2012 FECA Circulars which have previously been issued by the DFEC but have since been superseded by another Circular or inclusion in the FECA Procedure Manual.
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Circular |
Subject |
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Dual Benefits - FERS Cost of Living Adjustments |
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Current Interest Rates for Prompt Payment Bills and Debt Collection |
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Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately-Owned Automobiles Necessary to Secure Medical Examination and Treatment |
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Insurance Deductions |
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Bill Payment Practices and Restrictions |
Attention: This circular has been superseded and is inactive.
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FECA CIRCULAR NO. 12-01 Issue Date: February 24, 2012 |
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SUBJECT: Dual Benefits - FERS Cost of Living Adjustments
Effective December 1, 2011, benefits issued by the Social Security Administration (SSA) were increased by 3.6%. This requires the amount of the Federal Employees' Retirement System (FERS) Dual Benefits deduction to be increased by the same amount, to ensure the dollar-for-dollar offset remains current.
This adjustment will be made from the National Office for all cases that were correctly entered into the Compensation application of the Integrated Federal Employees Compensation System (iFECS). The adjustment will be effective with the periodic roll cycle beginning December 18, 2011. There will be no adjustment or overpayment declared for the period of December 1, 2011 through December 17, 2011.
The historical SSA cost of living adjustments are as follows:
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Dates |
Percentage |
|---|---|
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12/01/2011 - 11/30/2012 |
3.6% |
DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation
Distribution: All Claims Staff and Fiscal Personnel
Back to Top of FECA Circular No. 12-01
Attention: This circular has been superseded and is inactive.
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FECA CIRCULAR NO. 12-03 Issue Date: April 6, 2012 |
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SUBJECT: Current Interest Rates for Prompt Payment Bills and Debt Collection
The interest rate to be assessed for the prompt payment bills is 2.0 percent for the period of January 1, 2012 through December 31, 2012. This new rate has been updated in the Central Bill Payment system tables.
The rate for assessing interest charges on debts due the government has not been changed. The interest rate for assessing interest charges on debts due the government remains 1.0 percent for the period of January 1, 2012 through December 31, 2012.
Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2012 to determine if the Treasury has changed the rate.
Attached to this Circular is an updated listing of both the Prompt Payment and Debt Management interest rates from January 1, 1985 through the current date.
DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Attachments
Distribution: All Claims Staff and Fiscal Personnel
Back to Top of FECA Circular No. 12-03
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Dates |
Percentage |
Dates |
Percentage |
|---|---|---|---|
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01/1/12 - 12/31/12 |
2.0 % |
01/1/98 - 06/30/98 |
6 ¼ % |
Prior to 01/01/85 Not Applicable
Back to Top of FECA Circular No. 12-03
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Dates |
Percentage |
|---|---|
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01/1/12 - 12/31/12 |
1% |
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01/1/11 - 12/31/11 |
1% |
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1/1/10 – 12/31/10 |
1% |
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1/1/09 - 12/31/09 |
3% |
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7/1/08 - 12/31/08 |
3% |
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1/1/08 - 6/30/08 |
5% |
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1/1/07 - 12/31/07 |
4% |
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7/1/06 - 12/31/06 |
4% |
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1/1/06 - 12/31/06 |
2% |
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1/1/05 - 12/31/05 |
1% |
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1/1/04 - 12/31/04 |
1% |
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1/1/03 - 12/31/03 |
2% |
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7/1/02 - 12/31/02 |
3% |
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1/1/02 - 06/30/02 |
5% |
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1/1/01 - 12/31/01 |
6% |
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1/1/00 - 12/31/00 |
5% |
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1/1/99 - 12/31/99 |
5% |
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1/1/98 - 12/31/98 |
5% |
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1/1/97 - 12/31/97 |
5% |
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1/1/96 - 12/31/96 |
5% |
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7/1/95 - 12/31/95 |
5% |
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1/1/95 - 06/30/95 |
3% |
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1/1/94 - 12/31/94 |
3% |
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1/1/93 - 12/31/93 |
4% |
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1/1/92 - 12/31/92 |
6% |
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1/1/91 - 12/31/91 |
8% |
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1/1/90 - 12/31/90 |
9% |
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1/1/89 - 12/31/89 |
7% |
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1/1/88 - 12/31/88 |
6% |
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1/1/87 - 12/31/87 |
7% |
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1/1/86 - 12/31/86 |
8% |
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1/1/85 - 12/31/85 |
9% |
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Prior to 01/01/84 |
Not applicable |
Prior to 01/01/85 Not Applicable
Back to Top of FECA Circular No. 12-03
Attention: This circular has been superseded and is inactive.
