FECA Circulars

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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 4.875 percent for the period of January 1, 2024 through June 30, 2024. This new rate has been updated in the Central Bill Payment system tables.

The interest rate for assessing interest charges on debts due the government is 4.0 percent for the period of January 1, 2024 through December 31, 2024.

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.

Antonio Rios
Director for
Division of Federal Employees', Longshore and Harbor Workers' Compensation

Attachments: Prompt Payment Interest Rates
Debt Management Interest Rates

Distribution: All FECA Staff

ATTACHMENT TO FECA CIRCULAR NO. 24-01

ATTACHMENT TO FECA CIRCULAR NO. 24-01

Back to Top of FECA Circular No. 24-01

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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 January 1, 2024, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile INCREASED to 67 cents per mile per U.S. General Services Administration (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 FECA Program personnel.

Reference: Chapter 5-0204, Principles of Bill Adjudication, Part 8, Travel, Federal (FECA) Procedure Manual and 5 USC 8103.

Action: The Medical Billing Pay Contractor (MBPC) updated its system to reflect the new rates. Since there is no action required at the 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:

Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.

Antonio Rios
Director for
Division of Federal Employees', Longshore and Harbor Workers' Compensation

Distribution: All FECA Staff

Back to Top of FECA Circular No. 24-02

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Subject: Dual Benefits - FERS Cost of Living Adjustments

Background: Effective December 1, 2023, benefits issued by the Social Security Administration (SSA) were increased by 3.2%. Therefore, the amount of the Federal Employees’ Retirement System (FERS) Dual Benefits deduction needed to be increased by the same amount, to ensure the dollar-for-dollar offset required by 5 U.S.C. 8116 (d) (2) of the Federal Employees’ Compensation Act remains current.

Applicability: Appropriate FECA Program personnel.

Action: The adjustment was made from the National Office for all cases that were correctly entered into the integrated Federal Compensation System (iFECS). The adjustment was effective on the periodic roll cycle beginning December 03, 2023.

The historical SSA cost of living adjustments are as follows:

Antonio Rios
Director for
Division of Federal Employees', Longshore and Harbor Workers' Compensation

Distribution: All FECA Staff

Back to Top of FECA Circular No. 24-03

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Subject: Transmission of Documents from Insurance Carriers to the Office of Workers' Compensation Programs (OWCP) for Use in Adjudicating Claims under the War Hazards Compensation Act (WHCA).

Background: The WHCA supplements the Defense Base Act (42 U.S.C. 1651) (DBA), which is an extension of the Longshore and Harbor Workers' Compensation Act, 33 U.S.C. 901 (et seq.). All liability for injury, death and detention benefits under the WHCA is assumed by the Federal Government and is paid from the Employees' Compensation Fund established by 5 U.S.C. 8147.

Under Section 104 of the WHCA, an insurance carrier, self-insured employer, or compensation fund may claim reimbursement from the Employees' Compensation Fund for benefits paid on cases approved under the DBA, if it can be shown that the covered DBA injury or death was due to a war-risk hazard. Insurance carriers found liable under the DBA may, in certain instances where such liability arises from a war-risk hazard, obtain reimbursement from OWCP for their payments, pursuant to the WHCA. To prove their entitlement to reimbursement, the WHCA and its implementing regulations direct insurers to transmit to OWCP certain documents and information.

OWCP has determined that it is generally more cost-efficient for insurance carriers to send and OWCP to receive transmitted documents and information submitted in support of a claim for WHCA reimbursement via digital media or encrypted email. The integrity of the documents and information being transmitted will also be better maintained when sent via digital media or encrypted email rather than on paper.

Purpose: To provide guidance for insurance carriers to submit documentation to OWCP.

Actions:

1. There are two potential ways that claim documents and information can be sent to OWCP:

a) via encrypted email. The term "encrypted email" refers to transmission by means of email through a channel or application approved by OWCP for that purpose. The insurance carrier will use the DOL-approved email encryption service to send the claim documents and information via encrypted attachments.

b) via encrypted digital media. The term "digital media" in this document is used to refer to the transfer of electronic files and documents by USB Drive or CD-ROM sent through the mail. Insurance carriers will use "7 Zip" 256-bit encryption to encrypt the insurance carrier's files before downloading the files onto digital media. The password needed to decrypt the files will be sent separately from the digital media via e-mail to owcp-wh-carrier-reimbursement@dol.gov. If using digital media, the insurance carrier and its retained law firm's staff will include in the package that contains the digital media the names and dates of the file(s). The package that contains the digital media will also include the following written statement: "The information on this digital media is covered by the Privacy Act of 1974, as amended. By accessing this information, you certify you are complying with all requirements under the Privacy Act." The digital media will be mailed via a trackable method (e.g. USPS, FedEx, UPS) to:

US Department of Labor - OWCP/DFELHWC
Attn: War Hazards
400 West Bay Street Room 722
Jacksonville, FL 32202

OWCP staff will notify the carrier if the digital media arrives damaged.

2. Documents, data, and information submitted to OWCP by the insurance carrier or its retained law firm under either method will be covered under the Privacy Act.

3. This Circular eliminates the need to execute individual memoranda of understanding (MOUs) for the transmission of documents from insurance carriers to OWCP. To terminate any existing and duly executed MOU for the purpose of transmitting these documents, the procedures as established in the MOU shall be followed, and OWCP shall provide 30 days' written notice by means of email to the carrier of its intention to rescind the MOU regarding the transmission of WHCA claim materials.

Disposition: This Circular should be retained until incorporated into the FECA Procedure Manual.

NANCY GRISWOLD
Acting Director for
Division of Federal Employees', Longshore and Harbor Workers' Compensation

Distribution: Applicable FECA Program Staff and Stakeholders

Back to Top of FECA Circular No. 24-04

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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 4.625 percent for the period of January 1, 2023 through June 30, 2023. This new rate has been updated in the Central Bill Payment system tables.

The interest rate for assessing interest charges on debts due the government remains 1.0 percent for the period of January 1, 2023 through December 31, 2023.

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.

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Attachments: Prompt Payment Interest Rates
Debt Management Interest Rates

Distribution: All FECA Staff

ATTACHMENT TO FECA CIRCULAR NO. 23-01

ATTACHMENT TO FECA CIRCULAR NO. 23-01

Back to Top of FECA Circular No. 23-01

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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 January 1, 2023, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile INCREASED to 65.5 cents per mile per U.S. General Services Administration (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 FECA Program personnel.

Reference: Chapter 5-0204, Principles of Bill Adjudication, Part 8, Travel, Federal (FECA) Procedure Manual and 5 USC 8103.

Action: The Medical Billing Pay Contractor (MBPC) updated its system to reflect the new rates. Since there is no action required at the 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:

Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 23-02

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Subject: Dual Benefits - FERS Cost of Living Adjustments

Background: On October 13, 2022, the Social Security Administration (SSA) announced that benefits would be increased by 8.7% in 2023. Therefore, the amount of the Federal Employees’ Retirement System (FERS) Dual Benefits deduction needed to be increased by the same amount, to ensure the dollar-for-dollar offset required by 5 U.S.C. 8116 (d) (2) of the Federal Employees’ Compensation Act remains current.

Applicability: Appropriate FECA Program personnel.

Action: The adjustment was made from the National Office for all cases that were correctly entered into the integrated Federal Compensation System (iFECS). The adjustment was effective on the periodic roll cycle beginning December 04, 2022.

The historical SSA cost of living adjustments are as follows:

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 23-03

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Subject: Medical Treatment Adjudicators (MTA)

Purpose: To announce a new position within the Federal Employees’ Compensation Act (FECA) program, the Medical Treatment Adjudicator (MTA). The MTA will be responsible for ensuring that medical authorizations and medical bill payments are appropriate for the accepted condition(s) of the injured worker and are in accordance with the FECA program’s policies.

Background: The FECA covers injury in the performance of duty; injury includes a disease proximately caused by federal employment. The U.S. Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) Division of Federal Employees', Longshore and Harbor Workers' Compensation (DFELHWC) administers the FECA. The FECA provides to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103.

The FECA program employs claims examiners (CE) whose main tasks are to adjudicate claims; authorize benefits and set up compensation payments; manage individual cases, so that timely and proper actions are taken in each claim; and manage a caseload, so that FECA cases are handled promptly and effectively.

Because the review and processing of medical bills and authorization requests requires a high level of technical skill, the FECA program is adding MTAs who are experts in medical coding to support the cadre of CEs in handling medical bill and authorization transactions.

The MTAs will not only provide technical knowledge for claims examiners but will also be responsible for receiving, monitoring, communicating, intervening, and responding to medical authorization and billing inquires that require actions by the contract bill processor and/or DFELHWC. Further, the MTAs will provide customer service, including answering incoming phone calls and written inquiries from medical providers, claimants, and other claim stakeholders to provide technical assistance to a variety of medical authorization and bill related questions.

Actions: In accordance with the duties of the role as outlined above, MTAs hold the authority to approve treatment and expand accepted cases, including but not limited to:

1. Accepting a more severe condition for a body part already accepted by the CE, e.g. case accepted for knee strain, but the medical evidence shows the actual diagnosis was meniscal tear.

2. Accepting a more specific ICD code when the condition has already been accepted, e.g. case accepted for S83.92XA Sprain of unspecified site of left knee, but the provider is billing for S83.522A Sprain of posterior cruciate ligament of left knee.

3. Accepting a condition with an ICD-10 code based on the already accepted ICD-9 code or updating an ICD-10 code that is no longer complete, e.g. M48.06 Lumbar spinal stenosis was updated to include a final digit to become M48.061 lumbar spinal stenosis without neurogenic claudication or M48.062 lumbar spinal stenosis with neurogenic claudication.

4. Accepting a new body part where link to approved treatment is clear and unambiguous, e.g. a chipped tooth due to intubation during approved surgery if documented in operative report.

5. Authorizing diagnostic testing if the test is logically and causally related to the injury, e.g. motor vehicle accident with a neck condition leading to tests for post-concussion syndrome.

