EEOICPA CIRCULAR NO. 15-03 Date: October 15, 2014
SUBJECT: Requiring estimates for Durable Medical Equipment or Supplies
The purpose of this Circular is to notify all Division of Energy Employees Occupational Illness Compensation (DEEOIC) staff that estimates are no longer required when authorizing the purchase of Durable Medical Equipment (DME), supplies and custom devices when the Office of Workers’ Compensation Program (OWCP) Medical Fee Schedule applies.
When DEEOIC receives requests for authorization of DME or supplies, the medical bill pay contractor forwards the request via thread to the appropriate District Office (DO) Claims Examiner (CE). In addition to the request details, the thread will now include a statement as to whether or not the DME or supplies are subject to the OWCP fee schedule.
All requests for DME or supplies require review by the CE for a determination of medical necessity, as outlined in existing program procedure. In addition, all requests for medically necessary DME, supplies, and/or custom devices must be accompanied by a Letter of Medical Necessity (LMN). The CE may authorize medically necessary DME or supplies that have a total purchase price less than $500 or where the medical bill pay contractor specifies that the OWCP fee schedule covers the charge.
In instances where medically necessary DME or supplies have a total purchase price that is greater than $500 and the OWCP Medical Fee Schedule does not apply, the CE is to undertake development with the claimant in accordance with existing procedures concerning the collection of estimates for the requested DME or supplies. This requires the identification of at least two DME suppliers to include full company name along with contact information. In addition, each provider is to submit a signed statement describing in detail the basic, unadorned item meeting the treating physician's specifications, and a breakdown of all costs, including delivery, set-up, etc.
RACHEL P. LEITON
Director, Division of Energy Employees
Occupational Illness Compensation
Distribution List No. 1: Claims Examiners, Supervisory Claims Examiners, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, District Office Mail & File Section