Active FECA Circulars

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SUBJECT: Social Security Offset Cost of Living Adjustment

PURPOSE: To provide notification of the annual increase to Social Security Administration (SSA) offsets.

BACKGROUND: SSA benefits increased by 2.8% beginning with payments issued in January 2026. Therefore, the amount of the Social Security Dual Benefits deduction needs 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 (FECA) remains current.

ACTION: The adjustment was made for all cases with a current SSA offset effective the first payment in January, 2026.

Reference prior FECA Circulars for the historical SSA cost of living adjustments.

Jennifer Valdivieso
Director for
Division of Federal Employees’ Compensation

Back to Top of FECA Circular No. 26-01

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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' Compensation (DFEC) program protocols 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.

In May, 2023, FECA Circular 23-07 was published. This Circular outlined DFEC’s protocols regarding payment for DME. That circular contained a list of Healthcare Common Procedure Coding System (HCPCS) codes that were excluded from payment and others that had utilization restrictions. While the list of codes has been updated since that time using the same rationale DFEC had not published an updated Circular.

ACTION:
To increase transparency, DFEC will now leverage technology and post the HCPCS codes on a searchable web page. This web page will be updated as code determinations are updated with DFEC’s Workers’ Compensation Medical Bill Payment processor.

COVERAGE DETERMINATIONS:
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 past 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;
3) equipment that is not necessary or customary for treatment of work-related conditions;
4) higher priced items when a functionally equivalent option is available for a lesser price; and
5) unspecified HCPCS codes when a more appropriate HCPCS code is available.

To address these issues, the PIU works with OWCP’s Branch of Medical and Pharmaceutical Operations (BMPO) to determine the best practices in accordance with industry standard billing protocols, to include coverage determinations from other payers such as the Centers for Medicare and Medicaid Services (CMS). Based on these reviews and in accordance with the discretion granted to DOL and delegated to OWCP, the FECA program institutes 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.

A. Required Modifiers
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
DFEC places limitations on the rental and purchase of DME, e.g. once every year. These determinations are made based on clinical guidelines and the expected lifespan of the DME. The utilization limitations help ensure that the injured worker receives the necessary DME to aid in recovery while simultaneously preventing overutilization or misuse of resources.

To access current rental and purchase limitations, access the DFEC Durable Medical Equipment (DME) Rental and Purchase Limitations webpage.

C. Excluded from Payment
DFEC excludes some DME from payment. These determinations are made for a variety of reasons, which include, but are not limited to, the following:

• determinations made by other payers such as the Centers for Medicare and Medicaid Services;
• the DME is not customary for treatment of work-related conditions; and
• there are functionally equivalent options available at a lesser price.

To access current exclusions, access the DFEC Durable Medical Equipment (DME) Excluded from Payment webpage.

D. 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, or a bill is denied due to lack of authorization, the DME can be approved on an exception basis if a claimant's treating physician obtains approval by submitting rationalized medical evidence that explains why the specific DME is medically necessary to treat the effects of the specific work-related injury. The narrative must also 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 to request an exception based authorization 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.

JENNIFER VALDIVIESO
Director for
Division of Federal Employees’ Compensation

Back to Top of FECA Circular No. 26-02

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Subject: Postal Service Health Benefits (PSHB) Program

Background: The PSHB Program is a new, separate program within the Federal Employees Health Benefits (FEHB) Program, administered by the Office of Personnel Management (OPM). The PSHB Program will provide health insurance to eligible Postal Service employees, Postal Service annuitants, and their eligible family members starting on January 1, 2025. The PSHB Program will replace FEHB Program coverage for these groups, as well as Postal claimants and death benefit beneficiaries receiving compensation under the Federal Employees' Compensation Act (FECA).

Purpose: To provide guidance regarding how the PSHB Program will be implemented for FECA claimants and death benefit beneficiaries. Additional details regarding the PSHB Program can be found on OPM's website: https://www.opm.gov/healthcare-insurance/pshb/.

A. General Requirements

1. All claimants and beneficiaries who are enrolled in a 2024 FEHB plan and are currently, or formerly employed by the United States Postal Service (USPS) but not subsequently reemployed by another agency, will have their enrollment transferred to a PSHB plan beginning on January 1, 2025.

2. Any cancellations or terminations of PSHB coverage while in receipt of FECA benefits are considered final unless the employee returns to work and can enroll through the agency, during the Federal Benefits Open Season. This is the same as FEHB.

3. If a claimant or beneficiary elects to suspend their coverage in favor of a Medicare Advantage plan, TRICARE, or CHAMPVA while in receipt of FECA benefits, they do not irrevocably lose all future PSHB entitlement and can re-enroll in the future.

4. Under the PSHB Program, all USPS claimants are considered employees and are not required to enroll in Medicare Part B to maintain enrollment in PSHB, regardless of their Medicare eligibility status. For those USPS compensationers who choose to enroll in Medicare Part B, the PSHB plan will be considered the primary payer and Medicare will be secondary. The FECA program does not have discretion to change whether Medicare is the primary or secondary payer because such coordination of benefits is governed by Centers for Medicare & Medicaid Services Medicare Secondary Payer regulations. OPM provides guidance on secondary payer rules on their website. At retirement, compensationers may have to enroll in Medicare Part B, if eligible, unless they meet a qualifying exception.

5. The FECA program cannot convert coverage under a non-PSHB plan into coverage under PSHB. If a USPS employee loses their health insurance coverage under a non-PSHB plan because of career conversion they would need to seek continuing health insurance coverage through the USPS.

6. The PSHB System (maintained by OPM) will be used by claimants and beneficiaries to make their initial selection of a PSHB plan and initiate any future changes to their plan beginning during the 2024 Federal Benefits Open Season. The PSHB System will also be used by FECA staff to review and process plan changes.

B. Transition from FEHB to PSHB

1. The FECA program provided OPM with a data file containing details for all claimants/beneficiaries where the enrollment has been "transferred in" and deductions for an FEHB plan are being made on the Periodic Roll (every 28 days). This same data file will be provided to OPM on a recurring basis.

2. OPM will automatically enroll claimants/beneficiaries into a 2025 PSHB plan that has equivalent/similar benefits and cost-sharing to the 2024 FEHB plan option in which they were enrolled for the 2024 plan year. If the claimant's current FEHB plan is not part of PSHB, OPM will enroll them in the lowest cost nationwide plan. If the claimant/beneficiary wishes to choose a different PSHB plan, they can do so during the Federal Benefits Open Season (November 11 through December 9, 2024).

3. Eligible FECA claimants/beneficiaries will receive instructions from OPM regarding how to select a PSHB plan prior to Open Season.

4. The FECA program is not a part of this automatic plan enrollment process and cannot assist or provide guidance on how to select a plan or which plan to select. If the FECA program receives an SF 2809 (Health Benefits Election Form) or SF 2810 (Notice of Change in Health Benefits Enrollment), it will be returned to the claimant/beneficiary with instructions to contact OPM for information on how to submit changes. Other similar inquiries regarding PSHB enrollment will also be redirected to OPM. The FECA program will continue to address other non-PSHB enrollment questions.

5. When Open Season ends, OPM will transmit a data file to the FECA program that details the PSHB plan for each claimant/beneficiary. This same data file will be provided on a recurring basis. The FECA program's case management system will be updated to reflect the plan choice.

C. Premium Amounts

1. OPM will provide premium amounts for PSHB deductions prior to the 2025 Open Season and each year thereafter. The FECA program will load these rates into its case management system.

2. If a claimant/beneficiary is entitled to lower premium rates under PSHB because of contract negotiations under their union contract, or some other reason, the claimant/beneficiary must contact their servicing human resource office to request the refund from USPS (like any other benefit that is based on employer contract negotiations). The FECA program cannot issue a refund in those circumstances or take any action to reduce the premium amount. The FECA program will only use the standard PSHB rates provided by OPM.

D. Premium Deductions

1. Periodic Roll (PR) Cases - For claimants and beneficiaries already receiving FECA compensation on the PR (every 28 days), deductions for PSHB premiums will begin with the Periodic Roll cycle December 29, 2024-Janaury 25, 2025.

2. Daily Roll (DR) Cases – Generally, the USPS payroll office will make deductions through the last date in which the claimant received pay. Therefore, deductions for health benefits (and life insurance) are effective the next calendar day. If another date for the last deduction is clearly present on the claim form or in the case file (e.g., the end of the pay period), benefit deductions will begin the following day. If the claimant has been (or is projected to be) disabled for more than 60-90 days, the Claims Examiner (CE) should consider placement on the Periodic Roll, rather than continuing Daily Roll payments. The FECA program will use the PSHB code confirmed by the USPS on the CA-7 form. If the PSHB plan changes, then USPS should provide the FECA program with notice of the change.

3. Loss of Wage-Earning Capacity (LWEC) - Claimants receiving compensation based on an LWEC remain entitled to PSHB coverage (same as FEHB). If the compensation payments being made do not cover the premium amount, the claimant may consider a plan that will cost less than the amount of compensation payable. If the claimant decides to retain their higher cost plan, they must submit premiums in advance to FECA or on a quarterly basis to continue coverage.

4. Third Party Settlements - If a settlement is made and funds are received by a claimant who is entitled to compensation, the third-party settlement check must be applied to the compensation previously paid or future payments due until the credit is absorbed. In this situation, the claimant is entitled to compensation, and PSHB coverage may remain in effect (same as FEHB). The amount of the premium is paid by the claimant or deducted from the surplus.

E. Enrollment Transfer

1. When a claimant is placed on the Periodic Roll, their health benefits enrollment should be "transferred in" to the FECA program.

2. The PSHB enrollment will be "transferred in" (SF 2810) from USPS effective the first date of continuous total disability. When the health benefits transfer-in process is complete, the date should be entered in the case management system.

3. Once this update has been made, OPM will be notified via the recurring data file transmission. This is the trigger that alerts OPM that the FECA program has assumed the enrollment, acting as the payroll office temporarily until the claimant returns to work, retires or compensation is otherwise terminated or suspended.

4. If the claimant returns to work, the USPS should notify the FECA program so that compensation payments can be terminated. The USPS will "transfer in" (SF 2810) the claimant's PSHB enrollment.

5. If the claimant retires, OPM will "transfer in" (SF 2810) the claimant's PSHB enrollment.

6. If an employee is separated from USPS and is being paid by the FECA program but the enrollment "transfer in" has not been completed by the FECA program, the employing office should contact the FECA program to coordinate the transfer of the enrollment by SF 2810.

7. If the claimant's FECA compensation is terminated via a formal decision, benefit deductions are terminated. The claimant receives 31 days of coverage after the payroll office termination date. The claimant is not eligible for Temporary Continuation of Coverage (TCC).

F. Qualifying Life Events (QLE)

1. If a change occurs in the claimant's/beneficiary's family status, they can change their plan coverage (Self Only/Self Plus One/Self and Family) outside of the Federal Benefits Open Season in connection with certain QLEs. They can make this change under their current plan, or to any other PSHB plan. See OPM's website for additional information on QLEs.

2. All plan changes for QLEs must be submitted through the PSHB System. Any changes submitted directly to the FECA program will be returned to the claimant/beneficiary with instructions on how to submit changes through the PSHB System.

3. FECA Program staff will only access the PSHB System to review plan changes and update the payment record accordingly for those on the Periodic Roll.

4. If a change of enrollment is submitted for a QLE under the PSHB Program and the event took place in a prior plan year, the FECA program will only issue a refund retroactive to the start of the current plan year (same as FEHB).

G. PSHB System Customer Service

There are dedicated Customer Service lines to support different populations within OWCP. Compensationers on the Daily Roll will receive support from United States Postal Service's Human Resource Shared Service Center (HRSSC). Those on the Periodic Roll will receive support from OPM PSHB Customer Service. OPM, not the FECA program, will provide support and respond to inquiries related to the following issues:

• Access, password and login issues for the PSHB System
• Technical website issues with the PSHB System
• How to enroll or submit changes to benefit plans
• Qualifying Life Event (QLE) reporting and uploading supporting documentation

Nancy Griswold
Acting Director for
Federal Employees', Longshore and Harbor Workers' Compensation

Back to Top of FECA Circular No. 25-01

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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

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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: 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

Back to FECA Circulars Table of Contents

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 (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

Back to FECA Circulars Table of Contents

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

Back to FECA Circulars Table of Contents

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

Back to FECA Circulars Table of Contents

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

Back to FECA Circulars Table of Contents

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 – 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: 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: Mailing Address Change

On April 27, 2020, Division of Federal Employees' Compensation (DFEC) changed its mailing addresses from PO Boxes in London, KY to ones in San Antonio, TX. The change was a result of the start of operations for the new medical bill pay contractor, Client Network Services, Inc. (CNSI). Effective July 24, 2020, the mailing addresses were changed back to PO Boxes in London, KY.