6. Approving functional capacity evaluations, physical/occupational therapy, durable medical equipment and chiropractic care.

7. Authorizing surgery, including retroactive authorizations and carrier reimbursements, in cases where review by a District Medical Advisor (DMA) is not needed, e.g. carpal tunnel surgery or knee arthroscopy.

8. Approval of claimant travel and non-travel reimbursements.

MTAs have no authority to issue complex adjudication decisions (e.g., claim expansions in psychiatric cases, claim expansions for permanent aggravations, etc.) or formal denials of any type. Such authority remains with the CE.

Disposition: This Circular is to be retained until otherwise revised or incorporated into Part 5 of the FECA Procedure Manual.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC FECA Program Staff and Stakeholders

Back to Top of FECA Circular No. 23-04

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SUBJECT: Current Procedural Terminology Code (CPT) 20552 and 20553 Bill Payment Restrictions

PURPOSE: To provide notification of new Office of Workers' Compensation Programs (OWCP) Division of Federal Employees', Longshore and Harbor Workers’ Compensation (DFELHWC) FECA program policy with respect to payment for CPT code 20552, INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S) and CPT code 20553, INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES.

BACKGROUND: Under the Federal Employees’ Compensation Act (FECA), the Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) may provide to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103. The Act and its implementing regulations at 20 C.F.R. Part 10, Subpart I (20 C.F.R. 10.800) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

The American Medical Association provides the following definitions for CPT code 20552 and 20553:

CPT code 20552, INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)

The use of this code allows medical providers to bill for trigger point injections to one or two muscle groups.

CPT code 20553, INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES

The use of this code allows medical providers to bill for trigger point injections to three or more muscle groups.

The FECA program is committed to the safety of its claimants and the reduction of fraud, waste, and abuse. As part of this mission, the FECA Program Integrity Unit (PIU) identified anomalous billing patterns related to CPT codes 20552 and 20553. OWCP’s Branch of Medical Standards and Operations (BMSO) reviewed CPT codes 20552 and 20553 and determined that the number of services billed for individual dates of service for these codes were inconsistent with established medical guidelines. Specifically, per guidelines, the number of services or units allowable for each code per date of service is one (1) regardless of the number of injections. The program implemented edits on injection limitations for the aforementioned codes in 2013 and this circular does not change that policy.

ACTION: In accordance with the discretion granted to DOL and delegated to OWCP, the FECA program is updating its policy regarding reimbursement of CPT codes 20552 and 20553.

Effective April 13, 2023, DFELHWC will only recognize the billing of CPT 20552 or 20553 for one service/unit per day with a maximum of 10 encounters within a 12 month period. Billed services beyond one (1) per day and encounters greater than 10 per 12 month period for either CPT 20552 or CPT 20553 will not be reimbursable. The program may authorize additional injections on an exception review basis if the medical evidence is sufficient to demonstrate medical necessity consistent with the FECA.

This policy is effective April 13, 2023. All bills received on and after this date will be subject to this policy.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 23-05

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Subject: Employees’ Compensation Operations and Management Portal (ECOMP) Inquiry Escalation Process

Purpose: To announce a new component of ECOMP that enables users to seamlessly submit inquiries on their case files to the appropriate staff member. This circular pertains to Federal Employees’ Compensation Act (FECA) program users.

Background: ECOMP was released to the public on November 2, 2011 and can be accessed directly at the following URL: https://www.ecomp.dol.gov. The site originally contained two different types of functionality – electronic submission of documents and electronic submission of FECA case forms. ECOMP was later enhanced to allow registered and identity-verified users the ability to access real-time case status information, view imaged documents within cases, link cases with designated entities such as legal representatives, etc.

As a part of the FECA program’s ongoing efforts to improve customer service, the latest ECOMP enhancement will allow registered and identity-verified claimant and entity users to submit inquiries on specific issues. Once initiated, the request will be routed to the most appropriate FECA program staff member depending on the specific issue chosen by the user. If no response is received within the allotted timeframe, the user can then escalate that issue to a manager for review.

Actions:

1. Through their ECOMP case dashboard, claimant and entity users can now submit online inquiries regarding certain unresolved issues in their FECA case files. Currently, the issues that can be escalated through this process are:

a. Payment for wage loss
b. Payment of a medical bill
c. Authorization of medical treatment/procedure
d. Authorization of a medication
e. Health benefits or life insurance issues
f. Overpayment issues

2. Upon submission of an unresolved issue, the concern will be routed to the appropriate FECA staff member and will be made part of the case file. A standard response time of two business days is allowed for a response, during which time the user may not submit additional inquiries or escalation requests on the same issue.

3. If two business days pass from the first request, the user may escalate the inquiry which will result in submission to both the same FECA staff member and that individual’s supervisor. Again, two business days are allowed for a response.

4. If two business days pass from the second request and the issue remains unresolved, the user may escalate it again. This time, the issue will be raised to the Office Director.

5. The ECOMP escalation process will help ensure that inquiries are directed to the most appropriate FECA staff member and that both the inquiry and resolution will be fully documented in the claimant’s case file. Accordingly, e-mail communication to DOL and/or OWCP employees from claimants or entities registered in ECOMP regarding issues noted in item 1 above will be redirected to the escalation feature in ECOMP.

6. Help guides are available in ECOMP to assist claimants and entity users in this process. They can be accessed by selecting the “HELP” menu in the upper right-hand corner of the ECOMP home page (ecomp.dol.gov/#/), or at: ecomp.dol.gov/#/help.

Note - The ECOMP escalation feature is currently available to claimant and entity users. Similar features for employing agency users may become available in a future release. In addition, other escalation options may become available in a future release.

Disposition: This Circular is to be retained until otherwise revised or incorporated into Part 2 of the FECA Procedure Manual.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC FECA Program Staff and Stakeholders

Back to Top of FECA Circular No. 23-06

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SUBJECT: Bill Payment Restrictions for Durable Medical Equipment Purchases and Rentals

PURPOSE: To provide notification of Office of Workers' Compensation Programs (OWCP) Division of Federal Employees', Longshore and Harbor Workers’ Compensation (DFELHWC) FECA program policy with respect to payment for reimbursement requests for services related to Durable Medical Equipment (DME).

BACKGROUND: Under the Federal Employees’ Compensation Act (FECA), the Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) may provide to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103. The Act and its implementing regulations at 20 C.F.R. Part 10, Subpart I (20 C.F.R. 10.800) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

The FECA program is committed to the safety of its claimants and the reduction of fraud, waste and abuse. As part of this mission and ongoing efforts to enhance program integrity, FECA’s Program Integrity Unit (PIU) reviews billing for DME. The PIU’s analysis revealed several inconsistencies and anomalies, such as billing:

1) without consideration for warranty lifecycles;
2) daily rental rates when the item should be billed monthly; and
3) equipment that is not necessary or customary for treatment of work-related conditions.

To address these issues, the PIU worked with OWCP’s Branch of Medical Standards and Operations (BMSO) to determine the best practices in accordance with industry standard billing protocols. Based on this review of FECA’s current controls, and in accordance with the discretion granted to DOL and delegated to OWCP, the FECA program is instituting new controls for DME billing as outlined below.

Note - Even with these new controls, the underlying need for medical professionals to demonstrate medical necessity for DME is unchanged.

ACTION:

A. Required Modifiers

1. Healthcare Common Procedure Coding System (HCPCS) DME codes shall be billed with the appropriate modifier, rental (RR) or purchase (NU), if applicable. If these codes are submitted without modifiers the bill line will be denied.

B. Rental and Purchase Limitations

1. One (1) per 31 days – rental
Extension/Flexion devices (E1800, E1801, E1802, E1805, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1820, E1821, E1825, E1830, E1831, E1840)

2. Six (6) per year - purchase
Manual Swingaway (E1028)

3. One (1) per year - purchase
Canes/Crutches/Slings (E0100, E0105, E0110, E0112, E0114, E0621)
Headrest (E0955)
Actuator Replacement (E2378)

4. One (1) per 3 years - purchase
Walker accessories (E0156, E0158, E0159)
Conductive garment for TENS/NMES (E0731)
Non-implanted continuous glucose monitor/receiver (E2102)

5. One (1) per 5 years - purchase
Mobility assistance devices, wheelchair accessories, mattresses and hospital beds:
E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0165, E0170, E0171, E0181, E0182, E0183, E0184, E0185, E0186, E0187, E0193, E0194, E0196, E0197, E0198, E0235, E0240, E0245, E0247, E0248, E0250, E0251, E0255, E0256, E0260, E0261, E0290, E0291, E0292, E0293, E0294, E0295, E0301, E0302, E0303, E0304, E0305, E0316, E0471, E0620, E0625, E0627, E0629, E0630, E0635, E0636, E0637, E0638, E0639, E0640, E0641, E0642, E0958, E0968, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1010, E1012, E1029, E1030, E1035, E1036, E1038, E1039, E1050, E1060, E1070, E1083, E1084, E1085, E1086, E1087, E1088, E1089, E1090, E1092, E1093, E1100, E1130, E1140, E1150, E1160, E1161, E1170, E1171, E1172, E1180, E1190, E1195, E1200, E1221, E1222, E1223, E1224, E1225, E1226, E1227, E1228, E1230, E1240, E1250, E1260, E1270, E1280, E1285, E1290, E1295, K0800, K0801 K0802, K0806, K0807, K0808, K0812,K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0898, K0899

6. Two (2) per 5 years - purchase
Residual Limb Support (E1020)

7. One (1) per lifetime - purchase
Segmental pneumatic appliance(E0670)
TENS devices (E0720, E0730)
Osteogen ultrasound stimulators (E0748, E0760)

C. Not Covered
As of the effective date of this policy, the codes in Appendix A will no longer be covered by the FECA program.

D. Effective Date May 13, 2023
This policy is effective May 13, 2023. All bills received on and after this date will be subject to this policy.

If new/similar DME codes are identified/available in the future, similar restrictions will be implemented to conform with the intent of the controls in this Circular.

