes or "N" for no. The COP/TCM should ask this question of the claimant or the EA and enter the answer provided. If no answer is yet available, an entry in this field is not required. The COP/TCM will then close the file, input the date of closure in the COP/RTW Case Update screen and forward a completed worksheet to the SN. (See Attachment 3 - Sample COP/RTW Case Worksheet.)
4. A total of three calls should be attempted by the COP/TCM to reach either the claimant or the EA. If the claimant has not returned to work and there is some indication either from the claimant or the E/A that a return to work is planned within one week, the COP/TCM will note the projected return to work date on the COP/RTW Case Worksheet. The COP/TCM should then contact the claimant as soon as possible following the return to work date to verify that the return to work did occur. Once confirmed, the return to work date, type (i.e., full-time, part-time, regular or light duty) is entered into the COP/RTW Case Update screen. The date of the follow-up telephone call should be entered as well. The COP/TCM will then close the file, input the date of closure in the COP/RTW Case Update screen and forward a completed COP/RTW Case Worksheet to the SN.
5. If the claimant does not have a plan to return to work and/or has not returned to work by the second contact, the COP/TCM will initiate a call to the attending physician (AP) to request updated medical reports and physical limitations for a return to work. The AP should be requested to provide this information directly to the district office. The COP/TCM should then document this as the final call in the COP/RTW Case Update screen.
6. For those cases where the claimant does not return to work within the thirty-day intervention period, the COP/TCM will terminate the intervention and complete the COP/RTW Case Worksheet, including the appropriate triage code and recommending future actions to be taken by the CE. The COP/RTW Case Worksheet will be forwarded to the SN. Once the thirty-day intervention period has ended, the COP/TCM will not be permitted to input any further data into the COP/RTW Case Update screen. Under no circumstances will this period be extended.
7. At specific points in the case intervention, it will be appropriate for the COP/TCM to cease intervention, enter the data into the COP/RTW Case Update screen, document the details (return to work, no return to work, medical information obtained, etc.) and return all claimant related information to the SN who will distribute it to the appropriate CE. If, in the course of intervention activities, the COP/TCM discovers: A) the AP is planning imminent surgery prior to release for return to work; B) the AP is planning any invasive diagnostic examination; C) the claimant's injuries are catastrophic; or D) the claimant refuses to discuss his/her case with the COP/TCM, intervention ceases immediately. The COP/TCM will inform the claimant that the CE will be handling the case. The COP/TCM will record the appropriate triage code on the COP/RTW Case Worksheet, input the appropriate data into the COP/RTW Case Update screen and forward all documentation to the SN.
8. The COP/TCM should claim reimbursement at a "global fixed fee" rate of $100.00 per case. This amount represents reimbursement for both the professional and administrative services on the case and will be paid only at case closure using the unique code: COPTN (COP telephonic nurse). Reimbursement must be claimed on an HCFA-1500 and submitted with the completed COP/RTW Case Worksheet.
Claims Examiner Responsibilities
1. The CE should promptly input a return to work date, if he or she becomes aware of that information prior to the COP/TCM, by accessing Case Management Screen 41 (also listed as COP/RTW Case Update). The CE should include whether the return was full-time, part-time, regular, or light duty by completing the field marked "RTW TYPE." After a return to work date has been entered, the record will be locked and no further data input will be permitted.
2. In cases where the claimant is losing intermittent time from work, the "DATE STOPPED WORK" will be the first date the claimant stopped work and the "DATE RETURNED TO WORK" will be the claimant's most recent return to work. The CE should also respond to "DID THE CLAIMANT USE 45 DAYS OF COP?" prompt. Valid entries are "Y" and "N." An entry in this field is not required if the answer is not known.
3. The CE may view information recorded by the COP/TCM in Query screen 12, COP/RTW Case Update.
4. All short-form closure cases with a part-time return to work and 45 days or less of COP used will "flip" to UD status with an expired call-up note. The CE must then expedite adjudication and immediately initiate QCM, including referral to a field nurse. A QCM record should be created using the part-time return to work date as the track date.