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FECA CIRCULAR NO. 12-04 Issue Date: May 14, 2012 |
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EXPIRATION DATE: Date of Next Rate Change
SUBJECT: Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately-Owned Automobiles Necessary to Secure Medical Examination and Treatment.
Background: Effective April 17, 2012, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile was increased to 55.5 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 and 5 U.S.C. 8103.
Action: The Central Bill Pay (CBP) facility has updated its system to reflect the new rates. Since there is no action required at the District Office level, the rates are being provided for informational purposes only.
The following is a list of the historical mileage rates used to reimburse claimant travel expense:
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Dates |
Cents per mile |
|---|---|
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01/01/1995 - 06/06/1996 |
30.0 cents per mile |
DispositionThis Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.
DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Distribution: All Claims Staff and Fiscal Personnel
Back to Top of FECA Circular No. 12-04
Attention: This circular has been superseded and is inactive.
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FECA CIRCULAR NO. 12-05 Issue Date: May 14, 2012 |
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SUBJECT: Insurance Deductions
This circular is being issued to provide supplemental guidance on the effective date of insurance deductions. It updates the information previously contained in Federal Employees' Compensation Act (FECA) Circular 09 - 04 (Health Benefits Insurance and Life Insurance - General Guidance), issued June 1, 2009.
When a Federal employee enters a leave without pay (LWOP) status, the employing agency is no longer able to deduct for health benefits and life insurance premiums. If compensation for wage loss is payable under the FECA, the responsibility for making those deductions transfers to the Office of Workers' Compensation Programs (OWCP).
As noted in Circular 09-04, OWCP deductions for health benefits and life insurance become effective on the first day of LWOP status. Historically, OWCP did not actually begin making the deductions until the claimant has been in receipt of compensation for 28 days. Once the claimant had received compensation for more than 28 days, deductions were made retroactively to the date compensation began.
Beginning in August, 2010, OWCP discontinued the practice of delaying deductions for that 28-day period and instead began the deductions effective the first day of LWOP. Beginning deductions promptly, rather than making a retroactive deduction at a later date, enables OWCP to provide continuity of payment for the injured worker with no interruptions in insurance deductions.
Note - Insurance deductions are not made for intermittent hours or days within a pay period.
DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Distribution: All Claims Staff and Fiscal Personnel
Back to Top of FECA Circular No. 12-05
Attention: This circular has been superseded and is inactive.
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FECA CIRCULAR 12-06 |
June 26, 2012 |
SUBJECT: Bill Payment Practices and Restrictions
This circular is being issued to document certain current billing practices and restrictions for the Division of Federal Employees' Compensation (DFEC) under the Federal Employees' Compensation Act (FECA). See 5 U.S.C. 8103. 20 C.F.R. Part 10, in particular Subpart I, also provides additional details concerning the responsibilities of claimants and providers in regard to medical billing and reimbursement.
I. Medication Dispensed by a Provider
20 CFR §10.809, which was updated effective August 29, 2011, outlines how payments are made for medication. This regulation specifically states that, "Payment for medicinal drugs prescribed by physicians shall not exceed the amount derived by multiplying the average wholesale price, or as otherwise specified by OWCP, of the medication by the quantity or amount provided, plus a dispensing fee."
Effective June 17, 2012, any bill submitted on a Form OWCP-1500 for the payment of medications dispensed in the office using one of the unlisted HCPC "J" codes (J3490, J8499, J8999 and J9999) will be paid based on the Average Wholesale Price or the Medispan Average Wholesale Price. The reimbursement will be determined based on the date of service and the price for the National Drug Code (NDC), which accompanied the unlisted drug code, as outlined below.
1. Providers submit bills for payment of medications dispensed in the office on an OWCP-1500 billing form. The bills for these services contain one of the following unlisted HCPC "J" codes: J3490, J8499, J8999, and/or J9999. These codes are accompanied with an NDC code and the day's supply, which are key factors for determining the payment amount.
2. The pharmacy system, using the billed diagnosis, will validate the appropriateness of the NDC with the claimant's accepted condition. If the medication is not payable in accordance with the claimant's accepted conditions, the bill will be denied. If the NDC code is payable and appropriate for the claimant's accepted condition, the bill will be paid.