E. Authorization and Exceptions
Not all DME requires pre-authorization if billed within the timelines and protocols outlined above. A provider can check whether authorization is needed by accessing the Workers’ Compensation Medical Bill Process (WCMBP) portal and utilizing the check eligibility tool.

Even if the DME is not covered under FECA’s processing guidelines, the DME can be approved on an exception basis when a claimant's treating physician acquires pre-authorization by submitting rationalized medical evidence that explains why the authorization of the DME is medically necessary. Similarly, if a provider’s bill is denied due to lack of authorization, they may submit rationalized medical evidence explaining why the specific DME is medically necessary to treat the effects of the work-related injury. The narrative should include a discussion explaining why a covered item could not be used for the same purpose. The medical evidence will be reviewed by FECA staff and if the DME cannot be approved, the claimant may receive a formal decision with appeal rights.

Medical evidence can be submitted directly into the claimant’s case file by uploading it through ECOMP at https://www.ecomp.dol.gov, or by mailing it to P.O. Box 8311, London, KY 40742-8311.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 23-07

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Subject: Hearing Aids and Related Supplies/Services

Background: As part of its ongoing program integrity efforts, the Office of Workers’ Compensation Programs (OWCP) performed an analysis of bill payment data for hearing aids and related supplies paid for by the Division of Federal Employees' Longshore Harbor Workers’ Compensation (DFELHWC) – FECA program.

OWCP’s Branch of Medical Standards and Operations (BMSO) obtained hearing aid pricing information from state workers’ compensation programs and the US Department of Veterans Affairs. While OWCP often uses Medicare as a benchmark for pricing, Medicare does not provide coverage for hearing aids or examinations; the beneficiary is responsible for 100% of these costs. Therefore, a comparison with Medicare was not possible.

Of the 44 unique hearing aid services/codes paid for by the FECA program in FY22, Healthcare Common Procedure Code System (HCPCS) code V5261, Hearing aid, digital, binaural, behind the ear (BTE) accounted for 73.7% ($9.7 million) of total reimbursements of $13.2 million. The top ten hearing aid services/codes accounted for nearly 100% ($13 million) of total reimbursements. The top ten providers accounted for nearly 50% ($6.1 million) of hearing aid reimbursements and 52% (75,852) of hearing aid transactions. The providers in Washington state were an outlier, accounting for 32% ($4.3 million) of all hearing aid reimbursements.

As a result of the cost analysis, the FECA program is updating its controls for hearing aids and related services for clarity and transparency.

Authority: Under the Federal Employees’ Compensation Act (FECA), OWCP may provide to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. §8103. FECA and its implementing regulations at 20 C.F.R. Part 10, Subpart I (20 C.F.R. §10.800) authorize OWCP to set limits and require pre-authorization for medical services and supplies were deemed necessary.

Action: In accordance with the discretion granted to DOL and delegated to OWCP, DFELHWC is updating its policy regarding authorization and bill pay procedures for hearing aids and related supplies.

A. Effective July 15, 2023, OWCP will adopt additional controls on hearing aids, as outlined below.

1. The maximum units for monaural and binaural hearings aids will be one (1).

2. Utilization restrictions will be applied to modify the frequency of authorizations allowed for new hearing aid purchases from every three years to every five years. If a request is submitted prior to the five-year mark, OWCP will consider such requests on a case-by-case basis and require supporting documentation, including applicable medical records, the hearing aid warranty information for the previously authorized hearing aids, a detailed statement indicating why replacement is necessary, and a statement attesting to the fact that repair is either impossible or less cost-effective than the purchase of replacement hearing aids.

3. Reimbursement of batteries will be limited to the quantity of 30 units per 180 days from the first dispense date of service.

4. Authorizations for hearing aid fittings, repairs or modifications, conformity evaluations, and dispensing fees will require preauthorization since these costs are typically included in the cost of new hearing aids, whether supplied by an audiologist or purchased over the counter.

5. If a claimant purchases hearing aids directly from a hearing aid supplier, the claimant may only be reimbursed at the fee schedule price.

B. Effective July 9, 2023, OWCP will implement a fee schedule for hearings aids and related supplies consistent with 20 CFR 10.805(a).

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 23-08

Back to FECA Circulars Table of Contents

Subject: Employees' Compensation Operations and Management Portal (ECOMP) Entity Management System

Purpose: To announce a new component of ECOMP that enables registered, designated representatives to securely view case data and documents in Office of Workers’ Compensation (OWCP) case files for the FECA program. Functionality for the Longshore program is being deployed separately. While the basic components of the Entity Management System in ECOMP are the same regardless of OWCP program, there are some program specific nuances. This bulletin pertains to Federal Employees’ Compensation Act (FECA) program users.

Background: Under the FECA, a claimant who has filed a claim with the Department of Labor's (DOL) Office of Workers' Compensation Programs, “may authorize an individual to represent him [or her] in any proceeding under this subchapter.” 5 U.S.C. § 8127(a). The Code of Federal Regulations provides that while the FECA claims process is informal, “a claimant may appoint one individual to represent his or her interests, but the appointment must be in writing.” 20 C.F.R § 10.700 (a). While injured workers are not required to select a representative in order to file or process their FECA claim, they do have the option to request a representative at any time in the life of their claim.

The Entity Management System is a new feature in ECOMP that allows designated representatives, such as law firms, union representatives, or individual attorneys, to access case data and case file documents electronically.

Entities must first register in ECOMP. Once done, any claimant may link an entity representative to their case file(s) in ECOMP. This may be someone who has already previously agreed to representation, or the claimant may request new representation directly in ECOMP. If the entity accepts the request for representation, the entity will have the ability to view case information such as payment history and pharmacy and bill payment transactions, and view case file documents electronically without waiting for a copy request to be completed.

The claimant is not required to have representation in order to file or process a claim and despite the ability of representatives to register in ECOMP, OWCP does not endorse any representative or their services, nor can OWCP compel a representative to work on any claim or for any claimant. Agreements regarding fees and other services are made solely between the claimant and the representative.

References: 5 U.S.C. § 8106, 8127; 20 C.F.R. § 10.700, 10.703; and OWCP Procedure Manual Chapter 2-1200

Actions:

A. Entity Organization Creation

A new ECOMP user who wishes to create an entity will first need to create a new account and then proceed through the identity verification process. The new user will need to provide their date of birth and social security number in order to complete the identity verification process. OWCP does not store social security numbers for these users; they are used only during the initial identity verification process. After completion of the identity verification process, the new user will have the option to create a new entity.

1. The new entity user will be prompted to provide basic registration information, including organization name, organization type and which OWCP program(s) they are registering with. The available entity organization types for FECA are Law Firm/Attorney, Union, and Authorized Representative (e.g. a family member who the claimant has authorized to represent them).

2. The new entity user will be allowed to request that claimants contact them prior to designating them as an entity in ECOMP. An affirmative selection will generate a prompt for the claimant to verify that they have contacted the entity prior to attempting to link with them in ECOMP, but OWCP cannot enforce this contact requirement.

3. Prior to creating the entity account, the user will be required to agree to three conditions of use:

a. Acknowledge that the information provided is correct and that the user is assuming responsibility for the entity and will be the Entity Manager.

b. The entity will be visible and selectable for assignment.

c. Confirm that the entity member(s) will use the features in ECOMP to view and download case file documents and will not request case file copy documentation from OWCP unless extraordinary circumstances exist.

4. Upon completion of this process, the entity organization will be created in ECOMP. This process is self-executing.

B. Entity Organization Maintenance

Once the entity organization is created several features are available to the Entity Manager.

1. The Entity Manager can view the active users in the entity, view pending (and rejected) requests to join the entity, and invite members to join the entity.

If additional members are invited (or if an entity user requests to join the entity), the entity organization must be reviewed by an OWCP program administrator. A request will be sent to the administrator and the Entity Manager will be notified that the request is pending review. The administrator may reach out to the Entity Manager directly before approving (or denying) the request. This administrative approval process will be used to help ensure that duplicate entity organizations are not inadvertently created; however, this administrative review process in no way means that OWCP is endorsing services of the entity organization; rather, the review and approval is administrative in nature.

Note – The ability to add additional members to the organization is not enabled for the entity type Authorized Representative since this is a single person, unlike Law Firm and Union organizations, which may include multiple individuals.

2. If new members are added to the entity, the Entity Manager can designate specific individuals as additional Entity Managers. In addition, the Entity Manager will decide if the new entity member will be available for selection by claimant users. For example, in a law firm entity, the Entity Manager may decide to have the attorneys available for selection by claimants, but not the paralegals or the administrative staff.

3. The Entity Manager can update the entity’s basic information, to include contact information such as address, phone number or website.

• NOTE – Changing the entity’s address in the entity’s profile in ECOMP will NOT update the representative’s address in the OWCP case file(s) to which that entity is assigned. The mailing address in ECOMP and iFECS are not integrated. If the mailing address for the representative changes, that change must be submitted by the representative to OWCP outside of the Entity application for each individual case file to which that representative is associated.

4. The Entity Manager can update the claimant contact preference that alerts the claimant whether contact with the entity is requested prior to selection in ECOMP.

5. The Entity Manager can update the visibility configurations:

a. Case Visibility – Full visibility allows all members of the entity to access and view the claimant’s case file, e.g. all members of a law firm. Partial visibility allows only the specifically designated representative chosen by the claimant as the primary contact to view the claimant’s case file, e.g. the specific lawyer chosen by the claimant. This functionality is restricted for Union entity types since the claimant will be required to choose a single primary contact; the entire union will not have access to the case unlike a law firm. This setting is also not applicable to the entity type Authorized Representative since this entity type consists of only one individual.

b. Claimant Visibility – This setting allows the user to choose whether the entity will be visible for selection by a claimant. The default will be set to Yes, and the entity will be visible in search results and a claimant will be able to select the entity. If the setting is changed to No, the entity will not show in any search results. While the expectation is that most entities will choose to be visible to claimants, this option is available for users who may wish only to represent a specific claimant, and once that claimant selection has been processed the user does not wish to be available for other claimants to choose.

c. Entity Visibility - This setting allows the user to choose whether the entity will be visible to other users to request to join the entity. The default will be set to Yes, and the entity will be visible in search results and allow other registered users to request to join the entity. If the setting is changed to No, the entity will not be shown in any search results. While the expectation is that most entities will choose to be visible to other users so that they can request to join, this option is available for entities who may not wish to display in any search results once all members of the organization have been added to the entity.

