2002 FECA Bulletins which have previously been issued by the DFEC but have since expired or been superseded by another Bulletin, Circular or inclusion in the FECA Procedure Manual.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 |
|---|---|
|
FECA Bulletin No. 02-01 |
FECA Bulletin 02-01 (not published) |
|
Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2001 |
|
|
Case Management - Authorization of Physical Therapy |
|
|
Revised procedures for processing work-related injury claims filed by employees of the Office of Workers' Compensation Programs and their relatives in the Midwest (formerly Chicago) Region |
|
|
Comp Pay/ACPS – Employing Agency Action to Notify DFEC of Claimant Ineligibility for Continuing Life Insurance |
|
|
Compensation Pay - Compensation Rate Changes Effective January 2002 |
|
|
Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2002 |
|
|
BPS -Revision in the Reimbursement Rates Payable for TheUse of Privately Owned Automobiles(POV) Necessary to Secure Medical Examination and Treatment |
|
|
FECA Bulletin No. 02-09 |
FECA Bulletin 02-09 (not published) |
|
Bill Payment-Physical Therapy Multiple Initial Evaluations |
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 02-02
Issue Date: March 1, 2001
Expiration Date: February 28, 2002
Subject: Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2001.
Purpose: To furnish instructions for implementing the CPI adjustments of March 1, 2001.
1. The new CPI increase, adjusted to the nearest one-tenth of one percent, is 3.4 percent.
2. The increase is effective March 1, 2001, and is applicable where disability or death occurred before March 1, 2000.
3. The new base month is December 2000.
4. The maximum compensation rates, which must not be exceeded, are the following:
| Amount | Time |
|---|---|
|
$ 6,476.44 |
per month |
Applicability: Appropriate National Office and District Office personnel.
Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981.
Action: On or about March 14, 2001, both the periodic disability and death payrolls were updated in ACPS. No supplemental record was created for cases with gross overrides. 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, 2001 and the start date of the periodic and death payroll cycles was February 25, 2001,a supplemental record was created for the period March 1 through March 24, 2001. Effective March 25, 2001, the periodic and death payrolls reflect the increased amount.
b. The CA-816, LWEC, program has been updated with the new CPI percentage. This update was performed for all district offices by the National Office.
2. 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, 2001.
3. Forms.
a. The benefit statement sent to each individual receiving benefits on the 28-day periodic roll for the roll cycle from March 25, 2001 to April 21, 2001 has been updated. The benefits statement provides 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 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.
DEBORAH B. SANFORD
Director, 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)
|
EFFECTIVE DATE |
RATE |
EFFECTIVE DATE |
RATE |
|---|---|---|---|
|
10/01/66 |
12.5% |
09/01/80 |
4.0% |
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).
| Date | Rate | Date | Rate |
|---|---|---|---|
|
Prior to 11/1/74 |
.08-.34 = .23 |
Eff. 11/01/74 |
.13-.37 = .25 |
District Office
Back to Top of FECA Bulletin No. 02-02
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 02-03
Issue Date: January 31, 2002
Expiration Date: January 30, 2003
Subject: Case Management -Authorization of Physical Therapy
Background: Physical therapy is one of the most common medical services authorized under the Federal Employees' Compensation Act (FECA). Nearly 25% of injured federal workers receive at least one physical therapy modality as part of their treatment. During FY 2000, physical therapy dollars constituted 13% of all medical outlays.
Currently, cases with physical therapy costs exceeding $8,000.00 per year make up 1% of all cases in which therapy is authorized. However, this 1% of cases is responsible for 11% of the total physical therapy costs paid under the FECA.
Reference: FECA Procedure Manual Chapter 2-810-16.
Purpose: To establish clear guidance on the proper authorization of physical therapy services and to transmit new procedures for the regular review of high cost physical therapy cases.
Applicability: Claims Examiners, Senior Claims Examiners, Claims Supervisors, Staff Nurses, Fiscal Officers, Technical Assistants, Bill Resolution Staff, Hearing Representatives, and Hearing Examiners.