3. The pharmacy system, based on the date of service, will systematically perform the pricing of the medication based on the date of service. If the date of service is prior to 09/30/2011, the pharmacy system will calculate the payment using the Average Wholesale Price (AWP). If the date of service is after 09/30/2011, the pharmacy system will calculate the payment using the Medispan Average Wholesale Price (MAW).
4. Similarly, if a bill is received with procedure code 99070 and the description of services is equal to "Dispensing Fee" and/or "Discount" (or any other description that represents a charge associated with the payment of medication), the line will be denied. If this procedure code is billed with a valid and appropriate supply description (tray, bandages, etc.), the line will be paid. Additionally, if the provider bills an NDC under this procedure code (99070), the NDC will be evaluated to determine payment just like the "J" code.
II. Generic Medication
20 CFR §10.809(c) provides that, "With respect to prescribed medications, OWCP may require the use of generic equivalents where they are available." This regulation was effective August 29, 2011. As the prior regulations already provided full authority for OWCP to require the use of generics, the most recent regulatory update did not alter DFEC's policy regarding generic medication. The regulatory update only moved the language referenced to a different section, as the same exact language now found in 20 CFR §10.809(c) was previously found in 20 CFR §10.310(b).
Effective November 01, 2008, DFEC revised the criteria for dispensing brand medication versus generic medication. As of that date, DFEC added an edit to review the Dispense as Written (DAW) field for all medication bills and claims for reimbursement. Brand medications process for payment only if the DAW is equal to one of the following:
DAW 1 (Brand selected when requested by physician)
DAW 8 (Brand dispensed as a result of generic not being available by the manufacturer)
DAW 0 (Brand drug selected when no generic available on the market)
Generic drugs will be selected automatically even when brand is available unless one of these DAW codes is present.
DFEC continues to use these criteria for medication authorizations.
III. Parenteral Fentanyl Products
On May 3, 2011, DFEC implemented a new policy and program to monitor and closely manage the use of fast-acting fentanyl products such as Actiq and Fentora and the prescribing of parenteral fentanyl products. An automatic processing rule was implemented whereby new prescriptions for fast-acting fentanyl products would be denied unless the claimant had an accepted work-related condition of cancer. See FECA Bulletin 11-05.
IV. Bills for Expenses Related to Medical Travel
Pursuant to 5 U.S.C. 8103 and 20 CFR §10.315, the employee is entitled to reimbursement of reasonable and necessary expenses, including transportation needed to obtain authorized medical services, appliances or supplies. In reviewing requests for reimbursement, OWCP considers the availability of services, the employee's condition, and the means of transportation. See also 3-0400 of the FECA Procedure Manual. Effective October 30, 2011, a new bill payment restriction was added such that any single claim in excess of 200 miles is rejected by the automated system so that it can be reviewed manually for approval. Prior to this change, the restriction was for any travel greater than 500 miles. Other restrictions, as outlined below, are also active.
A. Claimant Requests for Reimbursement
1. Claimants submit claims for reimbursement for travel expenses on Form OWCP-957. Items 5, 6 and 7 of this form are used to claim reimbursement for specific dates of travel. Data required to process such reimbursement is designated by specific alpha designated blocks for each date of service.
2. Only one date of travel will be accepted in block A (Date of Travel). Date ranges will not be accepted and will be returned to the claimant.
3. A Trip Code (one way or round trip) must be checked in block B. If not present, it will be returned to the claimant.
4. A departure and destination must be checked in elected blocks C (Travel From) and D (Travel To). If not present, it will be returned to the claimant.
5. The complete address of the facility to which the claimant traveled must be present in block E (Medical Facility Name and Address). If not present, the bill will be returned to the claimant. Note, however, this information is not required for travel to a pharmacy/medical supply facility.
6. Block F (Total Expenses/Cost) is used to claim reimbursement for items related to travel, other than the mileage. These items are listed below with applicable codes.
A0100 – Non-Emergency Transportation – Taxi
A0110 – Non-Emergency Transportation and Bus, Intra- or Inter-State Carrier
A0120 – Non Emergency Transportation Mini-Bus, Mountain Area Transportation or other Transportation System
A0170 – Transport Parking Fees/Tolls
A0180 – Non-Emergency Transport Lodging Recipient
A0200 – Non-Emergency Transport Lodging Escort
A0190 – Non-Emergency Transport Meals Recipient
A0210 – Non-Emergency Transport Meals Escort
A0130 – Non-Emergency Transportation Wheelchair Van
A0140 – Non-Emergency Transportation and Air Travel (Private or Commercial Intra- or Inter-State)
If the claimant requests reimbursement for any of these services, and the charges exceed $75.00, a receipt must accompany the reimbursement claim. Manual review is also required, and the Central Bill Payment Facility will seek approval and authorization to pay the services from the Claims Examiner. If the claim is less than or equal to $75.00, receipts are not required, and the service will pay without any manual review.