C. Joining an Existing Entity Organization

A new ECOMP user who wishes to join an existing entity organization will first need to create a new account and then proceed through the identity verification process as described in Section A. After completing the identity verification process, the new user will have the option to join an existing entity. The join request will be sent to the Entity Manager(s), who will confirm or reject the request.

D. Entity Functionality

1. All members of an entity organization have a case dashboard. This dashboard lists all cases associated with that entity (where the claimant has designated a representative in ECOMP and the representative has agreed to represent the claimant). For each assigned case, the designated representative will be able to view all imaged documents in the OWCP case file and download case documents. The case file data and documents available to the representative are the exact same as what is viewable by the claimant. As part of the initial sign up process, the entity agrees to receive/download case documents via ECOMP rather than submitting copy requests unless extraordinary circumstances exist.

2. The entity members can also view new claimant requests that they be designated for representation, and agree to represent the claimant or reject the request. The claimant will be notified via email of the decision. If the designation is denied, the representative must provide a reason, and this reason will be provided to the claimant.

3. The entity member can also use their case dashboard to disassociate from a case at any time, which would immediately remove the entity member’s ability to access the case.

E. Selection by Claimant

While claimants are not required to select a representative in order to file or process their claim, they have the option to request a representative at any time in the life of their claim. A claimant will be advised that designating an entity representative in ECOMP does NOT mean that that individual or group has agreed to represent the claimant.

If a claimant wants to designate a representative who is not registered in ECOMP, they may continue to submit that designation in writing to OWCP in the same manner they always have outside of ECOMP Entity. Claimants who have previously designated representatives for their case files will not be required to go through the ECOMP designation process to continue representation by the same representative. But if that representative wants access to a claimant’s case through ECOMP, the claimant must be fully registered in ECOMP and use the process outlined below. There is no other alternative for the representative to gain access through ECOMP.

A registered claimant who wishes to associate with an entity representative in ECOMP must complete the following steps for each case.

1. For each case, the claimant will be able to see if a representative is already connected to that case in ECOMP. If a representative is not currently connected with that case in ECOMP, the claimant is presented with the option to select a representative.

2. Designating a representative occurs on a case-by-case basis; if the claimant wishes to have a representative on multiple cases, they will have to designate the representative individually in each case.

3. If an entity is currently associated with a case, the claimant will be able to view information regarding the designated representative at any time. If a representative has been designated, the case page will show the representative’s name as well as an option to revoke the association. The claimant can revoke the association at any time, and doing so will immediately remove the entity’s ability to access case data and documents.

4. The claimant will be required to choose a primary contact and whether to restrict case access to only that specific individual (e.g. a specific attorney), or allow full visibility for the entity (e.g. all members in the law firm). For union representatives, the claimant will be required to choose a primary contact; full visibility for the entire organization is not an option. For the entity type Authorized Representative, there is only the single primary contact since this entity type consists of only one individual.

5. The claimant will be advised that the representative will be able to view the case data and documents in ECOMP in the same way the claimant is able to.

6. The claimant will be notified that OWCP does not endorse or promote any of the representatives who are registered in ECOMP and that OWCP cannot require that a representative accept a request for representation.

7. The claimant will be asked to confirm that they previously contacted the representative, if the entity organization chose this option when creating the entity.

8. Prior to confirming the representative, the claimant will be required to read and confirm understanding that while a representative is not required in order to file or pursue a claim, they are choosing to have a representative assist them. The claimant will be advised that the representative has the authority to view data and documents in the case file and may submit evidence on the claimant’s behalf. They will also have to agree that all fees to the representative are payable by the claimant.

F. FECA Claims Staff Actions

Three new memos have been created to document case specific actions within ECOMP’s Entity Management System:

1. ECOMP Entity Transaction Memo – This memo will be added to the OWCP case file when any entity related case specific transaction occurs in ECOMP, such as:

• Representation Requested (when a claimant first chooses a representative);
• Representation Request Denied (when a representative denies a claimant’s request for representation, in which case the reason for the denial will show on the memo);
• Representation Request Revoked by Claimant (when the claimant revokes a request for representation prior to the representative deciding); or
• Entity primary contact or visibility selections are updated by the claimant (e.g. if claimant changes to full visibility for the entity).

These memos do not require any action by the claims staff and serve only to document the transactions that are occurring in ECOMP. They will be placed into the case file in a Review Complete status.

2. Authorization of Representative Memo – This memo will be added to the case file after the claimant has chosen a representative in ECOMP and the representative has agreed to represent the claimant in ECOMP. It will be in an Unreviewed status. If the representative shown on the memo is already the representative in the file, no action is needed and the tracked document can be closed out with a memo documenting that the representative has already been authorized. If the representative is not listed as the representative in the file, the representative information should be updated in the case management system and an Attorney Fee Acknowledgement and Instruction letter should be issued to the representative with a copy to the claimant.

3. Removal of Representation Memo – This memo will be used to document that a representative is no longer associated with a case. This may stem from an action by the claimant or by the representative. If either removes the association, all case access for the representative is terminated. This memo will document the specific transaction and will be placed into the file as Unreviewed since this will require an update in the case management system.

G. Training videos and Help Available Online

Help guides are available in ECOMP to assist claimants and representatives in this process. Step-by-step video instructions for claimant specific questions will be contained in ECOMP’s Help site. New and existing representatives will also find step-by-step instructions on creating and joining entities in ECOMP. These and other guides can be found by selecting the “HELP” menu in the upper right-hand corner of the page, or at: ecomp.dol.gov/#/help.

Disposition: This Circular is to be retained until otherwise revised or incorporated into Part 2 of the OWCP Procedure Manual.

ANTONIO RIOS
Director for
Division of Federal Employees', Longshore and Harbor Workers' Compensation

Distribution: All DFELHWC FECA Program Staff and Stakeholders

Back to FECA Circulars Table of Contents

Subject: Current Interest Rates for Prompt Payment Bills and Debt Collection

The interest rate to be assessed for the prompt payment bills is 1.625 percent for the period of January 1, 2022 through June 30, 2022. This new rate has been updated in the Central Bill Payment system tables.

The interest rate for assessing interest charges on debts due the government was reduced to 1.0 percent for the period of January 1, 2022 through December 31, 2022. The rate has been updated in the iFECS system tables.

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.

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Attachments: Prompt Payment Interest Rates
Debt Management Interest Rates

Distribution: All FECA Staff

ATTACHMENT TO FECA CIRCULAR NO. 22-02

ATTACHMENT TO FECA CIRCULAR NO. 22-02

Back to Top of FECA Circular No. 22-02

Back to FECA Circulars Table of Contents

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 January 1, 2022, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile INCREASED to 58.5 cents per mile per U.S. General Services Administration (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 FECA Program personnel.

Reference: Chapter 5-0204, Principles of Bill Adjudication, Part 8, Travel, Federal (FECA) Procedure Manual and 5 USC 8103.

Action: The Medical Billing Pay Contractor (MBPC) facility has updated their system to reflect the new rates. Since there is no action required at the 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:

Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 22-03

Back to FECA Circulars Table of Contents

Subject: Dual Benefits - FERS Cost of Living Adjustments

Background: Effective December 1, 2021, benefits issued by the Social Security Administration (SSA) were increased by 5.9%. Therefore, the amount of the Federal Employees’ Retirement System (FERS) Dual Benefits deduction needed to be increased by the same amount, to ensure the dollar-for-dollar offset required by 5 U.S.C. 8116 (d) (2) of the Federal Employees’ Compensation Act remains current.

Applicability: Appropriate FECA Program personnel.

Action: This adjustment will be made from the National Office for all cases that were correctly entered into the integrated Federal Compensation System (iFECS). The adjustment was effective on the periodic roll cycle beginning December 05, 2021.

The historical SSA cost of living adjustments are as follows:

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 22-04

Back to FECA Circulars Table of Contents

Subject: Employees' Compensation Operations and Management Portal (ECOMP) Entity Management System (Updated)

Note: FECA Circular 22-01 was originally issued on November 8, 2021. The original Circular discussed an optional Case Visibility setting for Law Firms in Section B5a. However, that setting is not configurable by the Entity and is dependent solely on the claimant’s selection (see Section E4). That description has, therefore, been removed and the Circular updated and reissued accordingly.

Purpose: To announce a new component of ECOMP that enables registered, designated representatives to securely view case data and documents in Office of Workers’ Compensation (OWCP) case files for the FECA program. Functionality for the Longshore program is being deployed separately. While the basic components of the Entity Management System in ECOMP are the same regardless of OWCP program, there are some program specific nuances. This bulletin pertains to Federal Employees’ Compensation Act (FECA) program users.

Background: Under the FECA, a claimant who has filed a claim with the Department of Labor's (DOL) Office of Workers' Compensation Programs, “may authorize an individual to represent him [or her] in any proceeding under this subchapter.” 5 U.S.C. § 8127(a). The Code of Federal Regulations provides that while the FECA claims process is informal, “a claimant may appoint one individual to represent his or her interests, but the appointment must be in writing.” 20 C.F.R § 10.700 (a). While injured workers are not required to select a representative in order to file or process their FECA claim, they do have the option to request a representative at any time in the life of their claim.

The Entity Management System is a new feature in ECOMP that allows designated representatives, such as law firms, union representatives, or individual attorneys, to access case data and case file documents electronically.

Entities must first register in ECOMP. Once done, any claimant may link an entity representative to their case file(s) in ECOMP. This may be someone who has already previously agreed to representation, or the claimant may request new representation directly in ECOMP. If the entity accepts the request for representation, the entity will have the ability to view case information such as payment history and pharmacy and bill payment transactions, and view case file documents electronically without waiting for a copy request to be completed.