Action:
Initial Authorization of Physical Therapy
1. Physical therapy that is prescribed by the attending physician and performed within the first 120 days followingthe date of injury (DOI), date of authorized surgery or date of accepted recurrence should be approved if the accepted medical condition(s) warrants it, i.e. orthopedic or neurologic condition accepted. The claimant should be notified via acceptance letter of the period during which physical therapy services are authorized. The CE must be specific regarding the dates during which physical therapy is authorized.
a. The occupational disease acceptance letter, CA-1008OD found in the DFEC Letter Generation System under the Acceptance and Medical Authorization/Denial category, has been modified to require the inclusion of specific dates during which physical therapy treatment is authorized if that option is selected. The CA-1008 for traumatic injury claims was not modified. It continues to include an optional paragraph stating that physical therapy is authorized for a period of up to 120 days from the date of injury.
b. A recurrence acceptance letter has been added to the DFEC Letter Generation System under the Acceptance and Medical Authorization/Denial category. This letter contains an optional paragraph to authorize physical therapy and requires the inclusion of specific dates during which the services are authorized.
c. The letter authorizing surgery, CA-6059 found in the DFEC Letter Generation System under the Acceptance and Medical Authorization/Denial category, has been modified to address the authorization of physical therapy services and requires the inclusion of specific dates during which the services are authorized.
1. Physical therapy services provided during the first 120 days following the DOI for a traumatic injury or occupational disease, with an appropriate accepted medical condition, will continue to be processed for payment without CE intervention. The CE must enter the authorized 120 day period in screen #34, PHYSICAL THERAPY AUTH of the Case Management File (CMF) for accepted recurrences, periods following authorized surgery or any other events that fall outside of the 120 days from the DOI window. As a rule, previous authorization periods should not be overwritten or removed. If more than two authorization periods are required, the CE should overwrite the older period. However, this overwritten period must be entered into screen #12, NOTE of the CMF.
2. Extended physical therapy may be approved for severe brain or spinal cord injuries, extensive second or third degree burns or other severe injuries that have rendered the claimant bedridden permanently or for an extended period of time. The CE may authorize physical therapy services for up to one year in these circumstances. However, the accepted condition(s) must support this exception.
Physical Therapy Requests After the Initial Authorization Period
1. Physical therapy should not be routinely authorized for periods longer than 120 days when the accepted conditions are sprains and strains or other self-limiting musculoskeletal conditions.
2. When physical therapy is requested beyond the initial 120 day period, the CE should evaluate the evidence of record and the projected period and frequency of the additional physical therapy request based on the guidelines described in PM 2-0810-16.e. The CE may wish to utilize the district medical advisor (DMA) in assessing the medical evidence.
3. Prior to authorization of any additional physical therapy, the file must contain medical evidence that provides the following:
a. Diagnosis for which physical therapy will be administered.
b. Specific functional deficits that are to be treated, including a description of how these affect the patient's physical activities.
c. Specific functional goals of the additional therapy.
d. Expected duration and frequency of treatment.
e. Modalities, procedures and/or tests and measures to be administered as detailed by the Physicians' Current Procedural Terminology (CPT) codes.
f. Appropriateness of a patient-directed home exercise program as an alternative to supervised physical therapy.
4. Necessary medical development may be undertaken in one of the following ways:
a. Release of a physical therapy development letter to the treating physician. The DFEC Letter Generation System contains letter CA-6021 for this purpose. (This letter has been revised and is found in the Development/Medical Category of the Letter Generation System.) Both the claimant and physical therapy provider should be copied when the development letter is sent.
b. Second opinion evaluation.
c. Development by a Field Nurse (FN) if one is currently assigned.
5. If the medical evidence of record clearly supports the additional period, or a minimal (less than two week) period of additional therapy is requested, the CE may authorize additional physical therapy for the period requested or 90 days, whichever is less.
6. Authorization for additional physical therapy treatment must not be granted and no further physical therapy can be paid until the development of this issue is complete.
Assessment of Medical Evidence
1. The CE should review the evidence obtained to determine if the requested period of PT is deemed appropriate. Section 5 U.S.C. 8103 of the Federal Employees' Compensation Act (FECA) permits approval of services "likely to cure, give relief, reduce the degree or period of disability, or aid in lessening the amount of the monthly compensation". For most cases, 120 days of physical therapy is sufficient to satisfy the requirements of section 8103. For requests exceeding this amount of treatment, the CE is charged with ensuring the medical evidence contained in the file justifies how the additional physical therapy will benefit the injured worker within the parameters of section 8103. The evidence should be sufficient to allow an independent reviewer to ascertain the specific nature of the expected cure, relief or reduction in disability. The medical evidence should be assessed critically to ensure it clearly supports not only the benefits of the expected therapy, but the specific extent and duration of the additional treatment.