General Case Correspondence

Previous

U.S. Department of Labor
OWCP/DFEC
P.O. Box 34090
San Antonio, TX 78265

Current

U.S. Department of Labor
OWCP/DFEC
PO Box 8311
London, KY 40742-8311

Medical Bills and Claimant Reimbursements:

Previous

U.S. Department of Labor
OWCP/DFEC
P.O. Box 34450
San Antonio, TX 78265

Current

U.S. Department of Labor
OWCP/DFEC
PO Box 8300
London, KY 40742-8300

Provider Enrollments:

Previous

Provider Enrollment
Department of Labor - OWCP
P. O. Box 34690
San Antonio, TX 78265

Current

Provider Enrollment
Department of Labor - OWCP
PO Box 8312
London, KY 40742-8312

All OWCP forms with the San Antonio addresses will be updated with the London, KY addresses. Mail sent to the addresses in San Antonio will be forwarded to London, KY through September 30, 2020.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

Back to Top of FECA Circular No. 20-07

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Subject: FECA Pharmacy Benefits Management System

Purpose: To announce the implementation of the Office of Workers' Compensation's (OWCP) Division of Federal Employees' Compensation's (DFEC) Pharmacy Benefits Management System (PBM).

Background: Pharmacy benefit managers are third-party administrators (TPA) of prescription drug programs for commercial health plans, self-insured employer plans, Federal and State government employee health plans, etc. PBMs are primarily responsible for developing and maintaining formularies which include an approved listing of prescriptions, contracting with pharmacies to increase enrollment, negotiating discounts and rebates with drug manufacturers and processing and paying prescription drug claims.

Pursuant to 5 U.S.C. 8103 and 20 C.F.R. 10.809, OWCP DFEC has contracted with First Script to serve as DFEC's PBM for claimants covered under the Federal Employees' Compensation Act (FECA). DFEC's PBM will be responsible for pharmaceutical transactions including but not limited to implementation of OWCP DFEC eligibility determinations and pricing for pharmaceutical drugs provided to FECA claimants. All DFEC claimants will be required to use the PBM for prescribed medication; otherwise, payment of drugs will not be authorized at the pharmacy. The PBM will pay network pharmacies directly and then seek reimbursement for those payments via submission of a payment file to DFEC's Bill Pay System (BPS). Since the PBM is responsible for both ensuring eligibility and pricing for pharmaceutical transactions, the BPS will be limited to processing electronic payment files from the PBM and reimbursing the PBM only.

DFEC's PBM will also offer an optional Durable Medical Equipment (DME) and diagnostic testing component.

Actions: PBM implementation will be accomplished in a phased approach. In order to receive pharmacy benefits, injured workers must present their new pharmacy cards to a participating pharmacy along with prescriptions for their accepted, work-related condition(s). A listing of participating pharmacies can be found on the internet at www.feca-pbm.dol.gov. Further assistance in locating or verifying a participating pharmacy or transferring a prescription can be obtained by contacting First Script at 1-877-344-3811.

1. First Script/FECA pharmacy cards and welcome letters will be mailed to FECA claimant in multiple groupings. Due to urgent safety concerns, welcome packets will first be mailed on January 3, 2019, to claimants who have been prescribed opioids with daily dosages exceeding the 90 MED (Morphine Equivalent Dose).
   
   All Pharmacy cards will include a Bank Identification Number (BIN), the date the cards become effective, a PBM toll-free number for information, as well as claimant-specific information.
   
2. Additional phases are estimated to be deployed over the next several months of Fiscal Year 2019, and will include (1) pharmacy cards and welcome packets to all FECA claimants and (2) development and implementation of a user interface for pharmacy authorization transmittals, coordination with DFEC's existing central bill processing contractor and implementation of an interactive website. Subsequent FECA Circulars containing the details of those phases will be issued once those phases are ready for deployment.
   
3. Additional information and updates will be posted on the DFEC website and provided to the DFEC subscriber list found on the DFEC website.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

Back to Top of FECA Circular No. 19-04

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SUBJECT: FDA Medical Devices

PURPOSE: To provide notification of new DFEC policy with respect to payment for certain medical devices.

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 Bulletins 17-01 and 17-03; and FECA Circular 18-05. 21 U.S.C. §§ 321, 351-360n-1; 21 C.F.R. Parts 800-1299

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 Bulletin 17-01 (issued October 14, 2016) implemented new controls for the authorization of compounded medications.

FECA Bulletin 17-03 (March 22, 2017) implemented a new policy that herbal supplements would only be authorized on an exception basis.

FECA Circular 18-05 (issued February 14, 2018) implemented an exception-based policy pertaining to convenience kits and certain other combination medications. Authorization and payment for specified National Drug Codes (NDCs) now automatically denies when: 1. the Division of Federal Employees' Compensation (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 2. The primary use is for a condition not normally caused by a workers' compensation injury. With that circular, DFEC published on its website an initial list of 49 NDCs that were set to deny based on these criteria. Since publication, DFEC has continued to use data analytics to identify other NDCs that fit these criteria and add them to the list. The current list now stands at over 140 NDCs.

Since Circular 18-05 was published, DFEC has identified a new trend in the dispensing of specific prescription medical devices (that are billed with NDCs), which may have emerged as a possible substitute for the prior practice of compounding and prescription medication kits and combination medications.

A medical device is defined within the Food Drug & Cosmetic Act as "...an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is: recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them, intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or intended to affect the structure or any function of the body of man or other animals, and which does not achieve any of its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes." See, Is The Product A Medical Device?

Medical devices distributed in the United States are subject to general controls, and may also be subject to premarketing and other special controls. See, Overview of Device Regulation.

General Controls include:

1. Establishment Registration by manufacturers, distributors, repackagers and re-labelers,
2. Medical Device Listing with FDA of devices to be marketed,
3. Manufacturing the devices in accordance with Good Manufacturing Practices,
4. Labeling requirements, such as name and place of business of the manufacturer, intended use, and adequate directions for use, See generally 21 C.F.R. 801, 21 C.F.R. 809,
5. Medical Device Reporting of adverse events as identified by the user, manufacturer and/or distributor of the medical device.

Pre-marketing controls are device and classification specific. Pre-marketing controls for a medical device include Pre-Market Approval (PMA) for certain high risk devices or Pre-Market Notification 510(k) for devices not requiring PMA. Post marketing controls include Device Listing, Medical Device Reporting (MDR), Establishment Registration and Quality System Compliance Inspection.

Like convenience kits, the cost of some of these medical devices can be extremely high and, in some instances, there may be FDA determined safe and commercially available alternatives available at a lower cost.

For example, KamDoy Skin Emulsion is a topical skin care emulsion that is indicated to manage and relieve the burning and itching experienced with various types of dermatoses. It contains the following ingredients: deionized water, copolymer, vegetable oils from African palms, lidocaine HCl (less than 1%), and silver nanoparticles (as a preservative). There are over the counter and/or prescription alternatives for the ingredients in this type of product.

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 medical devices that fit the description above.

ACTION:

1. DFEC will apply the same basic criteria used for the review of convenience kits.
   
   Authorization and payment will automatically deny when:
   1. DFEC has determined that the items in the medical device can typically be obtained separately and/or at a lower cost and there is a reasonable commercially available alternative or substitute; or
   2. The primary use is for a condition not normally caused by a workers' compensation injury.
      
2. For ease of use and ready reference, DFEC will use the same Denial List for medical devices that it uses for updates based on Circular 18-05.
3. DFEC will continuously and regularly review and evaluate medical devices that fit this criteria in accordance with the above policy and set the corresponding NDC to deny. As this evaluation process progresses, additional non-payable medical devices will be added to the denial list. The list can be found in its entirety, with effective dates, on DFEC's website: DFEC List of National Drug Codes (NDCs) That Will Deny.
   
   Medical Devices Being Added to the NDC Denial List with the Publication of this Circular:

4. Providers are expected to review this list prior to dispensing to determine if the device will be covered for payment. DFEC will also place notice regarding this new policy on the DFEC Web Bill Processing website.

Exception Basis Note: DFEC policy on considering exceptions for specified medical devices as described in this Circular and on the list will follow that set forth in FECA Bulletin 17-03. This means that the medical devices on DFEC's denial list can only be approved on a District Director exception basis when a claimant's treating physician acquires pre-authorization by submitting rationalized medical evidence to the claims examiner that explains why the authorization of the medical device is medically necessary and cost effective, fully explaining why the commercially available alternative is not suitable for this condition for this particular claimant. In the event that the exception is denied, a formal decision will be issued to the claimant upon request.

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. 19-05

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Subject: Online method for debtors to make payments to the OWCP Division of Federal Employees' Compensation (DFEC).

Background: 20 CFR § 10.441(b) provides that when an overpayment of compensation under 5 U.S.C. § 8129 of the Federal Employees' Compensation Act has been made to an individual who is not entitled to further payments, the individual shall refund to the Office of Workers' Compensation (OWCP) the amount of the overpayment as soon as the error is discovered or his or her attention is called to the same.

The overpayment is subject to the provisions of The Federal Claims Collection Act, 31 U.S.C. § 3701, et seq., as amended by the Debt Collection Act of 1982 and the Debt Collection Improvement Act of 1996 (DCIA), and may be reported to the Internal Revenue Service as income. If the individual fails to make such refund, the OWCP DFEC may recover the same through any available means, including offset of salary, annuity benefits, or other Federal payments, including tax refunds as authorized by the Tax Refund Offset Program, or referral of the debt to a collection agency or to the Department of Justice.

Previously, if DFEC could not recover an overpayment from continuing compensation or through similar, alternative means, the debtor was required to submit a payer check by mail.

Applicability: Appropriate National Office and District Office personnel.

Reference: Chapter 6-0500, Debt Liquidation, Part 6, Debt Management, Federal (FECA) Procedure Manual.

Action:

1. Debtors now have the opportunity to make payments directly from their bank accounts or using a debit card via an online form on pay.gov, a program of the U.S. Treasury, Bureau of the Fiscal Service.
   
2. The form requires the DFEC debt number, case number, debtor name, street address and payment amount in order to be processed.
   
3. Payments will be posted to the account via the debt management application in the integrated Federal Employees' Compensation System (iFECS).

Disposition: This circular should be retained until incorporated into Chapter 6-0500, Debt Liquidation, of the FECA Procedure Manual.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

Back to Top of FECA Circular No. 19-06

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SUBJECT: Current Procedural Terminology Code (CPT) 99070 Bill Payment Restrictions

PURPOSE: To provide notification of new DFEC policy with respect to payment for CPT code 99070, Supplies and Materials

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, FECA Bulletins 17-01 and 17-03.

BACKGROUND:
FECA Circular 12-06 outlined that if providers billed a National Drug Code (NDC) in conjunction with CPT code 99070, the NDC would be evaluated to determine payment based on the same criteria as those billed with unlisted HCPCS "J" codes (J3490, J8499, J8999 and J9999).

FECA Bulletin 17-01 implemented new controls for the authorization of compounded medications.

FECA Bulletin, 17-03 implemented a new policy that herbal supplements would only be authorized on an exception basis.

FECA Bulletin 17-07 implemented new controls for the authorization of opioid medications.

FECA Circular 18-05 implemented a new exception-based policy pertaining to payment of convenience kits and certain other combination medications.

FECA Circular 18-06 implemented a new exception-based policy pertaining to payment of physician dispensed medications billed under Unspecified Healthcare Common Procedure Coding System (HCPCS) "J Codes".

FECA Circular 19-05 implemented a new exception based policy pertaining to payment of prescription medical devices.

The American Medical Association provides the following definition of CPT code 99070:

"Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)"

The use of this code allows medical providers to bill for supplies and material, such as prescription medications, that are not usually included as part of the medical service.