5. Receipt of a completed COP/TCM Case Worksheet indicating a part-time return to work on an accepted case should also prompt immediate QCM action.
6. Once thirty-five days have elapsed since the claimant stopped work and no "RETURN TO WORK DATE" has been input, all short-form closure cases which meet the criteria for COP nurse intervention will "flip" to UD status with an expired call-up note. The CE must then expedite adjudication, and initiate QCM action, including referral to a field nurse. A QCM record should be created using the date of injury as the track date.
7. Receipt of a COP/TCM Case Worksheet which shows that there has been no return to work due to surgery, invasive diagnostic testing, hospitalization or catastrophic injury (triage code 1), or that the claimant is not cooperating with the nurse (triage code 4) on an accepted case should also prompt immediate QCM action.
8. Upon initial acceptance of a traumatic injury claim, the CE will be prompted to enter a COP/RTW date if the COP/RTW record is not complete. A response will be required. For cases not meeting the criteria for referral to the COP/TCM the prompt will read "DID THE CLAIMANT STOP WORK FOLLOWING THE INJURY? (Y/N)". Valid entries are "Y" or "N". A "Y" response will open the COP/RTW Case Update window. For cases that have been referred to the COP/TCM the prompt will read "HAS THE CLAIMANT RETURNED TO WORK? (Y/N/U)". Valid entries are "Y", "N" or "U" (unknown). A "Y" response will also open the COP/RTW Case Update window. If the response is "N" and forty-five to sixty days have elapsed since the "DATE STOPPED WORK", the CE will be prompted with the question "DID THE CLAIMANT USE THE FULL 45 DAYS OF COP?". The CE may answer "Y" or "N" or may skip this field by using the Tab, Space or Enter keys. If it has been over sixty days since the "DATE STOPPED WORK" the system will automatically set the "DID THE CLAIMANT USE THE FULL 45 DAYS OF COP?" to yes. If the response is "U," neither the "RETURN TO WORK DATE" nor the "DID THE CLAIMANT USE THE FULL 45 DAYS OF COP?" fields will be updated.
9. Once a claim has been denied, no entry will be permitted in the COP/RTW Case Update screen.
10. If a Timely Payment of Compensation claim (TPCUP)is later paid for wage loss on a COP-QCM case with no return to work, the QCM track date should be changed to reflect the first date claimed on the paid Form CA-7. If a TPCUP record is later paid for wage loss on a COP-QCM case with part-time return to work, the track date should be changed to reflect the decision date on the approved CA-7 record. A weekly COP-QCM Cases Report will identify any cases with accepted wage loss claims whose track dates have not been changed.
11. QCM cases closed during the COP period for return to work full-time in regular or light duty should have their records "zeroed out". System enhancements are planned that will utilize the new COP-QCM status codes to automatically perform this function.
District Office Systems Manager Responsibilities
1. On a weekly basis, the Systems Manager in each district office will run two reports that identify cases for expedited adjudication and QCM action. Both reports will be sorted by responsible CE and triple-terminal digit.
a) The Adjudication Triage Report will identify UN/UD cases with either no return to work (when > 35 days since date stopped work) or part-time return to work (when < 45 days since date stopped work). The report will provide the claim number, claimant name, number of days elapsed since date stopped work, return to work date and type (if applicable), and the date of COP/TCM closure (if applicable).
b) The QCM Referral Triage Report will identify accepted cases with either no return to work or part-time return to work, COP/TCM closure and no QCM activity. The report will provide the claim number, claimant name, number of days elapsed since date stopped work, return to work date and type (if applicable), number of days elapsed since COP/TCM closure, and accepted ICD-9 codes.
2. On a weekly basis, the Systems Manager in each district office will run a report that identifies COP-QCM cases with wage loss and no adjustment to the QCM record. The COP-QCM Cases report will identify QCM cases in categories A, B or C with a track date equal to the date of injury, or a track date equal to the return to work date and part-time return to work, and a CA-7 with decision codes of A1/2 or I1/2. The report will provide the claim number, claimant name, decision date on approved CA-7 record, and beginning date claimed on the paid Form CA-7.