2. In determining the need for additional therapy the CE should weigh the medical evidence using the following criteria:
a. The physical therapy is directed to the accepted condition or to an accepted complication of this injury or condition, including surgery; and
b. The specific modalities, procedures and/or tests and measures include some form of active physical therapy as evidenced by the use of any of the following CPT codes: 97110 through 97116 (therapeutic exercises); 97240 through 97241 (pool therapy or Hubbard tank); 97500 through 97541 (orthotics, prosthetics and activities of daily living training); and
c. A functional deficit exists and the additional therapy is expected to produce some functional improvement. Pain alone does not constitute a functional deficit. To authorize additional physical therapy for pain, the CE should ensure that the pain is associated with measurable objective findings such as muscle spasm, atrophy and/or radiologic changes in joints, muscles or bones, or that pain has placed measurable limitations upon the claimant's physical activities.
Approving Additional Physical Therapy
1. If medical justification for additional physical therapy is sufficient, the CE should issue a letter indicating the specific period of authorization. The CE should notify the claimant, the treating physician and the physical therapy provider of the specific period of the extension. CA-6021 in the DFEC Letter Generation System can be used for this notification.
2. If the authorized period is shorter than the period requested, the letter should explain the basis for the limited authorization.
3. The additional period of authorized physical therapy treatment should not exceed 90 days.
4. The CE must update screen #34 in the CMF with the additional authorized period of physical therapy.
Denying Additional Physical Therapy
1. If the medical evidence of record is not sufficient to support the need for additional physical therapy, the CE should notify the claimant as to why the benefit cannot be granted. The prescribing physician and the physical therapy provider should be copied with this letter. This letter should not contain appeal rights.
2. Any request by the claimant for a formal decision on the denial of the additional physical therapy should be granted. (PM 2-1400.2a.(2)).
3. No pre-termination notice is required if the claimant was notified of the specific authorized period, i.e. 120 days from the DOI, date of recurrence or date of surgery, and any specified period of extension, and physical therapy is not paid for any period other than that actually authorized in writing. In this circumstance, OWCP has not led the claimant to expect that payment for the service will continue.
Alternative Approaches to Supervised Physical Therapy
1. Often physical therapists can instruct patients in home exercise programs or other types of self-directed exercise to achieve or preserve the functional goals of the physical therapy program. When presented with a request for additional physical therapy, the CE should explore whether the claimant is ready to transition to a self-directed home or gym exercise program.
2. In reaching this determination, the CE should carefully consider the efficacy of past supervised therapy and the magnitude of any expected functional improvement.
3. Developmental requirements for health facility membership and special equipment can be found in PM 2-810-15. The DFEC Letter Generation System contains development letters for health facility membership and in-home therapy equipment. (See CA-6042, CA-6043 and CA-6044.)
Chiropractic and Osteopathic Manipulative Treatment
1. If a spinal subluxation has been accepted, manual manipulation of the spine by a chiropractor is payable. However, other physical therapy services, even if performed by a chiropractor, are subject to the requirements described above.
2. When the treating physician prescribes manipulative treatment by a chiropractor or an osteopathic physician, this therapy is subject to the above procedures.
3. Physical therapy services provided by a chiropractor or osteopath must be recommended and directed by the treating physician.
Changes to the Federal Employees' Compensation System (FECS)
1. A new edit code, 380L, has been added to the Bill Processing System (BPS).
b. This limits payment of CPT-4 code 97001 (initial physical therapy evaluation) to one time per year.
c. This edit is set to deny without the possibility of override.
d. The Explanation of Benefits description is as follows: INITIAL PHYSICAL THERAPY EVALUATIONS ARE LIMITED TO ONE PER YEAR. THIS SERVICE HAS BEEN PROVIDED IN THE LAST 365 DAYS. FOR FURTHER CONSIDERATION, RESUBMIT BILL WITH MEDICAL JUSTIFICATION AND A COPY OF THIS NOTICE.