Current FECA policy for CPT code 99070 restricts the usage from durable medical equipment providers and establishes a maximum allowable reimbursement amount up to $125.00. However, since the controls for physician dispensed medications were implemented in FECA Circular 18-06, the Division of Federal Employees' Compensation (DFEC) has identified a trend in the dispensing of medication in physician offices using CPT code 99070.

Similar to the concerns outlined in FECA Circular 18-06, physician dispensing in this manner can present a safety concern as it presents obstacles for both a physician and pharmacist to identify harmful drug interactions when multiple physicians are treating a patient. The cost of physician dispensed medications can be significantly higher than those dispensed at a pharmacy when billing under 99070, and billing medication in this manner allows such submissions to bypass controls that DFEC has implemented. There may also be situations where the prescription of certain medications can be incentivized, potentially impacting physician judgment on medical necessity and the medication quantity prescribed.

The practice of dispensing medications in this manner inhibits DFEC from effectively administering program controls relating to safety, cost and medical necessity. It circumvents opioid controls as outlined in FECA Bulletin 17-07 and adversely impacts program controls on compound medications (FECA Bulletin 17-01) and implementation of the DFEC list of not covered national drug codes (Circulars 18-05 and 19-05).

In addition, as code 99070 is designed to be billed in combination with other medical services, there may be situations where it is used to unbundle services that are considered a component of the rendered service in an effort to increase reimbursable amounts.

Currently code 99070 is not considered a reimbursable code for the Office of Workers' Compensation Programs', Division of Energy Employees Occupational Illness Compensation or the Center for Medicare Services. For reimbursement of covered supplies and materials, an appropriate Level II HCPCS code must be submitted.

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, DFEC is updating its policy regarding reimbursement of CPT code 99070.

1. Effective June 1, 2019, DFEC will no longer recognize CPT code 99070 as a valid reimbursable code.
   
2. For reimbursement of covered supplies, materials, and medication, an appropriate Level II HCPCS code must be submitted.
   
3. DFEC will rely on the guidance set forth in FECA Circular 18-06 to determine whether medication dispensed and billed with one of the six unspecified codes will be authorized and paid. If the medication dispensed is indeed a drug, "that ordinarily cannot be self-administered", DFEC will authorize and pay for the medication without further claims development in accordance with 20 C.F.R. 10.800-826.
   
4. This policy is effective June 1, 2019. All bills received on and after this date will be subject to this policy.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

Back to Top of FECA Circular No. 19-07

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SUBJECT: Application of the Department of Labor’s (DOL) Suspension and Debarment Procedures to Medical Provider Payments under the Federal Employees’ Compensation Act (FECA)

Background: On August 10, 2011, the Division of Federal Employees’ Compensation (DFEC) issued FECA Bulletin 11-08, Exclusion of Providers, which outlines the steps required to exclude a provider under 20 CFR 10.815-10.826. Section 10.816 provides that DFEC will automatically exclude a provider that has been convicted under any criminal statute of fraudulent activities in connection with any Federal or State program for which payments are made to providers for similar medical, surgical or hospital services, appliances or supplies; or a provider that has been excluded or suspended, or has resigned in lieu of exclusion of suspension, from participation in any such Federal or State program. Sections 10.817-824 provide administrative procedures for exclusion of a provider that has engaged in activities enumerated in section 10.815(c)-(j). These procedures include review by DOL’s Office of Inspector General (OIG), a proposed decision and final decision and, if requested, a hearing before an Administrative Law Judge (ALJ). Nothing in this circular affects DFEC’s provider exclusion procedures under 20 CFR 10.815-10.826.

This circular provides notice that the Department of Labor has instituted nonprocurement suspension and debarment procedures that DFEC has determined will apply to medical providers providing medical services and supplies under FECA. This DOL nonprocurement suspension/debarment process is separate from the FECA regulatory provider exclusion process under 20 CFR 10.815-10.826.

Under DOL’s nonprocurement suspension and debarment procedures, the Department’s OIG can refer a provider to DOL’s Suspension and Debarment Official (SDO) when (1) there is reasonable belief indicating the provider has engaged in fraudulent billing practices, (2) a provider has been criminally indicted with defrauding the FECA program (suspension referral), and/or (3) a provider has been convicted criminally of defrauding the FECA program (debarment referral). The SDO is the ultimate decision-making authority as to whether DOL will take nonprocurement suspension and/or debarment actions against a provider.

If the SDO issues a Notice of Suspension, the provider may not receive payments for services provided on or after the date of the notice during the period of the suspension. The provider has an opportunity to respond to the notice of suspension but the payments cease immediately upon the notice. Suspensions generally are for a period of 12 months but may extend to 18 months.

If the SDO issues a Proposed Notice of Debarment, the provider has an opportunity to respond. If a Final Notice of Debarment is ultimately issued, the provider may not receive payments for services on or after the date of the notice during the period of debarment, which begins on the date the final notice is issued. The period of debarment is generally for a period of 3 years but may extend to five years based on the seriousness of the causes upon which debarment was based.

Since SDO decisions may be issued prior to conviction and serve to immediately halt payments to providers suspected to be acting in a fraudulent manner, DFEC is issuing procedures to make clear it will stop payments to medical providers based on either a notice of suspension or final debarment determination taken by the SDO.

Legal Authority: Discretionary suspensions and debarments are governed by two regulatory schemes - one for procurement (located in the Federal Acquisition Regulation, or FAR, at 48 C.F.R. Subpart 9.4) and one for nonprocurement (2 C.F.R. Part 180). A nonprocurement suspension or debarment applies to "covered transactions," which are defined in the nonprocurement rules common to all federal agencies (called the "NCR" or "common rule") and further defined in agency-specific regulations or policies. See 2 C.F.R. 180.210, 180.215, 180.970; see also Executive Order 12549, 51 Fed. Reg. 6370 (Feb. 18, 1986); Executive Order 12689, 54 Fed. Reg. 34131 (Aug. 15, 1989).

Under the nonprocurement common rule, a "covered transaction" is "any transaction, regardless of type (except procurement contracts), including but not limited to "grants, cooperative agreements, scholarships, fellowships, contracts of assistance, loans, loan guarantees, subsidies, insurances, payments for specified uses, and donation agreements." 2 C.F.R. 180.970. Covered transactions do not include "benefit[s] to an individual as a personal entitlement ..." but do include "benefits received in an individual’s business capacity." 2 C.F.R. 180.215(b).

DOL has determined that payments made to medical providers are considered a "covered transaction" under the nonprocurement common rule framework. FECA medical benefit payments are almost always made directly to the medical provider for providing medical services and supplies in his/her business capacity as a doctor, pharmacy, etc. and not as a benefit to which the medical provider is personally entitled.

DFEC has concluded that DOL’s nonprocurement suspension and debarment regulations shall be applied to medical providers providing medical services and supplies to FECA claimants.

References: 2 C.F.R. Part 180.

Purpose: To inform the affected parties of the effect of a decision issued by the DOL SDO on FECA providers and payments to such providers.

Applicability: Medical providers for FECA claimants, DOL SDO, OASAM, DOL OIG; Employing Agency personnel and OIG offices, all National Office staff and District Office claims personnel.

Actions:

1. If the DOL SDO receives a recommendation for suspension or debarment for a FECA medical provider from DOL OIG , DFEC will be provided with a copy of the referral. DFEC will update its records accordingly but no further action will be taken.
2. When the DOL SDO makes an initial determination to issue a notice of proposed suspension or debarment on the matter, DFEC shall be notified.
3. If the DOL SDO chooses to take no action on the matter, DFEC will update its records accordingly and take no further action as it relates to this process.
4. If the DOL SDO issues a Notice of Suspension, DFEC will issue a notice to the provider indicating that payment for services provided on and after the date of the SDO’s notice will be suspended. Upon a final determination by the SDO, DFEC will issue a notice to the provider that payment for services provided will not be made for the period outlined in the SDO’s Final Determination of Suspension.
5. If the DOL SDO issues an initial Notice of Debarment, DFEC will update its records accordingly but no further action will be taken until a final notice is issued. If a Final Notice of Debarment is then issued, DFEC will issue a notice to the provider indicating that payment will not be made for services provided on and after the date of the debarment decision for the period outlined in the SDO’s Final Determination of Debarment. DOL’s SDO will update the System for Award Management (SAM) to include the names of the provider under the list of suspended or debarred entities.
6. Since suspension and debarment applies only to those services that are provided after the date of the applicable notice or decision, DFEC will suspend/cease payments made after the effective date of the notice of suspension or final debarment decision. DFEC will pay for services which occurred prior to that effective date even if the request for payment comes after the effective date of the suspension notice or debarment decision.
7. To stop payments to the provider, DFEC will notify its central bill processing vendor to place the provider "on review." This action will stop payments from being made, and any incoming bills will be placed into a queue. DFEC’s National Office Bill Payment Specialist, or designee, will monitor that provider’s bill queue and authorize payment for bills for dates of service prior to the effective date of the suspension notice /debarment decision, if otherwise payable for the accepted work-related conditions in that case.
8. If the DOL SDO issues a decision that rescinds or alters its determination, DFEC will notify the provider accordingly and process unpaid bills, if needed.
9. DFEC will publish on its website a listing of providers that have been suspended or debarred, with the effective date and applicable periods. If an injured worker is currently receiving treatment from such a provider, a change will be authorized if requested.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

Back to Top of FECA Circular No. 18-01

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SUBJECT: Employees' Compensation and Management Portal (ECOMP) Disability Management Interface (DMI)

Purpose: To announce a new component of ECOMP that allows Agency Reviewers to submit specific requests for claims actions related to disability management directly into the Office of Workers' Compensation (OWCP) case.

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 Federal Employees' Compensation Act (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 DMI. DMI is a new feature that will allow ARs to request the Claims Examiner (CE) to take claims action on a particular claim. DMI will promote more efficient management of long-term total disability cases by highlighting pending job offers¹; identifying an absence of medical evidence supporting disability; by reporting information on an injured workers' work status; and by requesting certain case management actions. Only ARs who have been granted access to use ARi by their respective agencies will have the ability to use DMI. An agency's access to use DMI will be granted by DFEC after receiving the necessary training, and the agency's ECOMP Agency Maintenance User will manage access to DMI for individual ARs.

If information or a request is submitted using DMI, it should not be submitted via mail, fax or ECOMP WEEDs. Submission via DMI replaces these other methods of submission.

Actions: The following options will initially be available for an AR to submit through DMI:

• Request Updated Medical Evidence
• Report Job Offer Refusal
• No Return to Work after Job Found Suitable
• No Return to Work after 15 Day Letter
• No Response to Prior DMI Request

When one of the above options is selected, an interface will be displayed where the AR will enter pertinent information surrounding the request. Because the information provided may be relied on to provide the factual basis for a CE determination, it is essential that the AR ensure the entries are factually correct and any applicable documents are uploaded.²

The information provided by the AR will then be transmitted to the CE.

The CE may generate a letter to the injured worker or the employing agency (i.e. making a suitability finding, requesting medical evidence, etc.), which will be populated with the information that the AR submitted via DMI. While the CE will confirm that information provided by the AR conforms to evidence contained in the case record prior to releasing any correspondence. It is crucial that the AR confirm the accuracy of the information provided via DMI, and ensure that any corresponding evidence, such as a copy of a job offer (with all required documentation), has been uploaded to the file.

Additional options for ARs to report information or request actions via DMI may be added to ECOMP in the future.

¹ While it is anticipated that DMI will primarily be used for job offers of suitable employment for which sanctions under 5 U.S.C. 8106 are available, temporary assignment offers made pursuant to 20 CFR 10.500 and FECA Procedure Manual 2-814-9 may also be submitted through DMI.

² DMI access may be suspended if repeat incidents of providing inaccurate or inappropriate information are noted. ARs should be aware for that certain employees (such as those with more serious conditions and those over age 65) OWCP may in its discretion require less frequent documentation. See generally 20 C.F.R. 10.501.