The claimant is not required to have representation in order to file or process a claim and despite the ability of representatives to register in ECOMP, OWCP does not endorse any representative or their services, nor can OWCP compel a representative to work on any claim or for any claimant. Agreements regarding fees and other services are made solely between the claimant and the representative.

References: 5 U.S.C. § 8106, 8127; 20 C.F.R. § 10.700, 10.703; and OWCP Procedure Manual Chapter 2-1200

Actions:

A. Entity Organization Creation

A new ECOMP user who wishes to create an entity will first need to create a new account and then proceed through the identity verification process. The new user will need to provide their date of birth and social security number in order to complete the identity verification process. OWCP does not store social security numbers for these users; they are used only during the initial identity verification process. After completion of the identity verification process, the new user will have the option to create a new entity.

1. The new entity user will be prompted to provide basic registration information, including organization name, organization type and which OWCP program(s) they are registering with. The available entity organization types for FECA are Law Firm/Attorney, Union, and Authorized Representative (e.g. a family member who the claimant has authorized to represent them).

2. The new entity user will be allowed to request that claimants contact them prior to designating them as an entity in ECOMP. An affirmative selection will generate a prompt for the claimant to verify that they have contacted the entity prior to attempting to link with them in ECOMP, but OWCP cannot enforce this contact requirement.

3. Prior to creating the entity account, the user will be required to agree to three conditions of use:

a. Acknowledge that the information provided is correct and that the user is assuming responsibility for the entity and will be the Entity Manager.
b. The entity will be visible and selectable for assignment.
c. Confirm that the entity member(s) will use the features in ECOMP to view and download case file documents and will not request case file copy documentation from OWCP unless extraordinary circumstances exist.

4. Upon completion of this process, the entity organization will be created in ECOMP. This process is self-executing.

B. Entity Organization Maintenance

Once the entity organization is created several features are available to the Entity Manager.

1. The Entity Manager can view the active users in the entity, view pending (and rejected) requests to join the entity, and invite members to join the entity.

If additional members are invited (or if an entity user requests to join the entity), the entity organization must be reviewed by an OWCP program administrator. A request will be sent to the administrator and the Entity Manager will be notified that the request is pending review. The administrator may reach out to the Entity Manager directly before approving (or denying) the request. This administrative approval process will be used to help ensure that duplicate entity organizations are not inadvertently created; however, this administrative review process in no way means that OWCP is endorsing services of the entity organization; rather, the review and approval is administrative in nature.

Note – The ability to add additional members to the organization is not enabled for the entity type Authorized Representative since this is a single person, unlike Law Firm and Union organizations, which may include multiple individuals.

2. If new members are added to the entity, the Entity Manager can designate specific individuals as additional Entity Managers. In addition, the Entity Manager will decide if the new entity member will be available for selection by claimant users. For example, in a law firm entity, the Entity Manager may decide to have the attorneys available for selection by claimants, but not the paralegals or the administrative staff.

3. The Entity Manager can update the entity’s basic information, to include contact information such as address, phone number or website.

• NOTE – Changing the entity’s address in the entity’s profile in ECOMP will NOT update the representative’s address in the OWCP case file(s) to which that entity is assigned. The mailing address in ECOMP and iFECS are not integrated. If the mailing address for the representative changes, that change must be submitted by the representative to OWCP outside of the Entity application for each individual case file to which that representative is associated.

4. The Entity Manager can update the claimant contact preference that alerts the claimant whether contact with the entity is requested prior to selection in ECOMP.

5. The Entity Manager can update the visibility configurations:

a. Claimant Visibility – This setting allows the user to choose whether the entity will be visible for selection by a claimant. The default will be set to Yes, and the entity will be visible in search results and a claimant will be able to select the entity. If the setting is changed to No, the entity will not show in any search results. While the expectation is that most entities will choose to be visible to claimants, this option is available for users who may wish only to represent a specific claimant, and once that claimant selection has been processed the user does not wish to be available for other claimants to choose.

b. Entity Visibility - This setting allows the user to choose whether the entity will be visible to other users to request to join the entity. The default will be set to Yes, and the entity will be visible in search results and allow other registered users to request to join the entity. If the setting is changed to No, the entity will not be shown in any search results. While the expectation is that most entities will choose to be visible to other users so that they can request to join, this option is available for entities who may not wish to display in any search results once all members of the organization have been added to the entity.

C. Joining an Existing Entity Organization

A new ECOMP user who wishes to join an existing entity organization will first need to create a new account and then proceed through the identity verification process as described in Section A. After completing the identity verification process, the new user will have the option to join an existing entity. The join request will be sent to the Entity Manager(s), who will confirm or reject the request.

D. Entity Functionality

1. All members of an entity organization have a case dashboard. This dashboard lists all cases associated with that entity (where the claimant has designated a representative in ECOMP and the representative has agreed to represent the claimant). For each assigned case, the designated representative will be able to view all imaged documents in the OWCP case file and download case documents. The case file data and documents available to the representative are the exact same as what is viewable by the claimant. As part of the initial sign up process, the entity agrees to receive/download case documents via ECOMP rather than submitting copy requests unless extraordinary circumstances exist.

2. The entity members can also view new claimant requests that they be designated for representation, and agree to represent the claimant or reject the request. The claimant will be notified via email of the decision. If the designation is denied, the representative must provide a reason, and this reason will be provided to the claimant.

3. The entity member can also use their case dashboard to disassociate from a case at any time, which would immediately remove the entity member’s ability to access the case.

E. Selection by Claimant

While claimants are not required to select a representative in order to file or process their claim, they have the option to request a representative at any time in the life of their claim. A claimant will be advised that designating an entity representative in ECOMP does NOT mean that that individual or group has agreed to represent the claimant.

If a claimant wants to designate a representative who is not registered in ECOMP, they may continue to submit that designation in writing to OWCP in the same manner they always have outside of ECOMP Entity. Claimants who have previously designated representatives for their case files will not be required to go through the ECOMP designation process to continue representation by the same representative. But if that representative wants access to a claimant’s case through ECOMP, the claimant must be fully registered in ECOMP and use the process outlined below. There is no other alternative for the representative to gain access through ECOMP.

A registered claimant who wishes to associate with an entity representative in ECOMP must complete the following steps for each case.

1. For each case, the claimant will be able to see if a representative is already connected to that case in ECOMP. If a representative is not currently connected with that case in ECOMP, the claimant is presented with the option to select a representative.

2. Designating a representative occurs on a case-by-case basis; if the claimant wishes to have a representative on multiple cases, they will have to designate the representative individually in each case.

3. If an entity is currently associated with a case, the claimant will be able to view information regarding the designated representative at any time. If a representative has been designated, the case page will show the representative’s name as well as an option to revoke the association. The claimant can revoke the association at any time, and doing so will immediately remove the entity’s ability to access case data and documents.

4. The claimant will be required to choose a primary contact and whether to restrict case access to only that specific individual (e.g. a specific attorney), or allow full visibility for the entity (e.g. all members in the law firm). For union representatives, the claimant will be required to choose a primary contact; full visibility for the entire organization is not an option. For the entity type Authorized Representative, there is only the single primary contact since this entity type consists of only one individual.

5. The claimant will be advised that the representative will be able to view the case data and documents in ECOMP in the same way the claimant is able to.

6. The claimant will be notified that OWCP does not endorse or promote any of the representatives who are registered in ECOMP and that OWCP cannot require that a representative accept a request for representation.

7. The claimant will be asked to confirm that they previously contacted the representative, if the entity organization chose this option when creating the entity.

8. Prior to confirming the representative, the claimant will be required to read and confirm understanding that while a representative is not required in order to file or pursue a claim, they are choosing to have a representative assist them. The claimant will be advised that the representative has the authority to view data and documents in the case file and may submit evidence on the claimant’s behalf. They will also have to agree that all fees to the representative are payable by the claimant.

F. FECA Claims Staff Actions

Three new memos have been created to document case specific actions within ECOMP’s Entity Management System:

1. ECOMP Entity Transaction Memo – This memo will be added to the OWCP case file when any entity related case specific transaction occurs in ECOMP, such as:

• Representation Requested (when a claimant first chooses a representative);
• Representation Request Denied (when a representative denies a claimant’s request for representation, in which case the reason for the denial will show on the memo);
• Representation Request Revoked by Claimant (when the claimant revokes a request for representation prior to the representative deciding); or
• Entity primary contact or visibility selections are updated by the claimant (e.g. if claimant changes to full visibility for the entity).

These memos do not require any action by the claims staff and serve only to document the transactions that are occurring in ECOMP. They will be placed into the case file in a Review Complete status.

2. Authorization of Representative Memo – This memo will be added to the case file after the claimant has chosen a representative in ECOMP and the representative has agreed to represent the claimant in ECOMP. It will be in an Unreviewed status. If the representative shown on the memo is already the representative in the file, no action is needed and the tracked document can be closed out with a memo documenting that the representative has already been authorized. If the representative is not listed as the representative in the file, the representative information should be updated in the case management system and an Attorney Fee Acknowledgement and Instruction letter should be issued to the representative with a copy to the claimant.

3. Removal of Representation Memo – This memo will be used to document that a representative is no longer associated with a case. This may stem from an action by the claimant or by the representative. If either removes the association, all case access for the representative is terminated. This memo will document the specific transaction and will be placed into the file as Unreviewed since this will require an update in the case management system.

G. Training videos and Help Available Online

Help guides are available in ECOMP to assist claimants and representatives in this process. Step-by-step video instructions for claimant specific questions will be contained in ECOMP’s Help site. New and existing representatives will also find step-by-step instructions on creating and joining entities in ECOMP. These and other guides can be found by selecting the “HELP” menu in the upper right-hand corner of the page, or at: ecomp.dol.gov/#/help.