2. Some additional physical therapy edits will be added to the BPS early in 2002.
b. The BPS will limit payment of manual manipulation services to "R" type providers.
c. If no subluxation medical condition has been accepted, manual manipulation services furnished by an "R" type provider will pay only if prior authorization has been entered in screen #34, PHYSICAL THERAPY AUTH of the CMF.
d. All physical therapy services, other than manual manipulation services, furnished by an "R" type provider will pay only for periods of prior authorization entered in screen #34, PHYSICAL THERAPY AUTH of the CMF.
CE Review of High Cost Physical Therapy Cases
1. On approximately the tenth of every month, each district office will be provided with a Physical Therapy High Cost Cases Report for their office.
2. The list will include cases in which the physical therapy costs over the past 12 months are in the top 1% of physical therapy costs nationally and in which payment for a physical therapy treatment has been made within the last 90 days.
3. The report will list the responsible CE, case number, claimant's name, total physical therapy costs paid under this claim number during the last 12 months, CPT code(s) from the last payment made, provider type of the last provider paid, EIN and address of the last provider paid. (See Attachment 1.)
4. The responsible CE (or designated person) should carefully review the case file and ensure that the therapy being provided is appropriate and necessary. At the time of the initial review of each claim appearing on the high cost report, an Initial Evaluation Report must be completed and returned to the National Office coordinator for compilation and analysis of statistics. This should be accomplished electronically. Only one initial evaluation report is required per case. (See Attachment 2.)
5. If the case record does not support the need or benefit of continued therapy, the CE should utilize the PT High Cost Letter to query the prescribing physician on the effectiveness of the current program and on alternatives to supervised therapy. This is a new letter that has been added to the DFEC Letter Generation System under Miscellaneous/Physical Therapy.
6. Use of a second opinion evaluation is encouraged in these cases in order to independently confirm the need for continued therapy.
7. The responsible CE (or designated person) will be responsible for completing a Final Disposition Report at the point the physical therapy issue has been resolved. This report should be returned to the National Office coordinator for compilation and analysis of statistics. This should be accomplished electronically. If no development is being undertaken and the reason is described on the Initial Evaluation Report, a Final Disposition report is not required. (See Attachment 3.)
Disposition: Retain until the indicated expiration date.
DEBORAH B. SANFORD
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)
|
RCE |
Case Number |
Last Name |
First Name |
Total PT |
Last PT |
CPT Codes |
Provider Type |
EIN Name |
|---|---|---|---|---|---|---|---|---|
Back to Top of FECA Bulletin No. 02-03
|
___________________ |
__________________ |
INITIAL EVALUATION REPORT OF HIGH COST PT CASES
1) Is the case being excluded from development because a subluxation has been accepted and the attending physician is a chiropractor and the only therapy procedures being paid are either manual manipulation (CPT-4 codes 98940-98943) or office visits (CPT-4 codes 99201-99215)?
Yes _____________
2) Is the case being excluded from development because the accepted condition(s) is a severe brain or spinal cord injury, extensive second or third degree burns or other severe injury that has rendered the claimant bedridden permanently or for an extended period of time?
Specify condition(s): ____________________________________________________________
3) Is the case being excluded from development because the claimant received PT services only during the initial approval period of 120 days from:
Date of injury - Traumatic: __________________
OD: _______________
Date of authorized surgery (show date): _________________
Date of accepted recurrence (show date): ________________
4) Show all condition(s) for which physical therapy is being administered (based on evidence of record): ______________________________________________________________
5) Does the claimant have a pre-existing, non-work related medical condition?
Specify condition(s):
____________________________________________________________
6) Describe PT development initiated in this case.
Release of PT High Cost Letter (date released): ___________
Referral for SECOP/IME (date referred): ___________________
Other explain): ___________________________________________
7) If no PT development is being initiated for a reason other than those listed above, please provide an explanation of why development is not required.
____________________________________________________________
Back to Top of FECA Bulletin No. 02-03
FINAL DISPOSITION REPORT OF HIGH COST PT CASES
1) The attending physician determined no further physical therapy was required.
(Provide date PT stopped.) ______________________________
2) Physical therapy authorization was terminated as the medical evidence of record failed to support a continuing need.