7. Block G (Private Auto Only Miles Traveled) is used to specify the number of miles claimed for reimbursement. Applicable codes are A0080 and A0090. If the mileage billed in block G is greater than 200 miles per day, manual review is required, and the Central Bill Payment Facility will seek approval from the Claims Examiner. If the mileage billed in block G is less than or equal to 200 miles per day, the reimbursement claim will be paid without manual review.
8. Reminder – Reimbursement for travel expenses related to medical treatment/evaluation in DFEC claims is generally based on GSA requirements for travel. As such, DFEC will not pay for meals or lodging unless the travel requires more than 12 hours to complete.
B. Provider Bills
1. Providers submit bills for travel-related expenses on Form OWCP-1500.
2. Providers billing for mileage (codes A0080 and A0090) will be paid based on the General Services Administration (GSA) mileage rate. Payment will be calculated based on the number of units billed in Block 24-G of the OWCP-1500 billing form.
3. If the service exceeds 200 miles per day, prior authorization is required. If there is no such authorization on file when the bill is received, the bill will be denied and the provider will be directed to complete the Medical Authorization – Transportation and Travel Authorization template, which can be found on the Central Bill Payment contractor's website. If the service is billed at 200 miles or less, the service will pay without prior approval.
4. A provider may also use Block 24-D of the OWCP-1500 to bill for services related to travel, other than the mileage. These items are listed below with applicable codes.
A0100 – Non-Emergency Transportation – Taxi
A0110 – Non-Emergency Transportation and Bus, Intra- or Inter-State Carrier
A0120 – Non Emergency Transportation Mini-Bus, Mountain Area Transportation or other Transportation Systems
A0170 – Transport Parking Fees/Tolls
A0130 – Non-Emergency Transportation Wheelchair Van
A0140 – Non-Emergency Transportation and Air Travel (Private or Commercial Intra- or Inter-State)
Prior authorization for any of these services is required if the charge will be more than $75.00. If the provider submits a bill for any of these services, and the charges exceed $75.00, prior authorization is required, and an invoice showing the Departure and Destination of the trip must accompany the bill or be reflected on the bill when submitted. If there is no attachment showing proof of the trip, or the information is not contained within the bill, it will be denied. If the bill does contain sufficient detail regarding the trip, and prior authorization is not on record, the bill will be denied, requesting the submission of the Medical Authorization – Transportation and Travel template. If the bill is for less than or equal to $75.00, documentation of the trip details is not required, and the service will pay without any manual review.
V. Anesthesia Fee Schedule
Effective 12/05/10, updates were made to the anesthesia fee schedule. Effective this date, the fee schedule allowance for anesthesia services was based upon the formula: (Time Units + Base Units) x Conversion Factor. In addition, every anesthesia procedure billed to OWCP required one of the following modifiers: AA, QY, QK, AD, QX, or QZ.
When multiple procedures are performed during a single anesthetic administration, reimbursement is based on the line item representing the most complex procedure.
VI. Procedure Codes
A. RP100
Effective 07/01/2010, DFEC no longer utilized DOL homegrown procedure code RP100 (Pain Management). Effective that date, when rendering pain management services, providers were required to bill and/or submit for prior authorizations the appropriate HCPCS/CPT codes applicable for the services.
B. Consultation Codes
Effective March 1, 2010 DFEC no longer accepted the use of the AMA/CPT consultation codes ranges 99241-99245 and 99251-99255 for outpatient and office settings. This policy adhered to the decision made by the Center of Medicare and Medicaid (CMS) announced in MLN Matters, #MM6740.
VII. Place of Service on OWCP-1500
Effective 07/15/2010, DFEC required the place of service to be present on the OWCP-1500 (Box 24b). This requirement, however, did not affect any facility services billed on a Form UB04 or professional services billed for third party carriers, billing agents, contract nurses, second opinion contractors, and vocational rehabilitation services.
DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation
Distribution: DFEC Staff
Back to Top of FECA Circular No. 12-06