ANTONIO RIOS
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff; Employing Agencies

Back to Top of FECA Circular No. 18-07

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SUBJECT: OFFICE OF INSPECTOR GENERAL (OIG) INVESTIGATIONS PERTAINING TO FEDERAL EMPLOYEES' COMPENSATION ACT (FECA) CLAIMANT AND MEDICAL PROVIDER FRAUD

PURPOSE: TO ESTABLISH COMMUNICATION PROTOCOLS BETWEEN THE OIG COMMUNITY AND THE DIVISION OF FEDERAL EMPLOYEES' COMPENSATION (DFEC)

ISSUE DATE: MAY 8, 2017

I. BACKGROUND: Federal agencies' increased awareness of the monies spent on workplace injuries under the Federal Employees' Compensation Act (FECA) has prompted agencies and their respective Offices of Inspector General (OIG) to look for ways to reduce costs and return more people to work as well as to prevent and detect fraud. Consequently, DFEC is receiving an increasing number of requests for information from the OIG community as they perform audits, inspections and investigations. The Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) is committed to working with the OIG to reduce waste, fraud and abuse. To do so effectively, DFEC must coordinate with the OIG on projects to respond to requests while remaining focused on DFEC's core mission of providing benefits to injured federal employees. DFEC is instituting a consistent process to support these requests in a manner that preserves program resources, improves timeframes for providing information/data and avoids duplication of effort.

II. DFEC ROLES AND RESPONSIBILITIES: To help facilitate the exchange of information, DFEC has established a National Office Fraud Liaison, a District Office Fraud Liaison for each District Office and a Program Integrity Unit.

A. National Office Fraud Liaison - This DFEC employee serves as the Point of Contact (POC) for OIGs who have an active criminal or civil investigation on either claimants or medical providers. The role of the National Office Fraud Liaison is to assist in the coordination and tracking of all of DFEC's activities pertaining to ongoing fraud investigations, provide a level of consistency in the way DFEC supports investigations, and act as the POC for the District Office Fraud Liaisons.

B. District Office Fraud Liaison - Each District Office has a designated POC for OIG requests relating to suspected fraud of claimants or a medical provider whose services are limited to the jurisdiction of a single District Office. The role of the District Office Fraud Liaison is to assist OIGs with obtaining data from DFEC records, to include provider enrollment forms, limited copies of bills and reports on a provider's billing activity which can be generated locally. This individual also provides OIGs with guidance on FECA administration and program rules/regulations; coordinates oversight of non-criminal investigative memoranda; evaluates loss to the government calculation requests and provides testimony as appropriate.

C. Program Integrity Unit - In addition to the designated POCs, DFEC has established a Program Integrity Unit which provides an internal mechanism for DFEC to analyze claims data, including medical provider data, and make referrals to the OIG based on those findings.

III. DFEC CONTACTS FOR OIG: To facilitate, centralize and coordinate all communications between OIGs and DFEC staff, DFEC has created email addresses where all OIG communications should be directed, depending on the type of request and/or the status of a potential or active investigation.

If physical evidence such as photos or videos is part of the investigation (which occurs primarily with claimant investigations), it should be submitted to the District Office with jurisdiction of the case at the time the investigative report is submitted to the email address above. It should be submitted to the attention of the District Director, and it should be in a Windows Media Player compatible format.

The above email addresses are intended for use by the OIG community. If other agency and/or compensation personnel suspect fraud, they are encouraged to follow their agency procedures for reporting fraud and may contact their agency OIG for guidance.

Note: Suspected fraud can also be reported directly to the DOL OIG via the OIG Hotline available at the following website: http://www.oig.dol.gov/hotlinecontact.htm Alternatively, fraud can be reported jointly to the DOL OIG and OWCP/DFEC at the following addresses: Office of Inspector General, U.S. Department of Labor, 200 Constitution Avenue, N.W., Room S-5506, Washington, D.C. 20210 and National Office Fraud Liaison - OWCP/DFEC, U.S. Department of Labor, 200 Constitution Ave., NW, Room S-3229, Washington, DC 20210.

IV. OIG EMAIL SUBMISSION PROTOCOLS: In accordance with Office of Workers' Compensation Program (OWCP) policy, all requests submitted to any of the above email addresses from non-DOL OIG should be secured since the communication occurs outside the DOL network and therefore security of the transmission is not secured. Email sent between OWCP and DOL-OIG through the DOL network is considered secure and document encryption is unnecessary.

A. DOL OIG Submissions - Attachments should not be encrypted.

Claimant Submissions

• The subject line of the email should be the request type, e.g. Claimant Record Request, Claimant Investigation, etc.
• The DFEC case number and the claimant's name should be included in the body of the email message, but not in the subject line.

Provider Submissions

• The subject line of the email should be the request type, e.g. Provider Record Request, Provider Investigation, Provider Testimony Request, etc.
• The full name of the Provider(s) and EIN(s) should be included in the body of the email.

B. Non-DOL OIG Submissions - Attachments must be encrypted.

Claimant Submissions

• The subject line of the email should be the request type, e.g. Claimant Record Request, Claimant Investigation, etc.
• No reference to the complete SSN, claimant's name or other protected PII should be made in any part of the email message. The DFEC case number and the claimant's initials should be the only identifying piece of information in the email submission, and those items should be in the body of the email message.

Provider Submissions

• The subject line of the email should be the request type, e.g. Provider Record Request, Provider Investigation, Provider Testimony Request, etc.
• The full name of the Provider(s) and EIN should be included in the body of the email.

Attachments – All attachments should be encrypted with the following password protection format: Requesting Agent's first and last initials (capitalized), followed by the 2 character numeric month, date and year of the date the request is being transmitted via email, without hyphens, i.e. FLMMDDYY.

V. GUIDELINES AND RESTRICTIONS FOR OIG:

A. Privacy Act - All OWCP records relating to claims for benefits, including copies of such records maintained by an employer, are considered confidential and may not be released, inspected, copied or otherwise disclosed except as provided in the Freedom of Information Act (5 U.S.C. § 552) and the Privacy Act of 1974 (5 U.S.C. § 552a). OWCP information is available to be used by employing agencies, including agency OIG, only for purposes consistent with the routine uses in OWCP's system of records for FECA information, DOL/GOVT-1.

B. Contact with Physicians - Such interaction whether by personal visit or telephone by OIG agents in the context of an investigation may occur. As OIG are independent and separate from the employing agency, such contact does not violate 20 C.F.R. 10.506.

C. Agency Audits and Requests for Information - An agency OIG is permitted to audit/review only its own agency's processes. In accordance with the Privacy Act, the only data that could be made available would pertain solely to the requesting agency's cases. Because agency OIG is permitted to audit its own agency's processes, much of the information necessary for official investigative purposes is contained in the weekly, monthly and quarterly extracts provided to each agency's injury compensation management office. The weekly extracts contain case management, bill payment and compensation payment detail data; monthly extracts contain new case-create data; quarterly extracts contain agency chargeback data. DFEC will not duplicate its efforts to reproduce these data runs. The agency OIG should refer to their agency's injury compensation management program coordinator for information related to this data. If an agency audit requires data that is not routinely sent by OWCP to the employer, the agency OIG should provide a brief outline of what is needed, and such requests should be coordinated with that agency OIG's National Office. The OIG should also notify the DOL OIG Assistant Inspector General for Audit (AIGA) of the planned work.

VI. PROVIDER CASES: Examples of provider fraud include, but are not limited to, billing for services not rendered, up coding, unbundling billing codes, and anti-kickback violations. Providers may also be subject to civil prosecution under the False Claims Act or the Program Fraud Civil Remedies Act for submitting false claims.

Since an agency OIG only has a right to data on medical providers as it relates to their own injured employees, coordination with DOL OIG may be required to help ensure that all data is evaluated. In some instances, medical providers are treating injured workers from multiple agencies; therefore, failing to include DOL OIG may unnecessarily limit the scope of investigation and potential prosecution. In situations where DOL OIG has not been actively involved in an investigation or action, program data concerning other agencies may be provided to the prosecuting attorney or to agency OIG at the prosecutor's written request.

A. Provider Data/Record Requests - OIG may request the following kinds of provider documentation: provider utilization reports, provider enrollment documents, billing information and/or remittance vouchers. If the services of the provider(s) fall within the jurisdiction of a single district office, the OIG should submit any request for data or records to the "FECA Provider Fraud Local Record Request" email address identified in Section III. If the services of the provider(s) fall within the jurisdiction of multiple district offices, the OIG should submit any request for data or records to the "FECA Provider Fraud National Record Request" email address identified in Section III. If the scope of the practice is not known, the request should be submitted to the "FECA Provider Fraud National Record Request" email address.

B. Provider Investigations/Prosecution – If the OIG identifies a specific trend or concern for which investigation and/or prosecution is being undertaken, the OIG should submit an Investigation Initiation Memorandum to the "FECA Provider Investigation" email address identified in Section III.

1. The Investigation Initiation Memorandum should include as much information as possible with respect to the identity of the provider entity(s) and tax ID(s), the nature of the allegations or scheme, and any other relevant information to include the status of the investigation and prosecutorial action (if any). If the provider/practice in question is operating in different geographical locations, different names or numerous EINS, all available information is necessary for each location/practice, and if there is any indication of a wider operation, that information should also be included.

Should a criminal or civil case against a medical provider be accepted for prosecution and an indictment has been obtained, the OIG must outline the criminal charges and enclose the relevant and/or releasable court documents. In instances where special requests are also provided to DFEC with regard to the provider's ongoing practice and billing, DFEC will require written confirmation from the prosecutor on the specified course of action. (If DFEC Testimony is required, reference Section VIII of this Circular.)

2. DFEC Actions -

• If the Investigation Initiation Memorandum is received directly from the DOL OIG, DOL OIG will also include a recommendation regarding whether DFEC should pursue administrative actions, such as administrative review of the provider's bills. DFEC 's actions will be guided and informed by that recommendation.
• If the Investigation Initiation Memorandum is received from a non-DOL OIG, DFEC will forward the memorandum to DOL OIG for a preliminary review. After consideration of the non-DOL OIG position and status of the investigation, DOL OIG will provide a response regarding whether DFEC may pursue administrative actions, such as administrative review of the provider's bills, and DFEC's actions will be guided and informed by that recommendation.

3. Status Updates - DOL OIG and non-DOL OIG are expected to update DFEC accordingly if the status of the investigation and/or prosecution changes.

VII. CLAIMANT CASES: Agency OIG investigate fraud cases involving their own agency employees/former employees. The DOL OIG role may be limited unless the claimant in question is a Department of Labor employee. Examples of single case fraud include, but are not limited to falsifying an injury, failure to report earnings, and fraudulently claimed reimbursements for medical care and travel expenses.

A. Claimant Record Requests - During the course of the investigation, it may be necessary for the OIG to review case records. The OIG may submit a request for data or records to the "FECA Claimant Fraud Record Request" email address identified in Section III; however, in order to provide case documents in the most efficient and timely manner possible, DFEC is now allowing the OIG to use the Employees' Compensation and Management Portal (ECOMP) Agency Reviewer Imaging (ARi) application which allows the user to view (and print) a defined set of imaged documents within a case (see FECA Circular 13-06). If the agency OIG requires a complete copy of a case record, the request should be submitted to the email address identified above so that it may be provided on encrypted CD if the case is fully imaged.

ECOMP ARi for OIG

• Each OIG must sign a Memorandum of Understanding that sets out a description of the system and rules of conduct for system access, data use and retention.
• Each OIG agent must be authorized access by the Agency OIG Administrator. To obtain access to ECOMP ARi, agents should contact that designated individual.
• DOL OIG has access to all cases; agency OIG have access only to cases within the assigned agency.
• Once an account has been created, the OIG agent may access a case based on an investigation into a potential violation of law; the agent will be required to acknowledge that he/she is accessing the case file consistent with the routine use in DOL/GOVT-1.
• Unlike the Agency Reviewers in ECOMP ARi, these acknowledgment statements will not be placed in the individual case records (see FECA Circular 13-06, Section E). Instead, case access and the document downloads are recorded via an internal tracking mechanism from which reports can be created at a later date.

B. Claimant Investigations (non-prosecutorial cases) - The OIG should submit any documentation of an investigation that does not result in a criminal prosecution as an investigative memoranda (IM) to the "FECA Claimant Investigations" email address identified in Section III. Any documentation of an investigation that does not result in a criminal prosecution received by DFEC will be placed in the case file and used for case management actions in accordance with DFEC procedures. A designated individual will review each IM to determine if the investigation establishes inconsistencies or calls into question the validity of the medical evidence, the severity of the employment injury or the reported work restrictions or whether it establishes unreported work activity, and then take action accordingly. The OIG should be aware that documentation of misrepresentation of physical disability by the claimant does not result in immediate termination of compensation.