Informal denial letter sent. (Show date.): _______________
Formal decision issued. (Show date.): ____________________
3) Physical therapy was terminated as a result of SECOP/IME. (Provide date of formal decision.)
_____________________
4) Some form of self-directed therapy was authorized in lieu of on-going directed therapies. Describe the form of self-directed therapy authorized, i.e. home equipment or fitness center membership. (Include type of equipment authorized.)
__________________________________________________________
______________________________________________________________
5) All compensation and/or medical care was terminated as the evidence of record supported no continuing residuals of the accepted condition. (Show date of formal decision.)
_______________________________
6) Other. Provide explanation. ______________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Back to Top of FECA Bulletin No. 02-03
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 02-04
Issue Date: January 14, 2002
Expiration Date: January 2003
Subject: Revised procedures for processing work-related injury claims filed by employees of the Office of Workers' Compensation Programs and their relatives in the Midwest (formerly Chicago) Region.
Background: Current procedures for Mail and File require that all cases filed by employees of the Office of Workers' Compensation Programs and their relatives are under the jurisdiction of the Kansas City district office for adjudication and case management. The Kansas City district office is now assigned to the Midwest Region. The Midwest Region now includes Illinois, Indiana, Michigan, Minnesota, Wisconsin, Ohio, Iowa, Kansas, Missouri, and Nebraska. Therefore, procedures for adjudicating and maintaining injury compensation claims involving employees of the Office of Workers' Compensation Programs and their relatives must be revised. OWCP claims outside the Midwest Region will continue to be processed in the Kansas City district office (except Job Corps).
Reference: Federal (FECA) Procedure Manual, Chapter 1-200-2(g)2 and Chapter 1-200-2(l).
Purpose: To transfer jurisdiction for all claims filed by employees of the OWCP and their relatives originating in the Midwest Region (Illinois, Indiana, Michigan, Minnesota, Wisconsin, and Ohio) from the Kansas City district office (District 11) to the National Operations Office (District 25).
Applicability: Regional Directors, District Directors, Claims Examiners, Supervisory Claims Examiners, Mailroom Supervisors, and appropriate National Office personnel.
Action:
1. Effective immediately, all claims for work-related injuries filed by OWCP employees and their relatives in the Midwest Region are under the jurisdiction of and should be filed in the National Operations Office (District 25).
2. The Kansas City district office (District 11) will forward all existing case files, that involve OWCP employees and their relatives living and/or working in the Midwest Region to the National Operations Office (District 25) for maintenance and handling.
Disposition: This Bulletin should be retained until incorporated into the Federal (FECA) Procedure Manual, or otherwise superseded.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1--Folioviews Groups A,B,C,D (Regional Directors, District Directors, Claims Examiners, All Supervisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
Back to Top of FECA Bulletin No. 02-04
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 02-05
Issue Date: January 14, 2002
Expiration Date: January 31, 2003
Subject: Comp Pay/ACPS – Employing Agency Action to Notify DFEC of Claimant Ineligibility for Continuing Life Insurance.
Purpose: To furnish instructions on new Office of Personnel Management (OPM) guidance to employing agencies regarding determinations of continuing eligibility for life insurance.
Applicability: Appropriate National Office and District Office personnel.
Reference: FECA PM Part 5, Chapter 5-400(11)(a). OPM Procedures are detailed in OPM BAL Number 01-216 dated August 21, 2001.
Background: Agencies ordinarily notify DFEC of what type(s) of life insurance the employee has by means of a CA-7 (Claim for Compensation On Account of Traumatic Injury or Occupational Disease); DFEC withholds the FEGLI premiums accordingly from the individual's compensation. Employees who are receiving workers' compensation benefit payments may continue their Federal Employees' Group Life Insurance (FEGLI) coverage if they meet OPM's Five-Year/All-Opportunity requirement as of the date they start receiving compensation. Claimants that do not meet OPM's Five-Year/All-Opportunity requirement are still entitled to remain insured as an employee for up to 12 months in a non-pay status, or separation from federal service, whichever comes first. At that point the employing agency must make an eligibility determination and notify DFEC accordingly. It is the responsibility of the employing agency to notify both OPM and DFEC of any change in the claimant's entitlement to FEGLI coverage.