Disposition: This Circular is to be retained until otherwise revised or incorporated into Part 2 of the OWCP Procedure Manual.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC FECA Program Staff and Stakeholders

Back to Top of FECA Circular No. 22-05

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Subject: Employees’ Compensation Operations & Management Portal (ECOMP) Equity Initiative

Background: Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities through the Federal Government, issued on January 20, 2021, directed Federal Agencies to assess whether agency policies and actions create or exacerbate barriers to full and equal participation by all eligible individuals. In order to promote equitable delivery of government benefits, the Office of Workers’ Compensation Programs (OWCP) Fiscal Year 2022 Agency Management Plan tasks the Federal Employees Compensation Act (FECA) program with enhancing ECOMP to advance racial and gender equity and support underserved communities by collecting additional voluntary information from claimants on their race, religion, sexual orientation, marital status, and disability status; and by offering additional non-binary gender options for filing forms, expanded from the current binary-only gender options.

The information is being collected to help the FECA Program address any systemic barriers in accessing benefits available from OWCP, and so that the FECA Program can develop effective outreach strategies to ensure unfettered access to program services and benefits, especially to underserved communities.

Reference: Department of Labor, OWCP Fiscal Year 2022 Agency Management Plan

Applicability: Appropriate National Office and Field Office personnel.

Actions:

1. Field 4 of CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, and Field 4 of CA-2, Notice of Occupational Disease and Claim for Compensation, will be changed from “sex” to “gender.” Four options will be available: Male; Female; Transgender; or Non-Binary.

2. All FECA claimant profiles in ECOMP will include a voluntary section wherein the claimant can choose to provide OWCP with information regarding their race, religion, sexual orientation, marital status, and disability status. OWCP will provide information about the reasons this information is being requested and the ways in which it may be used and will inform claimants that answering is voluntary and their responses will not be made available to or used by claims staff to determine claims eligibility.

Disposition: This Circular should be retained until incorporated into the FECA Procedure Manual.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC FECA Program Staff and Stakeholders

Back to Top of FECA Circular No. 22-06

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Subject: Requests for File Copies in Conjunction with Case File Access within the Employees’ Compensation and Management Portal (ECOMP)

Purpose: This circular is being issued to clarify the policy of the Office of Workers' Compensation Programs (OWCP), Division of Federal Employees', Longshore and Harbor Workers’ Compensation (DFELHWC) with respect to requests for copies of documents from Federal Employees' Compensation Act (FECA) case files under the Privacy Act in conjunction with the availability of such documents to claimants and representatives through ECOMP.

Background: In accordance with the Freedom of Information Act (FOIA) (5 U.S.C. 552) and the Privacy Act, with implementing regulations at 29 C.F.R. Parts 70 (FOIA) and 71 (Privacy) governing the production or disclosure of information or materials, it has been the practice of OWCP to provide copies of FECA case files to claimants and/or their authorized representatives. This has historically involved the provision of paper or electronic copies transmitted to the requestor by mail or electronic communication. However, with the availability of ECOMP, claimants and their representatives now have the ability to access complete copies of their case file(s) online.

FECA Circular 22-05, issued January 26, 2022, announced the Entity Management System, a new feature in ECOMP that allows designated representatives, such as law firms, union representatives, or individual attorneys, to access case data and case file documents electronically. As part of the initial sign-up process, any entity must agree to receive/download case documents via ECOMP rather than submitting copy requests unless extraordinary circumstances exist.

This extends ECOMP functionality to representatives, allowing them access to a claimant’s file at any time. Claimants already had such access and they continue to be able to access their files at any time through ECOMP.

Actions:

1. Upon the submission of a request for documents from a FECA case file, from either a claimant or representative, OWCP will issue a letter advising that all such documents are available in the ECOMP system. If the claimant is not yet registered, the letter will provide instructions on how to create an account and access ECOMP.

2. If the claimant is unable or unwilling to access ECOMP, an explanation should be provided by the claimant to OWCP. For represented claimants, the explanation may be provided through the designated representative. OWCP staff may in their discretion reach out to the claimant to assist and facilitate registration. If still unable to register, OWCP will provide a copy of the case file to the requesting individual.

3. If a representative is requesting a copy of a case file and the represented claimant is able to access ECOMP, the representative must use the entity function in ECOMP to obtain access to case file documents. If the representative is unable or unwilling to do so, they will be directed to the claimant who, through ECOMP, can download their case file and provide it to the representative.

Disposition: This Circular is to be retained until otherwise revised or incorporated into the FECA Procedure Manual.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC FECA Program Staff and Stakeholders

Back to Top of FECA Circular No. 22-07

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Subject: Bill Pay – Reimbursement Claims Submitted by Third-Party Billers and Insurance Carriers (including Federal Employees Health Benefits carriers)

Background: Under the Federal Employees’ Compensation Act (FECA), the Office of Workers’ Compensation Programs (OWCP) may provide to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. § 8103. FECA and its implementing regulations at 20 C.F.R. Part 10, Subpart I (20 C.F.R. § 10.800) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

Pursuant to 5 U.S.C. § 8103, the FECA program will pay for services rendered by a medical provider, even when the billing for such services is submitted by an agent of the medical provider or by an insurance carrier that may have already paid the provider for such services (including Federal Employee Health Benefit (FEHB) carriers). Reimbursement claims from insurance companies and third-party billers most often occur when services are rendered prior to the FECA claim being accepted, but may occur at any point after claim acceptance if the provider of the service did not bill the FECA program. Most reimbursement claims are received from third-party billers and not directly from insurance carriers.

As part of its ongoing program integrity efforts, the FECA program’s Program Integrity Unit (PIU) conducted an analysis of reimbursements made to these billers. The PIU’s analysis revealed several anomalies resulting in multiple instances of improper payments by OWCP due to either inappropriate or untimely billing practices by third-party billers/insurance companies. Such billing practices and the program’s lack of controls to detect such anomalies led to the following:

• reimbursement to the third-party biller/insurance company and the provider of the service (e.g. the actual physician) for the same service, resulting in duplicate payment for the same service;
• reimbursement for services unrelated to the accepted work injury (e.g. payment of an eye exam in a case accepted for an orthopedic condition);
• reimbursement for services rendered without the required pre-authorization and review by claims staff (e.g. non-emergency surgery); and
• reimbursement for services not covered under the FECA (e.g. chiropractic services when a subluxation had not been accepted as work-related).

The PIU also found that reimbursement claims, specifically those submitted via Electronic Data Interchange (EDI), did not include the carrier reimbursement form or the bill that was paid so there was no documentation to support that the biller had actually made the payment.

Based on these findings, OWCP began implementing targeted controls on April 27, 2020 to address these vulnerabilities, and effective the date of this circular, additional controls will be implemented as described below.

Action: In accordance with the discretion granted to DOL and delegated to OWCP, OWCP’s FECA Program has updated its policy regarding authorization and bill payment procedures for reimbursement claims submitted by third-party billers and insurance carriers.

A. Controls that Existed Prior to April 27, 2020:

The following controls existed prior to April 27, 2020, but are being added to this circular for transparency.

1. Duplicate edits are enforced to help ensure that the same service is not paid multiple times to different billers.

2. Reimbursement requests that are over $50,000 are subject to review in the same manner as all other bills. These high-cost submissions are reviewed to ensure that the service was necessary and authorized for the work-related condition, and that sufficient medical documentation to support the procedure has been received. See FECA Bulletin 21-05.

B. Controls Effective April 27, 2020:

OWCP adopted the following controls for third party billers and insurance carriers effective April 27, 2020, but are being added to this circular for transparency.

1. Authorization Requirements - Reimbursement claims are subject to all prior and retroactive authorization requirements. Previously, only certain bills such as surgeries and inpatient hospitalizations required review by claims staff. Billers can determine whether prior authorization is needed, prior to submission of a claim, by using OWCP’s on-line medical bill pay portal. If the submission will require authorization, the biller must submit a statement from the treating physician to support that the service rendered was necessary for the work-related condition. If a procedure was performed (e.g. surgery), the medical records pertaining to the service must also be included when the authorization request is submitted to OWCP’s bill processor. This information will then be routed to the Claims Examiner (CE) for a determination.

2. Treatment Related to Accepted Condition(s) - Claims are subject to denial when the service rendered is not for the examination and treatment of the accepted work-related conditions. This includes the procedure code and billed diagnosis. Previously, claims bypassed these edits, which resulted in payment for services not covered for the accepted work-related conditions. Billers can determine if the service would be covered as work-related, prior to submission of a claim, by using OWCP’s on-line medical bill pay portal. If the service is found not to be for an accepted work-related injury, medical evidence must be submitted directly to OWCP that substantiates that the condition/service being billed is related to the work injury. If additional conditions are accepted as work-related, the third-party biller or insurance carrier can then submit the claim for processing.

3. Required Documentation - The carrier reimbursement template and copy of the original provider bill paid by the insurance company (e.g. CMS -1500 form) are required. Billers are also required to submit attachments of invoices for payment of implants in order to receive reimbursement, if the type of bill allows separate reimbursement of implants under the OWCP fee schedule. Previously, only the carrier reimbursement template was required for bill processing.

C. Control Effective June 4, 2022:

OWCP is adopting the following control that will be implemented on June 4, 2022:

1. Third-party billers and insurance carriers should submit their claims in a timely manner. No bill will be paid for expenses incurred if the bill is submitted more than one year beyond the end of the calendar year in which the expense was incurred or the service or supply was provided, or more than one year beyond the end of the calendar year in which the claim was first accepted as compensable by OWCP, whichever is later. This timely filing requirement is the same requirement that, pursuant to 20 C.F.R. § 10.803, currently applies to bills submitted by medical providers or their billing agents.

Applying this approach consistently for all medical billing allows OWCP to monitor costs and manage the case more effectively by monitoring treatment provided.

D. Fee Schedule Application

Historically, OWCP had excluded FEHB carriers from the application of the fee schedule. However, on August 16, 2020 OWCP began paying third-party carriers and insurance carriers based on the fee schedule. Given the unique circumstances surrounding provision of services by insurance carriers, and the third-party billers who bill on their behalf, OWCP has decided to revert to the prior policy and will remove the fee schedule application from these specific reimbursement claims and will reimburse the service as paid. In doing so, OWCP will realize the benefit of the paid contracted rate, if lower than the fee schedule, and protect the claimant from responsibility for any recoupment for services that were originally paid at a rate higher than the fee schedule.