Disposition: Retain until the expiration date or until superseded.
DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation
Distribution: List No. 1 - Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
|
CASE NO |
CITY |
STATE |
CLAIMANT PHONE |
REFER DATE |
AGENCY |
|---|---|---|---|---|---|
|
|
|||||
|
502222293 |
BALTIMORE |
MD |
(999) 999-9999 |
03/15/2000 |
1100FF |
|
Agency Contact ( ) -
|
|||||
|
505055569 |
GAITHERSBURG |
MD |
(202) 693-1029 |
03/15/2000 |
560000 |
|
Agency Contact: INJURY COMPENSATION SUPERVISOR (617) 654-5525
|
|||||
|
505555595 |
BATTLE CREEK |
MD |
(616) 962-6646 |
03/15/2000 |
2150BB |
|
Agency Contact: CASE MANAGER (804) 771-2900
|
|||||
|
505555596 |
WASHINGTON |
DC |
(616) 968-0191 |
03/09/2000 |
2150EE |
|
Agency Contact: CASE MANAGER (804) 771-2900
|
|||||
|
156666666 |
WASHINGTON |
DC |
(203) 637-4146 |
03/01/2000 |
2520BU |
|
Agency Contact: INJURY COMPENSATION OFFICER (617) 273-7332
|
|||||
|
505555569 |
BOSTON |
MD |
(301) 555-1212 |
03/01/2000 |
2520BU |
|
Agency Contact: INJURY COMPENSATION OFFICER (617) 273-7332
|
|||||
|
015555666 |
BOSTON |
DC |
(301) 555-1212 |
02/14/2000 |
560000 |
|
Agency Contact: INJURY COMPENSATION SUPERVISOR (617) 654-5525
|
|||||
|
062000007 |
ALEXANDRIA |
VA |
(707) 555-1212 |
02/10/2000 |
99995J |
|
Agency Contact: NOT FOUND IN DEPARTMENT AGENCY TABLE (V01). |
|||||
ATTACHMENT 2 - COP/RTW Case Update
ATTACHMENT - 3 COP/RTW CASE WORKSHEET
Worksheet - Page 1
Worksheet - Page 2
Back to Top of FECA Bulletin No. 00-15
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 00-16
Issue Date: September 5, 2000
Expiration Date: September 4, 2001
Subject: Bill Payment/BPS - Pharmacy Fee Schedule Change
Background: Effective January 4, 1999, a fee schedule for prescription drugs was implemented for charges processed on and after that date. The formula for computing the allowable fee was based upon the two-year high average wholesale price (AWP), plus a dispensing fee equal to 20% of the AWP. The dispensing fee could not be less than $2.50, nor greater than $15.00. The calculated amount was then rounded up to the nearest whole dollar.
Effective September 5, 2000, the formula for computing the allowable fee for prescription drugs will be changed, and will be applicable to prescriptions filled on and after September 5, 2000. The new formula will be based upon 95% of the two-year high AWP, plus a set dispensing fee of $4.00. The calculated amount will no longer be rounded up to the nearest whole dollar.
A private vendor is still the source of the AWP information. The data is updated weekly. The web page for performing pharmacy fee calculations has been revised to apply the new calculation formula. For dates of service prior to September 5, 2000, the allowable fee should be calculated manually using the AWP available on the web page.
Reference: FECA Bulletin No. 99-07, issued January 4, 1999.
Purpose: To communicate new formula for calculation of the allowable fee for prescription drugs.
Applicability: Claims Examining, Bill Processing and Contact personnel, and Coding Specialists.
Actions:
1. Prescription drug calculations for allowable fees should be performed in accordance with the following formula for service dates on and after September 5, 2000:
(AWP X quantity X 95%) + $4.00
2. If the calculated amount is less than the billed amount, the calculated amount is the payable amount. If the billed amount is less than the calculated amount, the billed amount is the payable amount.
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation
Distribution: List No. 3--Folioviews Groups A, B, C, and D
(All FECA Employees)
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