Action: For those claimants where it is clear that they will not meet OPM's Five-Year/All-Opportunity requirement, the employing agency must notify DFEC. This notification is necessary to ensure that optional life insurance withholdings can be appropriately stopped at the end of 12 months in non-pay status (or separation, if that happens first). In order to notify DFEC, the agency must complete a Notice of Life Insurance Ineligibility (copy attached). This form will be sent to the district office at the same time the Form CA-7 is submitted.
In addition to sending the Notice of Life Insurance Ineligibility to DFEC, a copy will be sent to the claimant. This will notify the claimant that the FEGLI coverage will terminate upon separation or completion of 12 months in non-pay, whichever comes first. The claimant will also be notified that they have the right to convert the coverage upon termination of FEGLI coverage.
The claims examiner will place a call-up in the system to indicate that life insurance premiums must be stopped at the end of 12 months of non-pay or separation.
Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2 --Folioviews Groups A and D (Claims Examiners, AllSupervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, and Rehabilitation Specialists)
Back to Top of FECA Bulletin No. 02-05
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 02-06
Issue Date: January 31, 2002
Expiration Date: January 31, 2003
Subject: Compensation Pay: Compensation Rate Changes Effective January 2002
Background: In December 2001, the President signed an Executive Order implementing a salary increase of 3.60 percent in the basic pay for the General Schedule. The applicability under 5 U.S.C. 8112 only includes the 3.60 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, 2002.
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, 2002. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10, which is now $107,357 per annum. The basis for the minimum compensation rates is the salary of $16,592 per annum (GS-2, Step 1).
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, 2002 |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$1,037.00 |
$6,709.81 |
The effect on 5 U.S.C. 8133(e) is to increase the minimum monthly pay on which compensation for death is computed to $1,037.00, effective January 2, 2002. The maximum monthly compensation as provided by 5 U.S.C. 8133(e)(2) is increased to $6,709.81 per month.
Applicability: Appropriate National and District Office personnel
Reference: Memorandum for Directors of Personnel dated December 2001; and the attachment for the 2002 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 January27, 2002, 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, 2002.
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, 2002. 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:
|
CA-842 – 01/02/02 |
||||
|
47.86-71.79 |
239.31-358.96 |
47.86 |
239.31(959.24) |
1,037.00 |
|
CA-843 – 01/02/02 |
||||
|
309.68 |
|
1,548.42(6,193.68) |
6,709.81 |
|
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 all payees receiving periodic compensation payments will be generated, informing them of potential changes to their compensation benefits.
The notices will be sent as an attachment to the Benefit Statement generated after each periodic cycle. 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.
DEBORAH B. SANFORD
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. 02-06
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 02-07
Issue Date: March 1, 2002
Expiration Date: February 28, 2003
Subject: Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2002.
Purpose: To furnish instructions for implementing the CPI adjustments of March 1, 2002.
1. The new CPI increase, adjusted to the nearest one-tenth of one percent, is 1.3 percent.
2. The increase is effective March 1, 2002, and is applicable where disability or death occurred before March 1, 2001.
3. The new base month is December 2001.
4. The maximum compensation rates, which must not be exceeded, are the following:
| Amount | Time |
|---|---|
|
$ 6,797.04 |
per month |
Applicability: Appropriate National Office and District Office personnel.
Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981.
Action: On or about March 14, 2002, 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, 2002 and the start date of the periodic and death payroll cycles is February 24, 2002, there will be a supplemental record created for the period March 1 through March 23, 2002. Effective March 24, 2002, 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 17, 2002, 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 14, 2002 AND MARCH 17, 2002. ACPS data entry may resume on March 18, 2002.
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, 2002.
4. Forms.
a. Beginning with the compensation payment cycle that covers March 24, 2002 to April 20, 2002, the Office will issue an updated 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.
DEBORAH B. SANFORD
Director, Federal Employees' Compensation
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
|
EFFECTIVE DATE |
RATE |
EFFECTIVE DATE |
RATE |
|---|---|---|---|
|
10/01/66 |
12.5% |
03/01/81 |
3.6% |
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).11
| Date | Rate | Date | Rate |
|---|---|---|---|
|
Prior to 11/1/74 |
.08-.34 = .23 |
Eff. 11/01/74 |
.13-.37 = .25 |
Back to Top of FECA Bulletin No. 02-07
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 02-08
Issue Date: February 5, 2002
Expiration Date: February 5, 2003
Subject: BPS -Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles(POV) Necessary to Secure Medical Examination and Treatment.