C. Claimant Investigations (potential prosecution) - Should the case be accepted for prosecution by a federal or state prosecutor, a loss to the government or statement on materiality may be requested. DFEC bears the responsibility for calculating the financial loss to the government.

Calculation of Loss to the Government:

1. Submission - When requesting a loss to the government calculation, the OIGs should submit a memorandum requesting a loss calculation to the "FECA Claimant Fraud Prosecution" email address identified in Section III. The request and accompanying evidence will not be placed in the DFEC case record until the investigation is completed. However, a decision cannot be rendered that considers the evidence until all relevant documents are included in the case record.
2. Loss Request Memorandum Requirements - The request should include a summary of the following (with all supportive documentation):
   1. the date range(s) in question,
   2. the claimant's employment and/or earnings activities
   3. the actual dollar amount earned or the approximate number of hours worked per day/week during the CA-1032 or CA-7 period(s),
   4. the status of any criminal prosecution,
   5. a date by which the loss calculation is needed, and
   6. the "current" salary for the date of injury position as of the first date of unreported earnings [since the loss calculation is based on a loss of wage earning capacity utilizing the Shadrick formula (see FECA PM 2-0815.4.b.)].
3. Actual Earnings Not Available - In those cases where actual earnings are unavailable, the evidence submitted should support that the claimant was performing employment activities for a specific number of hours per day or week for the duration of the period(s) in question. In these cases, the description of employment activity performed should be as detailed as possible so that the most comparable hourly wage may be constructed by DFEC. That wage is then multiplied by the number of hours the claimant worked, as established by the evidence, and used as the constructed weekly wage in the Shadrick formula.
4. Evidence Determined to be Insufficient - If the information provided in the request is insufficient to allow for a loss calculation, DFEC will contact the OIG and request clarification or assistance in identifying and obtaining any missing data points.
5. DFEC Calculation - Once all of the information is received, the District Office POC and/or other designee will calculate the loss. This is accomplished by calculating the gross amount that the claimant would have been entitled to in accordance with the Shadrick formula had he or she truthfully reported earnings/work activity and deducting that from the amount of gross compensation actually paid. The difference represents the loss to the government. Once completed, all calculations must be certified by the National Office. Upon certification, the National Office Fraud Liaison or designee will authorize the release of the loss calculation to the requesting party.
6. Processing Time - The necessary lead time to certify a loss calculation is dependent upon the accuracy and comprehensiveness of the supporting documentation and whether such loss is based on actual or constructed earnings. Generally, after the District Office Fraud Liaison has calculated the loss and submitted it to the National Office Fraud Liaison up to 2 weeks may be necessary to certify the calculation. It is recommended that all requests for calculation of loss to the government be submitted as early as possible.
7. Concurrent Dissimilar Employment and Passive Income - There are instances where unreported earnings can result in no loss to the government. If the fraud investigation is based on failure to report earnings from a position that the claimant held on the date of injury, and the concurrent employment was dissimilar to their government position, then those earnings cannot be used to reduce compensation. While the behavior itself may be determined to be fraudulent and such earnings are required to be reported on the CA-1032 under the regulations, the fact that those earnings could not have been included in the pay rate for compensation purposes means that the government would have paid total disability regardless and the financial loss may be zero. Similarly, if the income is more properly characterized as income from passive investment in a business, this income cannot be the basis of a loss of wage-earning capacity determination.
8. Grand Jury Protection - If evidence is shielded by grand jury protection, the OIG agent should contact the District Office Fraud Liaison and National Office Fraud Liaison simultaneously to appropriately identify those individuals who should be granted access to the necessary information.

D. Claimant Conviction or Guilty Plea - Upon conviction or a guilty plea entered in open court, notice should be sent to the "FECA Claimant Prosecution" email address identified in Section III.

1. The request should include a memorandum outlining the disposition of the criminal proceeding and relevant court documentation that the guilty verdict or plea was accepted by a judge in open court. Should a victim impact statement be required, this should be included in the request. Any funds for restitution imposed by the court should be directed to DFEC for processing. Restitution payments will be credited to the agency's chargeback bill once received by DFEC.
2. The District Office Fraud Liaison will see that compensation benefits are terminated in accordance with 5 U.S.C. 8148 and all other appropriate case actions are completed. (See 20 CFR §§10.16, 10.17).
3. It is particularly important in the case of state prosecutions that the charging documents, information/indictment clearly identify the charge as involving FECA fraud in order to form the basis of termination of compensation under 5 U.S.C. 8148 (a).
4. In cases of claimant incarceration in a State or Federal jail, prison, penal institution or other correctional facility due to a State or Federal felony conviction that would trigger the provisions of 5 U.S.C. 8148 (b), notification of such should be provided in an Investigative Memorandum and submitted in accordance with Section VII B (above).

VIII. DFEC Testimony – As much advance notice as possible is required to allow for the time necessary to process the request for testimony in any claimant or provider fraud case.

1. Federal Court Cases - When requesting the testimony of a DFEC official the issuance of a subpoena is not required, however, advance notice of the date and place of the proceedings are essential.
2. State Court Cases - Cases brought in state court do require the issuance of a subpoena and participation is subject to the Department of Labor's Touhy Regulations. 29 C.F.R. 2.20-2.24. The prosecutor (in collaboration with the OIG agent) should submit a request and include a written description of the expected testimony. In accordance with the Touhy Regulations, the Deputy Solicitor of Labor must preapprove participation in the proceeding before the state.
3. Requests for testimony in a provider fraud case should be submitted to the "FECA Provider Investigation" email address identified in Section III.
4. Requests for testimony in a claimant fraud case should be submitted to the "FECA Claimant Fraud Prosecution" email address identified in Section III.

IX. OWCP Actions: All requests submitted to any of the email addresses identified above will be tracked by DFEC upon receipt. The OIG originator will receive email acknowledgement that the request has been received. DFEC will also provide notification that the report/request is being acted upon or is completed in accordance with FECA Bulletins 17-04 and/or 17-05.

ANTONIO A. RIOS
Director for
Federal Employees' Compensation

Back to Top of FECA Circular No. 17-03

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SUBJECT: Electronic Document Approval Process (ELAPP)

PURPOSE: To announce the use of electronic signatures for the FECA program

The Office of Workers' Compensation Programs' Division of Federal Employees' Compensation (DFEC) routinely responds to a myriad of written inquiries. Claims staff also issue written correspondence when developing and adjudicating a claim, and when terminating, reducing or suspending entitlement following case acceptance.

DFEC previously issued guidance on specific correspondence that must bear a signature prior to release.¹

However, a signature need not be a wet signature. To that end, DFEC has created an Electronic Document Approval Process (ELAPP) which creates a signing record incorporating an approval process confirming that the signature is legally binding and valid.

The ELAPP process requires any member of the DFEC claims staff choosing to sign a document electronically to certify as follows:

I agree that my electronic signature is the legally binding equivalent to my handwritten signature and that my electronic signature has the same validity and meaning as my handwritten signature.

Once agreed upon, the electronic signature generated in ELAPP produces a QR code. This code contains the following information, verifying the document was signed by the corresponding DFEC staff member:

• Case Number
• Date
• Name of DFEC Staff Member
• Staff Member Signature ID

The QR code appears on the bottom left hand side of each page of any applicable letter, and can be read by any QR Code reader.

Documents requiring multiple signatures display multiple QR codes on the bottom left hand side of each page. Each QR code represents the electronic signature of one DFEC Staff Member.

ELAPP signatures are tracked in the DFEC IT databases.

¹FECA Bulletin 16-01 (Issued October 13, 2015).

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff, OWCP

Back to Top of FECA Circular No. 16-06

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SUBJECT: Federal Occupational Health (FOH) – District Medical Advisors (DMAs)

PURPOSE: To announce the transition to the nationwide FOH-DMA Interagency Agreement

The Office of Workers' Compensation Programs' Division of Federal Employees' Compensation (DFEC) uses physicians called District Medical Advisors¹ (DMA) to perform medical evaluations of case files under the Federal Employees' Compensation Act. DMAs have historically been hired to provide services through each District Office, generally through the use of a Memorandum of Agreement.

DMA medical evaluations are performed for a variety of purposes. When Claims Examiners (CEs) need assistance with interpretation of medical reports or need review of the appropriateness of a medical authorization (such as surgery), the DMA can be asked to provide an opinion to assist the CE with medical management. DMAs also provide written opinions assessing and/or calculating the percentage of permanent impairment in accordance with the American Medical Association's (AMA) Guides to the Evaluation of Permanent Impairment. See FECA Procedure Manual 2-600-3; 2-808-6; 3-200-4; 3-600-3; 3-700-3.

Effective November 16, 2015, the Department of Health and Human Services' Federal Occupational Health Service (FOH) will be providing DMA services for all 12 District Offices through an interagency agreement with DFEC. See 5 U.S.C. 7901 and 42 U.S.C. 231. FOH will provide a network/cadre of active, current Board-certified and licensed physicians and/or specialists to deliver the DFEC District Offices with DMA medical evaluations/services in accordance with established DFEC policies and procedures. DMA reviews will be classified into three categories: (1) Impairment Rating, (2) Medical/Surgical Review, and (3) Death Claim Review. Reviews will also be designated as routine (for more basic issues) or as complex (for those requiring a more extensive review). Cases can also be designated for Expedited Review, when a quicker response is needed.

There has been no change to DFEC policy with regards to the case file circumstances that necessitate a DMA referral nor any change regarding the services provided.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff, OWCP

¹DMAs are referred to as Office medical advisors in the decisions of the Employees' Compensation Appeals Board.

Back to Top of FECA Circular No. 16-03

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SUBJECT: ICD-10 TRANSITION

On October 1, 2015, the Office of Workers' Compensation Programs' Division of Federal Employees' Compensation (DFEC) will transition to the new International Classification of Diseases (ICD), Tenth Revision and Clinical Modification (ICD-10-CM) Coding System. The ICD is used to standardize codes for medical conditions and is the standard diagnostic tool for epidemiology, health management and clinical purposes.

The U.S. Department of Health and Human Services (HHS) issued a Final Rule finalizing October 1, 2015, as the compliance date for health care providers, health plans and health care clearinghouses to transition from ICD-9 to ICD-10, the tenth revision of the ICD. The transition to ICD-10 is coordinated by the HHS Centers for Medicare & Medicaid Services (CMS) and is mandatory across the country, including for DFEC. For all claims filed on or after October 1, 2015, the ICD-10 is the operative code for decisions, correspondence, and development.

ICD-9 had not been updated in more than 35 years and contained outdated and obsolete terminology. The new ICD-10 system consists of more than 68,000 codes, compared to approximately 13,000 ICD-9 codes. ICD-10 incorporates greater specificity and clinical detail.

1. ICD-10 differs from ICD-9 in its organization and structure, code composition and level of detail. ICD-9 codes consisted of three to five characters. In ICD-10, codes will consist of three to seven characters. The first digit is alphabetical and all letters are used except for U. The second and third digits are numeric and the fourth through seventh digits can be alphabetical or numeric. The decimal is placed after first three characters.

2. All injury types are categorized by body part. The first three digits of the ICD code will identify the category. The second three digits identify the etiology, anatomic site and severity. The last digit is an extension that identifies the episode of care. Code extensions (the seventh digit) have been used in many instances to identify the encounter as initial, subsequent or sequelae.

3. DFEC will utilize ICD-9 codes for all cases accepted through and including September 30, 2015. ICD-10 codes will be utilized for all cases accepted on or after October 1, 2015. For medical providers, ICD-9 codes should be used for services rendered through 11:59PM on September 30, 2015. ICD-10 codes are to be used for services rendered at or after 12:00AM on October 1, 2015.

4. ICD-9 codes added prior to October 1, 2015, will remain in the case management system and be automatically cross-matched to the corresponding ICD-10 codes by ACS for medical bill payment. ACS will utilize a general equivalency mapping program to transition the ICD-9 codes in the case management system to ICD-10 codes for appropriate bill processing. The medical bill processing team will use the bill's dates of service and/or coverage dates to determine which version of ICD diagnosis and procedure codes should be billed, and will edit accordingly.