All bills processed for FEHB carriers, Third Party Billers and non-FEHB insurance providers (i.e. those entities that are provider type 95) on/after August 16, 2020 will be reprocessed to allow a bypass of the fee schedule.

E. Pharmacy Bills

The programmatic controls outlined in this circular apply to all types of medical bills, to include reimbursement for pharmacy payments. This includes submission of all information necessary to determine if the medication was prescribed for the work-related condition and would be authorized under OWCP pharmaceutical policies and applicable formularies, such as the national drug code (NDC), days supply, quantity, etc.

F. Future Application

In the future, as new OWCP program integrity controls are implemented that apply to all provider types, FEHB carriers, Third Party Billers and non-FEHB insurance providers (provider type 95) will be included, unless otherwise specified.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff and FECA Program Stakeholders

Back to Top of FECA Circular No. 22-08

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Subject: Employees’ Compensation Operations & Management Portal (ECOMP) Form Retention

Background: Executive Order 14058, Transforming Federal Customer Experience and Service Delivery to Rebuild Trust in Government, issued on December 13, 2021, directed the Secretary of Labor to update rules, policies, and procedures to eliminate, consistent with applicable law and to the extent practicable, requirements for workers' compensation claimants to submit physical documents, but to retain the option for physical submission for claimants who cannot otherwise submit them.

FECA Circular 13-03, issued February 14, 2013, announced the launch of ECOMP to facilitate electronic submission of documents and electronic submission of Federal Employees’ Compensation (FECA) claim forms. With claim forms being submitted electronically, they no longer retained an actual signature from the injured worker or the Supervisor. Circular 13-03 therefore indicated a requirement explicitly set forth in each employing agency’s Memorandum of Understanding (MOU), for the agency to print, sign and retain hard copies. Specifically, the MOU provides that, "To the extent that any forms containing the signature of an employee are submitted electronically, including, but not limited to, Form CA-1, CA-2, CA-7, CA-7a, [AGENCY NAME] agrees that it will retain the original form(s) submitted by the employee, bearing original signatures, and make such forms available for inspection by the DFEC. Although the signed copies of such forms are physically maintained by the employing agency, they remain covered by the government-wide Privacy Act system of records entitled DOL/GOVT-1."

As ECOMP now has the ability to confirm the claimant’s identity through two-factor authentication, a claimant’s electronic signature through ECOMP is as valid as a wet signature. Accordingly, the FECA program has determined that it is no longer necessary for agencies to retain paper copies with wet signatures of the electronic forms it submits. ECOMP will retain the identity and electronic signatures from those completing forms on an indefinite basis. Documents submitted prior to the date of this Circular must still be maintained.

Reference: Executive Order 14058, FECA Circular 13-03

Actions:

1. Effective the date of this Circular, employing agencies are no longer required to retain paper copies of claim forms submitted through ECOMP.

2. The FECA program will modify its MOUs with each employing agency upon expiration, to reflect this change in policy.

Disposition: This Circular should be retained until incorporated into the FECA Procedure Manual.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All DFELHWC FECA Program Staff

Back to Top of FECA Circular No. 22-09

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Subject: Bill Pay – Psychological Exams and Evaluations Services - Utilization Restrictions

Background: Medical providers performing psychological testing and examinations issued complaints regarding existing limitations for reimbursement of services within the Workers’ Compensation Medical Bill Process (WCMBP). The Office of Workers’ Compensation Programs (OWCP), Division of Federal Employees' Longshore Harbor Workers’ Compensation, Federal Employees’ Compensation Act (FECA) Program reviewed the matter and found the existing limitations do not sufficiently account for the way these services were provided. While the program allows two tests per calendar year, a test is technically a series of codes when conducted, and is easily 6-8 hours per session, and frequently performed over several days. Further, there is no delineation between a neuropsychological exam and a psychological exam, which poses an additional problem, as they are technically different services.

OWCP’s Branch of Medical Standards and Operations (BMSO) reviewed these concerns and found a problem with the existing Utilization Restriction (UR) edits applied to the psychological codes in the WCMBP system. It appears that Psychological Exams and Evaluations service codes were updated in 2019. This update may have caused the applied URs in the system to be invalid.

OWCP’s chief medical officer facilitated a meeting with several professional experts, including a John Hopkins University psychologist, federal government psychologists, and a medical coder who specializes in psychological service codes. The team of experts provided their professional guidance, aiding BMSO to establish accurate and medically supported utilization restrictions.

BMSO recommended that the program change the utilization restrictions for the service codes listed below, which will help to prevent unsupported UR denials.

Authority: Under the Federal Employees’ Compensation Act, OWCP may provide to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. § 8103. FECA and its implementing regulations at 20 C.F.R. Part 10, Subpart I (20 C.F.R. § 10.800) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

Action: In accordance with the discretion granted to DOL and delegated to OWCP, OWCP’s FECA Program is updating its policy regarding authorization and bill pay procedures for Psychological Exams and Evaluations Services.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore
and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 22-10

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Subject: Medical Management Application

Background: The Medical Management Application (MMA) in the Integrated Federal Employees' Compensation System (iFECS) allows program users access to a database of Board-certified specialist physicians in order to schedule impartial referee examinations (IME) under the Federal Employees' Compensation Act (FECA). An IME under 5 U.S.C. 8123 of FECA is used where there is a conflict in medical evidence between a claimant's physician and a physician for the Office of Workers' Compensation Programs (OWCP) such as a District Medical Advisor or a second opinion physician. MMA contains an automatic and strict rotational scheduling feature, provides for consistent rotation among physicians and records the information needed to document the IME selection.

If a physician in the rotation cannot or will not schedule an examination, he or she must be bypassed in the "Schedule Appointments" application in iFECS so that the next physician in the rotation can be considered for IME scheduling.

If a physician will not accept DOL or OWCP cases for medical examinations, the physician's record in the "Physicians" application in iFECS should be updated so that the physician no longer appears in the rotation in the "Schedule Appointments" application.¹

The FECA program staff reported repeated issues with the scheduling of IME examinations, creating a significant administrative burden on the program and potential delay in scheduling referee examinations. For that reason, a comprehensive review of data in the MMA was undertaken. That review revealed that while many physicians have been repeatedly bypassed by medical scheduling staff due to their unwillingness to accept DOL or OWCP cases, they were not removed from the referee rotation.

Applicability: Appropriate National Office and Office personnel.

Reference: 5 U.S.C. 8123, Federal Employees' Compensation Act (FECA) Procedure Manual Chapter 3-0500, OWCP Directed Medical Examinations

Action:

1. A significant number of physicians in MMA have been regularly bypassed because they will not accept any Department of Labor (DOL) cases, will not do IMEs, will not accept workers' compensation cases, or are not willing to perform examinations for OWCP.
2. It is burdensome for OWCP to continue to contact these physicians as they appear in the rotation. These contacts result in delays in IME impartial referee medical examination scheduling and slows claims processing. OWCP removed from the MMA those physicians whose offices have reported to OWCP their unwillingness to perform referee medical examinations.
3. Physicians bypassed for other reasons, such as those that have relocated from the address indicated in MMA, will not be removed through this process.

Disposition: This Bulletin should be retained until incorporated into the FECA Procedure Manual.

¹ FECA Procedure Manual 3-0500.6.

Antonio Rios
Director for
Division of Federal Employees', Longshore and Harbor Workers' Compensation

Distribution: All FECA Staff

Back to FECA Circulars Table of Contents

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 January 1, 2021, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile DECREASED to 56 cents per mile per U.S. General Services Administration (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 FECA Program personnel.

Reference: Chapter 5-0204, Principles of Bill Adjudication, Part 8, Travel, Federal (FECA) Procedure Manual and 5 USC 8103.

Action: The Medical Billing Pay Contractor (MBPC) facility has updated their system to reflect the new rates. Since there is no action required at the Office level, the rates are being provided for informational purposes only.

Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 21-02

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Subject: Dual Benefits - FERS Cost of Living Adjustments

Background: Effective December 1, 2020, benefits issued by the Social Security Administration (SSA) were increased by 1.3%. Therefore, the amount of the Federal Employees’ Retirement System (FERS) Dual Benefits deduction needed to be increased by the same amount, to ensure the dollar-for-dollar offset required by 5 U.S.C. 8116 (d) (2) of the Federal Employees’ Compensation Act remains current.

Applicability: Appropriate FECA Program personnel.

Action: This adjustment was made from the National Office for all cases that were correctly entered into the integrated Federal Compensation System (iFECS). The adjustment was effective on the periodic roll cycle beginning December 06, 2020.

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 21-03

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Subject: Bill Pay – Requests for Durable Medical Equipment (DME)

Purpose: This circular is being issued to document authorization and pricing procedures for Durable Medical Equipment (DME) that went into effect on April 27, 2020.

The FECA program has been using these pricing procedures since April 27, 2020 and continues to do so.

Authority: Under the Federal Employees’ Compensation Act (FECA), the Office of Workers' Compensation Programs (OWCP) may provide to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103. The Act and its implementing regulations at 20 C.F.R. Part 10, Subpart I (20 C.F.R. 10.800) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

The below protocols supersede the rental vs. purchase procedures outlined in the FECA Procedure Manual, 2-810-17; the need to demonstrate medical necessity for DME is unchanged.

Action: In accordance with the discretion granted to DOL and delegated to OWCP, the FECA program updated its policy regarding medical authorization and bill pay procedures related to DME.

1. Effective April 27, 2020, authorization requests for durable medical equipment are now examined to determine whether there was a previous authorization for the same provider, claimant, procedure code and rental (RR) modifier for past 365 days based on the “To Date” received on the authorization request.


2. Authorization requests for DME rental up to 90 days will be processed as usual, depending upon the nature of the DME requested and the associated level of authorization.


3. If the 90 day DME rental period is not exhausted, but the authorized dollars for the rental are exhausted, then another DME Authorization for rental or purchase must be requested.