Background: Effective January 21, 2002, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile has increased to 36.5 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, this rate will also apply to individuals covered by the FECA who travel by POV in order to obtain necessary medical examination and treatment.
Applicability: Appropriate National Office and District Office personnel.
Reference: Chapter 5-0204, Principles of Bill Adjudication, Part5, 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. Vouchers being processed for travel periods after January 21, 2002 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.
DEBORAH B. SANFORD
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/Bill Pay Personnel)
Attachment 2
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
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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.
1. 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).
2. 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).
3. 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.
4. 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:
| Dates | Amount |
|---|---|
|
January 1, 1995 to June 6, 1996 |
30.0 cents per mile |
If mileage expense is claimed prior to January 1, 1995, contact your OWCP district office for rates.
5. 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.
6. 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.
7. 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.
8. 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.
9. After a voucher SF-1012 has been completed, it must be signed in ink or indelible pencil in the space provided for the payee.
10. The travel voucher should not be submitted if there is no expense claimed.
INSTRUCTION CA-77
Revised January 2002
Back to Top of FECA Bulletin No. 02-08
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 02-10
Issue Date: June 14, 2002
Expiration Date: June 14, 2003
Subject: Bill Payment-Physical Therapy Multiple Initial Evaluations
Background: Edit code 380L was added to the Bill Processing System (BPS) to limit payment of CPT-4 code 97001 (initial physical therapy evaluation) to one time per year. This edit is set to automatically deny without the possibility of override. The Explanation of Benefits advises that the medical provider can resubmit the bill with medical justification for further consideration of payment (see FECA Bulletin 02-03). Medical providers are now presenting valid reasons for the use of the 97001 code more than one time per year. Since CPT-4 Code 97001 is allowed payment only one (1) time a year this inhibits the payment of medical providers following further consideration. The use of another code prevents the application of the fee schedule and duplicate edits. Additionally, there is no established system for monitoring these transactions.
A new OWCP Program-Specific Code has been developed to assist district offices in making payment in those cases that are medically justified for more than one initial physical therapy evaluation in a year.
Reference: FECA Procedure Manual Chapter 2-810-16, FECA Bulletin NO. 02-03 and FECA Procedure Manual Part 5.
Purpose: To notify district offices of the OWCP Program-Specific Code used only in cases in which more than one (1) initial physical therapy evaluation is medically justified within a year.
Applicability: Claims Examiners, All Supervisors, System Managers, District Medical Advisors, Mail and File Personnel, Fiscal and Bill Pay Personnel, Staff Nurses, Technical Assistants, Hearing Representatives and Hearing Examiners.
Action:
1. A new OWCP Program-Specific Code, PT2IE, (physical therapy second initial evaluation) payment for multiple PT Initial Evaluations has been added to the Procedure File (V30) in all district offices.
2. All provider requests for further consideration for the use of 97001 should be referred to the district office's medical coding specialist or other designated staff member (Assistant District Director, fiscal or bill processing personnel, FECA PM Part 5).
3. The medical coding specialist or other staff member will assess the validity of the request. Situations that require a second initial physical therapy evaluation within a one (1) year timeframe include: a newly accepted consequential injury, surgery, and claimant referral to another health provider for evaluation.
4. Should the service be considered payable, the reviewer will re-process the bill. The reviewer will use PT2IE instead of the original 97001. There will be limited use of this code. The designated reviewer will provide instruction in the notes that the bill is approved for payment processing.
5. If the service is not deemed payable, the reviewer should notify the provider that the service is not payable by the program.
6. Training should be done by an appropriate staff member within thirty (30) days. This item will be viewed as part of the physical therapy standards and will be subjected to case review in upcoming Accountability Reviews.
Disposition: Retain until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List NO.2-Folioviews Group A,B and C (Claims Examiners (including Seniors), All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants,Rehabilitation Specialists, Staff Nurses, Fiscal and Bill Pay Personnel)
Back to Top of FECA Bulletin No. 02-10