5. The ACS Web Portal contains information and informational links for providers seeking information about the ICD-10 conversion. The portal can be accessed at the OWCP web bill portal.

6. DFEC has notified the employing agencies that all data extracts that are sent electronically to them will be modified for this transition.

7. In anticipation of the ICD-10 transition, the 2011 update of the FECA Regulations at 20 C.F.R. 10.801 (c) instructs providers to use "International Classification of Disease, 9th Edition, Clinical Modification" (ICD-9-CM), or as revised." [Emphasis added] See also 20 CFR. 10. 802.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff

Back to Top of FECA Circular No. 16-01

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SUBJECT: Employees' Compensation and Management Portal (ECOMP)

PURPOSE: To announce the Office of Workers' Compensation Programs' (OWCP) web-based portal for the electronic submission of Federal Employees' Compensation Act (FECA) claim forms and case related documents.

BACKGROUND: The OWCP completed a comprehensive update of the FECA regulations in 20 C.F.R. Part 10, effective August 29, 2011. 20 CFR §§ 10.100, 10.101, 10.102 and 10.103 (Claims for traumatic injury, occupational disease, wage loss compensation, and schedule awards respectively) direct that all such notices should be submitted electronically wherever feasible to facilitate processing of such claims. Each of these regulations also explicitly requires that, "All employers that currently do not have such capability should create such a method by December 31, 2012."

To facilitate electronic form filing, the OWCP has created its own web-based application (ECOMP), with a comprehensive electronic system for recording workplace injuries and illnesses, and processing claims under the FECA. ECOMP is available to all federal agencies who wish to use it for electronic form filing free of charge.

ECOMP, which was released to the public on November 2, 2011, can be accessed directly at the following url: https://www.ecomp.dol.gov. The site currently contains two different types of functionality – electronic submission of documents and electronic submission of FECA claim forms.

1. Web-Enabled Electronic Document Submission (WEEDS). At the time of initial release, the only available component was the electronic submission of documents. This component, WEEDS, enables all stakeholders to upload documents directly into a FECA case file. Utilizing WEEDS provides numerous important advantages: a) the document is viewable in the OWCP case file by the Claims Examiner usually within 4 hours of submission - thus the time it takes for documents to travel via mail or fax is eliminated; b) ECOMP provides a Document Control Number (DCN) when a document is uploaded so the user can track when it has been uploaded into the case file; and c) upon receipt of a claim number for a new injury, documents can be uploaded into the claim record right away rather than mailing or faxing them, which can facilitate and speed processing and adjudication of claims.

2. Electronic Form Filing. On February 27, 2012, the second component of ECOMP was made available. This component allows injured workers (employed by an enrolled federal agency) to electronically file specified FECA claim forms. Some employing agencies already provide an electronic means for form submission, and the OWCP will continue to accept forms submitted via those existing, currently approved employing agency electronic submission platforms.

ACTIONS:

A. Web-Enabled Electronic Document Submission (WEEDS)

1. This feature enables all stakeholders to upload documents directly into a FECA case file. Stakeholders include, but are not limited to, injured workers (and their representatives), employing agencies, contract field nurses and rehabilitation counselors, and medical providers. Many of the letters used by the Division of Federal Employees' Compensation (DFEC) contain language referencing this option for document submission.

2. A user does not have to register or enroll with ECOMP to use this feature. Rather, any stakeholder with an internet connection and specific information about a FECA claim can upload documents directly into the case file. Before attempting to upload documents via ECOMP, a user needs to have the following pieces of information: claim number, claimant's last name, claimant's date of birth, and the date of injury. If these pieces of information do not match the OWCP case data exactly, submission of a document is not allowed.

3. Once a document has been uploaded to the case file, ECOMP can only be used to verify that the OWCP received the document, not when or if a response has been provided. Any stakeholder having a question about a document that has been submitted must contact the servicing District Office.

4. Some specific documents should NOT be uploaded through the WEEDS component of ECOMP. The ECOMP interface and associated documentation clearly note these exceptions, which include the following:

B. Electronic Submission of Claims Forms

1. Employing Agency Enrollment

2. Injured Worker (Claimant) Registration

3. Reporting an Injury or Illness

4. Claims for Traumatic Injury and Occupational Disease

5. Claims for Wage Loss and Schedule Award

6. Signatures on Claim Forms

7. Training and Assistance

8. Time Requirements for Claims Submission

Reminder: The OWCP's regulations prescribe employing agency time limitations for the submission of claims for traumatic injury and occupational disease, as well as claims for compensation. ECOMP has several features that allow an employing agency to actively manage the timely submission of claim forms, including automatic and manual reminders for the supervisor and Agency Reviewer.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: All DFEC Staff; Employing Agencies

Back to Top of FECA Circular No. 13-03

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SUBJECT: Offsets as the result of the receipt of lump-sum incentive payments made by the United States Postal Service

PURPOSE: This circular is being issued to provide supplemental guidance on the necessary claims actions when a claimant in receipt of disability compensation receives a lump-sum incentive payment from the United States Postal Service (USPS) as the result of (1) choosing optional retirement pursuant to a Voluntary Early Retirement Authority (VERA), or (2) voluntarily resigning.

BACKGROUND: Certain eligible full-time employees of the USPS who voluntarily elected to retire or resign by December 2012 qualified for a $15,000 lump-sum incentive, with $10,000 to be paid on or about May 24, 2013, and $5,000 to be paid on or about May 23, 2014. Part-time employees were also eligible for the incentive, with the amount to be prorated based upon hours worked.

An offset is required only where the claimant receives an incentive payment when in receipt of (or eligible to receive) compensation for temporary total disability (TTD). No offset is required when the claimant is in receipt of compensation for loss of wage-earning capacity (LWEC), schedule award, etc.

ACTIONS: Upon receipt of documentation (e.g. personnel action form or other documentation from the USPS) that a claimant in receipt of compensation for TTD has received a separation incentive payment, the claims examiner (CE) should take the following steps:

(1) Review PM 2-1000.17 with respect to separation pay. For purposes of this offset, TTD compensation should be suspended effective the date of each lump-sum incentive payment.

(2) Determine the claimant's weekly salary at the time of separation.

(3) Divide the amount of the incentive payment by the weekly salary amount.

(4) The resulting number is the number of weeks that the claimant is not entitled to compensation. If the resulting number is a decimal, use the following to calculate the number of days equivalent to the decimal.

(5) Determine the correct time period (weeks plus days) that the claimant is not entitled to compensation.

(6) Complete a memo for the file outlining the offset calculation and period.

(7) Terminate compensation effective the date of the incentive payment. Send the claimant a letter outlining the period of ineligibility for FECA benefits. This letter should advise the claimant to submit a Form CA-7 at the expiration of the period if he/she wishes to resume FECA benefits in an effort to verify employment status and payment eligibility to avoid improper payments.

8) If a CA-7 is received at the end of the period (and the claimant is not working or in receipt of retirement benefits), the claimant should be placed back on the periodic roll as long as new medical evidence has not been received in the interim period indicating that the claimant's condition has resolved or he/she can return to full duty.

• If the claimant is in receipt of retirement benefits, an election of benefits is required, and compensation should not be paid until OPM confirms annuity payments have stopped.

(9) If TTD compensation resumes at the expiration of the offset period, send the claimant a CA-1049. In the first payment, HB/LI deductions should be made retroactive to the date compensation was suspended (if applicable and if not made by OPM). This should be explained in the CA-1049.

(10) Set a reminder for early May, 2014 to check the case to ascertain whether the second incentive payment is still scheduled to be made on May 23, 2014 as planned so that appropriate actions can be taken.

Note - A claimant, if eligible, may elect to receive benefits from OPM on or before the date of the incentive payment. Such an election should be processed consistent with established procedure.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

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

Back to Top of FECA Circular No. 13-05

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Subject: Employees' Compensation and Management Portal (ECOMP) Agency Reviewer Imaging (ARi)

PURPOSE: To announce a new component of ECOMP that allows Agency Reviewers to securely view documents in the Office of Workers' Compensation (OWCP) case file concerning claims under the Federal Employees' Compensation Act (FECA).

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 Federal Employees' Compensation Act (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 create a third functionality to allow designated ECOMP Agency Reviewers (AR) the ability to view imaged documents for cases assigned to their agency. The new functionality is called Agency Reviewer Imaging (ARi). Initially, only a few specific agencies were granted such access; however, after this initial deployment phase, ARi access will be provided to other enrolled agencies on a rolling basis.

Employing Agencies can currently review/obtain case file documents, but must do so by other means, such as submitting a written request to the OWCP or by visiting the district office and reviewing/printing documents on a kiosk. Deployment of ARi allows the OWCP and Employing Agencies to contain costs and increase program efficiencies by providing ARs access to the case documents without generation and submission of a written request or scheduling a visit with the district office, and by eliminating the time and expense it takes the OWCP to respond to such requests. Allowing the ARs to view case file documents also facilitates better Employing Agency collaboration with the OWCP in regard to disability management and return-to-work efforts. For example, the Employing Agency can view work restrictions in a case and craft a job offer for the injured worker without first making a request to the OWCP for such medical evidence and waiting for the OWCP's response. This allows the injured workers to return to work as soon as possible, which furthers the OWCP's mission to facilitate reemployment of injured workers who are able to work.

STATUTORY AND REGULATORY PROVISIONS: FECA claim file information is covered by the Privacy Act of 1974. See 5 U.S.C. 552a. The FECA regulations at 20 C.F.R. §10.11 provide in part that "All records relating to claims for benefits filed under the FECA, including any copies of such records maintained by an employing agency, are covered by the government-wide Privacy Act system of records entitled DOL/GOVT-1 (Office of Workers' Compensation Programs, Federal Employees' Compensation Act File). This system of records is maintained by and under the control of the OWCP, and, as such, all records covered by DOL/GOVT-1 are official records of the OWCP." DOL/GOVT-1 provides that federal agencies that employed the claimant at the time of the occurrence or recurrence of the injury or occupational illness can access OWCP case file information in order to verify billing, to assist in administering the FECA, to answer questions about the status of the claim, to consider rehire, retention or other actions the agency may be required to take with regard to the claim, or to permit the agency to evaluate its safety and health program. 77 Fed. Reg. 1728, at 1738-41 (January 11, 2012), viewable at http://www.gpo.gov/fdsys/pkg/FR-2012-01-11/pdf/2012-345.pdf.

ACTIONS:

A. Intended Use

1. Each time an AR accesses a case, he/she receives a Privacy Act warning consistent with DOL/GOVT-1, which is referenced above:

Access to this case file and data must be restricted to only those authorized employees who need it to perform their official duties, and confidentiality of the records should be protected in such a way that unauthorized persons do not have access to any such records.

Case documentation and data contained in this system is and remains Department of Labor data that is subject to the Privacy Act (5 U.S.C. 552a) and to the Systems Notice for DOL/GOVT-1. Absent a court order from a court of competent jurisdiction or a written release from the individual FECA claimant, such data may only be used pursuant to DOL's OWCP interpretation of a routine use published in DOL/GOVT-1 and in a manner that is compatible with the purpose for which the record was created; that purpose is the administration and payment of FECA compensation. Before any data from DOL/GOVT-1 can be used in a personnel or similar action, there must be a written release from the claimant or an order from a court of competent jurisdiction, or agreement by DFEC management that disclosure of the information is permitted under the Privacy Act. For further information see http://www.dol.gov/sol/privacy/dol-govt-1.htm.

2. By proceeding with the retrieval of the case after having received such warning, the AR is certifying that he/she is accessing the case file information for a reason consistent with a published routine use.

B. Access

1. ARi is a feature granted only to agencies that have executed a Memorandum of Understanding (MOU) with the OWCP relative to ECOMP (see FECA Circular 13-03), and are actively using ECOMP to electronically file workers' compensation forms (CA-1/2s and/or CA-7s).

2. ARi functionality is limited to users granted access to a Digital Rights Management (DRM) license. A specific number of licenses is provided to agencies actively using ECOMP for forms filing.