4. If the cumulative days of the DME rental request exceeds 90 days then the request will be considered level 3 and thus assigned to the claims examiner for review. The claims examiner should consider the purchase price of the DME and if the original authorization was for rental only, a new DME authorization request for purchase should be requested to authorize the remaining unused purchase amount.

Antonio Rios
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 21-04

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SUBJECT: Healthcare Common Procedure Coding System Code (HCPCS) P9020 Bill Payment Restrictions

PURPOSE: To provide notification of new DFEC policy with respect to payment for HCPCS code P9020, Platelet Rich Plasm, Each Unit

REFERENCES: 5 U.S.C. § 8103; 5 U.S.C. § 8124 (a)(2); 5 U.S.C. § 8128; 5 U.S.C. § 8145; 5 U.S.C § 8149. See 20 C.F.R. 10.800-826.

BACKGROUND: The American Medical Association provides the following definition of HCPCS code P9020:

“Platelet Rich Plasma, Each Unit”

The use of this code allows medical providers to bill for the intravenous infusion of platelet rich plasma for the treatment of thrombocytopenia and other blood defects. This code should not be used to describe the injection of platelet rich plasma into a specific site as a means of treating musculoskeletal injuries and/or joint conditions.

The Office of Workers' Compensation Programs (OWCP) Division of Federal Employees', Longshore and Harbor Workers’ Compensation is committed to the safety of its claimants and the reduction of fraud, waste and abuse. As part of this mission, OWCP analyzed medical billing practices for HCPCS code P9020 and determined that this code could be potentially used for purposes inconsistent with the HCPCS description.

AUTHORITY: Under the Federal Employees’ Compensation Act (FECA), the Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) may provide to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103. The Act and its implementing regulations at 20 C.F.R. Part 10, Subpart I (20 C.F.R. 10.800) authorizes OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary.

ACTION: In accordance with the discretion granted to DOL and delegated to OWCP, the FECA program is updating its policy regarding reimbursement of HCPCS code P9020.

1. Effective September 18, 2021, DFEC will only recognize HCPCS code P9020 as a valid code if rendered and billed by Inpatient and Outpatient facilities. Services rendered by a provider in-office and billed with HCPCS code P9020 will not be reimbursable.

This policy is effective September 18, 2021. All bills received on and after this date will be subject to this policy.

ANTONIO RIOS
Director for
Division of Federal Employees’, Longshore and Harbor Workers’ Compensation

Distribution: All FECA Program Staff

Back to Top of FECA Circular No. 21-05

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SUBJECT: Pharmacy Kit Maximum Quantity Restrictions

PURPOSE: To provide notification of an updated DFEC policy with respect to payment of maximum quantities for certain prescription kits

REFERENCES: 5 U.S.C. § 8103; 5 U.S.C. § 8124 (a)(2); 5 U.S.C. § 8128; 5 U.S.C. § 8145; 5 U.S.C § 8149; 20 C.F.R. 10.800-826; FECA Procedure Manual 3-400-3-a. FECA Bulletins 17-01 and 17-03; FECA Circulars 18-05.

BACKGROUND:

Under the Federal Employees' Compensation Act (FECA), the Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) may provide to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103. The Act and its implementing regulations at 20 C.F.R. Part 10, Subpart I (20 C.F.R. 10.800) authorize OWCP's FECA program to set limitations and require pre-authorization for medical services and supplies where deemed necessary, including the issuance of an exception-based policy.

FECA Circular 18-05 (issued February 14, 2018) implemented an exception-based policy pertaining to convenience kits and certain other combination medications. Under this Circular, authorization and payment for specified National Drug Codes (NDCs) will automatically deny when DFEC has determined that the items in the kit/medication can typically be obtained separately and/or at a lower cost and there is a reasonable commercially available alternative or substitute; or the primary use is for a condition not normally caused by a workers' compensation injury.

DFEC has identified another trend in the dispensing of prescription kits in which providers are billing an incorrect and inflated number of "units" for pharmacy claims resulting in overpayments. According to the National Council for Prescription Drug Programs (NCPDP) Billing Unit Standard, kits are designed with the intent to be dispensed and billed as a unit of "each" versus a "gram" or "milliliter". If the recommended maximum unit quantity to be dispensed for a particular kit is two, but the pharmacy bills for the total number of actual grams in the kit, such as 60 grams, this would result in an overpayment.

In accordance with the discretion granted to DOL and delegated to OWCP, DFEC is instituting a new exception-based policy pertaining to payment of certain drugs that fit the description above.

ACTION:

1. DFEC will continue to review all pharmacy kits and medications for inclusion into the NDC deny list (FECA Bulletin 18-05). There is no change to our current NDC denial list protocols.
2. DFEC will utilize a drug information compendia to identify NDCs that are considered to be kits.
3. A unit quantity restriction will be implemented for any kit not suitable for the NDC deny list. This will be done retroactively for kits not yet approved for the NDC list.
4. DFEC will apply maximum dosage restrictions based on recommendations from the U.S. Food and Drug Administration, the medical literature, or from the best available evidence for all kits determined to be payable.

Please note that DFEC will continuously and regularly review and evaluate Kit NDCs in accordance with the above policies and set the corresponding NDC to deny or be subject to maximum quantity restrictions.

Exception Basis Note: DFEC policy on considering exceptions for maximum quantities of DFEC specified Kit NDCs will follow that set forth in FECA Bulletin 17-03 and FECA Circular 18-05. Allowance for more than the DFEC maximum quantity can only be approved on a District Director exception basis when a claimant's treating physician acquires pre-authorization by submitting rationalized medical evidence explaining why the authorization of that quantity is medically necessary.

ANTONIO RIOS
Director for Federal Employees' Compensation

Distribution: All DFEC Staff, OWCP Branch of Medical Standards and Rehabilitation

Back to Top of FECA Circular No. 20-01

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Subject: Claims Examiner Query Link (CE-LinQ)

Purpose: This Circular is being issued to announce the new iFECS-ECOMP communication system. This iFECS-ECOMP communication system is named CE-LinQ. CE-LinQ is a new subsystem process for the OWCP/DFEC claims staff to submit letters to employing agencies via an automated process that connects iFECS with ECOMP in a bidirectional process. It leverages existing ECOMP electronic agency dashboards and lines of communication to facilitate information exchanges between the OWCP/DFEC claims staff and employing agency personnel. CE-LinQ ensures fast and secure communications to assist in claims processing.

Background: ECOMP was released to the public on November 2, 2011, and can be accessed directly at the following url: https://www.ecomp.dol.gov. The site originally contained two different types of functionality – electronic submission of documents and electronic submission of FECA claim forms. See FECA Circular 13-03, Employees' Compensation and Management Portal (ECOMP), for more detail on those features. Effective April 9, 2013, ECOMP was enhanced to allow designated ECOMP Agency Reviewers (AR) the ability to view imaged documents for cases assigned to their agency. See FECA Circular 13-06, Employees' Compensation and Management Portal (ECOMP) Agency Reviewer Imaging (ARi), for more detail on the additional features. Effective August 3, 2018, ECOMP was further enhanced with the implementation of the Disability Management Interface (DMI). See FECA Circular 18-07, Employees' Compensation and Management Portal (ECOMP) Disability Management Interface (DMI), for more detail on those features.

Effective December 10, 2019, the new iFECS-ECOMP communication system (called CE-LinQ) was released. CE-LinQ leverages a fully electronic method to pass correspondence back and forth between iFECS and ECOMP. As a result, requests for information will no longer be reliant on the speed of traditional paper mail processes. CE-LinQ will also allow data to be transferred back and forth between iFECS and ECOMP 24 hours per day, thus speeding up communications. With CE-LinQ, obtaining information from employing agencies will become faster and more efficient, allowing the OWCP to render speedier entitlement decisions, and make quicker benefit payments to the injured workers.

Actions:

1. The OWCP DFEC claims staff will continue to send employing agencies requests for information via Correspondence Library letters, as usual. When claims staff send letters using CE-LinQ, a task linked to each specific letter is generated and will appear in the new ECOMP agency dashboard created specifically for CE-LinQ tasks.
   
2. The following documents indexed with select Subject Descriptions are examples of documents that may be sent via CE-LinQ:
   
   • Compensation Claim Development;
   • Controversion/COP/CA1038;
   • Initial Development;
   • Job Offers/Return to Work;
   • Pay Rate/Payment;
   • Reconsideration; and
   • Recurrence Development.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
3. Employing agency responders will then be able to utilize the ECOMP CE-LinQ feature to generate a response document, plus upload attachments (if needed). Responses will appear in iFECS Imaging as ECOMP generated new mail.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution:All DFEC Staff

Back to Top of FECA Circular No. 20-02

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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 2.125 percent for the period of January 1, 2020 through June 30, 2020. This new rate has been updated in the Central Bill Payment system tables. The rate was changed from 2.625 percent because there was a difference in the Current Value of Funds (CVF) interest rate of more than two percent.

The rate for assessing interest charges on debts due the government remains unchanged again this year. The interest rate for assessing interest charges on debts due the government is 2.0 percent for the period of January 1, 2020 through December 31, 2020. The rate has been updated in the iFECS system tables.

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.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Attachment: Prompt Payment Interest Rates
Debt Management Interest Rates

Distribution: All DFEC Staff

ATTACHMENT TO FECA CIRCULAR NO. 20-03

ATTACHMENT TO FECA CIRCULAR NO. 20-03

Back to Top of FECA Circular No. 20-03

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Subject: Dual Benefits - FERS Cost of Living Adjustments

Background: Effective December 1, 2019, benefits issued by the Social Security Administration (SSA) will be increased by 1.6%. 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.p>

Applicability: Appropriate National Office and District Office personnel.

Action: This adjustment will be made from the National Office for all cases that were correctly entered into the integrated Federal Compensation System (iFECS). The adjustment will be effective with the periodic roll cycle beginning December 08, 2019.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

Back to Top of FECA Circular No. 20-04

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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 January 1, 2020, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile DECREASED to 57.5 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 8, Travel, Federal (FECA) Procedure Manual and 5 USC 8103.

Action: The Central Bill Pay (CBP) facility has updated their 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.