3. DRM licenses are granted to an agency's ECOMP Agency Maintenance User (AMU) by the ECOMP DFEC Administrator. These licenses are then assigned to specific AR users under that AMU's jurisdiction. When providing ARi access to an AR, the AMU is required to instruct each user that only that single user may utilize his/her license in accordance with this guidance. The DFEC Administrator and the AMU can verify who has access to ARi for a specific agency at any time via a specific application in ECOMP.

4. The assignment of a DRM license activates the ARi feature enabling designated ARs to view imaged workers compensation cases assigned to chargeback codes to which that AR is already assigned.

C. Reviewing Cases

1. The ARi user must have the following pieces of information: claim number, claimant's last name, claimant's date of birth, and the date of injury. If these pieces of information do not match the OWCP case data exactly, or if the case is not assigned to a chargeback code to which the AR has been granted access in ECOMP, viewing of the requested case will not be permitted.

2. ARi users may download up to 5 cases to their Review Cases Dashboard. It takes approximately 24 hours from the time the request is made to the time the imaged case becomes available to the ARi user.

3. Cases may be viewed for up to 5 calendar days, but an ARi user may release a case at any time to free-up a slot on the Dashboard. The user can only see documents available at the time the case is requested; there is no refresh option.

4. ARi users can view all imaged documents in a case that have been received within the last 3 years, as well as all other imaged documents beyond 3 years old that are indexed in the OWCP case file as a decision, a form, or as outgoing correspondence.

D. Saving and Printing Documents

1. ARi users may download/save any or all documents in a case on their dashboard.

2. When the user chooses to download a document, he/she must first indicate why the documents are being saved. An available list of the "routine uses" is provided, but there is no default. The ARi user must choose an available option before ECOMP will download the documents. Available choices are:

• To answer questions about the status of the claim
• To consider return-to-work opportunities
• To evaluate the agency's safety and health program
• To assess continuing eligibility for FECA benefits
• To verify billing

3. Documents are downloaded via a secure PDF document. This PDF document is encrypted using DRM and is accessible only to the ARi user who created the document.

4. Each time the secure PDF document is accessed, the ARi user is required to enter his/her ECOMP user ID and password. If the user ID and password for the document are not valid, the user will not be granted access to that document.

5. Each page of every document downloaded from ECOMP by an ARi user will be marked with an annotation atop the document that indicates it was "Printed from ECOMP," with the user's ECOMP user ID and the date it was printed.

E. Documentation of Case File Review and Record of Saved/Printed Documents

1. The fact that a case was reviewed in ARi is recorded in the OWCP case file via an automated memo uploaded directly to the case by the ECOMP system. This memo denotes when a case was accessed and who accessed it.

2. The memo for the OWCP case file also details any documents that the ARi user saved/printed and the reason for such action. See D2 above.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: All DFEC Staff; Employing Agencies

Back to Top of FECA Circular No. 13-06

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Subject: Improper Document Submissions

PURPOSE: This circular is being issued to clarify the policy of the Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) with respect to the submission of case file records of another injured worker as evidence in support of a claim for compensation under the Federal Employees' Compensation Act (FECA).ACTIONS: OWCP has determined it will not permit the inclusion of case file records about another individual in the FECA claim file maintained under the name and personal identifier of the claimant who is the subject of the case file in question.

The provisions of the Privacy Act are meant to assure the private citizen's right to confidentiality of personal information, including financial and medical history, in records filed in a system of records under the individual's own name. This law sets forth the government's responsibility to properly maintain and restrict access to these records. The contents of an employee's case file, to include medical records (including District Medical Advisor reports), decisions of the Branch of Hearings and Review, etc. are protected under the Privacy Act. More specifically, 5 U.S.C. 552a(e)(5) requires a federal agency to "maintain all records which are used by the agency in making any determination about any individual with such accuracy, relevance, timeliness, and completeness as is reasonably necessary to assure fairness to the individual in the determination."

OWCP has concluded that, absent unusual circumstances such as group injuries (where such information would be relevant but the names and personal identifiers of the other individuals would be redacted), it is not consistent with the Privacy Act to permit the inclusion of documents from one case file in the case file of another individual.

In addition to OWCP's Privacy Act responsibilities, such submissions interfere with and are inconsistent with OWCP's adjudicatory responsibilities under the FECA.

MEDICAL REPORTS FROM OTHER CLAIMANTS - As medical reports about other individuals are not relevant to any determination in another FECA case and do not serve as precedent, the inclusion of such medical reports serves only to confuse the individual physicians reviewing the record, agency workers' compensation specialists reviewing documents for return to work, Office of Inspector General agents, as well as any individuals within the Department of Labor who exercise review authority over FECA determinations (such as an OWCP Hearing Representatives and Employees' Compensation Appeals Board judges).

DECISIONS OF OWCP'S BRANCH OF HEARINGS AND REVIEW - OWCP formal decisions (including decisions of Hearing Representatives from the OWCP Branch of Hearings & Review) are limited to the facts in each specific case, are Privacy Act protected, are not published, and are not considered to be precedential. Because these decisions are not precedential, they are not relevant, probative, or material in any way to OWCP's adjudication of a different claim.

The above restrictions on document submission apply regardless of whether (1) the personally identifiable information (PII) of the other individual is redacted (except in extraordinary circumstances such as group injuries as addressed above), or (2) a waiver or release has been obtained from the other individual authorizing use of his or her case file records.

ECAB DECISIONS - Decisions of the Employees' Compensation Appeals Board (ECAB) may of course continue to be submitted as precedent in support of a claim for FECA compensation. The full name or OWCP case file number of the corresponding injured worker should not be used or otherwise appear in the submission. ECAB decisions should be properly cited by using their caption such as D.F., Docket No. 2013-xxxx (issued July 1, 2013).

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: DFEC Staff

Back to Top of FECA Circular No. 13-07

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SUBJECT: Agency Query System (AQS) Access for Agency Employees, Contractors and Inspector General Offices

PURPOSE: Because of continued heightened concerns over disclosure of personal information, the Office of Workers' Compensation Programs (OWCP) is instituting this formal policy on AQS access.

While OWCP realizes that AQS information could be useful to other entities such as pharmacy providers, OWCP believes that the very limited information needed by these entities is available through other means, such as the bill pay portal.

BACKGROUND:

1. AQS is a secure internet site that provides access to certain information on Federal Employees' Compensation Act (FECA) claims to authorized personnel from federal agencies. The information available includes the claimant's name, social security number, home address, current claim status, compensation payment history, medical bill payment history, and COP Nurse assignment information.

2. Within each federal agency, there is a designated Intra-Agency Coordinator (IAC) recognized by DFEC as the sole point of contact for AQS user access within that particular agency. Any employing agency personnel who contact DFEC directly for AQS access are routed to the applicable IAC. The IAC then contacts the Division of Federal Employees' Compensation (DFEC) to gain permission for that user. A specific user name is assigned to that user; access is password protected.

3. Access to AQS cannot be granted on a case-by-case basis, nor can AQS data fields be limited by user. Access is granted based on employing agency chargeback codes.

4. All records relating to claims for FECA benefits are covered by the government-wide Privacy Act system of records entitled DOL/GOVT-1. Information from the FECA file may only be released pursuant to a need to know (applicable only to disclosures within the Department of Labor), a published routine use, a signed Privacy Act waiver, or a court order from a court of competent jurisdiction. Release of information in accordance with a routine use must be consistent with the purpose for which the file was created; that purpose is the administration of the FECA claim. The FECA regulations at 20 C.F.R. §10.11 make clear that the protection, release, inspection, and copying of records covered by DOL/GOVT-1 should be carried out in accordance with the rules, guidelines, and provisions of Subpart A of the FECA regulations, as well as those contained in 29 C.F.R. parts 70 and 71, which are the Department of Labor's regulations implementing the Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C. 552a) respectively, as well as with the notice of system of records and routine uses published in the Federal Register.

5. A "routine use" authorizes disclosing information from the FECA claim file without first obtaining the claimant's permission. Such disclosure is acceptable because the routine use is listed and published in the Privacy Act Systems Notice for DOL/GOVT-1; because OWCP has concluded that disclosure in the particular circumstance is compatible with the routine use; and because the anticipated use of the information is consistent with the purpose for which the information was collected. A listing of the universal routine uses which apply to all Department of Labor (DOL) systems of records can be found at http://www.dol.gov/sol/privacy/intro.htm. A listing of the routine uses specific to DOL/GOVT-1 can be found at http://www.dol.gov/sol/privacy/dol-govt-1.htm. [See DOL Privacy Act System of Record Notices, 67 FR 16825, at 16827-16828 (April 8, 2002).] Further guidance can also be found at http://www.dol.gov/sol/privacy/intro.htm.

A. Access for Employing Agency Personnel and Certain Agency Contractors

1. A routine use published in the Federal Register permits disclosure to "federal agencies that employed the claimant at the time of the occurrence or recurrence of the injury or occupational illness in order to verify billing, to assist in administering the FECA, to answer questions about the status of the claim, to consider rehire, retention or other actions the agency may be required to take with regard to the claim, or to permit the agency to evaluate its safety and health program." This, combined with another routine use, permits access to contractors performing workers' compensation functions for agencies, e.g. federal contractors retained to provide claims filing, case management and return to work services. In limited circumstances, other individuals may be granted access based on a particular routine use.

2. Based on DOL OWCP's responsibility to protect the information that resides in a Privacy Act System of Records, AQS access must be limited to authorized users in federal agencies (and, where appropriate, contractor employees) who are performing activities authorized by the language in the routine use above. Examples of such authorized users include agency injury compensation specialists. Other employing agency personnel (such as immediate supervisors, safety and health officials without any workers' compensation duties, and Accident Review Panels) generally do not have a sufficient business reason for access to this level of personal information and will not qualify as authorized users.

3. DOL does not consider medical providers and entities that perform ancillary functions (for example, pharmacy billing and management) authorized users, as AQS provides a level of detail and personal information far beyond what is needed by those entities. If such providers and entities need information on a particular claim, other methods for accessing the more limited information needed by them are available through the billing portal or from the agency, but direct access to AQS will not be authorized.

4. Agencies may wish to encourage their employees to utilize the Claimant Query System as an additional resource to meet their needs.

B. Access for Employing Agency Inspector general Offices

1. FECA Circular 08-04 (DFEC Protocol Statement - OIG Audits, Evaluations and Investigations) was released in response to the increased number of requests for information received from the Office of Inspector General (OIG) community as they performed audits, evaluations, inspections and investigations. DFEC recognizes that employing agencies and their respective OIG offices have an interest in reducing costs, returning people to work, and identifying and preventing fraud. In an effort to fully cooperate with the OIG community, while simultaneously coordinating the interaction in a way that would not interfere with our ability to perform our mission, DFEC outlined a specific protocol that would be used to respond to such requests that would preserve program resources and avoid duplication of effort. This circular detailed that when an employing agency OIG investigator requests to view a case record, he/she will be required to sign a brief statement prior to gaining access to the file indicating that access to the file is being requested based on an investigation into a potential violation of law. The guidance provided in FECA Circular 08-04 has not changed.

2. FECA Circular 09-05 (Release of Documents from Federal Employees' Compensation Act (FECA) Files) was released to provide District Offices guidance in situations where information or copies of documents are requested from a claimant's FECA case file. The circular focused on such requests made by employing agencies and clearly outlined that all records relating to claims for FECA benefits are covered by the government-wide Privacy Act system of records entitled DOL/GOVT-1. Specifically, this circular provided that DFEC may grant requests from employing agencies for records pertaining to their employees as a permitted routine use, but that blanket release of the entire case record is not appropriate, except to an investigative body. This circular also outlined that a request from the employing agency for copies of documents contained in the FECA case record must contain a reason for the request, and that the use of these copies must be consistent with the reason the information was collected (connected in some way with the compensation claim). The guidance provided in FECA Circular 09-05 has not changed.

3. Employing agency OIG access to information in the FECA file is permitted by the first sentence of routine use b of DOL/GOVT-1- the same routine use that permits the employing agency to receive information about specific cases of its own employees. However, DFEC's experience with providing employing agencies access to the AQS system has demonstrated that the current structure, which establishes the use of the agency IAC to provide the appropriate level of access to AQS for each individual within that agency who seeks access, has worked effectively and efficiently. For this reason, any request for independent AQS access received from a non-DOL employing agency OIG, or other investigative body, will not be granted. Access to the AQS system for any agency personnel, including any OIG offices or other agency investigative body, must be coordinated with and channeled through the agency IAC who has been recognized by DFEC. Separate access, outside that designated IAC channel, will not be granted by DFEC.

4. Upon receipt and review of a written request delineating in detail the need for such access and the specific timeframe requested, an exception to the access procedure in #3 above may be granted only by the Deputy Director for Federal Employees' Compensation.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All DFEC Staff; Employing Agencies

Back to Top of FECA Circular No. 12-02

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SUBJECT: Debt Collection – Classification of Aged Delinquent Debts as Currently Not Collectable (CNC)

Pursuant to Office of Management and Budget (OMB) Circular No. A-129, and recent policy released by the Department's Office of the Chief Financial Officer (OCFO), the iFECS Debt System will re-classify aged delinquent debts. Specifically, all debts which remain delinquent for two years or more, including those referred to the U.S. Treasury, will be re-classified as "Currently Not Collectable" or "CNC". While this re-classification will remove the debts from the active debt balance that the Program maintains, per OMB and OCFO guidance, the debts will remain eligible for recoupment.

It will be the responsibility of the DFEC National Office to re-classify these debts as they become eligible for CNC status. Debts in CNC status will continue to be reported in the Receivables Report, under a separately defined reporting category. In addition, these debts remain eligible for both Treasury offset and cross-servicing. Should funds be recovered by Treasury on a CNC debt, monies will be applied to the debt in the same manner as all delinquent debts.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

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

Back to Top of FECA Circular No. 08-01

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SUBJECT: Case Management and Coding of Beryllium Claims

As noted in the MEDGUIDE as well as FECA Circular 05-03, there are several medical conditions which may result from exposure to beryllium, the more common being the pulmonary form or Chronic Beryllium Disease (CBD). These resources provide guidance on the initial adjudication of beryllium related claims, including medical facilities that provide the necessary objective testing.

Beryllium sensitization occurs in a subset of the people exposed to beryllium. In some of the workforce studies, the rate of CBD among those individuals with Beryllium Sensitivity (BeS) varied from 14 to 100%. The course of CBD is variable, ranging from a stable condition controllable with or without prescription medications to a poorly controlled, progressive condition that is debilitating and can be fatal. Because beryllium sensitization can progress to CBD in the presence or absence of added exposure, and, additionally, CBD can be treated, it is important to detect the pathologic changes in the lungs as early as possible. As a result, medical care will include the costs of periodic monitoring for the development of CBD where the accepted diagnosis is BeS.

Medical monitoring for patients with BeS includes:

Physical examination (CPT codes 99241 - 99245)
Chest x-ray (CPT codes 71010 - 71030)
CAT scan of the thorax (CPT codes 71250 - 71260)
Pulmonary function studies (CPT codes 94010, 94060-94070, 94375)
Diffusing capacity studies (CPT codes 94720 - 94725)
Exercise tolerance test (CPT codes 94620 - 94621)
Complete blood count (CPT codes 85004 - 85032)
Multiple blood chemistries (CPT codes 80048 - 80053)
Arterial blood gases (CPT codes 82800 - 82820)
Bronchoscopy (CPT codes 31622 - 31629, 31632-31633)
w/trans bronchial lung biopsy w/wo fluoroscopic guidance
w/trans bronchial needle aspiration biopsy
w/biopsy (rigid or flexible)
Serum neopterin

These tests are usually performed on a yearly basis when the claimants are stable and symptom-free. However, if changes in the clinical condition of a claimant are noted, the treating physician may want to perform some or all of these tests at shorter intervals. A definitive diagnosis of CBD hinges on the presence of granulomas and/or mononuclear cell infiltrates in a lung biopsy, so a bronchoscopy and bronchial lung biopsy are the most important tests.

Unlike a more common condition, there are a limited number of physicians who specialize in the testing and treatment of beryllium related illnesses. When a request for authorization of testing or treatment is received (to include travel authorization when necessary), it should be reviewed and approved when reasonable. In order to insure that bills are paid correctly, please use the following acceptance codes:

Beryllium Sensitivity - V81.4
Chronic Beryllium Disease (Berylliosis) - 503

These codes are active in Code It Fast and should be utilized on all beryllium claims. The related objective testing and treatment authorizations are a part of the treatment suites for these codes, simplifying claims management.

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List 1 (Claims Examiners, All Supervisors, District Medical Advisers, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Circular No. 06-04

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SUBJECT: Adjudication of Claims - Claims Related to Beryllium Exposure

It has come to the attention of OWCP that there is likely to be an increase in claims filed under the FECA for illness and disability resulting from work-related exposure to beryllium. The Occupational Safety and Health Administration (OSHA) has provided extensive information regarding this issue in its OSHA Hazard Information Bulletins and pamphlets. The most likely federal employees to claim FECA coverage due to industrial exposure to beryllium are those of the Department of Energy and certain categories of employees at OSHA.

When OWCP receives claims for beryllium sensitivity, chronic beryllium disease (CBD) or other illnesses related to industrial exposure to beryllium, claims examiners (CEs) should note that even minimal or one instance of exposure can result in beryllium sensitization. The Med Guide (available in FolioViews) has been updated with information that will assist CEs in the adjudication of these cases. In addition, CEs are reminded that the 5 basic requirements necessary to establish entitlement under the FECA apply to these claims. Guidance for adjudicating occupational disease cases as set forth in the FECA Procedure Manual, Chapter 2-0806, should be used to establish the period, length, and levels of exposure in beryllium claims. Claims for schedule awards should also be processed in accordance with established regulations and procedures. It should be noted, however, that because this disease is closely connected to industrial exposure, CEs need not be concerned with possible non-work-related exposure if exposure during Federal employment is documented.

Although receipt of benefits under the Energy Employees' Occupational Illness Compensation Program Act (EEOICPA) does not affect a claimant's entitlement to benefits under the FECA, 42 U.S.C. § 7385c(c), the EEOICPA should serve as the primary payer of medical benefits for these FECA cases.

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1--Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

Back to Top of FECA Circular No. 05-03

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SUBJECT: Referee Evaluations--Claims of Bias

A number of complaints of bias on the part of certain physicians selected to perform referee examinations have recently been received. Because we want to ensure a consistent, uniform response to all such complaints, we are providing this summary of existing procedures on how to handle complaints regarding OWCP selection of or use of physicians.

The FECA Procedure Manual describes the processes for responding to various types of complaints relating to medical evaluations and reports. These include: complaints concerning physical examinations (see FECA PM Ch. 3-900-14); the process for excluding medical reports from impartial medical examinations (IMEs) (see Ch. 20810-13); suspending the use of physicians in the Physician Directory System (PDS) (FECA Bulletin 00-01; issued November 5, 1999); exclusion of medical providers from payment (see 20 CFR 10.815-826 and PM Ch. 3-800). If the claimant or representative objects to the use of a particular IME physician prior to the examination and presents documented evidence of bias or unprofessional conduct on the part of that physician, see the FECA PM at Ch. 3-550-4.

Credible, reliable medical evidence is vital to the claims process and it is particularly important that OWCP-directed medical examinations are not compromised in any way. Where a complaint is received concerning a physician and/or challenging a medical report, the claims examiner should, enerally, address the complaint in the context of the specific FECA case. The CE should first evaluate the charge and supporting evidence to determine how to proceed. In evaluating any corroborating evidence, the CE may take note of such evidence as public statements made about a physician's credibility, but such evidence (such as derogatory newspaper articles or negative statements about a physician's credibility made in other forums) would not by itself be sufficient to conclude that the physician's report cannot be considered by OWCP. The mere fact that a physician's testimony has been discredited or criticized in another forum does not necessarily discredit the report by the same physician in the OWCP claim. Rather, credibility of the physician must be based on all the facts and circumstances, and the action by OWCP must follow the appropriate procedure manual sections cited above.

If OWCP receives a written complaint concerning a physician's professional conduct (which includes allegations concerning veracity, discrimination or bias) before or following an OWCP-directed medical examination, and that complaint is supported by credible evidence of the type detailed in the procedure manual, the CE may ask the DO manager or district medical director to help develop the evidence. In accordance with FECA Bulletin 00-01 (issued November 5, 1999), OWCP may provide the physician an opportunity to respond to the allegations. OWCP's determination concerning the physician must, however, be based on credible, reliable and objective evidence. Such evidence may include the findings of other administrative bodies where the physician is a party (as opposed to a witness) in the action. Depending on the nature of the allegations, OWCP may also contact the state medical licensing agency to determine whether the physician has had his or her license suspended or revoked.

All offices should note that the memorandum from Acting Director Nancy Ricker to Robert Barnes, Chief of the Branch of Hearings and Review, dated November 3, 1999, concerning this issue is hereby rescinded. It should not be relied upon in making determinations regarding bias.

DENNIS M. MANKIN
Acting Director for
Federal Employees' Compensation

Distribution: List No. 1, Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisers, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Circular No. 00-08

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SUBJECT: LOSS OF WAGE EARNING CAPACITY – USPS AND REASSIGNMENT TO PART TIME FLEXIBLE POSITIONS

The purpose of this Circular is to acquaint claims staff with the Snow Arbitration Decision and the impact of this decision on reassignments within the Postal Service.

Sometimes, the Postal Service, in finding a position for a partially disabled employee, reassigns the injured employee to a position that is in a different craft than the position held when injured. The Snow Arbitration Decision requires the Postal Service, when placing an employee in a different craft, to follow the rules of the receiving craft, so that the placed employee does not adversely impact other current craft employees. Therefore, if there are Part Time Flexible (PTF) employees in the receiving craft, the employee must be placed in a PTF job.

The Procedure Manual at 2-814.7,a(1) states that a part-time job is not suitable employment for an employee who was full time at the time of the injury.

The Postal Service guarantees the reassigned employee 40 hours of work per week. The reassignment is therefore viewed by OWCP as a full-time position.

Also, when placing an injured worker in a PTF position in another craft, the Postal Service converts the employee at a saved rate that guarantees the employee's salary as of the date of injury. The hourly rate of pay is computed by dividing the annual salary by 2000, rather the 2080 used for full-time employees. The 80 hour difference represents the 10 Federal holidays. The employee makes more per hour to accommodate the missing holiday pay. If, in fact, the employee then works a holiday, they are paid again for the holiday. Therefore, there is no loss of wage earning capacity associated with the reassignment.

In claims where the Postal Service has reassigned a partially disabled employee, who had full time career status on the date of injury, to a position that is classified as Part Time Flexible, the claims examiner must look at the terms of the reassignment to determine whether the reassignment represents suitable employment. If the position guarantees 40 hours of work per week, it is considered a full-time position, even though it is categorized as PTF administratively. If it meets the physical requirements of the employee, it is a suitable job. If the conversion to PTF is at a saved rate of pay, there is no Loss of Wage Earning Capacity. A zero LWEC decision should be issued in these cases based upon the reassignment.

Complaints of loss of advanced annual leave, seniority, bidding rights and other privileges are not covered by the FECA and are not relevant to a decision on LWEC. These are labor management issues that should be resolved in that arena.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 1, Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

Back to Top of FECA Circular No. 99-03

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SUBJECT: Bill Pay--OWCP Liability for Sales Taxes

Periodically the question arises as to whether the FECA program must pay state and local sales taxes on purchases for which payment is made from the Employees' Compensation Fund.

The federal government is exempt from paying state and local taxes on purchases made and used by agencies in their "governmental capacities". However, purchases made from the Compensation Fund for individual employees are not exempt, even when the district office pays for the purchases directly. This is because the party using the service, appliance or supply is the claimant, not the federal government.

The Supreme Court has spoken to this issue in a number of decisions. For instance, in South Carolina v. Baker, 485 U.S. 505, 523 (1988), the Court wrote that:

under current intergovernmental tax immunity doctrine the States can never tax the United States directly but can tax any private parties with whom it does business, even though the financial burden falls on the United states, as long as the tax does not discriminate against the United States or those with whom it deals.

Therefore, OWCP is liable for payment of state and local sales taxes, except where the state or local government has specifically exempted the federal government from such payment.

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

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

Back to Top of FECA Circular No. 97-06